Wednesday, April 27, 2005

discrimination against conscience

Pharamacists complain that they shouldn't be required to participate in procedures they disagree with. Senators declare that opposing the appointment of judges well outside the mainstream to lifetime positions is religious discrimination. They're hardly alone. Police and military services discriminate against pacifists. Jury selection discriminates against death penalty opponents. People working in corporations struggle with conflicts between personal ethics and job responsibilities every day. No one's coming to their defense.

The aim of all the special pleading isn't to prevent discrimination against people following their consciences. It's to create a privileged conscience. It's to say that there is a particular set of beliefs that should be privileged everywhere, and that those who hold those beliefs should be allowed to impose their beliefs on those around them at any time or place.

Monday, April 11, 2005

corruption, policy, and politics

Matthew Yglesias writes bout the importance of linking personal corruption to policy in the DeLay case:
They're not free marketers who happen to take bribes on occassion. The policymaking is fully continuous with the corruption.
Both regular readers of my blog will recall that I've written about this before. Personal corruption makes good TV, but it's not really the point. Proof of personal corruption wouldn't make DeLay bad for the country. He'd be bad for the country even if he were Mr. Clean. As long as he was on their side, he'd still get money from corporations defending their interests. If he wasn't, he wouldn't get much no matter how corrupt he was.

Those looking to purchase an agenda probably prefer to buy from the less corrupt. True believers make better spokesmen. They're more reliable. They don't end up in court or hauled before ethics committees. They don't drag their donors' names through the mud with them.

Even without petty corruption, candidates who accept large donations are more likely to represent the interests of their donors than not. Donors support candidates because they expect them to advance an agenda, and they tend support agendas that advance their interests. A candidate's donor list tells you more about what that candidate will do than months of press reports, and the longer a politician's career, the more predictive the donor list will be.

Tuesday, April 05, 2005

taking it to the streets

I found my way through eschaton to hullabaloo, to read musings on the nature and relevance of protest. I found myself thinking of the deaf ear turned towards those who took to the street to protest against a war driven by the powerful, and the attention given those who besieged a hospice, a man, and his dying wife. I thought of economic summits held far from the public eye, for fear the public would become unruly. I thought of inaugural parades in front of angry crowds, with those crowds barely noticed by news cameras. I thought of the protests against Syrian occupation in Lebanon, and of the protests in its favor. I thought of the protests that brought down the government in the Ukraine. I thought of tanks in Tiananmen Square.

Monday, April 04, 2005

alas, poor darpa

Mark Kleiman mourns DARPA, rightfully so. The NYT article he references describes some of the details. It's a shift away from an open research model to a defense industry model. Even without an explicit shift of dollars from universities to the private sector, the imposition of defense industry accounting practices and restrictions on publication would have driven most university researchers out of the mix.

It is difficult to find a non-cynical explanation for the shift. The result will be neither more efficient nor effective. The need for secrecy is no larger today than it was during DARPA's cold-war heyday. Security did not become more important when the Soviet Union fell.

Cynical explanations, on the other hand, are easy. Defense contractors make campaign contributions. They support the administration. They get more money. They support the new policy:
Despite the complaints, some pioneering researchers support the changes being driven by Dr. Tether and say they are necessary to prepare the nation for a long battle against elusive enemies.

"There are pressures and demands on Darpa to be relevant," said Robert Kahn, a former Darpa administrator who is now president of the Corporation for National Research Initiatives in Reston, Va. "People think it should stay the same, but times have changed."

When war is peace, all things are possible. Any policy can be justified as long as it purports to keep the bogeyman at bay.

Friday, April 01, 2005

inexplicable! inconceivable!

Kevin Drum looks at a new study that appears to show that actual malpractice costs have risen little over the past 15-20 years, and then says:
If doctors were smart, they'd team up with trial lawyers instead of fighting them. Together, they could probably agree on both genuine malpractice reform (as opposed to bogus and ineffective "caps") and insurance industry reform. Instead, they allow themselves to be suckered over and over again by insurance industry lobbyists. It's inexplicable.
It's not inexplicable to me, but then I have the advantage of growing up in a doctor's family and hearing his conversations with friends. They didn't view the rest of us as peers, at least with regards to medicine. We were simply not qualified to hold them to account. Lawyers, who as a group most often did so, were the enemy. Medicine was seen as an inexact art, bad outcomes as inevitable, and accountability as little better than second-guessing.

There are exceptions to this. Atul Gawande has written of the advances made in anesthesiology (death rates reduced from 1 in 5000 operations to 1 in 200000) that occurred when the speciality stopped viewing itself as a craft and began systematic efforts to reduce bad outcomes, in part due to financial pressure from malpractice claims. Anyone who's answered questions before a procedure ("How much alcohol do you consume? Do you use illegal drugs?") has seen the results. Dr. Gawande himself wasn't sure how to apply the same process to a field like surgery, but as long as doctors oppose systematic data collection for fear of adverse personal consequences, the data needed to drive the process won't even exist.

In some ways, I'm quite sympathetic to the doctors' view. Medicine is an inexact science, and tort law a terrible mechanism for addressing inevitable bad outcomes. When such outcomes occur, however, someone has to clean up the mess--pay for additional medical care, support the medically indigent and their dependents, etc. Without better alternatives, lawsuits are inevitable, and I don't see doctors leading the search those alternatives.