Press Release: An Instrument of Distortion

I loosely follow a rule in my blogging that I don’t bother with press releases. They’re skewed to push the angle of whoever is paying the bill. It might be worth picking out the propaganda from a press release to find the facts, but I can usually achieve that with less effort by going to news sources to make a point. (Of course, most news sources reporting on circumcision are filled with propaganda, too.) Generally a press release is only good for demonstrating propaganda. This recent press release is a good example:

Hospitals in states where Medicaid does not pay for routine male circumcision are only about half as likely to perform the procedure, and this disparity could lead to an increased risk of HIV infection among lower-income children later in life, according to a UCLA AIDS Institute study.

The first half is fact. The second half is conjecture. News, then propaganda. The HIV-circumcision studies researched the effect of voluntary, adult male circumcision in reducing the risk of female-to-male HIV transmission from heterosexual intercourse. It is inaccurate to draw the conclusion that the foreskin puts men at higher risk of HIV. Unprotected sex with HIV-infected partners increases an individual’s risk of HIV infection. The male must first engage in that specific activity to become infected. Focusing on the foreskin distracts from efforts to reduce such behavior.

But that doesn’t sell the way fear sells.

But recent clinical trials in South Africa, Kenya and Uganda have revealed that male circumcision can reduce a man’s risk of becoming infected with HIV from a female partner by 55 to 76 percent. In June 2007, the AAP began reviewing its stance on the procedure.

By now you know what was left out of that summary, right? When public health officials talk about voluntary, adult male circumcision, they never mean voluntary, adult. Never.

As the press release so helpfully theorizes in its opening line:

Lack of coverage puts low-income children at higher risk of HIV infection

Think of the (poor) children. That’s not very original. It has the added bonus of being inaccurate. Are these children sexually active? Specifically for the age of the children discussed in this press release, the answer is no for 100% of them. They are not at risk of (female-to-male) sexually-transmitted HIV infection. But those necessary, contradictory details must be ignored. Think of the (poor) children.

That is how propaganda is done.

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Not to let an opportunity go to push for a collective response to an individual problem, the Family Planning Cooperative Purchasing Program helpfully regurgitates this press release, with the necessary bits of speculation helpfully emphasized in bold. An example:

In addition to the overall lower circumcision rates, the researchers found that the more Hispanics a hospital served, the fewer circumcisions the hospital performed. For Hispanic parents, the circumcision decision was about more than simply cost, since male Hispanic infants were unlikely to receive the procedure even in states in which it was fully covered by Medicaid.

What point is FPCPP trying to make with that emphasis, given the sentence that follows it? The only justification I infer is an implicit suggestion that we need to encourage Hispanics to “Americanize”. That wouldn’t surprise me because it’s the typical, mindless support for non-therapeutic genital mutilation in America. And FPCPP files this under “Public Policy”, among other categories. See above re: voluntary and adult. If it’s not that, I’m stumped.

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You and I, through a grant from the National Institute of Mental Health, paid for this research. Mental Health? With mission creep like that, who could possibly worry about government-run health care?

However, this raises the question of national health care and the future of routine infant male circumcision in America. I’ve long held that the former would not end the latter. The political environment for defending non-therapeutic circumcision is too strong, as evidenced by studies like the one leading to the above press release. No politician is going to say that parents can’t circumcise, despite the clear constitutional flaw in our status quo.

Ending public funding isn’t sufficient. The state should not pay for mutilation, but fails to end the practice. Poor parents pay for the surgery out-of-pocket. They complain about it, citing the potential benefits as an excuse for why Someone Else should pay, but they pay the cost anyway. Their sons are not protected by their state’s lack of Medicaid reimbursement. And ending government reimbursement doesn’t always end government reimbursement, as Minnesota’s politically-motivated solution showed.

Still, I need to have a think on my position. I won’t suddenly support government-run health care, but I should explore the nuances further.

How to Require Extra Rules for Opponents

Steven Pearlstein began his Friday Washington Post column with this line:

To most Americans, the language on Page 52 of the report of the House Committee on Appropriations would have seemed perfectly sensible.

He’s picking a fight, but he intends to pretend that he’s not fighting because only the other side is fighting what is supposed to be “perfectly sensible”. Given that President Obama uses this tactic repeatedly to push the deficit spending bill, Pearlstein is not alone.

He continues:

The report spelled out the committee’s rationale for including $1.1 billion for something called “comparative effectiveness research” in the massive economic stimulus bill. For those of not steeped in the argot of health policy, that’s research done by doctors and statisticians who troll through large number of patient records to determine, for any particular disease, which treatments work best.

“By knowing what works best and presenting this information more broadly to patients and healthcare professionals, those [treatments] that are most effective . . . will be utilized, while those that are found to be less effective and in some cases more expensive will no longer be prescribed.”

Those of us Pearlstein attempts to discredit are those who will ask the important question. It doesn’t matter that comparative effectiveness research already occurs. Who will make those decisions? Stating without support that “nearly all experts agree [the effort] is a necessary first step to reforming a broken health-care system” does not dismiss the question.

After describing the opposition as a right-wing brushfire, he continues:

It’s not that these various groups have no reason for concern. If comparative effectiveness research is done badly, or if the results are used simply as an excuse to deny insurance coverage for all expensive treatments, then there would be plenty of reason to get out the pitchforks and storm Capitol Hill. And there are surely examples from Britain and other countries of people being denied access to the latest drugs and procedures, including some that are significantly more effective than other treatments.

So, we’re in agreement, right? What were we arguing about?

What the critics don’t have, however, is any shred of evidence that the professionals who do this research are incompetent or have any but the best intentions in trying to figure out what treatments are the most effective for patients. …

This is a bait-and-switch. We’re not arguing about the ability or integrity of the researchers. No one said anything about that. The issue is who will make decisions resulting from the research. Pearlstein’s desire to obfuscate the issue suggests he has an intention he doesn’t want fully known. It’s obvious since he spoke of experts he did not quote, but he gives it away as the paragraph continues:

… There is no reason to believe that once this clinical research is completed, it cannot be used in a disciplined, scientific way by physicians, economists and medical ethicists to determine whether there are drugs, tests, surgical procedures or devices that simply don’t deliver enough benefit to justify their cost. …

Physicians? Sure. Many could use a lesson about cost-benefit mixed with ethics. It’s easy to fall into a pattern of inertia, despite evidence. But where do economists come into this? Again, who is making the decision? I don’t think he means economists at insurance companies or parents as economic actors. As Pearlstein continues:

… And there is no reason we cannot set up reasonable procedures, overseen by independent health professionals, to protect patients who can demonstrate a special need for a treatment that is not normally cost-effective.

We finally get there. Patients need procedures to demonstrate a special need for “not normally cost-effective treatments”. When not trying to pretend that is enlightened, it’s called rationing. Regardless of an individual’s willingness to pay, someone else must decide if it’s cost-effective rather than first asking if the treatment is effective, followed by the question of how much it costs? That’s government-run health care, despite Pearlstein’s pretense that it is not.

Remember: Good, cheap, and universal. We can only have two. Yet, we actually try for three, despite Pearlstein reciting the tired lies that America denies “vital medical services to the 40 million Americans without health insurance”. Lies, plural, because we do not deny care to the poor in the manner Pearlstein implies, nor are there 40 million Americans without insurance because of it’s cost. He’s advocating services without visible sacrifice. Why would anyone think the goal of this is government-run health care?

Linkfest

LINK: Think government manipulation of intervention in the economy is good? Read George Will’s latest column. (H/t: Cafe Hayek)

LINK: Jim Harper has an entry on Cato @ Liberty discussing President Obama’s pledge to post all bills for 5 days of public comment before signing them. Mr. Harper reviews the steps the administration has taken and offers a positive review of the idea, although he correctly criticizes the administration for playing loosely with the 5 day timeline.

I agree with that in principle, but that’s not my concern here. The deficit spending bill mistakenly labeled The American Recovery and Reinvestment Act of 2009 is now online for public comment. I thought about adding comments, but why? I’m realistic enough to understand that what I say will not matter. It will not matter how many people comment against it, this is a done deal. The five days concept as implemented is worthless political propaganda. Honestly, if members of Congress can’t be bothered to read the bill, yet they’ll happily vote by party line, they don’t care what the American people think. They’re trading favors for power. The game hasn’t changed. So, wake me when this fails and tell me what the next stupid idea is.

LINK: I reject non-therapeutic infant circumcision because it is logically and ethically unacceptable. I question the science surrounding claims, particularly those involving HIV risk reduction, because there are obvious holes in the argument. However, unlike (too) many activists, I have no problem with vaccines. I think the logical and ethical arguments differ, and I don’t believe in conspiracy theories about Big Pharma. And from what I’ve read, the autism-vaccine link appears weak, at best. This report seems to confirm that (link via Kevin, MD):

THE doctor who sparked the scare over the safety of the MMR vaccine for children changed and misreported results in his research, creating the appearance of a possible link with autism, a Sunday Times investigation has found.

I would use this as a lesson for everyone who thinks that a claimed HIV risk reduction for (adult, voluntary) male circumcision need to be concerned about the long-term reality of their idea. I think we will eventually look back on the HIV-foreskin connection and realize the mistakes in the studies. But I do not approach the topic from that angle. I don’t need it, of course. I can concede the point for the argument and rely on ethics and objective indications of health and easier methods prevention.

For now, it’s too late anyway. The link has gained widespread acceptance because people want to believe it, regardless of facts or reasonable caution. The mindset is the same, as this excerpt from Orac’s post at Respectful Insolence suggests. (I read the post, but there’s too much to parse easily, so I’m using the summary pulled by Kevin, MD.)

“None of this will matter to antivaccinationists,” he writes, “who view Wakefield as . . . a persecuted scientific hero . . . I’m sure that [anti-vaccine proponents] will wax ridiculous about what a great doctor and man Wakefield is and how it’s big pharma and its minions who, frightened by the implications of Wakefield’s work, are working hard to demonize him and suppress his ‘science.'”

When emotion precedes logic in an objective debate, reason is lost. That would be unfortunate but defensible if it only affected the decision maker. It does not. The individual fears of parents results in poorly conceived decisions for children. Vaccinate but circumcise. Don’t vaccinate and don’t circumcise. Neither combination is justifiable when weighing the evidence with logic and ethics.

LINK: To lighten things up just a bit, will the Mets never learn?

“Whatever they did last year, they already got paid,” [Francisco] Rodriguez told the New York Daily News. Whatever they did, I have all the respect in the world. They worked hard and they deserve it. This is a different year and different ballclubs now. I don’t want to make any controversy, but with me and (J.J.) Putz and the additions in the bullpen, I feel like now we are the team to beat.”

K-Rod should ask Carlos Beltran how that worked out last year. However, I love this rivalry.

From the Archives: The Ethics of Vanity, Part III

The madness continues [emphasis added]:

About 150 patients in the U.K. have already received injections of Vavelta, a foreskin-derived skin treatment aimed at rejuvenating and smoothing skin withered with age or damaged by scarring from acne, burns and surgical incisions, according to a spokesperson for Intercytex, PLC, the Cambridge, England-based company that makes the product. The U.S. Food and Drug Administration (FDA) has not approved Vavelta, nor have any other federal agencies outside the U.K., where it was introduced in June 2007.
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The fibroblasts in Vavelta are isolated from the foreskins taken from baby boys [ed. note: healthy baby boys], given several months to grow and multiply in the lab, and then packaged into treatment vials that are shipped to a select group of U.K. physicians. Each vial costs approximately 750 pounds, or $1,000], according to the company spokesperson.

I discussed Vavelta in November.

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Last week I saw news links similar to discussed before. And, while I’m happy an ethical issue appeared in the article…

There are also ethical issues to consider, especially if the folks behind Vavelta start paying parents for their sons’ severed sheaths.

… it hints at the wrong ethical issue. Parents do not own their sons’ foreskins. That’s why they don’t have the right to cut them off, much less demand payment for them. If a similar value worked for freshly circumcised adult foreskins, adult males should be free to sell for the highest price. They’re not, because the state thinks selling parts of your body is “wrong”. But taking healthy, functioning body parts from a child for no objective reason without his consent? That’s somehow a valid parental choice. It’s madness.

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There was more in the original post, but it’s not necessary to repeat for this. I’ll add that discarded foreskins from adult males do not work well for this procedure. That changes nothing surrounding the ethical argument that demands stopping this practice.

2009: Party like it’s 2008

Pitchers_Catchers_09.jpg
Photo lovingly “borrowed” from Phillies.com

One year ago today, I wrote these words to mark the opening of Spring Training:

Now begins the process of trying to love this team more than last year’s National League East Division Champions.

Process over. Like learning to love a newborn, it’s instantaneous. World Series or Bust. Go Phillies!

Pitchers and catchers report today. My sentiment is as true this year as it was last year. Except – and this is something I pheared I’d never be able to say – I must modify last year’s sentiment. 2009: World Series Repeat or Bust. Go Phillies!

“Stimulus” suggests we should constantly change the rules.

From a Forbes article on the porktastic spending bill’s impact on business:

Currently firms are allowed to record their losses during the previous two tax years. The compromise bill permits only companies with $15 million in gross revenues to account for the losses five years back. That’s particularly bad news for big manufacturers and homebuilders who have been hammered by the downturn.

Many firms had already planned on taking the tax break. “We had a large number of clients who were very far down the road of having their taxes prepared,” says Clint Stretch, a tax expert at Deloitte Tax.

If I’m to believe the porktastic spending bill will stimulate the economy, isn’t this the type of wasteful productivity we want to root out? They’ve produced their tax returns already. Bah. If we change the rules, they’ll have to do them again. Think of how many people tax firms will have to hire. It’s brilliant.

While we’re at it, change the 2008 individual tax filing rules. I’ve already filed mine, so changing the rules would make me do work. And maybe pass a law that only TaxCut can get the new rules, since I used TurboTax. I’ll have to buy a new copy of software. Sure I can deduct that from my taxes, but it would stimulate the economy.

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No matter how many times it’s identified, the Broken Window fallacy will never go away. Why should it, of course? Advocating for inefficiency has its privileges, like a plush gig at the New York Times.

From the Archives: Sirius XM

Consider:

Financially strapped Sirius XM Radio Inc. said Friday that it could file for bankruptcy as early as Tuesday if it cannot successfully negotiate with the holders of its debt.

Flash back to February 2007, where I defended the then-newly-proposed merger between Sirius and XM:

More to the case at hand, perhaps it’s better to let one of the two surrender and preserve assets for productive use than to make them fight each other until one company is toast.

Or both companies are toast, thanks to the FCC ignoring its 180 window for review and burdening the merged company with its theories on how satellite radio should operate. Look at the positive side, though. If Sirius XM fails, there won’t be a monopoly. Merger opponents will have saved the American consumer from a catastrophe!

(Disclosure: I own shares in Sirius XM. I expect the company to go into bankruptcy. I do not expect it to disappear.)

Mobility Improves an Economy

I dislike putting requirements on the ability to exercise a right, but we don’t live with a perfect government. In that context I endorse the idea Thomas Friedman discussed earlier this week:

Leave it to a brainy Indian to come up with the cheapest and surest way to stimulate our economy: immigration.

“All you need to do is grant visas to two million Indians, Chinese and Koreans,” said Shekhar Gupta, editor of The Indian Express newspaper. “We will buy up all the subprime homes. We will work 18 hours a day to pay for them. We will immediately improve your savings rate — no Indian bank today has more than 2 percent nonperforming loans because not paying your mortgage is considered shameful here. And we will start new companies to create our own jobs and jobs for more Americans.”

This is not the first time I’ve heard this idea; the first was possibly from Jonathan Rowe. It made sense when I first read it. I haven’t changed my mind.

I disagree with part of Friedman’s conclusion, though. It’s the same short-sighted belief that government can accurately predict all economic factors.

We don’t want to come out of this crisis with just inflation, a mountain of debt and more shovel-ready jobs. We want to — we have to — come out of it with a new Intel, Google, Microsoft and Apple. I would have loved to have seen the stimulus package include a government-funded venture capital bank to help finance all the start-ups that are clearly not starting up today — in the clean-energy space they’re dying like flies — because of a lack of liquidity from traditional lending sources.

Friedman was so close. He is saying that government should (partially) get out of the way of economic growth, but it should get in the way of decisions made to build wealth by those who benefit from better immigration policy. Now we need to require that immigrants buy a house and have skills in politically preferred sectors. A question or three: Would government-backed venture capital have funded Apple when it wanted to build its first home computer in the 1970’s? Would it have funded a company making mainframes? Would a major industry player like IBM have leaned on politicians?

Still, the bulk of this argument is logical, which is why our government will never do it. Our present climate of fear and populism is too strong.

Ted Poe Field at House of Representatives Stadium?

Following up on a story I discussed last month, six U.S. House members from New York urged Treasury to ignore the call to cancel Citigroup’s naming-rights deal with the New York Mets:

“It is deceitful and unreasonable to single out Citigroup for an agreement signed several years ago,” they wrote, “without referencing the many other companies who have stadium naming rights deals and also received federal assistance.”

“Are we ready to remove their names from those stadiums?” Engel asked in a statement. “Or is this a rule to apply solely to Citigroup and the Mets?”

Naturally one of the original instigators, Rep. Ted Poe (R-Texas), gave a rebuttal:

“All companies that came to Washington with their hands out for taxpayer money should have to answer to the taxpayer as well,” he said. “This is the consequence of getting in bed with the federal government — they are going to tell you how to spend your money.”

Isn’t it interesting that Rep. Poe refers to this as “getting in bed”? A responsible government leader would’ve rebuffed such advances. Instead we have an excuse to force control of resources and business decisions – retroactively – upon those companies. This includes the companies that tried to refuse former Treasury Secretary Henry Paulson’s “take or take it” offer.

I have no reason to believe that the six New York representatives are acting out of principle. But the push is correct. And the Treasury Department is playing along:

“While we have implemented new restrictions on executive compensation and luxury perks, we will not get involved in individual companies’ marketing decisions,” Treasury spokesman Isaac Baker said Wednesday.

We’ll see.

Australia Imports American Nonsense

Arguing in favor of circumcising male infant to reduce their risk of HIV infection is flawed thinking, even in places like Africa. It’s exceptionally ridiculous when looking at the extent to which pro-circumcision advocates bypass logic. From a recent Reader’s Digest Australia article on male circumcision, included in the section labeled “Verdict”, this quote:

“‘If it ain’t broke, don’t fix it’ is the understandable attitude of many Australians,” says [University of Melbourne] Professor Roger Short. Yet he questions this wisdom. “Australia is blessed with a low prevalence of HIV infection, but parents need to remember their children will encounter high rates in many countries they visit.”

How does he know male individuals will visit other countries? How does he know that those countries will have high rates of HIV infection? How does he know male individuals will have vaginal intercourse with HIV infected women? Where logic demands a different conclusion, Professor Short relies on propaganda. He began with his conclusion and grasped for assumptions to build around that to defend what is objectively indefensible.

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That’s unsurprising because the article is structured to reach one conclusion. Among the arguments offered in favor of circumcision, the article includes “Appearance”:

Research by Professor Marvel Williamson from the School of Nursing at Oklahoma City University found women prefer the look of a circumcised penis. “Generally women said it is more sexually appealing,” says Williamson. “Ninety per cent of women said it looks sexier and 85% said it’s nicer to touch.”

This is a non-medical argument used to excuse surgery on a non-consenting, healthy child. It’s also a subjective criterion that will be irrelevant to the 10% and 15% of women, respectively, who disagree with the majority. It will also be irrelevant if the male is gay. This conclusion also demands that we accept an external locus of control for all male sexuality. What the society wants matters more than what the individual wants for himself. Human rights belong to the individual, so we must reject all of this.

But look at what the article explicitly ignored. It’s obvious by the location of the research. A quick scan of the study reveals the omission.

This study clearly support the hypothesis that American women prefer circumcision for sexual reasons. The preference for circumcision does not necessarily come out of ignorance nor from lack of exposure to uncircumcised men.

Yeah, noting that the conclusion concerns American women might help Australian parents, except Australian statistics look nothing like American statistics in 2009. Also, this assumes that the mother’s preferences – or the father’s opinion about his own penis – matters. We’re not assuming that because it doesn’t matter. Professor Williamson incorrectly thinks it does, as shown in the design of her study:

Of 145 new mothers of sons responding to this survey, …

Are we really so stupid that a parent’s opinion on the sexual aesthetics of a child’s genitals is considered a valid reason for surgical alteration? I want to believe we are smarter, but the evidence is very clear that parents can and do use this excuse. That position is indefensible. Remember that all tastes and preferences are subjective, unique to each individual. The choice on whether or not to allow the subjective tastes and preferences of his future sexual partners to influence his decision regarding cultural, medically unnecessary circumcision must be left to him. Ethically, parents may offer proxy consent to circumcision only when medical need exists, and then only when less invasive solutions are insufficient.