Vitamin-D Deficiency
This vitamin-D infographic from Information Is Beautiful is nice and timely, as the Institute of Medicine is just out with a new report on recommended allowances for vitamin D. The trouble is, it looks like the information, while beautiful, may not be entirely reliable. For example, the graphic suggests that 77% of Americans aren’t getting enough vitamin D. But, according to the LA Times, the IOM report suggests we do get enough:
The panel concluded that “with few exceptions, all North Americans are receiving enough calcium and vitamin D” from the foods they eat — many of which have been fortified with both nutrients. For all but a few, adding more of those nutrients in pill form would be useless at best and, at worst, would risk harm, added the report, which was two years in the making.
And the IOM report didn’t even factor in the levels of vitamin D our bodies produce through sun exposure, making it even less likely that we are undergoing an epidemic in vitamin-D deficiency. The dispute about how many of us are vitamin-D deficient is, as you’d probably guessed, about where to draw the line between enough and not-enough. NPR:
The new report says people’s blood levels of vitamin D don’t need to be higher than 20 nanograms per milliliter of blood. Leading proponents [of high-dose supplements] aim for a blood level of 30 or even 40.
If 30 were the right number, more than half of the U.S. population could be considered deficient in vitamin D.
Obviously, the dietary-supplement industry’s boosters want the number to be higher. But the IOM report did not find reliable evidence supporting the need for higher levels, though it deemed a daily intake of up to 4,000 IUs to be reasonably safe (for adults and teenagers). IOM did not find evidence for benefits other than bone health.
Here’s the infographic. Click to biggerize it.
Hat tip to coolinfographics.
Food Bill Irony
The food safety overhaul passed the Senate 73-25 today. And not only did it achieve a modicum of bipartisanship in the form of GOP votes, it was also fueled by bipartisan snacks:
Some Republican and Democratic Senate staff members — who in previous terms would have seen each other routinely — met for the first time during the food negotiations. The group bonded over snacks: specifically, Starburst candies from a staff member of Senator Mike Enzi, a Wyoming Republican, and jelly beans from a staff member of Senator Richard J. Durbin, an Illinois Democrat.
Starburst and jelly beans are what they ate? While negotiating legislation to ensure that the nation’s food supply is healthy? That is . . . just . . . there’s only one word to describe it: Art.
Food policy sage Michael Pollan talks about the substance of the bill with Ezra Klein here.
Without Peer (Review)
This blog is not peer-reviewed. And do you know what else wasn’t peer-reviewed? Watson and Crick’s famous paper on the structure of DNA, that’s what! And probably most of Albert Einstein’s work. Einstein was apparently so insulted by a negative report from an anonymous referee that he simply withdrew his submission and never sought to publish again in the journal in question. (Einstein and others also discovered errors in the paper before publishing in another journal, though it’s not clear that they were the same as those found by the reviewer.)
Not a Good Time for Medicaid Cuts
Source: Kaiser Family Foundation (pdf). Via NEJM.
Ikea Particle Accelerator
Via Ed Yong.
The Costanza Strategy
The main draw of the healthcare reform panel in Berkeley last week was, for me, Jonathan Oberlander. Unfortunately, though, his short talk didn’t ever really get beyond the historical backdrop and explanation of the Obama legislative strategy. What he did say was engaging and entertaining, to be sure, but I’d really hoped to hear more about present and future policy challenges related to implementation of the ACA. (More like this, for example.)
It was obvious that Oberlander would have had much more to say, given the chance. But unfortunately the moderator was lax on timekeeping for the panel’s ACA detractors, and Sally Pipes and Alain Enthoven essentially filibustered away the discussion time. Consequently the whole arch of discussion seemed weirdly disengaged from the actual contents of the law enacted some eight months ago. (By the way, who comes to Berkeley and argues that the public option was a bad idea because it would have led to Medicare for all? Sally Pipes, that’s who. As if the reductio ad single-payer would close the deal here. Lady, this is Berkeley! At least half the room must have thought she was for the public option when she said it would lead to single-payer.)
Oberlander framed Obama’s approach as the “George Costanza strategy,” referring to an episode of Seinfeld in which George decides to do the opposite of everything he’d done before, because everything he’d done before was wrong. Similarly, to avoid the failures of past administrations’ efforts to reform the healthcare system—and particularly the Clinton effort—Obama’s strategy would be to just do the opposite of what had failed in the past. The natural implication of framing the story this way is that Obama swung too far towards deference to Congress. I didn’t get the impression that Oberlander himself believed that was the case, necessarily, but a lot of people clearly do.
The Costanza trope is cute, but I think it feeds a false impression. Namely, that any given president can choose whether and how much to defer to the congressional lawmaking process. Whether the president is successful in enacting a legislative agenda is not first and foremost a reflection of political acumen, gamesmanship, character, backbone, or whatever. Those things matter on the margins, but they pale next to the structural forces in explaining political behavior. In a strongly partisan atmosphere, with a fragile coalition of 60 votes in the modern 60-vote Senate, the test of presidential leadership turns on whatever any one of those 60 senators wants. If senators want pork, then a “great” president will lasso pigs. But if senators are determined to spend months on end in the vain pursuit of a veneer of bipartisanship, then a great president will discover that the better part of valor is discretion. That’s because a great president is one who succeeds, and the only way to succeed in passing legislation is to secure a majority of votes in the House and a 3/5 supermajority of votes in the Senate. The only people who have votes in the House and Senate are members of Congress who must be persuaded that it is in their political interest before they will vote for a bill. There is no other way to make laws in the United States Congress.
Anyway, this was just one event and not really indicative of anything. But I do think it illustrates a significant problem: It is proving to be very hard to de-presidentialize health reform. And because of that, the “issue” remains too hot for political opponents to pass up any chance they might have to obstruct its implementation.
My Opinion about Public Opinion
Last week I attended a healthcare reform panel discussion in Berkeley. Mollyann Brodie of the Kaiser Family Foundation’s opinion research group gave a presentation about KFF’s monthly surveys of public attitudes towards health reform. The most important thing to note about the results of these surveys is that, even though people indicate favorable and unfavorable views of the health reform law in roughly the same proportion, large majorities consistently say they support nearly all the major components of the law (all except for the individual mandate).
According to Brodie, the polls illustrate that the public is largely confused about what’s in the new law and that opposition to the Affordable Care Act is superficial. Because of these facts, Brodie reasoned, messaging is extraordinarily important for those who wish to keep up public support and make health reform a success.
A few thoughts:
First, there is nothing actually incoherent about opposing the ACA while favoring many or most of its essential components. You might like every provision but one—one you hate so much you’d rather scuttle the whole merry ship than see such a baneful provision enacted. Or you might support all the key parts separately but reject the whole package, because you think the sum of their effects includes something objectionable. Or you might just be a pessimist about the prospects of complex, large-scale public programs in general. The point is, it’s not necessarily the case that the public is confused about what they want.
Confused or not, it is quite likely that people are taking cues from opinion leaders, as political scientist Jonathan Bernstein has suggested. And because there are still approximately zero Republican leaders at the national level who publicly support the “Obamacare” package—even though they too endorse many of its constituent elements—a large chunk of the public is holding firm in opposition to the whole, while favoring its parts.
Second, to the extent that there is elasticity in public opinion about the ACA, I don’t think that elevates the relative importance of messaging. I do not doubt that messaging makes a difference for some people. But if you can get people to change their minds about healthcare reform simply by telling them about the ACA’s insurance regulations, the subsidies, closing the doughnut hole, and so on, then obviously their opinions are not very deeply held.
It seems to me very unlikely that more messaging will make them hold favorable opinions any more deeply than the unfavorable ones they initially professed to have. For that, you need results. The law must succeed in providing people with real benefits—benefits they don’t want to give up, When that happens—if it happens—opinion will congeal.
Far more than messaging, health reform needs results. Now—if not sooner.
Chart credit: Kaiser Family Foundation (pdf).
Weekend Wordery: The Plural of ‘Syllabus’
According to the OED, the word syllabus is a Latin corruption of the Greek sittybas, the accusative plural form of sittyba.
Asked to adjudicate between syllabuses and syllabi, Mark Liberman at Language Log goes with syllabuses:
So if we were going to be etymologically exact, the singular should be “sittyba” and the plural should be “sittybes”, or something like that. Why should we invent a fake Latin plural to go with the fake Latin singular? My advice is to stick with plain English syllabuses.
I’ll stick up for the fake Latin syllabi. Two reasons: (a) everyone knows or thinks syllabi is a joke anyway; and (b) syllabuses is harder to say. Also, if double-fake Latin is what it takes to keep real Latin alive—or undead, or whatever—then I’m all for it!
Note to Self
When carrying a real, live, 80-pound tortoise down a flight of stairs with someone a foot shorter than you are, it would probably be best that you go down the steps first.
Will the Election Affect the Supreme Court’s Decision on Healthcare?
Brad Joondeph thinks so. As Michael Dorf recently wrote, the “framing power” of the politics makes it very hard to predict what judges will do.
We’re seeing that already. And the bigger the case gets—that is, the greater the public pressure on the Justices becomes—the more political its results are likely to be. The signs are pointing to this being the biggest, most politically volatile case since Bush v. Gore.
Here’s Joondeph, writing on the eve of the election:
[T]he election results are apt to affect the outcome of the ACA litigation in two ways. First, there seems little doubt that the federal courts generally, and the Supreme Court in particular, are influenced by the views of the other powerful institutions in our constitutional system. Thus, if the House and Senate are controlled by majorities that are hostile to the ACA, that will leave judges greater room to rule in favor of the states. Second, and perhaps more important, if tomorrow is a landslide for Republicans, and the narrative that takes hold (particularly in elite circles) is that the Democrats lost power due largely to the ACA–for instance, if attention is paid to those House members who lost their seats allegedly because of that vote–then the election may well be seen, at least in large part, as a rejection of the ACA by the American people. To the extent this occurs–regardless of its accuracy as a matter of political science–it would create an environment in which it was far easier for the Supreme Court to invalidate the ACA. For it would reduce the degree to which the Court would be attacked politically for such a decision, increase the likelihood that such a decision would be supported by the public, and diffuse some of the media and academic criticism.
In short, 18 months from now, we may well look back at [the election] as the single most important moment in the states’ constitutional challenges to the ACA.
All bets are off.
Brief, Anti-Brief
Briefs and motions for summary judgment in the Florida ACA lawsuit were filed last week in the District Court in Pensacola. I have a few thoughts in response to the administration’s brief (pdf).
But first, an aside: The administration’s lawyers cite the 1877 Supreme Court case of Pensacola Telegraph Co. v. Western Union Tel. Co., 96 U. S. 1 (1877), a case which is not at all on point, but which has some local historical interest in Pensacola. Of course, Judge Vinson is from Pensacola (and used to live a few blocks from where I grew up—though all I know about him is that he is really into camellias), and so one might well view this citation as a tasteless attempt at ingratiation. Personally, I think it’s a nice touch. And the case does provide a serviceable, if tangential, quotation about the adaptability of federal commerce regulation to new economic circumstances. So there’s that.
Now a few points about the administration’s brief. Recall that Judge Vinson ruled that the mandate penalty is not a tax, so it all comes down to the Commerce Clause. (Summary here. There is a separate issue about whether the ACA’s Medicaid reforms amount to federal coercion of state government, but there aren’t many people who think this claim has legs.)
The brief cites other federal laws requiring individuals to purchase insurance. It appears that each of these requirements is predicated on receipt of a federal benefit of some kind. For example, federal law requires you to get flood insurance if you live in a flood zone—if you want a federally subsidized mortgage, that is. I’m not sure that generalized benefits—like the availability of hospital care supported by federal funds—are sufficiently similar to these specific ones to make a neat analogy. For one thing, it’s extremely hard to imagine making the availability of federally subsidized hospital services conditional upon each individual’s insurance status. Denying someone a mortgage is easy; but barring the hospital door? In any case, no such conditions are attached to the insurance mandate in PPACA.
The brief is fairly persuasive in its treatment of Commerce Clause doctrine, arguing that there is no activity requirement in the Constitution and that the Court has never relied on one. (That horse has been, and will no doubt continue to be, well-flogged here.)
The brief also argues that there is no general bar against the federal government compelling individual citizens to act, pointing to forced sales of property through eminent domain and to compulsory military service through the draft. It is true of course that the commerce power is not a “second-class enumerated power” next to these, but it seems to me that there is an essential difference between the power to regulate commerce and each of the other powers cited. Those other powers include by their very nature the authority to impose certain affirmative obligations concomitant to them. The power to force land sales is inherent in the power to take private property for public use (with just compensation). The power to compel payment of taxes is inherent in the power to tax. The power to compel military service is (historically, if not logically) inherent in the power to raise armies. But I would hesitate to say that the power to compel engagement in commercial activity is inherent in the power to regulate commerce.
It’s the difference between saying “all bachelors are male” and saying “the sky is blue.” The first, as philosophers would say, is analytically true—i.e., true by virtue of the meanings of the words. The second just happens to be true (sometimes) as a matter of empirical observation. Similarly, the powers of eminent domain, raising armies, and taxation (and others like those) may entail the power to compel action by the very nature of what those powers are, or what they have historically meant. But the power to regulate commerce does not necessarily entail such a power to impose affirmative obligations. It might do so, but it need not necessarily do so. It could instead be limited to restrictions on regulable activities.
To conclude, I’m not taking one side or the other here. The whole question is really up in the air for me.
Profiles in Cyberchondria Infographic
Below is an infographic about cyberchodriacs—er, I mean, “e-patients”—in the United States.
I find it hard to believe that “85.6 million adults admitted they doubted a medical professional’s opinion or diagnosis because of information they read on the Internet.” First of all, there’s no way they actually surveyed that many people. Surely they’re just extrapolating from a sample. Secondly, this would mean a very high percentage of people think 10 minutes online can trump 10 years or more of medical training and experience. But that runs in the face of one of the great bromides of the public policy debate over healthcare: that people trust their doctors. I tend to think the truth is closer to the latter.
Via Coolinfographics.
Selected Behavior
I’m enjoying Karl Smith’s guest posts at Ezra Klein’s place so much that I went to check out his usual digs at Modeled Behavior. There I ran into this little foray into the theory of Darwinism:
Natural selection in our world operates through inheritance but inheritance is not necessary for this this to hold. If creatures were simply randomly popping into existence and some [were] devoured by others and some not, then we would still observe a set of creatures that looked as if was designed not to be devoured.
Why?
Because all the others would have been devoured and thus rendered unobservable.
Now that’s just not quite right. There are three components to the theory of natural selection: replication, variation, and differential survival. These three elements don’t boil down any further; you have to have them all. The key to natural selection is that differential selectors act upon diverse populations so as to change the prevalence of certain traits in successive generations of those populations. It’s not simply that the survivors are observed and the devoured are not—the evolutionary analogue of the-victors-write-the-history—but that the population’s gene pool has actually adapted to a selection environment. And as this process plays out in complex ecosystems, the result is inevitably that populations bear so many minute and intricately adapted traits that they appear to have been purposely designed to do what they do.
One of the insights of Universal Darwinism is that, in a sense, they have been designed that way, but not purposely.
Quantitative Easing Demystified
As if people need to be reminded that they, we, don’t understand how the Federal Reserve conducts U.S. monetary policy, the term “quantitative easing” periodically surfaces to do exactly that. Basically QE consists of the Fed buying Treasury bonds to pump money into the economy. Which, coincidentally, also describes what the Fed normally does to control interest rates. Karl Smith, guest-blogging for Ezra Klein, explains:
Most people are probably pretty familiar with the idea that the Fed raises or lowers interest rates. Yet, how does it do that?
Well suppose the Fed wanted to lower interests rates. The Federal Open Market Committee – which Ben Bernanke heads – issues orders to the open market desk.
Traders at the open market desk are told to start buying bonds. As they do bonds go up and price and the yield or interest rate goes down. The traders are ordered to continue buying until the interest rate hits the committee’s target and then stop.
However, currently interest rates on short-term bonds are basically zero. What are the traders to do? Well, consistent with their orders they simply stopped, and the market halted where it was.
Now, the Fed is issuing a new kind of order. It used to say keep buying until you hit a target interest rate. Now it is saying keep buying until you have spent $75 billion per month. The traders will begin buying as ordered, and instead of stopping when they see a certain interest rate, they stop once they’ve spent a certain amount of money.
Economists like to think in terms of prices and quantities. Usually the orders from the FOMC come in the form of prices, in this case the price is called the interest rate. Now the orders will come in terms of quantities. This is why the whole thing is called quantitative easing. It is a quantity target instead of a price target.
Otherwise, it is the same.
Oh, That? Don’t Worry, It’s Only Puke.
Apparently, this is a brand of chips from China. More examples of unfortunately named foods from abroad here.
Via Language Log.
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