Wednesday, June 13, 2018

Conor Friedersdorf Clanks Again: The Anti-Male Agenda Of Modern Academic Feminism

Conor Friedersdorf and his milquetoast attacks on feminist extremists (viz., his response to the Scott Aaronson fracas) continue with a review of Suzanna Danuta Walters’ two-minutes’-hate against men in the pages of the Washington Post, of all places. (Imagining that paper publish a screed against women — can anyone do it?) Friedersdorf argues that her
argument is actually a perversion of “Team Feminism”—that is, the web is awash with feminists earnestly dismissing the notion that “Team Feminism” hates men, and the view is so unrepresentative of the various strands of “in real life” feminism that it is encountered more commonly among ideological enemies trying to parody or undermine feminism than among earnest advocates like Walters.
The problem with such gabble is that none of it is true. Pen poison pieces like this, and it gets you multiple tenured professorships — including as the founder of Indiana University's Women's Studies program. Presume men are always guilty of sex crimes, and you get to head the Title IX bureaucracy in a perverse redefinition of "civil rights". Vote for anybody other than Hillary Clinton as a Democrat, and you're slandered as a sexist ("Bernie bro"). Go off the ideological reservation, and get canned by a corporate feminist political officer. Offer criticism of a beloved comedy franchise's clumsy, unfunny, political reboot, and get waylaid as misogynist. "Team feminism", in reality, is the majority in the trade, if not the only kind on tap.

Perhaps my assessment of causality is wrong; perhaps Walters wasn't extreme enough in her prior writing, perhaps she is doing this as a plea for help, or attention. The only way men can win this game is not to play. Friedersdorf fails to even survey the landscape.

Thursday, May 24, 2018

"Check Your Privilege" Meets The Royals: The Surprising Compatibility Of Modern Feminism With Monarchy

Joanna Williams in Spiked explains why "Monarchy And Feminism [Are] A Perfect Marriage". "Bold declarations of feminist intent do not show that the monarchy has changed: instead, they show how much feminism has changed."
Today, feminism ... doesn’t call for an expansion of democracy, but for democracy to be tamed. All-women shortlists and quotas for women on company boards deny people a free choice in appointing anyone they choose. They move us away from seeing gender as an irrelevance and treating people as equals. Instead, we’re told that women need to be afforded special privileges. In the past few weeks we’ve had calls for the banning of sexist adverts and the criminalisation of street harassment. Rather than calling for women to be recognised as adults, today’s feminism insists women are treated like children.

The only question campaigners and commentators have so far raised about Meghan’s feminism is whether she’ll get away with it. Is it realistic to think she can be both a feminist and a royal? Of course it is. Feminism today poses no threat to the establishment. Feminism is the establishment. Feminism is now concerned with enforcing etiquette, telling boorish men how to behave, and calling for censorship and regulations. It is elitist and condescending – a perfect match for the monarchy. Today’s younger royals reveal all about mental-health troubles and want us to know that despite wealth and privilege, they suffer too. Again, a perfect match for a feminism that allows rich celebrities to swap stories of disadvantage.
(Emboldening mine.) The advantages of being rich collide with feminist ideals:
Where Meghan differs from other women is that she has given up her own career for marriage. Today, over 70 per cent of all women and 90 per cent of female graduates are employed. Yet on the royal website, details of Meghan’s acting career – presumably earned through her own merit and tenacity – are given only a cursory nod.
The New Feminist Woman may have never materialized in the real world, but the old one — class-conscious as ever — still sets the rules.

Saturday, May 19, 2018

Burning Down The Medical Village To Save It: The Folly Of Big Data In Medicine

Rena Xu's recent piece in The Atlantic on physician burnout is mostly interesting for its between-the-lines reporting. Yes, Big Data (i.e. medical coding) is driving a lot of physician burnout:
Regulations governing the use of electronic medical records (EMRs), first introduced in the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, have gotten more and more demanding, while expanded insurance coverage from the Affordable Care Act may have contributed to an uptrend in patient volume at many health centers. These changes are taking a toll on physicians: There’s some evidence that the administrative burden of medicine—and with it, the proportion of burned-out doctors—is on the rise. A study published last year in Health Affairs reported that from 2011 to 2014, physicians spent progressively more time on “desktop medicine” and less on face-to-face patient care. Another study found that the percentage of physicians reporting burnout increased over the same period; by 2014, more than half said they were affected.
But won't we need ever-more new physicians to deal with the aging US population? Yes, we will, but —
A quarter of U.S. physicians are expected to retire over the next decade, while the number of older Americans, who tend to need more health care, is expected to double by 2040. While it might be tempting to point to the historically competitive rates of medical-school admissions as proof that the talent pipeline for physicians won’t run dry, there is no guarantee. Last year, for the first time in at least a decade, the volume of medical school applications dropped—by nearly 14,000, according to data from the Association of American Medical Colleges. By the association’s projections, we may be short 100,000 physicians or more by 2030.
And this despite modest, recent upticks in new physicians, even despite Medicare's meddling in internship slots. In addition, the article cites the "Resident Physician Shortage Reduction Act ... [which] would add 15,000 residency spots over a five-year period." That's a 1.6% increase vs. the 2014 physician population of 916,264, but nothing compared to the gaping hole implied by 100,000 missing doctors. Mandated medical coding — the raw material of Big Data in medicine — contributes to a physician burnout we can scarcely afford.

But this kind of insanity is to be expected. The people who imagine they are helping very frequently do not subject themselves to the consequences of their "help" (viz., Jonathan Gruber, who is not a doctor). The meretricious belief that big data will somehow "bend the cost curve" is deeply embedded, including, especially, in service providers with something to sell. There are costs to acquiring that data, and that cost is, more administrative overhead (emboldening mine):
...[D]octors are most valuable when doing what they were trained to do—treating patients. Likewise, non-physicians are better suited to accomplish many of the tasks that currently fall upon physicians. The use of medical scribes during clinic visits, for instance, not only frees doctors to talk with their patients but also potentially yields better documentation. A study published last month in the World Journal of Urology reported that the introduction of scribes in a urology practice significantly increased physician efficiency, work satisfaction, and revenue.
And who pays for that increased revenue? Ultimately, it's the patients, of course, or the government (taxpayers) if it's Medicare/Medicaid.

Saturday, May 5, 2018

The Supreme Court Blesses Inter Partes Review, And The Possibilities For Pharma Reform

One of my big complaints about medicine is the ongoing problems with patents (general complaints here, a more specific example here) needlessly driving the costs of pharmaceuticals higher. The Supreme Court recently delivered some good news on this front in the case of Oil States Energy Services v. Greene's Energy Group. Essentially, the 7-2 decision said that the USPTO can revoke its own granted patents in a process called Inter Partes Review.
The basic idea behind the IPR process was an admission that the USPTO is historically bad at properly reviewing patents before granting them. It grants a lot of bad patents. The IPR process allows anyone to present evidence to the PTO that it made a mistake and granted a patent that should never have been granted. If the PTAB is convinced, it can invalidate the patent. Seems pretty straightforward. Except that the usual patent lovers (mainly patent trolls and big pharma) insisted that this was some sort of unconstitutional taking of property, without the review of a court. This is wrong for a whole bunch of reasons -- starting with the incorrect view of patents as traditional "property."
 The reaction of the pharmaceutical business, which is often predicated on shabby patents, is highly negative, but it’s unclear whether there’s enough momentum behind the process, as “Pfizer, Merck, Novartis and Sanofi are among the companies to have used the IPR process” to invalidate patents. Unfortunately, because IPR is a strictly bureaucratic creature, it is also subject to regulatory capture, i.e. if Big Pharma (say) gets hold of it, it will actually result in worse outcomes than appeals before Article III judges. A study by BiologicsHQ shows that “despite widespread concerns about the PTAB operating as a patent death squad in IPRs, ‘such concern is not justified for drug patents.’” The study found that
According to the March 2017 IPR statistics issued by the PTAB, 53 percent of IPRs resolved as of March 31, 2017 were instituted; the rest were either denied institution or reached some other resolution prior to the institution decision. 35 percent of all resolved IPRs resulted in final written decisions and 23 percent led to findings of all claims unpatentable. Only 7 percent of all resolved IPRs led to final written decisions finding that no claim was unpatentable, and 5 percent led to mixed claim findings.
This suggests that only the most obscenely obvious patents will end up invalidated, and even among those patents that do go through the process, not all of them end up being instituted! But the numbers are even worse for pharmaceutical patents:
By contrast, drug patents fare better under PTAB scrutiny in terms of having claims upheld. Of the 4,563 resolved IPRs, BiologicsHQ reports that 222 petitions (5 percent) involved patents covering drugs listed in the Orange Book. Focusing on just the IPRs involving Orange Book patents, 44 percent were instituted and 38 percent reached a final written decision, but only 16 percent led to final written decisions where all claims were found unpatentable. No instituted claim was found unpatentable in 50 percent of final written decisions (19 percent of the total number of resolved Orange Book IPRs).
 (The Orange Book is the list of FDA-accepted drugs.) Far from being a salvation, IPR might prove to be an industry Trojan Horse. To be clear, there’s no immediate evidence that regulatory capture is currently running rampant at the USPTO,  but the outcomes certainly point in the same direction.

Monday, April 23, 2018

"Is There A Smarter Way To Deal With Sexual Assault On Campus?" Asks The New Yorker

A steaming heap of dogma from Jia Tolentino, who had the incredible gall necessary to write that
Seven years ago, the Office of Civil Rights, under President Obama, issued a “Dear Colleague” letter, reasserting that sexual violence on campus was a violation of Title IX, and pushing universities to handle sexual-assault cases in a timely, transparent, accuser-friendly manner.
Two out of three ain't bad? Then there's the friendly interview with serial liar Emma Sulkowicz that conveniently omits the fact that Sulkowicz filed her report months after the alleged incident, or Cathy Young's embarrassing revelations of Sulkowicz's friendly text messages in the wake of the purported "assault". The two principles of the study at the center of the piece, Jennifer Hirsch and Suzanne Goldberg, meet at a conference and resolve to conduct an "enthnography". It sounds really important! Except, of course, what they mean is, "unverified stories".

They call the ensuing project SHIFT, whose clumsy retronym stands for "Sexual Health Initiative to Foster Transformation". Already we know we are among advocates who know what they want to find and do. They're smarter! They've got Ideas!
... Hirsch and Mellins think about sexual assault socio-ecologically: as a matter of how people act within a particular environment. They are doggedly optimistic that there is, if not a single fix, a series of new solutions.
But, rape is hard to prove! Can we expand it?
Today, the D.O.J. defines sexual assault as unwanted sexual contact, which means that groping counts, as does attempted assault. The crime hinges on intention, and there are often no witnesses, which makes it uniquely difficult to adjudicate in any legal system, let alone one made up of college administrators. Campus judiciary systems don’t have a criminal court’s investigative powers or evidentiary procedures, but they do have many of a criminal court’s responsibilities. To complicate matters further, everyone involved in the process—accuser, accused, administrator—essentially works under the same roof. Betsy DeVos, Trump’s Secretary of Education, has called the current approach a “failed system,” and said that she would seek to replace it.
"It might seem simpler to let the criminal-justice system handle things," Tolentino intones, "but universities have a responsibility to insure that women have equal access to education." Pesky due process! (But wait, aren't women already a majority of students enrolled in college?) And then there's all those juicy staff positions:
Columbia now has twenty-three staffers with Title IX responsibilities, including case managers, investigators, and administrators, and provides free legal services to accusers and accused. The school’s gender-based misconduct policy is thirty-one pages long.
Somebody has to hire all those Womyn's Studies majors, not to mention attorneys who skipped class on the day they taught rape in crim law. It's a good thing, because in the end, Hirsh likens the situation to that with drunk driving; included in the "solutions" for that problem are
new laws, and social change, as school and community programs taught people to designate a driver and to intervene when a wobbly friend grabbed his car keys. It also involved changes to the physical environment: cities established police checkpoints, and offenders were required to install Breathalyzer locks on their cars. Citizens lobbied for better street lights, more speed bumps.
 What possible analog exists for these among sexual assault? Chastity belts? Whatever it might be, there's no doubt that some idiot will propose it, and it will rush through the legislatures in California, Illinois, and New York with hosannas. At last! Sexual assault has been cured! Meanwhile, young men will find themselves spied upon and spat upon for no reason other than owning a penis. Misbehavior or even missed communications on a date will result in unpardonable ejection. That is, the answer to the title question is "no".

Saturday, April 21, 2018

The Politicization Of Science And Gun Control: The CDC's Hidden Data

I was involved some time ago in a conversation with a friend regarding the longstanding ban on the CDC engaging in research on gun control, with my friend taking the position that there was no reason for them not to do so, as it is a legitimate area of inquiry. My objections were two:
  1. The CDC stands for the Centers for Disease Control (and Prevention). That is, it is about the control of infectious or other kinds of disease, and thus research into guns represents mission creep.
  2. The CDC would immediately be used as a friendly home for gun control advocates to produce shoddy, biased work that would be used to cloak their activities in the white lab coat of science while ignoring anything that contradicted the party line.
 The second was particularly important as a factor in 1994, when CDC Director for Injury Prevention and Control Mark Rosenberg said "We need to revolutionize the way we look at guns, like what we did with cigarettes ... It used to be that smoking was a glamour symbol—cool, sexy, macho. Now it is dirty, deadly—and banned." In 1996,
Congress passed an amendment to a spending bill that forbade the Centers for Disease Control and Prevention from using money to “advocate or promote gun control.”

The National Rifle Association had pushed for the amendment, after public-health researchers produced a spate of studies suggesting that, for example, having a gun in the house increased risk of homicide and suicide. It deemed the research politically motivated. ...

The actual amendment sponsored by Jay Dickey, a congressman from Arkansas, did not explicitly forbid research into gun-related deaths, just advocacy. But the Congress also lowered the CDC’s budget by the exact amount it spent on such research.
(Dickey later expressed regret for his part in introducing the bill.) So it was no small surprise to me when Reason published a piece yesterday indicating that the CDC had actually performed research on the defensive use of guns after that legislation passed, in 1996, 1996, and 1998. What they found was that guns were used literally millions of times annually for self-defense, the vast majority of which did not involve firing a single shot. (Emboldening in the passages below are mine, as ever.)
Florida State University criminologist Gary Kleck conducted the most thorough previously known survey data on the question in the 1990s. His study, which has been harshly disputed in pro-gun-control quarters, indicated that there were more than 2.2 million such defensive uses of guns (DGUs) in America a year.

Now Kleck has unearthed some lost CDC survey data on the question. The CDC essentially confirmed Kleck's results. But Kleck didn't know about that until now, because the CDC never reported what it found.
The CDC survey turned up numbers very similar to (but not identical with) Kleck's more recently (2001) published figures, a discrepancy Kleck attributes to a generally declining crime rate since then. (Gun control advocates are more wont to use National Crime Victimization Survey figures of about 100,000, an order of magnitude smaller.) The essay makes no effort to determine CDC's the motives for burying these results, but the obvious ones are
  1. CDC honchos were gunshy, as it were, about publishing anything on the subject after a significant maelstrom that resulted in funding cuts.
  2. They did not like the results they got, and hid them.
  3. Some other reason.
If the first, why did the CDC pursue this study in 1997 and 1998? Funding is finite, so why bother when there are other areas of research that need money as well? This alone suggests that the latter two are in play, and the optics surely argue for the second (particularly given Rosenberg's remarks). If gun control advocates wish to develop some credibility on the subject of state-sponsored gun injury research, they need to stop acting in ways that are visibly dishonest.

Wednesday, April 18, 2018

Sarah Kliff, Promoter Of Democratic Healthcare Fantasies

Vox's Sarah Kliff, last seen before 2016 election whistling past the Obamacare graveyard, now chirps about the number of Democratic health care proposals! Yay, team!
It’s notable to me that Democrats seem really keen on having another health care debate. They’re preparing for it by putting all these different options on the table, to sort through where a consensus might exist.
And the "options" really boil down to a Hobson's choice: how do you want your government-controlled health care delivered? All from the government right now (single-payer, a consistent loser at the polls)? Pretending that single-payer isn't the endgame right away (Medicare/Medicaid buy-in, i.e. the public option)? However you cut it, the belief in magical government intervention as an elixir is central to all of them. None of these will fix the physician shortage, nor will it fix the patent system, nor the regulatory moats around pharmaceuticals. Kliff doesn't concern herself with those kinds of details; her job is that of cheerleader. We know this because the second half of her article goes on to explain the wonders of the Murphy-Merkley plan, during which she writes the following:
The Choose Medicare Act envisions that individuals and companies would cover their costs for buying into Medicare, meaning actuaries would need to determine what those premiums would look like. There is some reason to expect these premiums would be lower than premiums for private insurance, because Medicare typically pays lower prices.
There are a lot of things to say about that, not least the shifting terrain that a large influx of new "insureds" would look like; recall that the Obamacare cohort was sicker than the general population, i.e. the incentives are for such people to seek out such care. There's hardly a reason to think a "public option" would save material costs, and considerable reasons to think it would do worse (i.e. the Democrats would be sure to goose the actuarial realities by way of further subsidies).

Another problem is the quip sometimes attributed to Stalin, that quantity has a quality all its own. Kliff is right that private payers pay more for their services than Medicare. But assuming Medicare expansion will fix costs also assumes that physicians will continue to accept Medicare patients. While data is hard to come by, Texas Medical Association figures showed a dramatic drop in the acceptance of new Medicare patients from 2000 (when 67% of physicians accepted all comers) to 2010 (only 31%). Moreover, given that Medicare represents a relatively small fraction of physician income (as of 2011, around 40% in Texas, see PDF page 5), expanding it would demand physicians take a substantial pay cut. That they might opt out of accepting new patients or stop seeing Medicare patients altogether. Second-order effects: we can haz them!