Don’t panic! 9/30/08
Don’t panic if you lost money in Monday’s stock market drop. There’s still a lot of value in the U.S.A. Our workers are still the most productive in the world. Our real estate is still the most valuable in the world — just not as valuable as some banks and borrowers made it appear in recent years — and even the small percentage of homes that are in foreclosure have substantial value. (Those homes aren’t really worth $0. It’s just that it’s very difficult to determine what they’re really worth after they’ve been bundled together with thousands of others and sold, and resold, and resold again. That’s why nobody wants to offer more than pennies on the dollar for the bundled mortgages until the individual homes can be identified and appraised accurately. In time, that will happen, and in many cases, I think they’ll prove to be worth 80-90 cents on the dollar, which is why, instead of the government buying them all up with our tax dollars, I’d rather see them auctioned off to private investors. And by the way, that might not even be necessary if the government would simply change the accounting law that requires assets to be reported as having zero value just because there’s not a willing buyer present in the market on a given day.) The point is, the sky’s not going to fall if Congress doesn’t pass a massive “bailout” boondoggle bill by midnight, as pundit after pundit and legislator after legislator have been saying for days. Many — make that most — people will still have money, and they’ll need to put that money somewhere, which means there will still be banks, maybe just not quite as many, and those banks will need to make loans to stay in business, which means there will still be loans, maybe just not quite as many. Borrowers probably will actually have to prove that they have stable incomes and that the assets they want to buy with borrowed money are worth as much or more than the amounts borrowed. Sounds to me like the way things should have been all along. Yes, harder-to-get credit will be more expensive, meaning interest rates will be higher, but so will the interest rates that people earn on their deposits. There will still be cash in the ATMs, food in the grocery stores, gas in the gas pumps, clothes in the malls, movies in the theaters, etc. I simply do not believe that we’re headed for another “Great Depression.”
Don’t panic if you have a life insurance policy and you’re worried that it might be worthless because of what’s happening in the Heath Ledger case. Ledger bought a $10 million life insurance policy in 2007, then as you probably know, died under suspicious circumstances (in his bed with a bloodstream full of prescription and over-the-counter drugs) earlier this year. It was widely reported on Monday that even though the medical examiner in the case ruled Ledger’s overdose accidental, his insurance company wants to conduct further investigation of the circumstances of his death before paying the $10 million death benefit to Ledger’s three-year-old daughter. That’s a totally-understandable and prudent step for the company to take before handing over $10 million of its shareholders’ money to the little girl when Ledger’s death could’ve been a suicide, which would’ve invalidated the policy. If it turns out that there’s no way to prove it was a suicide, then the little girl should be paid in full, and if she needs money in the meantime, the company can advance some money to her. However, the speed with which New York authorities wrapped up their initial investigation makes me inclined to think that with $10 million on the line, it’s reasonable to take a little more time to be sure. Either way, this is obviously a situation that’s extremely rare and incredibly unlikely ever to apply to you.
Don’t panic if you’ve been diagnosed with heart disease and saw Monday’s news about your risk of also being depressed. The American Heart Association is just recommending that people with heart disease be screened for depression because 1) research shows a heightened frequency of depression among people with chronic illnesses like heart disease, and 2) depression can have negative effects on people’s physical health.
Don’t even panic if you’re O.J. Simpson. The prosecution rested its case in “O.J. Trial, the Sequel” on Monday, and the defense is just getting started! Interestingly, defense attorneys led off by re-calling one of the prosecution’s witnesses, a sports memorabilia dealer who’s one of Simpson’s alleged robbery victims (he’s the one who testified previously that Simpson didn’t do anything wrong and that the charges against Simpson should be dropped), but instead of coming to court in a suit and tie like before, the witness showed up on Monday in jail garb and shackles (certainly no surprise at this point, but another amusing O.J. trial moment — apparently, the dude’s being held in a Las Vegas jail pending transfer back to California after committing a parole violation). Stay tuned.
Economic fear factor, kids-kids-kids, and yes…your semi-daily O.J. 9/26/08
First up today, I have to comment on the fear factor behind this proposed Wall Street “bailout.” It’s really sad to see fear driving Americans to embrace socialism in order to avoid some relatively-short-term economic pain in the form of a recession. Recessions come and go, and the economy survives and bounces back stronger time and again. I’m not convinced that our next recession is imminent without the proposed “bailout,” but even if I were certain of it, I think that in the long run, a recession would be preferable to adopting socialism as our national economic policy. Never before have Americans allowed fear to determine the country’s destiny, and I hate to see us on the verge of doing just that.
Next up, you may have heard that a widowed father dropped his nine minor children off at a Nebraska hospital saying that he could no longer care for them alone. Nebraska has a law that allows parents to abandon children under the age of 18 at specified locations, hospitals among them, without being prosecuted for the abandonment. First of all, if the guy couldn’t handle caring for the children, then I’m glad that he at least realized it and got the kids to a safe place rather than just taking off, endangering the kids, etc. Secondly though, I think it’s problematic that the only solution this guy could see was to get the taxpayers of Nebraska to assume his parental responsibilities. Since the abandonment, multiple relatives have offered to take the children in, which suggests that they probably would’ve been willing to help the father out had they known how overwhelmed he was. In addition, I’ll bet a widower with nine minor children who wanted to keep them with him could’ve received an outpouring of private assistance from strangers in his community by appealing to church and civic groups. Maybe the guy was having trouble seeing his options clearly, in which case I’m glad that the option he saw was at least safe for the kids. I just think that this might be symptomatic of what happens in a culture when government increasingly bills itself and comes to be seen as the solution to every societal problem.
In a related story, a Louisiana state legislator is under fire for suggesting that families who are receiving public assistance should be encouraged not to conceive additional children until such time as they can be supported without involving taxpayers. Since making that suggestion, the guy’s been accused of being everything from an idiot to a racist. But what’s more irresponsible than procreating when you can’t even feed, clothe, and shelter yourself and any kids you already have, no matter what race you are? I also believe that anyone receiving public assistance should have to be drug tested. Why not? Why should anyone be allowed to use taxpayers’ dollars to purchase illegal drugs (or alcohol, or cigarettes for that matter)? Many taxpayers have to prove that they’re clean and sober in order to earn their dollars, so when those dollars are redistributed, why should the recipients have it any easier?
And while we’re on the subject of parents who are unable to care for their children, adults who were adopted as babies sometimes ask me what I think of them trying to find and form relationships with their birth parents. While I consider the specific circumstances of each case, in general, I don’t like that idea. I think the people who invest the time and money and love to raise a child are that child’s parents regardless of who conceived the child. When adoptive parents choose to accept the responsibilities and make the investments of parenting, simply out of love for a child that wasn’t originally theirs, I think it’s a little insulting to them if the grown child then wants to share the rewards of parenting with people who didn’t do any parenting. Don’t get me wrong — I’m a big fan of adoption. I think it’s one of the most loving and selfless acts in all of humanity when a parent realizes that he or she can’t care for a baby properly and secures a safe, loving, nurturing family for that baby, but I also think it’s one of the most loving and selfless acts in all of humanity when a person makes the choice to assume the responsibilities of a birth parent who can’t fulfill those responsibilities. In other words, as I see it, a birth parent’s decision to do the right thing for a baby doesn’t obligate the baby’s adoptive parents to share the product of their parenting with the birth parent. Also, the reunifications of grown adopted children with their birth parents that I’ve heard about haven’t produced the healthiest relationships between any of the people involved. Some adopted children who want to find their birth parents use health history as an excuse (i.e. they say they need to know if certain conditions run in their biological lineages), but I think that’s generally a lame excuse. I’m not a medical doctor, but I’m not aware of a medical issue for which a person’s risk of serious complications can’t be managed without input from a biological parent.
Lastly today, your semi-daily O.J., with highlights from Thursday’s and Friday’s testimony. One of the victims of the robbery alleged in “O.J. Trial, the Sequel,” testified on Thursday that he didn’t think Simpson did anything wrong and questioned whether the audio recording of the altercation, introduced earlier in the trial, is authentic. Also on Thursday, one of Simpson’s alleged accomplices testified about items that he helped Simpson remove from the hotel room in which the altercation took place. Then on Friday, another of Simpson’s alleged accomplices testified that Simpson not only asked him and another accomplice to bring guns to the altercation but also asked him to show his gun and “look menacing.” All in all, it appears that the pendulum swung back somewhat in the prosecution’s direction as this week of the trial came to a close, but testimony resumes next week, and it’s an O.J. trial, so anything still can happen. Stay tuned.
Mental health parity (and yes, your semi-daily O.J.) 9/25/08
In the midst of the debate about bailing out failed financial institutions with the taxpayers’ money, Congress is also trying to pass a bill to require “mental health parity” in health insurance policies. The bill would prohibit insurance companies whose policies cover mental health care from placing restrictions on mental health services that don’t apply to physical health services. As it is now, many health insurance policies contain specific limits on reimbursements for mental health care. For example, many insurance companies limit their policyholders to a certain number of psychotherapy sessions (anywhere from 6-20) in a 12-month period. If you didn’t know my philosophy on government intervention in the health care market (or any market — see my previous posts “Dr. Brian’s Rx for health care” and “Bad medicine for the economy”), you might think I’d support this bill because it’s expected to make mental health services more accessible to more Americans (and if you’re a cynic, to put more money in the pockets of mental health professionals like me). If you’ve read this blog long enough, however, you know that I don’t compromise my beliefs to benefit anyone, including myself. I believe in freedom of contract (i.e. that adults generally should be free to make whatever agreements they want between themselves, as long as they’re not agreeing to do something of a criminal nature), and an insurance policy is a contract. Therefore, insurance companies should be free to offer policies that limit mental health services, and customers should be free not to purchase those policies. I know the government’s poised to make a huge purchase of private mortgage assets with the taxpayers’ money, but until then, this is capitalism that we’re living in, and market competition is how needs are best filled. If people really want policies that include broader mental health coverage, then insurance companies will not only have to offer such policies to remain competitive, but they’ll also be able to make money selling such policies. Forcing insurance companies to expand coverage that isn’t demanded by consumers and isn’t profitable could end up causing the exact opposite of the parity bill’s intended effect. Health insurers will likely raise the prices of their policies, delete mental health coverage from their policies entirely, or both, which ultimately will reduce Americans’ access to mental health services. And even though I’m a mental health professional who wants Americans to be as mentally-healthy as possible, I can’t really blame insurers for responding that way. After all, there’s a lot of room for subjectivity in the clinical diagnosis and treatment of mental conditions. It’s not like a psychotherapist can draw blood from a patient and determine with virtual certainty whether that patient is really depressed. A forensic mental examination for a court case involves many hours of painstaking, labor-intensive analysis of information obtained from the examinee and from multiple other sources (including psychological tests, past treatment records, and people who know the examinee well) to form conclusions within a reasonable degree of scientific certainty, but even that process isn’t as objective as finding a fracture in an x-ray image. In busy clinical practices, less-extensive diagnostic evaluations can lead to unsubstantiated diagnoses and overestimates of treatment necessity, which could allow mental health reimbursements to spiral out of control in the absence of coverage limits. In addition, the mental health parity bill will force insurers that cover mental health to cover extremely-costly, rarely-effective substance-abuse treatment, and if you’re a regular reader, it will come as no surprise to you that I would never require health insurers to pay to “treat” what I don’t think should even be considered an “illness.” Just like the proposed mortgage bailout is bad medicine for the economy, the mental health parity bill is bad medicine for mental health care.
And now, your semi-daily O.J. Wednesday’s installment of “O.J. Trial, the Sequel” included the most incriminating testimony against Simpson thus far. Another witness (and another real “class act”) who was present during the alleged armed robbery testified that Simpson not only knew about the presence of guns but specifically asked the witness and others to bring guns to the altercation. The weight of the evidence may have started to shift in the prosecution’s favor. Stay tuned.
You won’t believe this, but… 9/24/08
Another mass shooting at a college, this one outside the United States: It happened in Finland, and ten people were killed, eleven if you care about the shooter (he committed suicide at the end of his shooting spree). I’ve been to Finland and liked the country and the people I met there very much, but I have to be critical here because just like every school shooting in the U.S., this one appears to have been totally preventable. The shooter had posted threatening videos on YouTube prior to the shooting, warning people “You will die next,” and YouTube apparently did more about it than the Finnish authorities did. YouTube removed the threatening content, and Finnish police interviewed the would-be shooter about it but failed to take him into custody, apparently failed to conduct a thorough investigation, search, etc., and failed to suspend his license to own a gun, even temporarily. The very next day, he committed mass murder. This is the second school shooting in a year’s time in Finland, and it sounds like the Finnish need to learn the same lesson that we do about erring on the side of public safety when people show signs of being dangerous to their fellow citizens. One notable difference between this school shooting in Finland and school shootings in the U.S. is that the shooter in Finland wore a ski mask. I’ve been asked whether I think that says anything significant about the Finnish shooter, and I really don’t. Concealing his identity would have been important only if his plan was to try to escape the scene alive, but it looks to me like he probably planned to shoot himself at the end because he left notes explaining that he hated all humanity. (By the way, see what I mean about these people being capable of rational thought but making conscious choices to act on emotion instead?) So, I think the mask was probably just part of some stupid commando fantasy that he was acting out through this terroristic crime.
Another nutty “preacher”: Ex-con and “preacher” Tony Alamo has been making the rounds of t.v. news shows after several children were removed from his Arkansas “church” compound amid disturbingly-familiar accusations of barely-pubescent girls being “married” to and forced to have sex with decades-older men. In the midst of insulting tirades against the various interviewers’ “unfairness” to him, Alamo has repeatedly said that the Bible condones both polygamy and sex with girls who’ve reached puberty, but I have yet to hear an interviewer ask the right follow-up question, which is, “Do you believe it’s OK to go ahead and do something that’s illegal by state and federal law as long as it’s condoned by the Bible as you understand it?” Alamo might not give a straight answer, but if he did, I think it would be “Yes.” Looks to me like we might have another Warren Jeffs on our hands.
Another stunning decision in the Winkler case: Remember Mary Winkler, the Tennessee mother who served almost no jail time after shooting her preacher husband in the back while he was asleep (and while their children were in the house!) in 2006? The jury bought her “emotionally-battered-woman” story, ending in the shooting for which she claimed she could see no alternative (see my previous post “The preacher’s wife”). If you were as appalled by that as I was, you’ll also be appalled to learn that Winkler has now regained full custody of her children (they had been living with their paternal grandparents). So, she shoots her sleeping husband in the back, and life pretty much just goes on.
Another public Hollywood custody battle, this one with a seemingly-positive outcome: Actress Sharon Stone, who lives in the L.A. area, and her ex-husband, who lives in the San Francisco area, had been sharing joint physical custody of their eight-year-old son, but a judge has ended that arrangement, awarding full physical custody to the father and visitation to Stone (the actress still has “joint legal custody” which basically means that she retains parental rights, e.g. the right to be involved in major decisions – educational, medical, religious, etc. – involving the boy’s upbringing). In my opinion, this was a victory for the son, not the father. I hate it when parents put their kids in these stupid cross-country-custody situations, where the kids are expected to shuttle back and forth between cities to spend equal time with two parents who can’t even figure out how to live in the same city together, and in Stone’s case, I see absolutely no excuse for it – she has plenty of money to reside in San Francisco (where the child has continued to live and attend school in the wake of the couple’s divorce) if having equal time with the kid is really that important to her.
Another piece of disturbing news about prescription drugs: Researchers at the University of California, San Francisco, have confirmed what I’ve been saying about the difficulty in obtaining accurate information about the pros and cons of various prescription drugs (I’ve focused on drugs for psychiatric conditions, but it’s a problem across the board). In many cases, they found that unsuccessful clinical trials of drugs go unreported and that reports of slightly or partially-successful trials are “spun” by professional writers to make the drugs look better (more effective, less dangerous, etc.) than they really are.
Another release of evidence in the Casey Anthony case: After releasing reams of documents and audio recordings of interrogation interviews with Anthony, Florida police have now released hundreds of text messages sent by the mother many suspect of playing a role in the disappearance of her little daughter Caylee. Previously-released evidence has revealed numerous lies, omissions, and inconsistencies on Casey’s part, and so far, it looks like these text messages are not any more flattering of her.
Another O.J. update: “O.J. Trial, the Sequel” continued on Tuesday with another participant in the alleged armed robbery testifying that Simpson did not plan for anything illegal to happen but was aware of the presence of a gun. The witness, however, acknowledged making a plea bargain with prosecutors in which he received reduced charges in exchange for testimony against Simpson, and he also acknowledged that his memory is generally faulty. Like I said last night, so far, Simpson’s looking like the classiest person involved in this fiasco, which just might translate into an acquittal.
OK, maybe you do believe it.
Equality, empathy, and O.J. 9/23/08
Up first, equality — a new study published in the Journal of Applied Psychology suggests that men who have “traditional” attitudes about male-female work roles (e.g. that it’s a man’s job to be the primary breadwinner for his family and his wife’s job to be the primary caretaker of their children) earn more money on average than men who have less-traditional attitudes (e.g. that it’s fine if the traditional roles are reversed). The study’s authors seem to interpret their findings to mean that sexist men occupy the high-earning, high-responsibility positions in corporate America and that their sexist attitudes perpetuate the often-reported, rarely-critiqued “wage gap” between male and female workers. While the average female worker’s pay is often reported to be 76% of the average male worker’s pay, that statistic is often misinterpreted to mean that the American workplace is sexist. It’s usually not an apples-to-apples comparison for several reasons. Women are less likely than men to negotiate their starting salaries up from initial offers, which creates a salary gap between female and male hires that can persist throughout their careers. At the same time, women are more likely to prioritize flexible hours over pay in choosing the jobs for which they apply. Women also choose to go into relatively low-paying fields like elementary education with higher frequency than men do, and they’re more likely to leave the work force for a period of years when their children are young. When you really do compare apples to apples, like two lawyers, one male and one female, who were hired on the same day at the same law firm and have been employed there continuously for the past ten years, it’s tough to find a statistically-significant “wage gap.” Think about it, do you know anyone who seriously thinks that women deserve lesser pay for doing the same work as men? It’s like trying to find a sane capitalist who’d seriously sacrifice income to hire a less-qualified white applicant over a more-qualified black applicant. That kind of idiocy is tough to find among America’s hiring managers in 2008 — they wouldn’t last long in today’s competitive economy if they operated that way, not to mention the fact that it’s been against the law for decades now. Every time the “wage-gap” debate has come up, I’ve asked whoever’s been on the other side to show me an apples-to-apples situation, a situation in which some idiot employer seriously pays an identically or better-qualified and experienced woman a significantly-lower wage than an identically or less-qualified man, and if they could show me that situation, I’ve offered to file a federal complaint on behalf of the woman. I’ve never filed a complaint after one of those debates. In short, I don’t think there’s a sexist “old-boys network” keeping male and female workers’ wages unequal in corporate America. The authors of the study throw a back-handed bone to men with “traditional” attitudes, suggesting that perhaps these men feel a greater responsibility to provide for their families (because, of course, they see their wives as less capable of it) than men with more “egalitarian” attitudes feel, and therefore, “traditional” men feel obligated to work harder and work longer hours than “egalitarian” men do. As is usually the case with these “studies,” I think there’s a much simpler, more obvious explanation for the disparity in incomes between “traditional” and “egalitarian” men (if the disparity is even statistically-legit): I would expect that men who have “traditional” attitudes toward male-female work roles also tend to have “traditional” attitudes in other areas — like work ethic, personal responsibility, integrity, etc. — and that those latter “traditional” attitudes explain any disparity between the average earnings of “traditional” and “egalitarian” men.
Up second, empathy — another study out this week suggests that many American physicians need a refresher course in bedside manners. It says that doctors, on average, exhibit disturbingly little empathy when talking with patients who are facing serious, even terminal, health crises. In my experience, outstanding doctors do have compassionate, reassuring bedside manners, but too often, rank-and-file docs either feel too rushed to take personal interests in their patients or feel too uncomfortable discussing their patients’ emotions, particularly about death. In truth, I don’t think it would take significantly more time for physicians to do a better job of expressing personal concern for patients, and I think it can be profoundly helpful to patients facing serious health crises, so if physicians are uncomfortable doing it, they might want to consult (or at least suggest that the patients consult) a psychologist who has training in that area.
Finally, O.J. — the apparent second ejection from the courtroom in “O.J. Trial, the Sequel” and the second visit to the courtroom by paramedics both involve crime writer Dominick Dunne. A female spectator apparently approached Dunne during last week’s proceedings, kissed him, and was promptly ushered out by court staff (it’s not clear whether it was the same woman who reportedly was ejected last week after asking Simpson for his autograph). Then on Monday, the 82-year-old Dunne was rushed to the hospital after suffering pains in the courtroom (it’s since been reported that he’s OK). Also on Monday, the man who apparently helped Simpson arrange, and then audio-recorded, the altercation that led to the current trial resumed his testimony. He said that the presence of guns during the altercation was a surprise to him and that it could’ve been a surprise to Simpson as well. The witness also admitted that he sold portions of the audio recording to various media outlets for more than $200,000. So far, things seem to be going fairly well for Simpson in that the other people involved in the alleged armed robbery seem to be coming off as sleazy or sleazier than he does. Stay tuned.
Quick takes and updates 9/20/08
The U.S. government has done exactly the opposite of what I recommended here two nights ago. Instead of bailing out some large mortgage lenders (and other financial institutions that bought overvalued mortgages from the original lenders in recent years), I recommended letting real estate valuations fall, across the board, to wherever the market dictates that they should be so that we can then get on with the real, long-term economic growth created by hard work and personal responsibility, in place of the artificial, short-term growth illusion created by a rash of irresponsible borrowing and lending. Well, instead of bailing none of the financial institutions out, the government has announced plans to essentially bail all of them out by purchasing the bulk of the overvalued mortgages in the country with taxpayer dollars, which will turn the bad medicine that I wrote about two days ago into even worse medicine, for our economy and for our culture.
Now, here’s something that the government is doing that might turn out to be positive. The Homeland Security Department is experimenting with something called “Future Attribute Screening Technology” (F.A.S.T.), which if workable, will measure certain physiological signals given off by airline passengers and alert screeners when someone has an unusual elevation in anxiety while passing through security, suggesting the need to screen that individual further to determine whether it’s anxiety about being caught with a weapon or anxiety about flying in general. It will be years before the technology will be in use in airports, if it even works at all, and privacy advocates will no doubt oppose it (which is interesting because they’re the same people who always oppose any kind of differential screening based on demographic attributes like nationality, no matter how statistically correlated with past acts of terrorism, as unacceptable “profiling,” and F.A.S.T. would screen every passenger equally.)
Also tonight, a college professor at Metro State College in Denver, Colorado is getting a lot of media attention after some of his students contacted media outlets and complained that he required them to write papers critical of vice-presidential candidate Gov. Sarah Palin. I applaud my colleagues in the media for paying as much attention as they have to the students’ complaints. As someone who teaches part-time at a major university myself, I’m not bothered by a professor respectfully expressing his views in a class discussion with adult students (but if it were an elementary school teacher telling kids that the existence of man-made global warming is a fact, I’d be extremely bothered). It’s absolutely unacceptable, however, when a teacher evaluates students based upon the extent to which they agree with his opinions, as apparently would’ve occurred in this Colorado professor’s class, absent the media attention.
Speaking of personal views, vice-presidential candidate Sen. Joe Biden has articulated a position on the issue of abortion that I don’t understand, and I consider myself a well-educated individual. He said he believes that a human being’s life begins at the moment of conception, but that he cannot “impose that belief on others.” Now let’s think about that for a moment. He’s basically saying, “I believe this act is murder, but because others don’t believe it’s murder, I have to allow them to commit the act.” It makes no sense to define murder so loosely as to say that an act is murder unless the person committing it believes it isn’t. Biden is a government official responsible for imposing law on all of us based on his reasoned analysis of the information available to him in a given situation. So, if he’s honestly convinced that innocent people are being murdered in this country, it’s his responsibility to do something about it, and if he doesn’t want to, then I wonder why he even wants to hold public office. Regardless of someone’s position on the abortion issue, I think he/she needs to have a rational basis for that position (and any other positions that he/she takes on issues of great consequence), and until he/she does, in my humble opinion, he/she has no business being involved in determining what our law on it should be.
Finally tonight, an O.J. trial update. On Friday, jurors in “O.J. Trial, the Sequel” visited the hotel room in which the alleged armed robbery took place. The action resumes next week, so have a good weekend, and stay tuned.
The politics of biology, “No Child Left Accountable” in Dallas, and an O.J. trial update 9/19/08
First up tonight, the politics of biology. A new study published in the journal Science suggests that there’s a connection between how our brains work and the political parties with which we most identify. Specifically, the study concluded that people who were more easily startled were more likely to be Republicans while people who startled less easily were more likely to be Democrats. The researchers interpreted those results to mean that people who were more biologically-sensitive to threats were more likely to take conservative stances on issues while people who were less threat-sensitive were more likely to take liberal stances. The entire study had just 46 participants, so to me, the results are pretty much meaningless, but if they were replicated in a much larger group, I’d still interpret them a little differently. First, I’d point out that the existence of a correlation between two variables (i.e. a pattern involving them) does not mean that there’s any causal relationship whatsoever between those two variables, in this case startle response and political affiliation (i.e. some other variable could be in play, affecting both of the variables in the study). Second, I’d say that if there is a causal relationship, it’s not clear which variable causes which (i.e. whether the startle response affects political thinking or political thinking affects startle response — thought patterns can affect brain physiology just as brain physiology can affect thought patterns). Finally, if startle response causes any predisposition toward one political affiliation or the other, I’d say that people who have strong startle responses are probably, generally, more comfortable when they’re in control of what happens to them in life, which in turn might make them more comfortable with conservative political ideas (personal responsibility, toughness on crime, nationalism, etc.). In contrast, I’d say that people who have relatively weak startle responses are probably, generally, more comfortable with risk and uncertainty in life, which in turn might make them more comfortable with liberal political ideas (collectivism, non-judgmental-ism, internationalism, etc.).
Next up tonight, it’s “No Child Left Accountable” in Dallas this year. The Dallas Independent School District has instituted a policy whereby students are allowed to take every test multiple times, and only their best scores count. And homework deadlines? What homework deadlines? Teachers are required to give students credit for homework turned in whenever the students want! But what if the students don’t like the scores that they receive on their late homework assignments? No problem there either — teachers have to drop their students’ worst homework scores! No, this isn’t me being comical — it’s really happening, and the only part of it that I’m OK with is a requirement that parents be notified when their children receive scores of zero on tests and homework assignments (although I’m not sure how a score of zero can happen with these other measures in place). District officials say the measures are intended to encourage fewer dropouts, but they’re just another, particularly-blatant, example of defining away deviancy (i.e. taking a problem that they’ve been unsuccessful at solving and making it “disappear” by simply defining it as normal). Like I said in last night’s post (and that’s just the most recent time), you don’t encourage people to do more of the right thing by making it easier to do the wrong thing! These stupid measures in Dallas’ public schools will do nothing but reinforce underachievement and send students into the real world unprepared, set up to fail, and demanding to be rescued (just like the people I wrote about last night). At the school-district level, this kind of thinking is bad for the kids, and at the national level, it’s bad for the culture, bad for the country.
Finally tonight, an O.J. trial update. Since the last installment of “O.J. Trial, the Sequel,” there’s been some yelling among the lawyers that had to be refereed by the judge, and there’s been an ejection from the courtroom — a female spectator apparently trying to get Simpson’s autograph on Thursday! Less exciting events have included testimony about whether an audio recording of the alleged armed robbery is authentic, arguments about whether the jury should hear it, and the playing of the recording, which will continue on Friday.
Bad medicine for the economy 9/18/08
While I usually stick to psychology and law-related issues here, I do also have an MBA and a good understanding of economic issues, and I’d like to weigh in on these recent government bailouts of financial institutions that are on the brink of collapse after investing heavily in overvalued home mortgages. I think that bailing any of these institutions out is the wrong move and that it sends the wrong message to both future lenders and future borrowers. I realize that letting these institutions fail would be a tough pill for the economy to swallow right now and that it would have ripple effects on financial markets worldwide, but I think that those would be relatively short-term consequences and that they’re preferable to the long-term consequences of bailouts. This won’t be a popular position, but I believe that a large-scale “correction” in the valuation of assets in this economy probably needs to happen, and that letting it happen naturally, across the board, rather than in bits and pieces, would be the quickest way to get us back on a healthy economic track. Our modern credit markets are incredible facilitators of human productivity — they make it possible for people with good ideas and willingness to work hard but without capital to access capital to start businesses and buy homes, cars, etc. — but in recent years, they’ve become too loose. Traditionally, borrowers had to prove that they were good credit risks, either by having (or buying, or building) assets that were likely to be at least equal in value to the credit obtained. In recent years, that changed. Lenders extended credit to borrowers who weren’t good credit risks, hadn’t established track records of earnings sufficient to service their debts (i.e. make their mortgage payments), and/or purchased assets (i.e. homes) that were not greater or equal in value to the amounts of their loans (i.e. if they couldn’t make the payments, and their lenders foreclosed or repossessed their homes, the homes weren’t worth enough on resale to cover the amounts owed). By the way, it’s important to note here that we’re talking about roughly 4% of American home buyers — the vast majority of American home buyers, roughly 96%, are not in foreclosure and are making their payments — but when you add up 4% of mortgages in the U.S.A., we’re still talking astronomical amounts of money, and when that 4% is overvalued, we’re talking astronomical losses. And, the transactions between original home buyers and lenders were just the first in a whole string of transactions based on bad bets rather than on real underlying value in the homes. Many lenders sold their overvalued mortgages, which were often resold multiple times, to other financial institutions who also were playing with borrowed dollars. I know it isn’t popular, but let’s face it: when mortgage loans were made, taken, bought, and sold on a lot of real estate in this country in recent years, that real estate simply was not worth what people (buyers and lenders) bet that it was worth, and today, it isn’t worth what those people bet that it would be worth by now. There’s actually a profound and far-reaching psychological factor in play here: bailing out a whole bunch of people and financial institutions who made bad bets is not the way to encourage safer bets in the future. It’s just setting us up to have to weather more of these economic storms in the future. Like I always say, you don’t get people to do more of the right thing by making it easier for them to do the wrong thing. Yes, failures of some of the country’s largest financial institutions will affect all of us — people will lose jobs and purchasing power, investors will lose value, etc. But I think these bailouts will affect all of us just as much — probably to the tune of a trillion tax dollars when it’s all said and done — and just as negatively. The real estate isn’t going anywhere. People will end up living in these foreclosed homes, people whose mortgage loans will come from more conservative lenders in amounts commensurate with the values of their homes, people whose incomes will be sufficient to make the payments on those mortgages. And people who have to give up homes that they can’t afford don’t have to be homeless — they might have to rent for a while, work consistently, save up money to make significant down payments on more modest homes, and pursue the “American dream” of home ownership again in a few years. That’s how capitalism is supposed to work — to put capital (assets) into the hands of people who will make the most responsible use of it — and capitalism is what gives us the economic liberty that, along with personal liberty, allows each of us to develop our unique potentials (and in the process, pursue happiness) here in the U.S.A. Government bailouts leave capital in the hands of people who’ve made irresponsible use of it, not to mention the fact that the government acquiring a stake in any business is anti-capitalist by its very definition — just like proposed government intrusions into the private health care system, it’s a move away from what has made our economy strong enough to weather storms like this and toward what has made other countries’ economies weak enough that they couldn’t — wrong move, wrong message, bad medicine for the economy.
Guess what, another new study, this one suggesting that social isolation literally makes people feel physically cold. Wonder if that means you can just go off somewhere by yourself on a hot day and get cool without air conditioning? No wait, the cooler you become, the more other people will want to be around you, so I guess you’ll have to keep avoiding people to stay cool. I know, I’m being a little absurd here, but that’s because the study’s a little absurd. For instance, one of the methodologies was to have participants think of a time when they felt socially-rejected or isolated and then guess the temperature of the room in which the experiment was conducted. Another methodology was to have participants play a computer game in which some were ignored by other players and then choose either a hot or a cold beverage. Ok, it’s not the greatest science I’ve ever seen, but we’ve known for some time that our emotions can affect our physiology, so maybe there’s more to expressions like “warm welcome” and “cold shoulder” than we thought.
Speaking of cold-hearted snakes (I think that expression actually has to do with reptilian cold-bloodedness), the prosecution’s star witness in “O.J. Trial, the Sequel” was expected to paint Simpson as a stone-cold armed robber when testimony resumed on Tuesday, but that isn’t exactly what happened. The sports memorabilia collector, who had to suspend his testimony on Monday due to heart palpitations, actually testified that some of the memorabilia taken from him by Simpson in last year’s alleged armed robbery rightfully belonged to Simpson’s children. Could O.J. be looking at another “not guilty” verdict? Stay tuned.
Until next time, warm regards,
Kids & psychosis, sex & strokes, O.J. & heart trouble 9/16/08
A new study published in the American Journal of Psychiatry found that state-of-the-art antipsychotic medications really aren’t any more effective than an old-school antipsychotic in kids suffering from Schizophrenic symptoms (e.g. psychosis — hallucinations, delusions, confusion, etc.). What’s more, none of the drugs tested in the study proved very effective, and all had highly-undesirable side effects. I’ve cautioned against a push by the pharmaceutical industry and some mental health professionals to start giving such medications to children for other psychiatric symptoms — most notably Bipolar (a disorder far less debilitating than Schizophrenia and traditionally diagnosed post-adolescence) symptoms — and this new study seems to bolster my concerns (see my previous post “Follow the money”).
If you saw the story in the news on Monday about a young woman who had a stroke during sex, and now you’re worried, let not your heart be troubled. What happened to her was an extremely rare confluence of 1) increased heart rate (due to sexual excitement), 2) a heart defect that allows blood to flow rapidly from the heart to the brain during exertion, and 3) a blood clot that happened to enter the heart at just that time. So far, the woman has made about a 99% recovery, thanks to an injection of the anti-clotting drug “tPA” directly into her brain, and had she gotten to the hospital sooner — like immediately instead of waiting hours after experiencing slurred speech and partial paralysis — it might be a 100% recovery by now. Even though it’s extremely unlikely to occur during sex, especially in someone of a relatively young age, it’s a good idea to recognize symptoms of a stroke (like sudden numbness/weakness, vision loss, slurred speech, paralysis, confusion, dizzyness, loss of coordination, and/or sudden severe headache) and if they occur at any time in someone’s life, to call 911 immediately.
Speaking of increased heart rate, the first day of testimony in “O.J. Trial, the Sequel” was cut short on Monday when the star witness against Simpson, a sports memorabilia collector with a history of heart problems, experienced heart palpitations on the witness stand and had to be treated by paramedics. Come on, it’s an O.J. trial — you didn’t expect things to go smoothly did you? Stay tuned, testimony is scheduled to resume Tuesday.
12 Non-Angry White Men & Women 9/13/08
The jury in O.J. Trial Part II has been selected, and each juror has sworn that he or she harbors no anger toward O.J. because of O.J. Trial Part I, in which he was found “not guilty” of murdering his ex-wife and a male acquaintance of hers. But some are crying foul because no one on the newly-selected jury is of African descent. As I see it, there’s no evidence of any impropriety in the selection of this jury. A defendant is entitled to a voire dire (jury selection process) free of racial bias but is not entitled to any particular racial representation among jurors. In addition, we all know that you can pick seven or eight M&Ms out of a bag without looking and not get a blue one, even though one in every six M&Ms is blue (if you’re skeptical, buy some M&Ms, strictly for scientific experimentation purposes of course, and give it a try, or several tries). It’s just like that with O.J.’s jury. When you pick 12 people from a community like Las Vegas (where the alleged crimes took place) in which one in every ten residents is of African descent, it’s not shocking if no one of African descent is among the 12 (i.e. it’s well within the realm of statistical normalcy). The trial is expected to last up to five weeks though, so stay tuned — this is probably just the first controversy to come out of it.
Lingering mental health effects of 9/11 9/11/08
This seventh anniversary of the 9/11/01 attacks on New York City and Washington, D.C., including the attack that was foiled by heroic Americans over Pennsylvania, is a day to remember and recount losses, and some of those losses occurred in the area of mental health. A study published in the Journal of Urban Health estimates that 35,000-70,000 people developed PTSD (Post Traumatic Stress Disorder) following exposure to the New York attacks alone. That estimate, even the low end of it, seems unrealistically-high to me, but there’s no doubt that many people suffered post-traumatic stress after 9/11. PTSD is different from grief. Grief is the profoundly negative emotional experience of people who’ve suffered a loss, like the loss of a loved one on 9/11, and it’s characterized by sadness and sometimes by emotions like anger and guilt. While it can seem unbearable at or near the time of the loss, grief usually becomes less intense with time. It’s not that people ever forget lost loved ones but that they become better able to contemplate the future without them. PTSD is the negative emotional experience of some people who’ve suffered or observed a traumatic event, like the collapse of the World Trade Center, and it’s characterized by recurring memories of the event (sometimes in the form of nightmares or flashbacks) and by anxiety about a recurrence of the event. PTSD can get worse over time. As is the case with other anxiety disorders, like OCD (Obsessive-Compulsive Disorder), people often change their behaviors to avoid feeling anxiety, but those behavioral changes can end up reinforcing and perpetuating anxiety to the point that it becomes debilitating. For example, a person who felt uncomfortable being inside of tall buildings or flying on airplanes immediately after 9/11 and responded to that feeling by staying out of tall buildings and not flying for the past seven years might now be physically unable to enter a tall building or fly on an airplane without experiencing a panic reaction (increased heart rate, hyperventilation, possibly even fainting). The good news is that PTSD is treatable, and many people who’ve experienced it are now living normal lives. If you think that you or someone you love may be experiencing PTSD, there’s a good chance that a local psychologist trained in the treatment of PTSD can help (and for residents of New York City, treatment for mental health issues related to 9/11 is still available at no cost, sponsored by the City).
Commentators confusing candidates’ comments 9/10/08
As you may have heard, presidential candidate Barack Obama has endorsed guidelines published by the Sexuality Information and Education Council of the United States (SIECUS) for “age-appropriate” sex education in public schools, while some media outlets have reported that vice presidential candidate Sarah Palin is opposed to sex education in public schools. (And by the way, when reporting Palin’s stance on sex ed, they usually throw in the fact that her 17-year-old daughter is pregnant, suggesting that sex ed would’ve prevented the pregnancy, but there’s no good data to support that conclusion.) I think that some in the press haven’t paid enough attention to the particulars of either candidate’s stance. It’s one thing to be against any sex ed, but it’s something else entirely to be concerned about sex ed being administered to your kids by a public school teacher who may not share your values, let alone your beliefs about what’s “age appropriate.” Let me give you a few examples from the SIECUS guidelines. They say that it’s appropriate for a public school teacher to tell children aged 5-8: that certain body parts feel good when touched, that people rub their own genitals to feel good, which is called masturbation, and that some people are homosexual, which means they fall in love with people of the same gender. Now if you want your 5-8-year-old to be told those things, that’s your right as an American parent, but if you’re concerned about your child hearing those things at those ages, that’s your right as well, and I agree with you. I’m not opposed to “don’t talk to strangers,” “good touch vs. bad touch,” “tell a trusted adult if anyone tries to give you a bad touch” messages in the elementary school years. I’m also not opposed to scientific discussion during the teenage years of how humans develop sexually (including theories of how sexual orientation develops, and I’m more than fine with making strong mention of the unacceptability of treating anyone in a cruel manner), how the body normally functions with respect to reproduction, how the body can malfunction and be harmed (STDs) with respect to reproduction, and how medications and devices can enhance (fertility procedures) or inhibit (contraceptives) reproduction. I’m not opposed to high school students getting those facts from public school teachers, so long as there’s absolutely zero tolerance for any teacher condoning the students having sex, because I think people need the information in order to be educated Americans, but I want parents to be responsible for teaching their children values.
News-2-O: O-besity and O-J 9/9/08
News flash: a new “study” has revealed that exercise — yes exercise — can actually prevent obesity! That’s right, even in people who are “genetically predisposed” to become obese! Shocking! What a revolutionary discovery! But seriously, it just confirms what I’ve been saying for years: no one has to be fat, no one.
Also today, jury selection is underway in “O.J. Trial, the Sequel” in which O.J. Simpson faces charges of participating in the armed robbery of some sports memorabilia collectors in Las Vegas last year (he’s basically accused of stealing back some of his own memorabilia). Once again, the evidence against O.J. looks like it’s going to be “clear-cut,” but in O.J.’s favor, as far as I know, he’s the only witness involved in the case who’s not a convicted felon. So, the only certain outcome is some good t.v.
Dr. Brian’s Rx for health care 9/8/08
I don’t opine about many political issues here, but as I am a licensed health care provider, and as health care is such an important issue in this current election cycle, I’d like to weigh in on it.
First, I’d like to frame the issue properly. To listen to some politicians talk about health care, you’d think we have the world’s worst system, that it’s getting worse by the day, that nobody has access to it, and that those who do have access to it can’t afford either services or medications. None of that is true. Former U.K. Prime Minister Tony Blair said that you should judge countries based on how many people living in them want to get out and how many people living elsewhere want to get in, and I think that’s also a good method for judging health care systems. The fact is, people of means from virtually everywhere else in the world, including the many countries with government-run health care systems, flock to the U.S.A. for their health care, and those who don’t have the means wish they did. Not only is it the best system in the world, but it’s the best it’s ever been, and it’s getting better by the day thanks to the dedicated study, training, and innovation of the best medical minds in the world. The vast majority of Americans have access to it and are able to afford both services and medications. Of course everyone wishes that those things were less expensive, but people need to put those costs in perspective. Health care is among the most important things that we purchase in life – it’s never going to be, nor should it be, among the cheapest. After all, it requires the lengthy and rigorous training of its providers, as well as some of the most high-tech chemical and electronic equipment ever developed by mankind, it’s extremely labor-intensive, and the liability associated with it is extremely high. We keep hearing that over 40 million Americans don’t have health care. That’s not true either. Those people have health care. What they don’t have is insurance. And it’s not over 40 million at a time. It’s only over 40 million when you add up all of the people in the country who went without insurance for some portion, however short, of the year. Not all of those people are citizens either, so there’s a worthwhile debate to be had about whether insurance should even be made available to them as it would be an additional incentive to be here illegally. Even if we accepted that 40 million people in this country have no health insurance at this moment, it would mean that close to 90% of America is covered, yet some politicians want to “change” the entire U.S. health care system to get that figure closer to 100%. To me, that makes no sense at all. You don’t “change” an entire country or that country’s entire economy, or its health care system, to solve a problem that affects a relatively small minority of its population. (By the way, that’s exactly what happened with the Medicare “Part D” boondoggle – four percent of senior citizens were unable to afford their prescriptions, so the government, very unwisely, instituted a massive new program that covers every senior citizen, including the 96% who were able to afford their prescriptions as it was.) What you do instead is try to come up with solutions that address the needs of the people who have the problem – i.e. let the people who currently are providing their own coverage continue to do so, and try to come up with a way for those who can’t provide their own coverage to get it. That’s of course if you want the vast majority of people to remain independent of the government – i.e. if you judge your success not on the number of people dependent on the government but on the number of people who aren’t dependent on the government.
So, why do millions of people in this country (but way fewer than 40 million) not have health insurance at any given moment in time? Well, some people, like indigent kids and people who’ve had serious health conditions since birth, lack insurance through no fault of their own – the kids are too young to get it for themselves, and those with lifelong conditions often can’t qualify for coverage – but together, they comprise a relatively small minority of Americans. Some others qualify for coverage, but for various reasons, like physical or mental limitations or single-parenthood of multiple pre-school-age children, can barely afford food, clothing, and shelter and have no money left to purchase insurance. Fortunately, they too comprise a relatively small minority of Americans. Don’t get me wrong, I’m concerned about those people, and I’m going to address their needs shortly. But I think we have to make a distinction between them and the millions of others who are able-bodied, able-minded adults and have no health insurance, not because they can’t qualify and not because they can’t afford it, but because they choose to gamble with their health and spend their paychecks on other things. Remember, when those people need health care, even they can still get it – hospitals in this country are required to treat anyone who shows up in need of urgent care – but afterward, they might have to sell non-essential belongings and make payments for years to pay off all, or more often just a portion, of their health care bills. I confess that I’m not so concerned about that group. What do you want to bet that the majority of uninsured adult Americans have cable or satellite television in their homes? Why shouldn’t there be serious consequences for serious irresponsibility? If we eliminated those consequences, we’d be removing a powerful incentive for the vast majority of Americans to continue to behave responsibly and secure their own insurance. You don’t encourage responsible behavior by making it easier for people to behave irresponsibly. I’m always amazed at how easily some politicians talk about our “moral obligation” to hand more out while ignoring completely a recipient’s “moral obligation” not to have his/her hand out when he/she is capable of meeting his/her own needs, as are the vast majority of Americans. I acknowledge both moral obligations and weigh them equally.
Now, let’s take a step back and look at why health care costs have risen more sharply than costs in other high-tech industries over the past several decades. Believe it or not, in large part, it’s because so many Americans actually have had health coverage and because that coverage has continuously expanded to encompass more and more services. Health insurance used to be like other insurance, intended to guard against catastrophes. People purchased health coverage at relatively-modest prices to protect themselves against financial devastation in case they needed relatively rare things like surgery or were diagnosed with a major illness like cancer that required extensive and expensive services and medications. Back then, insurance wasn’t intended to cover routine office visits for minor things like sore throats and colds. People paid out-of-pocket for expenses associated with such common conditions. Enter the h.m.o., the answer to American consumers’ demands for ever-expanding coverage at ever-decreasing costs and one of the most vilified institutions in America. Over the years, Americans wanted to pay lower and lower premiums for health insurance, while, at the same time, they wanted their policies to cover more and more services and medications, including common things like routine checkups, colds, and cough medicine. Well, insurance doesn’t work when the likelihood of covered incidents occurring among policy-holders on an annual basis is high – not unless the premiums are extremely high or the coverage is extremely limited. H.m.o.’s met consumer demand for low premiums and expanded coverage in two ways. First, they contracted with doctors to pay reduced prices for services (e.g. percentages of the doctors’ customary charges). Second, they made it difficult for patients to see doctors with whom they didn’t have contracts, difficult for patients to see specialists, and difficult for patients to receive costly treatments and medications. While traditional insurance policies have remained available, many Americans have opted for the h.m.o.’s to save money during times of good health, only to complain about their limited coverage and bureaucratic procedures after health issues have arisen.
As the trend toward h.m.o.’s was developing in America, so was the trend toward health insurance premiums being paid by employers rather than patients. That began when employers realized that they could use their volume purchasing power to accomplish two things. First, they could secure health coverage for their employees, which they hoped would result in healthier employees and lower rates of absenteeism. Second, they could offer the insurance to their employees as a benefit and reduce employees’ salaries by more than the bulk-rate cost of the insurance. You see, it was out of economic self-interest that employers got involved in providing health insurance for their employees. But over time, the practice has become so ubiquitous that many employees have lost sight of that fact and now look to their employers almost as some kind of quasi-parental figures, obligated to pick up “in loco parentis” where their parents left off with respect to providing their health care. When you think about it, that’s kind of a bizarre notion. Why should the person who pays you for your work be responsible for taking care of you if you get sick? Why not your parents, or your barber, or your grocer, or your landlord? Just because a lot of employers do it doesn’t mean it’s an employer’s moral responsibility. If they choose to do it, great, but I don’t see a moral or legal basis for mandating that employers cover their employees, as has been proposed recently. So, the combination of these two trends – expanded, albeit corner-cutting, health coverage administered through h.m.o.’s, and employer-provided health coverage – created a market in which the end-users of health care services and medications no longer had any incentive to care about the cost of those services and medications, effectively removing normal market forces, e.g. competition, from the health care market. It should be no surprise to anyone then that costs have continued to rise sharply.
Most politicians seem to share the goals of reducing the costs of health care and prescription drugs and giving every American access to health insurance. The fundamental disagreement seems to be about how to accomplish those goals. Some want to have the government take over the entire health care system, and in my opinion, that would be a disaster. From a practical standpoint, think of the last time you interacted with a government agency. Do you want your doctor’s office to operate like that? I think it would degrade the system terribly. It would result in all of us having equal access to a mediocre system, when today, the vast majority of us have access, albeit expensive, to the best system in the world. What’s needed is more competition, more providers, more insurers, more choices for consumers, and more personal responsibility in the system. Those are the elements that made the U.S. health care system, and the entire U.S. economy, the envies of the world. Abandoning all of that and adopting a government-run “single-payer” system would be moving in the exact opposite direction and would lead to the exact opposite result. I hate it when people propose moving our country’s economy away from the traditions that made it strong and toward the traditions that have made other economies, e.g. European economies, weak (and as their economies have dwindled, so has their geo-political relevance and influence). Personally, I believe, philosophically and Constitutionally, that it’s neither a fundamental purpose nor a permissible undertaking of our government to make sure that every American has health care. People often misinterpret that whole “promote the general welfare” thing in the Constitution — it means that the government should have plans for what to do and take action if we have a drought or an epidemic of Bird Flu or something, not that the government should be paying for everyone’s day-to-day nourishment or health care. I believe that there’s a critically-important distinction to be made between responsibilities that are government’s and responsibilities that are society’s. I believe that our responsibilities to look out for one another and to take care of those who are unable to take care of themselves are societal, not governmental, responsibilities and that they should be carried out by private, not public, institutions and individuals. Ours is the most generous society that the world has ever known, and I believe that the less government tries to mandate and regulate our generosity, the more generous we are. For example, there are children’s hospitals all over this country that will treat any child for any condition without regard for that child’s parents’ ability to pay. Religious and university hospitals often do likewise for adults. Television talk-show host Montel Williams is traveling all over the country to make Americans aware of a program through which the major pharmaceutical companies, vilified as they are by some politicians, make medications available for low cost or no cost to uninsured Americans who can’t afford them (and by the way, they’re doing the same in Africa with H.I.V. medications, which are among the most expensive in the world). And perhaps the most vilified corporation in America after “big oil” is Wal-Mart, but that company has made many common prescriptions available to its customers for as little as four dollars (for a month’s supply), and a number of its competitors have followed suit. I love those kinds of solutions! But I understand that more needs to be done, and I don’t disagree that government has a role to play – I just disagree about what the appropriate role of government is.
Generally, I want the government to get further out of the business of health care rather than further into it. When it comes to cost, government can reduce the tremendous overhead cost of malpractice liability insurance by making it more difficult to sue health care providers and recover large sums of money in the absence of clear misconduct by providers. But I also want to hear politicians talking more about personal responsibility, about Americans needing to go back to the old days, buying relatively low-cost catastrophic coverage and paying out-of-pocket for routine health expenses, incentivizing patients to shop around, maintain healthy lifestyles, and avoid overuse of the health care system, while incentivizing health care providers to compete on price. And when it comes to access, I want the government to make it easier for Americans to start new health insurance companies to compete with the entrenched industry players on both price and coverage, for Americans in all 50 states to purchase health insurance from companies operating anywhere in the country (currently, people’s options are limited by the states in which they live), for insurance companies to offer limited coverage to people who have one expensive condition that keeps them from obtaining coverage for any other condition (e.g. insure a smoker for everything but lung cancer), and for Americans to set aside and accumulate money tax-free in health savings accounts for out-of-pocket expenses. (And while we’re on the subject of what the federal government can do for health care in America, I want to see a program whereby the parents of babies who die tragically in the womb can donate their babies’ embryonic stem cells if they so choose so we can sidestep the debate about whether it’s morally permissible to get them either from aborted babies or from embryos created during in vitro fertilization procedures.) Essentially, I want to see the government removing barriers to health care and increasing health care options but not distributing services and medications to people. Believe it or not though, there’s one instance in which I do think it’s our federal government’s responsibility to pay directly for people’s health care, and that’s when the recipients are veterans whose needs for health care arise from their service to our country. Having worked in the V.A. health care system though, I can tell you that you need look no farther than the V.A. to see why you don’t want government-run health care. I would skip the radical reformation of the V.A. health care system that most politicians promise, and I would disband it altogether. In its place, I would have the government purchase private health insurance to cover any condition(s) related to a veteran’s service for that veteran’s lifetime.
So there you have it, Dr. Brian’s election-year prescription for health care. Use as directed, and call me in four years.
Analysis of political convention speeches 9/7/08
If you watched the political conventions over the past two weeks, or even if you didn’t, here’s my psychological analysis of the two parties’ appeals to voters:
Basically, I looked at two brain processes, the first being emotion and the second being logic, which actually occur in two different regions of the brain — emotional processing in the more primitive limbic area and logic in the more advanced cerebral area.
When it came to motivating voters, I saw both parties’ speakers appeal to emotion, but their appeals were different — one party appealed to compassion (i.e. “feel sorry for struggling Americans”) while the other appealed to patriotism (i.e. “feel proud of what Americans have overcome/achieved”).
When it came to policy solutions though, I saw one party appeal far more often to emotion (i.e. “because you feel sorry for struggling people, change the country for everyone, raise taxes, expand the government, and make their lives easier by paying for their health care, mortgage payments, etc.) while I saw the other party appeal far more often to logic (i.e. “don’t radically change the country to solve problems that affect a minority of citizens but target solutions to those affected by the problems, don’t raise taxes and expand the government when those things have been historically ineffective in stimulating the economy and meeting people’s needs”).
Basically, one party encouraged people to judge the government based on how many struggling people it’s assisting, while the other party encouraged people to judge the government based on how many financially-stable people don’t need its assistance.
Intellectually, the party with the more emotion-based appeal had the easier job because all it had to do was point out needs and promise that the government would meet those needs. The other party had the tougher job because it had to acknowledge problems but put those problems in national/historical perspective and explain why direct government intervention in people’s lives is generally not effective/efficient. At the end of the two weeks, however, I think the more logic-based appeal will be more persuasive because it was essentially optimistic, and I think human beings generally prefer to think optimistically.
Which party is which? It’s up to you to figure that out!
Teen suicides reportedly on the rise — why? 9/4/08
The Journal of the American Medical Association is reporting that an increase in the teen suicide rate first observed in 2004 apparently continued into 2005. No, I don’t know why it takes so long to compute these stats, and because of the lag, we don’t know whether the rate has remained elevated or has dropped back down. Just to get some perspective on this, we’re still talking about an average of approximately eight suicides for every 100,000 teens in 2004, but that was up from 2003 (when it was more like seven for every 100,000), reversing a multi-year decline trend. Of course eight per 100,000 is still way too many, and it’s a serious problem that needs to be seriously addressed. Some are saying that it’s because fewer pediatricians and family doctors are prescribing antidepressants to teenagers (i.e. depressed teens aren’t getting meds, causing their mental health to deteriorate into suicidality). Well, it’s not that simple. In 2004, the FDA put a “Black Box” warning (that’s about as serious as it gets) on several common antidepressant drugs, cautioning physicians that the drugs had actually been associated with increased suicidal thoughts and behaviors when prescribed to teens. It gets even more complicated. While it’s true that depressed people, teens and adults, sometimes commit suicide after taking antidepressants for a while, a causal relationship isn’t clear. It may be that the drugs actually cause suicidal thinking. But, it may also be that once some severely-depressed people start to feel a little better because of the drugs, they contemplate suicide as a way to avoid what they perceive to be an inevitable return to “rock bottom,” and because the drugs have actually increased their functioning slightly, they then have the mental and physical energy to follow through with it. I’m not just hypothesizing here — psychologists have known for years that one of the riskiest times for suicidal thinking is when a person is actually starting to emerge from the lowest depths of depression. My guess: A steady decline in positive parental involvement in kids’ lives — fueled by rampant divorce and facilitating childhood exposure to unhealthy influences like illegal drugs — has contributed more than prescribed drugs to an increase in teen suicides.
Another preventable mass shooting 9/3/08
There’s been yet another shooting spree, this time in Washington (state), six dead. The shooter is in custody, and you’ll be shocked to learn that he has a history of both mental illness and criminal behavior. As we learn more about this guy, I have no doubt that the following will become clear: he was a known, predictable danger who shouldn’t have been loose on the street when he perpetrated this tragedy — i.e. this too was preventable. I’d refer you to my previous posts about getting tough on people, putting them away, before their crimes become deadly, but unfortunately, there are too many posts on that subject to go back and catalog them all at 3:00 a.m.
New research on Bipolar Disorder & drug ads 9/2/08
If you’re a man over the age of 30, and you’ve heard about a new study suggesting that the risk of developing Bipolar Disorder is elevated in children fathered by men over 30, let not your heart be troubled. The reported overall elevation in the incidence of Bipolar Disorder among people fathered by men over 30 was 11%, but the base rate (frequency of a diagnosis within the general population) of Bipolar Disorder is only about 2%. So, according to the study, if an average of two out of every 100 people eventually get diagnosed with Bipolar Disorder, then an average of 2.22 out of every hundred people fathered by men over 30 eventually get that diagnosis. See what I mean? No cause for alarm in my book.
But there’s another new study that I was happy to see. This one says that t.v. commercials aimed at getting people to ask their doctors to prescribe specific drugs generally have not increased sales of those drugs significantly. If you’re as sick of those commercials as I am (in my opinion “Viva Viagra” has overtaken “Head On, apply directly to the forehead” as the most annoying commercial ever), let’s hope the pharmaceutical companies take heed and direct their marketing efforts back to prescribers rather than to patients.