Sneaking Suspicions

Archives-- July 7-13, 2002 (Week 27)


Commentary from a practical perspective

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This page includes posts from July 7-13, 2002 in the usual reverse order. Each week's postings on the home page are perma-linked to these pages.

July 12, 2002

It’s news again when people forget it was news before

The morning paper ran a piece in its People section that it cribbed from the Washington Post about Candice Bergen and Dan Quayle:

Turns out actress Candice Bergen really did agree with Dan Quayle.

Ten years ago, then-Vice President Quayle criticized Bergen's "Murphy Brown" TV character for "mocking the importance of fathers by bearing a child alone and calling it just another 'lifestyle choice.'"

"I never have really said much about the whole episode, which was endless," Bergen said Tuesday. "But his speech was a perfectly intelligent speech about fathers not being dispensable and nobody agreed with that more than I did."

This was a famous little cultural dust-up that in fact led to some spirited debate about family roles and single parenting. Perhaps one of the best results of the brouhaha was Barbara Dafoe Whitehead’s article in The Atlantic, Dan Quayle Was Right, which thankfully is still available on the Web.

The odd thing about today’s news item, however, is that it wasn’t news.

Bergen was quoted in the Washington Post and Los Angeles Times just over four years ago saying much the same thing:

In the news: Candice Bergen, who plays Murphy Brown, says she agrees with "the body of [Dan Quayle's] speech" criticizing the Brown character for having a baby out of wedlock.

Bergen said it was "the right theme to hammer home . . . family values . . . and I agreed with all of it except his reference to the show, which he had not seen. . . . It was an arrogant, uninformed posture, but the body of the speech was completely sound." Judith Michaelson, Washington Post, May 17, 1998, at Y07 (originally published in L.A. Times).

I’m not suggesting that repetition of prior statements is a bad thing, but the tenor of today’s piece gives the mistaken impression that Bergen’s agreement with Quayle’s argument was a new development in an old story.

Click here for this week’s golf column and here for a new book review of In My Dreams I Walk With You.

July 11, 2002

Scoped or scammed?

Now here’s a story combining medical ethics and detective work that should warm the hearts of health insurance companies throughout the country. (This assumes, of course that such companies have hearts, figuratively speaking):

An operation performed about 300,000 times a year on U.S. patients with arthritis is completely ineffective, according to an unusual study that compared the procedure with phony surgery.

The study, by researchers at the Houston Veterans Affairs Medical Center, compared two versions of arthroscopic knee surgery for osteoarthritis with a placebo operation in which patients were given a sedative and received only small skin incisions. All patients reported reduced pain and better knee function, and there was no difference in outcome between those who had real surgery and those who got the placebo procedure.

In fairness to orthopedic surgeons who performed these procedures in the past, the Washington Post article makes clear that there were plenty of reported instances where the scoping was deemed beneficial. The problem was to determine whether it was the surgery that actually provided the relief, or whether there was some other explanation.

On the other hand, once this report achieves wide circulation, it will be hard to show any good reason for the scoping techniques’ continued use for these purposes.

Unlike other placebo studies, it’s very difficult to set up a test regimen to figure out if invasive surgery is truly necessary. In this case, the researchers managed to devise an ethically sound methodology:

Placebo controlled studies of surgical procedures are rare because it is difficult to devise sham operations that fool participants, and because researchers cannot ethically subject people to phony operations that carry significant risks.

... [R]esearchers convinced patients they had had surgery without subjecting them to more than minimal risks. The 180 participants did not know until the end of the two-year study which treatment they had received, but they were told in advance that they might not get real knee surgery and had to write out a statement showing that they understood. Forty-four percent of patients who were invited to participate declined, said Baylor ethicist Baruch A. Brody.

"We were happy about that," he said. "It was real evidence that people were understanding. . . . If the refusal rate had gotten too low, we were going to stop the trial."

Scoping a knee, after all, carries just a tad less direct impact and risk if one's mistaken about a medical condition than, say, an amputation or a liver transplant.

The placebo methodology could also help determine whether other popular surgeries actually prove nothing more than the possible power of suggestion:

[J. Bruce] Moseley [of Baylor College of Medicine] said several other operations commonly done to relieve pain would be good candidates for studies testing them against a placebo. He suggested disk surgery for lower back or neck pain, tendinitis surgery for tennis elbow and operations for people with carpal tunnel syndrome, in which a pinched nerve causes pain and numbness in the hand.

Millions of dollars are spent each year on surgeries for a variety of aches and pains, including carpal tunnel syndrome.

There are other costs as well. I once handled the workers' compensation defense work for a city government. It was largely self-insured for these claims, so there was a strong incentive to keep costs down as low as possible. Nonetheless, there was also an inevitable political element to the city's treatment of the cases.

My clients tried very hard to return injured employees to productive work. It was far better for the employee in the long run, and it saved the city many dollars in recruitment and training if no replacements were needed. The city's comp staff also attempted to convince the employees and their physicians to try other techniques for pain relief short of surgery, for the same reasons.

In my eight years of workers' comp experience, none of the employees who underwent disc surgery ever made a full recovery. In fact, the debilitating effects of the surgery itself often seemed to make the employees' situation worse.

These placebo studies could be truly beneficial to patients and the health insurance system, by helping to shift health care dollars from paying for the knife to paying for less dangerous but potentially equally beneficial therapies.

July 10, 2002

THERE’S NO TYING IN BASEBALL*

All the recent talk about the potential for yet another Major League baseball strike had just the right effect on me.

I didn’t bother to watch the All-Star Game last night.

Oh, I’m sorry. Did I call it a game? As others much younger than me might say, "My bad."

Calling the game off with the score tied was simply unbelievable.

Just when you thought baseball couldn’t sink any lower in public esteem, the lords of the diamond take it down yet another notch.

I suggest that any further media references to the Baseball Commissioner must always use the word "hapless," as in this example:

With both teams' rosters depleted and neither manager willing to extend someone else's pitcher beyond a two-inning stint, the game was halted -- following a meeting of both managers with [hapless] Commissioner Bud Selig near Selig's box seats -- with the score tied at 7, infuriating a sellout crowd of 41,871 at Miller Park.

The added word seems to fit the current situation. It can also be used in a family newspaper or other publications where sensitive eyes might be offended by a somewhat coarser description.

Note: This post’s title is a play on a bit of dialogue from A League of Their Own, a great movie about a real baseball team. Here’s the passage in full:

Jimmy Dugan: Evelyn, could you come here for a second? Which team do you play for?

Evelyn Gardner- RF: Well, I'm a Peach.

Jimmy Dugan: Well I was just wonderin' why you would throw home when we got a two-run lead! You let the tying run get on second base and we lost the lead because of you! Start using your head. That's the lump that's three feet above your ass!

[Evelyn starts to cry.]

Are you crying? Are you crying? ARE YOU CRYING? There's no crying, there's no crying in baseball! Rogers Hornsby was my manager, and he called me a talking pile of pigshit! And that was when my parents drove all the way down from Michigan to see me play the game! And did I cry? NO! NO! And do you know why?

Evelyn Gardner- RF: No, no, no.

Jimmy Dugan: Because there's no crying in baseball!

July 9, 2002

No conflict with the company’s interests

Sometimes it’s refreshing to see such a direct connection between one’s desires and the means chosen to attain them.

Thomas Siebel is the CEO of a California software company. The company developed software that they believe will be highly beneficial to the federal government, a major purchaser of information technology.

The company also contends that their products will be particularly beneficial in the burgeoning market for new software to enhance the nation’s homeland security.

"There is no question that the largest vertical market for what we do will be the public sector," Siebel said last year at a conference in Aspen, Colo.

Thanks to the new campaign finance reform legislation and rulings by the Federal Election Commission, the company is now poised to follow through on one of the most effective means of obtaining valuable federal government contracts--lobbying through a Political Action Committee (PAC).

Setting up a PAC is not all that unusual. Siebel took things a step further, however. He gave those employees with a substantial stake in the company’s fortunes a clear path to show that they understood how to make their own contribution to the eventual bottom line.

Siebel …beamed e-mails to hundreds of his most fervent employees with an unmistakable message: Cough up $5,000 each for the company's new political action committee.

It worked. Siebel Systems’ staffers raised $2.1 million in very short order, making it the second largest single corporation PAC behind only UPS ("Big Brown?").

When Siebel says, "go," all of the employees "get pretty enthusiastic," says Thomas Gann, vice president of the company's government affairs office here. Siebel "is setting the example" other companies should follow, said NRCC Chairman [Thomas M.] Davis.

As Jim VandeHei wrote in today’s Washington Post, the new PAC and the company’s other marketing efforts seem to be working quite nicely:

Company officials said their campaign has already paid dividends: It has been awarded several grants and is well-positioned to land others when the administration divvies up the homeland defense money.

What I liked about this arrangement is its utter transparency.

There’s nothing high-falutin’ or pretentious about what Siebel and his employees are trying to do here. There are no soaring platitudes or patriotic bromides about the private sector and what it can do for the rest of us.

Siebel simply made the direct connection between political contributions and eventual contracting with the Federal government. The link could not be made any more obvious than what occurred here.

Thanks to the internet and folks like PoliticalMoneyLine, we can eventually follow the money from the PACs to elected officials, and then watch how the money flows back to the company’s coffers.

If anyone has a problem with the eventual results, at least we know how it happened and who benefited.

We should applaud the near-total lack of hypocrisy that this arrangement illustrates.

July 9, 2002

Netblogging

The title of this post may be a new word, but it seems to fit.

Blogrolling, as I’ve seen the term used, refers to recommending blogs to own’s one readers and other bloggers.

Networking, as I’ve seen the term used, refers to finding ways to knit together folks with common interests, professional or otherwise.

Netblogging, as I suggest the term be used, refers to the phenomenon of blogging or blogrolling that leads to networking opportunities.

Here's an example that provoked the new word's creation.

As I mentioned recently, one of the surprising benefits of blogging has been to meet a wide range of fascinating people I wouldn’t have come across otherwise, either personally, in correspondence, or by reading their blogs.

For instance, William Sulik often writes about legal matters, but also posts graceful commentary on theological matters and other intriguing topics. It just so happens that Sulik likes how I write about Supreme Court cases and other stuff, and was kind enough to mention this on his blog. He also wrote similarly pleasant compliments about Ann Salisbury’s new blog. Pretty standard blogrolling, in other words.

Considering Sulik’s obvious ability to recognize real talent when he saw it in me <g>, I naturally took him up on his invitation to read Two Tears in a Bucket.

Sulik was right. Salisbury is a self-described Orange County, California lefty, but she’s open to discussion on what that means. Salisbury also enjoys reading and commenting respectfully on ideas and arguments from all sides of the political spectrum, which is a welcome relief from the tone set by some other blogs that I don’t feel like mentioning right now.

Salisbury started reading this site, and found something in my stuff she liked.

Without more, this story would simply be a three-way backpatting, blogrolling episode--except that there is more to it, in fact.

Salisbury, Sulik, and I discovered that we share common professional responsibilities and interests in our work as lawyers.

Salisbury and I talked recently and sent each other materials relating to these professional issues. I telephoned Sulik yesterday to thank him for the Salisbury referral and its unexpected professional benefits. We also discussed some work-related shared responsibilities, and plan to do lunch when I next travel to DC on business.

Sounds like networking to me.

In this context, however, it’s more like netblogging--and I appreciate it.

July 8, 2002

An odd limitation on HIV/AIDS reporting

In matters of HIV/AIDS disease control, the unfortunate fact remains that denial is not just a river in Egypt:

The vast majority of young gay and bisexual men in the United States who were found to have the AIDS virus in a new study were unaware of their infection, according to findings reported as the 14th International AIDS Conference opened here today....

Among those found to have H.I.V., the AIDS virus, 90 percent of blacks, 70 percent of Hispanics and 60 percent of whites said they did not know they were infected.

Most of these infected men perceived themselves to be at low risk of being infected, despite having engaged in frequent high-risk sex like unprotected anal intercourse, said Duncan MacKellar, an epidemiologist from the federal Centers for Disease Control and Prevention in Atlanta....

The sad but ultimately unsurprising news that some folks either don’t know or don’t want to know about the potential consequences of their actions is bad enough. In addition, there were other disturbing points raised in the NYT article.

For example, the ability to develop accurate data about the scope of the HIV/AIDS disease continues to be hampered, for reasons that must be more political than practical:

Because not all states report new H.I.V. infections, federal health officials use data from the 25 states that have monitored H.I.V. the longest to help gauge national trends. One problem officials must consider in extrapolating information elsewhere is that the 25 states account for only one-fourth of the nation's AIDS cases.

This makes no sense to me.

There’s absolutely nothing sacred about infectious communicable diseases, no matter which segment of the population seems to be suffering more from their existence at a given time. Surely there have been enough other instances involving other diseases, such as TB or syphilis, where effective reporting regimens are universally followed by all states.

What keeps HIV reporting in such an especially sensitive condition that some states fail to require and disclose the information about new infections?

Here’s one reason why this is an important issue. The following graphic shows the variance in AIDS rates among the states, based on the information thus far available or estimated.

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When the CDC and others are forced to extrapolate from limited data, and the variances are as wide as shown on this map, there is an increased risk that the resource and medical decisions to be made about detection, treatment, and prevention will be seriously flawed.

Why should this reporting limitation be permitted to continue to exist?

A related issue discussed in the piece also helps illustrate the risks of insufficiently valid data:

Health officials said they were troubled about trends in the incidence of sexually transmitted diseases and risk behavior in California, Florida and New York, which are not among the 25 states from which the disease centers reports its findings of trends.

Syphilis rates among men in New York City rose to 6.9 per 100,000 people in 2001, from 2.8 in 2000. Most cases were among gay men. In San Francisco, the number of reported syphilis cases rose to 116 cases in 2001, from 22 in 1999. Preliminary figures suggest the number will rise even higher in 2002.

The reason this information is troubling, of course, is that reported syphilis cases are a proxy of sorts for assessing the spread of HIV/AIDS, over and above the problems associated with syphilis. Considering the rate at which syphilis cases are now rising, it would be far better to have the actual HIV data, rather than being forced to rely on proxies and estimates.

I live in a state with a higher than average incidence of AIDS. It's an issue that does generate discussion among Delawareans, but much of the dialogue I've heard seems to involve arguments that run past each other on the way to scoring some kind of political point.

For those who argue against such reporting from a variety of perspectives, tell me again why this is a good thing. Tell me again why it’s not important to report all new HIV infections in every state. Tell me again why confidentiality is more important than public health and safety. Tell me again that confidentiality can’t be managed successfully while continuing to obtain useful information. Tell me again that this disease is limited to the homosexual "lifestyle" and therefore not worth pressing the effort. Tell me again that the disease is limited to minority populations, and therefore not really putting the rest of "us" at risk.

Tell me again why I should give those who actually make these arguments any credibility at all.

I realize that I’ve been in government service for most of my career. I try to keep that in mind when considering the limitations of public action. On the other hand, there are some responsibilities that governments should undertake at a minimum, for the sake of all of us. Public health and disease control is not something that should be left to the tender mercies of political agendas of the left or the right.

Ask your state’s public health agency if your state doesn’t report new HIV infections. If they don’t, ask them why.

Then ask them to change their rules.

NOTE: For a thoughtful comment on another aspect of the NYT article, check out Andrew Olmsted’s post.

July 8, 2002

Hazy days of summer, thanks to Canada

Early yesterday morning I completed my third round of match play in the club’s annual Cup competition (Winning 1-up on the 18th hole, and thank you for asking).

As I drove north to the golf course before the match, I saw the gray haze of what I assumed was the normal Delaware 3-H summer combination (hazy, hot, humid). When I left the car in the parking lot and walked toward the putting green, however, it didn’t feel right. The humidity that would normally leave my shirt sticking to me before I walked a hundred feet simply wasn’t there.

Everything looked normal but wasn’t. As it turned out, we had the Canadians to thank for the odd atmospheric condition:

[W]ildfires in central Quebec were ignited Tuesday by lightning strikes in extremely dry forests east of James Bay. By yesterday, 46 wildfires had consumed 150,000 acres and continued to burn....

By yesterday, visibility at airports in Philadelphia and Baltimore was cut to two or three miles by the smoke, which filtered the sunlight of a cloudless summer day into a milky glow and delayed flights in Philadelphia.

The haze continued all day Sunday and into the early afternoon today.

During the summer we usually look forward to a blast of cooler air from our friends in The Frozen North. While the slight break in temperature was indeed welcome, the smoke was certainly an odd accompaniment.

July 7, 2002

Help for the insufficiently self-aware

If you love to watch people, just come to the beach.

Every minute of the day, on the boardwalk or on the sand, there’s an endless parade of humanity in all its forms.

Therein lies the problem, apparently:

A beach town on France's laid-back Mediterranean coast is getting a dress code.

Starting Monday, people in La Grande-Motte will face a $39 fine if they go shirtless or wear just a bathing suit in the town's streets and shops, police said.

Shopkeepers complained after being subjected to the sight of just a bit too much skin. Fortunately, the town developed a pretty fair policy for how to enforce the new code:

Police have been instructed to give people a last chance to cover up before ordering a fine. They've also got T-shirts to hand out to those in the lurch.

I tend to doubt that the French police will issue coverlets that say anything along the lines of "My parents went to La Grand-Motte and all I got was this lousy T-shirt!"

We see a truly astounding variety of shapes and sizes here in Rehoboth Beach, usually with a high percentage of skin exposed for easy access to the sun's rays. Most of the shops carry the traditional warning, "No shirts, No service," but that prospect doesn't seem to phase many people.

For some of those on display, the only truly honest thing to murmur to oneself is "Thank you, God."

For others, well, T-shirts might not be enough.

Even so, reactions such as pointing, hooting, or crying out "My eyes! My Eyes!" are considered bad form, and should be discouraged.



Contact Information:

Fritz Schranck
P.O. Box 88
Nassau, DE  19969
USA

fschranck-at-
sneakingsuspicions.com


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Official small print disclaimer: This is, after all, a personal web site. Any opinions or comments I express here are my own, and don't necessarily reflect the official position of my work as a government attorney or any of my clients.

That fact may become obvious later on, but it needs to be said here anyway.


Frederick H. Schranck 2002