There are important questions about the appropriate role of government in encouraging healthy behavior. As a free society we should have deep reservations about forcibly taking people’s money and using it to tell them how they should live, even when we are sure that would make for a better society. History is replete with examples of tyrannical majorities wasting resources and even fueling crime combating`harmful’ behavior. Thus we already have plenty of reason to tread carefully when legislation to discourage tobacco use, encourage exercise or promote a healthy diet is proposed. However, I have a much more fundamental question. Is it even preferable to have a society where people live longer?

At first glance this seems to be a truly stupid question. After all it’s bad when people die early. Isn’t it? Well, I certainly don’t want to die and neither do most people but that misses the point. We all die eventually and even if we personally want to put off death as long as possible can we truly say that a society where the average life span is 90 years rather than 70 is a better place? Would a society where the average life span was 200 years be even better? What sort of life span would be optimal?

It’s tempting to answer ‘infinite’ and certainly it would be wonderful if we could all retain our youth for forever and never have to grieve over lost friends and family. However, for the immediate future this simply isn’t possible. No healthy diet or prudent lifestyle can reduce the (average) number of friends we must mourn¹ and no amount of yoga or wheatgrass smoothies can prevent old age from taking it’s toll. Moreover, suppose we really could increase our lifespan indefinitely. At least for the next century or so we would have to virtually stop reproducing to avoid outgrowing our resources.

Ultimately we can’t simply say ‘life is good so we want more of it.’ Almost certainly such a policy would actually demand we divert money from healthcare into programs encouraging reproduction. As a society we’ve already reached the conclusion that it’s better to maintain a relatively small population that can live well than to expand into a great multitude that can barely make do. But rationally applying this insight to this question suggests that investing in longer life spans might not make sense.

Certainly we feel greater pain when someone is snatched from life too early and so we certainly shouldn’t stop pursuing more effective treatments to save people who might otherwise be struck down in the prime of life. Nor would we want to create distress or anger by denying people treatment. However, researching ways to further prolong our life span would likely introduce greater variability (some people die of heart attacks at 65 others make it to 130) and thus prolong the time people would have to endure the loss of loved ones as well as the sense of tragedy and anger at their deaths. Other things being equal a society is better if people spend a smaller proportion of their lives old and frail and since extending old age is unlikely to make people substantially happier (on average²) investing in technologies to lengthen our lifespan seems counterproductive. Of course we should look for technologies that let people be healthy and fit for a greater fraction of their lives and if we are able to make 80 feel like 55 that might justify more investment in keeping people alive till 80.

The observation that merely putting off death is not necessarily a desirable end in and of itself also has substantial consequences to what kind of charity and aid is best to give to the third world. However, that will have to wait for another post.

Perhaps that title is a little over the top since I don’t mean all doctors but it captures the sense I got from a recent radio discussion on KQED (NPR station) about at home genetic testing. On that show two prominent doctors were warning about the dangers and harms of these unregulated kits for at home genetic testing and complaining that people were getting this information without the counseling of a medical professional or a clear understanding of what the information meant. Hopefully their demands for regulation went beyond what most doctors would support but it was my sense that they represented a view that a sizable fraction of the medical community would support.

Now there are real concerns that ought to be addressed by regulation. Any at home genetic test should be regulated to guard against fraudulent misinformation or scientifically unsupported medical advice. They should also be regulated to ensure that they give accurate results and report the chance of type I and type II error to the test taker. However, it seems self-evident to me that as citizens in a free country we ought to have the right to any information about our own genetic profile we wish to receive. So long as the test manufacturer does nothing besides inform the customer of what genetic variants they possess and what the current research suggests about these variants they should have the right to supply us that test.

The doctors on the program raised the valid concerns that people might very well not know how to react to the type of genetic information they receive. For instance they implied that individuals might be better off not being told they have a gene that boosts their change of cancer by 1.2 times since people have trouble understanding what a small effect this is and may then demand extra tests that increase their risk and burden the medical system. Well perhaps these individuals would be better off not knowing this information but is that valid grounds to legally deny it to them? I think not. The doctors kept insisting that we needed studies to determine what information improved public health and what didn’t which is important but in terms of regulation misses the broader point that public policy has broader goals than maximizing public health.

No doubt public health would increase if restaurants and supermarkets were only allowed to sell us food that our doctors approved but obviously we should have the right to buy the food of our choice. The fact that people generally have a poor understanding of the effect of food choice on their health is irrelevant. In the long term we tend to find that the harms to innovation, frustration at being told what to do, and the slippery slope towards further regulation that result from the restriction of freedom are worse than the more obvious immediate harms. In other words if our society believes freedom is so important that we protect racist and bigoted speech then surely we ought not to restrict people’s access to their own genetic information just because they might not understand it.

If I want to find out if I have gene BLAH I should have the legal right to do so and so long as the company offering me the test for this gene doesn’t misrepresent our certainty about the role of BLAH they should have the right to offer me such a test. Of course doctors should be free to discourage us from using such tests just as they are free to discourage us from using tobacco or eating junk food but the law shouldn’t require us to do what our doctor asks. So long as doctors don’t drag their feet on incorporating genetic information into their practices as quickly as the science allows I expect the percentage of people who insist on ignoring their doctor’s advice will remain quite low. Ultimately though, the right to obtain information about our own genetic makeup is so central to our freedom and liberty that nothing short of a plague level public health catastrophe would justify denying this freedom.

Hopefully I merely misinterpreted the doctors on this show and they weren’t proposing that we bar companies from offering genetic information unless it offers a net public health benefit. However, doctors are people too and it’s very easy for people to get caught up in their personal mission (especially when it’s something noble like serving the public health) and forget that this isn’t the only, or even primary, aim of public policy. Of course if you are a doctor and you see people coming into your office with information from genetic tests that you don’t know how to properly interpret and demanding what are likely harmful procedures your likely to want to clamp down on these tests. It’s a natural human reaction to want to control things that interfere with our mission but that just isn’t how we should handle them in a free society.

It’s quite reasonable to believe that we ought to tax the rich more and use that money to better fund our public schools. Though I think guaranteeing free college educations to students who perform well might be more effective than anything the school districts could buy with the money.

None of this, however, justifies calling out Bill Gates for being insufficiently generous. I was absolutely flabbergasted to see the SF Bay Gaurdian offering a populist critique of Gates because he only gives 350 million to US schools despite the vast wealth our society has allowed him to accumulate. I mean jesus christ how can this paper avoid gagging on it’s own hypocrisy when it criticizes the rich for not sufficiently helping out the less fortunate because they are giving their money away to aid the truly poor. Even poor american kids are quite wealthy compared to children in much of Africa that Gates is trying to help with his donations.

Sigh, yet more evidence that neither side is motivated by a serious examination of choices and consequences but instead are motivated by simplistic emotional reactions to what they see on the news.

Now I occasionally complain about the reporting of some science story in the press but that’s mostly for what amounts to poor choice of analogy in what is essentially a fluff piece that props up public support for science research. This particular example is something different. It’s not only negligent, if not downright fraudulent, as far as journalism goes but is likely to fairly directly result in the death of at least one woman. True, many newspaper stories likely result in a gain or loss of life years but when the loss of life is an obvious effect of misleading reporting.

What I’m talking about is the article in the East Bay Express on the Gardasil vaccine for HPV (thus cervical cancer) titled “One Less“. True, the article describes the ‘controversy’ about the Gardasil vaccine’s deadly side effects for HPV (thus Cervical cancer) without article asserts nothing factually untrue. I don’t doubt the mother of the girl who died as the result of blod clots shortly after taking the vaccine really said the quotes attributed to her nor that the semi-anonymous remarks really do come from someone who had the shots. However, the whole article is set up to portray these as reasonable fears that are on one side of a ‘growing debate’ while plastering a picture of a sweet little 17 year old who died after taking the vaccine on the front of the print magazine with the “One Less” slogan of Gardasil written over it.

I mean the arguments for the involvement of Gardasil are really this bad:

“Some are pretty hard to discount as being a reaction,” Grothe said. “When a patient dies of a blood clot three hours after getting a Gardasil vaccination, that’s pretty consistent to me.”

Of course all the medical professionals interviewed point out that the birth control pills being taken by the girls who died are likely the cause but that doesn’t stop the article from throwing logic overboard to pander to the emotions of a grieving mother and friends or by mixing in real concerns and disadvantages of the vaccine as if they were concessions. Of course even if you grant that the vaccine is as horrible as the grieving mother trying to blame it claims it is hard to see how the harms would overwhelm the 4,000 deaths it could save a year not to mention the suffering it could erase.

Given that newspaper articles like this generate readers and likely convince people not to take the vaccine I have grave doubts about the ability of jurors to evaluate expert testimony in drug and medical device trials.

I dunno if it is a good idea from a technical point of view but Antarctica has the wonderful property of having no (permanent) residents and thus, unlike Nevada, no NIMBYism to block any disposal site. It just seemed strange to me that the Antarctic Treaty System (ATS) specifically forbids this sort of disposal. I agree such a disposal system should be approved and managed by some international body but if not Yuca mountain this seems like the only place that will work even if the transportation problem makes it less than ideal.

As an aside Yuca mountain is a perfect example of the problems of representative government, and I think one of the best real criticisms of the electoral college system. It’s also a perfect illustration of the fact that you must be dishonest or stupid to win the presidency. I mean it’s obviously much riskier to keep the nuclear waste sitting in unsecured pools besides the reactors than it is to deposit it in Yuca mountain but you can bet anything you like that anyone who stood up and said this would lose Nevada.

Maybe there is some way to pay off the people in Nevada to take the waste repository. Ohh and before anyone asks I wouldn’t have any problem living 90 miles from it myself.

In the chronicle of higher education yesterday there was a short snippet about academics taking performance enhancing drugs and if you have a nice proxy server you can read the longer article or the commentary in nature (you can also find the Volokh Conspiracy article that brought it to my attention). Now I was quite pleased with the reasonable approach taken in the Nature article. In particular I thought the following paragraph hit things right on the head.

Rather than individuals purchasing substances over the Internet, we believe it would be better to ensure supervised access to safe and effective cognitive-enhancing drugs, particularly given potentially dangerous drug–drug interactions. Such regulation must be evidence-based and a product of active dialogue between scientists, doctors, ethicists, policy-makers and, importantly, the general public. This may necessitate a new form of regulation because the remits of the existing health and drug agencies are for the regulation of medicines for treatment, not for enhancement.

If a new class of compounds (so far most ‘cognitive enhancers’ are effectively less euphoric versions of amphetamines) really is developed that appeals primarily to educated wealthy people rather than being associated with lower socioeconomic classes such a change in our regulatory outlook might actually occur. True, I’m skeptical that more than a modest cognitive enhancement effect is possible from drugs (they can’t fundamentally rewire the brain) but accepting the careful use of drugs as enhancements has the potential for massive increases in utility. While I doubt drugs are ever going to make us all geniuses there is no reason to believe that future pharmaceutical research can’t produce mood enhancing drugs with only mild side effects. The benefits to depressed people alone of not stupidly insisting that depression is always a disease (rather than an unfortunate extreme end of a distribution) and researching medications that might make everyone a bit happier would be huge¹. More broadly I’m sure that everyone has noticed that some people tend to be more happy and energetic than others (and studies have suggested these people are more productive as well). The benefits to society of a compound that could shift everyone’s baseline amount of happiness up to where it naturally lies for these bright happy people would be greater than any other change since the industrial revolution.

However, in the chronicle article we find a much less enlightened view from one interviewee.

The notion raises hackles in some parts of academe. “It smells to me a lot like taking steroids for physical prowess,” said Barbara Prudhomme White, an associate professor of occupational therapy at the University of New Hampshire, who has studied the abuse of Ritalin by college students. Revelations about the use of performance-enhancing drugs in professional baseball have stirred public interest recently, and she sees parallels between athletes and assistant professors. “You’re expected to publish and teach, and the stakes are high. So young professors have to work their tails off to get that golden nugget of tenure.”

Now I’ve always thought it was kinda silly to keep performance enhancing drugs out of sports² but there at least it’s merely a game and fairness is a principle concern. In academics, however, we are supposedly actually producing something of worth. We don’t try and tell academics they can’t spend more time on their work because other people have children to take care of or family obligations. It’s not about being a fair competition but about maximizing academic output. True, perhaps one might reasonably worry that these performance enhancing drugs don’t genuinely lead to more performance in the long run, i.e., they are a way of gaming the system, but short of that I see no reason why they shouldn’t be allowed.

Also I found it amusing the way everyone seemed to assume that it was unacceptable for students to take these sorts of drugs during exams yet no one tries to stop people with ADD from taking ritalin or amphetamine during exams and often even give them extra time. Of course ADD is a real issue but it falls on a continuum and the same drugs that help concentration with ADD have been shown to boost everyone’s scores on the SAT.

So California assemblyman John Benoit announced legislation today that would set up numerical limits for the amount of illegal drugs (I believe schedule 1 substances excluding marijuana¹) one could have in your blood stream and legally drive similar to the .08 BAC limit for alcohol. Apparently the lack of such specific limits is making it difficult to prosecute inebriated drivers (presumably because they must convince the jury of they reached some subjective level of impairment). This is a good reasonable idea that would likely save lives

But of course a proposal as sane and reasonable as this was too good to be true. Benoit has now said (same article) that he is seriously considering making this a zero tolerance law. Yup, that’s right apparently demonstrating our moral outrage that people are taking illicit substances is more important than saving lives on our highways.

As we all know from drug testing in athletes drugs can be detected in your bloodstream long after the individual in question has sobered up. Thus if you are a drug user the net effect of such a zero tolerance law would be to decrease the relative penalty for driving while inebriated. If you know that even if you wait till the next morning to drive the police could still throw you in jail because of the residual drugs in your bloodstream then why bother waiting? We’ve already (unreasonably in my opinion) expressed our moral disapproval of drugs by making them illegal but it’s criminally stupid to put our moral outrage over people’s lives. Not to mention the perfectly sober people who partied the night before who will end up in jail under such a program.

Of course if groups like Mother’s Against Drunk Driving are really about saving lives and improving highway safety I expect them to come out strongly against bills like this one. I On the other hand if they are about revenge and getting even with that type of person they will probably support this kind of zero-tolerance legislation. I’ll leave it to the reader to decide which is more likely.

Schwarzenegger said that pot is not a drug but better than that is his totally pragmatic attitude to the subject (“Why should I care if a politician takes sleeping pills every night so long as he can do his job?”).

Of course after the fact his media people rushed out to say he was just joking and that of course pot is a drug but it’s still great to see the mainstreaming of the attitude that pot isn’t a big deal.

Note that despite what sticklers like to assert the claim that, “Pot is not a drug” is not actually false or meaningless. There are clearly two different definitions of drug. One is the technical medical usage on which things like alcohol, aspirin, etc… qualify as drugs but people who have used aspirin or had a beer don’t answer affirmatively when asked “have you ever used drugs?” The meaning of drug in these contexts is something more like, dangerous addictive psychoactive substance¹. Applying the standard rules of conversational charity it is clear that Arnold was (reasonably) saying either that pot isn’t dangerous/problematic like other drugs or that it isn’t really socially forbidden.

So listening to the radio out here in Berkeley one constantly hears righteous denunciations of Haliburtuon, their sub-sub-sub contractors Blackwater and the role of private companies in the Iraq occupation. Now there may be valid reasons to think that private military contractors are harmful but I’ve yet to hear anyone even really try. Instead the fact that private companies are performing military duties is usually cited as if it was an obvious harm itself. Even more puzzlingly one often hears a condemnation of the military contractors on the grounds that the Bush administration wouldn’t be able to support such a massive military presence in Iraq without them.

Trying to be charitable one might try and interpret these individuals as arguing that private military contractors are bad because the Iraq war is bad and they make it easier for the administration to extend the war. While this is a reasonable argument it is incompatible with the usual aim of those bringing up the role of private contractors in Iraq: to marshal further reasons to condemn the war. Moreover, it is in direct conflict with the accepted wisdom of where Bush went wrong in Iraq — entering the conflict without enough troops to stabilize the country. Also most demands for a prompt withdrawal are justified by the price being paid by our honorable young servicemen in Iraq (they certainly don’t present evidence that withdrawal would best serve the Iraqis). Presumably if your objection to the continuing occupation is that the costs to the US military is to high even if it might be somewhat beneficial to the Iraqis for us to stay longer you should welcome private contractors as they lighten the burden that our soldiers must bear¹.

Even more strangely much of the opposition to military contractors seems to focus on the fact that private companies are making a profit on the war. Part of this seems to result from the bizarre belief that since every contractor and subcontractor involved is making a profit somehow the American public must be getting a bad deal. This is tantamount to arguing that the federal and state governments should always build bridges themselves rather than contracting it out to private companies because those companies will be making a profit. At least those who note that the rate companies like Blackwater charge to supply troops are much higher than the wages of US troops are only being foolish not falling into simpleminded anti-profit bias. The military only hires companies like Blackwater when they actually need them and that flexibility demands a premium². All that really matters is whether the US army could hire more soldiers to take over these jobs at a cheaper rate than what companies like Haliburton and Blackwater charge and unless we plan on staying in Iraq for many many years this is highly unlikely³.

The worry that these companies now have a profit interest in the war is slightly more reasonable but seems inconsistently applied. When we use private air carriers to fly our troops over to staging areas or send wounded soldiers to private hospitals for treatment no one seems to worry about the profit interests of these companies. Moreover, the political influence of small mercenary companies like Blackwater is minuscule compared to that of companies like Lockhead and TWA and their interest isn’t continuing war but in increased funding for new military technology which the war in Iraq has curtailed.

Ultimately this whole issue perfectly illustrates how intellectually bankrupt the whole debate over the war really is. Those supporting a continued occupation seem more concerned with rhetoric about supporting the troops and not making their sacrifice meaningless (i.e. the sunk cost fallacy) rather than any evidence that the occupation is likely to pay off. Those demanding a pullout seem more interested in throwing together a bunch of emotional ploys (isn’t it horrible that we hire mercenaries) than in making a coherent argument. The war in Iraq is a perfect example of the sort of failure of public opinion “The Myth Of The Rational Voter” postulates. People take their positions because they have an emotional reaction to the war (support troops/repulsed by war) and it is more appealing to group up with others who have similar emotional reactions rather than actually consider the issues and potentially be forced to support something you find distasteful. Of course when people realize their decisions will really have massive effects on millions of lives (instead of just being something to bitch about over lunch) they tend to get a lot more serious which is why the congress (thankfully) can’t really bring itself to shut down the occupation.

Of course this isn’t to say their aren’t real concerns about the use of mercenaries but thankfully someone else has already written a nice post explaining why these are often overblown.

I’m sitting here listening to general Petraeus give his report to congress and while the senate does better than the public discourse they still seem to have fallen into this simplistic ‘are we winning or losing’ narrative. Obviously it’s the senate’s job to discern the prospects for success in Iraq and pull the plug if they determine that American troops are doing more harm than good in Iraq but that’s not the same thing as saying we are likely to lose. If we pull out of Iraq precipitously the country could explode into a full fledged genocidal civil war.¹ How likely does success have to be for us to try to prevent another holocaust? If there was a 10% chance of saving the citizens of Boston from death at the hands of a rapacious bloodthirsty militia would we refuse to send in the army because it might cause a few thousand casualties?

At least the people who believe that we did the Iraqis a favor by invading have a bit of an excuse². They can say, “we did you a favor now it’s up to you,” but the rest of us can take no such comfort. We invaded Iraq and fucked up their country and it’s now our responsibility to do the best by the Iraqi people. It’s downright disgusting to hear senators telling Petraeus that Iraq is distracting from the war on terror, that it’s creating terrorists, or that it’s negatively impacting our military readiness. Is that going to be what we tell the millions of Iraqi mothers, and brothers and children when their family members are killed in a civil war. “Sorry, we needed to go fight terror. You should have managed your country better after we fucked it up.” Sure it’s frustrating to see so little progress and disheartening to think that we might have to stay there for ten years but neither of these justify risking millions of lives in a potential genocide. Saying that “the American people won’t tolerate continued lack of progress,” isn’t an excuse to let millions die.

Sure one or two Senators made the claim that our troops create more violence than they deter. That’s an important theory that ought to be seriously examined but you’ll excuse me if I don’t believe it is a justified belief when I only hear it from hardcore anti-war Senators in the middle of rants about how our military belongs at home not fighting wars for incompetent administrations. Quite obviously these politicians and their supporters have first decided to oppose the war and demand our troops come home and then looked for a justification for that view. The war might have been a horrible mistake but it’s a mistake we made and now we need to figure out the best way to mitigate the harm we caused.

As disappointed as I am in many of our Senators it’s groups like moveon.org that truly disgust me. I used to like them as an energetic democratic fund raising group and even considered donating money to them during Kerry’s candidacy but running across this advertisement today made me sick. Not only does this ad trivialize the lives of millions of Iraqis when it criticizes Petraeus for not saying, “what Americans are desperate to hear: a timetable for withdrawing all our troops.” but it also blatantly misrepresents the source documents it uses to indict Petraeus. The GAO report merely says exactly what Petraeus himself has said, that many of the political objectives the Al-Maliki government set for itself were not met. The National Intelligence Estimate also backs up Petraeus when it says that there has been “some security progress but political reconciliation elusive.” Finally the report by the Jones Commission argues that while the Iraqi police have proven ineffective the army is making progress but isn’t yet ready to take over independent operations. All statements compatible with the view that we need to stay in Iraq longer but none of them about the really important issue of what will happen when we leave. Jesus christ you are supposed to be a liberal organization where is your concern for the Iraqis? Don’t you think they deserve more than a ‘yah yah they’ll be better off without us’? Like say seriously considering whether keeping the soldiers in Iraq would save lives?

Ironically despite the constant hand wringing by many liberals about “the American Empire” it is their assault on a general called back from a war to answer primarily domestic concerns that reminds me of the worst aspects of the Roman empire. Any old country can invade and occupy another country but only an empire can so blithely play domestic politics with millions of foreign lives. This behavior makes me ashamed to be an American and a liberal. When the Bush administration placed the lives of the Iraqis second to their ideological agenda it was bad enough but for the liberals to follow them down the rabbit hole and not even seriously consider the welfare of the Iraqis is downright evil. These are real people just as worthy of moral consideration as the ones who live in Indiana no matter what milestones their government has failed to meet. Let’s step back and put aside our ideological preferences and figure out what is most likely to fix Iraq. I genuinely want to know what policy will most likely bring success in Iraq but no one else seems interested³

Each and every one of you out there has a real moral obligation to the Iraqi people not to demand a pullout (or a continued occupation) without good reason to believe it is in the Iraqi people’s best interest. If we pull out because people like you demanded it without seriously considering the consequences the blood will be on your hands.

FOR THE LOVE OF GOD PEOPLE IF WE MAKE THE WRONG CHOICE MILLIONS OF PEOPLE JUST LIKE YOU MIGHT DIE, TENS OF THOUSANDS MAY BE RAPED AND TORTURED, AND MANY MORE FORCED TO FLEE AND IT’S ALL OUR FAULT. Isn’t that more important than political ideology and domestic considerations? Would it really be that hard to admit that you aren’t sure what the best policy in this complicated situation is? If you were in congress you wouldn’t bet their lives on a gut feeling without looking at the evidence so don’t demand that your congressmen bet their lives on your uninformed feeling.