June 24, 2004
Earplugs
Noise is annoying. (Indeed, I'm pretty sure the words are from the same root.) The physiologists tell us that noise is a stressor, and one to which only partial tolerance develops: even people who subjectively don’t mind noises their conscious minds have grown used to still show signs of stress in noisy surroundings.
Unfortunately, noise has never been treated as the serious environmental problem it is, especially in big cities. The Carter-era EPA made a head-fake in that direction, but the election of St. Ronald put an end to such liberal nonsense.
Noise is part of the reason long-distance travel, whether by car or by airplane, is so tiring. On top of the sitting in confined spaces, there’s the constant noise of the engines or the freeway. I have a remarkably quiet car, as cars go, but at 70 mph lots of noise still gets through.
Fortunately, for about four bucks any big drugstore will sell you ten pairs of 30-decibel earplugs. Since each bel represents a doubling of the amount of energy reaching your eardrums, 30db means a factor of eight reduction.
For the past three years or so, I’ve made it a rule never to travel without a pair of earplugs, and the difference has been astonishing. I'm more comfortable during the trip, and much less tired and cranky when it's done. I can still understand speech and hear music: indeed, I've found that I can hear the soundtrack of the airplane movie more clearly with the earplugs in place. (I have yet to try the 33 db earplugs, which ought to be about a factor of twelve. That might turn out to be too much.)
I don't know anyone else who uses this approach, and I've never seen anyone else putting earplugs in on an airplane. Airlines don't offer them to passengers. More surprisingly, perhaps, hospitals don't offer them to patients. (If they did, there would be less incentive to pay the outrageous surcharge for a private room. Calling a shared hospital room with two television sets, either of them with headphones, "semi-private" is like calling a bed of nails "semi-comfortable." But that's another rant.)
Earplugs also come in handy in hotel rooms with thin walls, and on Saturday night if your neighbors share the widespread belief that the fun level is directly proportional to the noise level.
Your mileage may vary, but for four bucks I think it's worth a shot. Try it on your next airplane trip and see if it works for you. And let me know, one way or the other.
About delegation
If, as his flatterers insist, George W. Bush's Presidential style is that of a corporate CEO, it seems to me that the firm is in desperate need of a shareholder revolt. Putting aside the moment my view that most of the things he wants to accomplish are evil, it's pretty clear that the place simply isn't being very well manged right now.
There's a book by an actual, and quite successful CEO -- High Output Management, by Andrew Grove of Intel's glory days -- that gives at least one hint of the cause of the massive incompetence that has led to such misterable failure. Grove discusses the central importance of delegation: letting other people actually make decisions. (That's the lesson that Jimmy Carter and Bill Clinton never adequately learned.)
But Grove defines "delegation" to mean assignment of authority and monitoring of process and results. "Delegation without monitoring," says Grove, is abdication."
Abdication is delegation for the lazy. I know; I practice it myself. Sometimes the results are spectacular, and sometimes they're spectacu-lousy. That's one of the many reasons I wouldn't hire me to run a hot-dog stand.
So when the President tries to weasel out of responsibility for the torture of prisoners by saying he never read the memos, he's describing not delegation but abdication.
Hey, I hear there's a shareholder meeting coming up in November.
June 22, 2004
Light blogging ahead
I'm on the road this week, giving a talk on drugs, violence, and terrorism tomorrow night at the Esalen Institute. (Hey, it's a tough life, but someone has to lead it.)
When you enter the building holding the Esalen hot-tubs, perched rather precariously on a cliff looking down on the Pacific, there's a sign with an arrow pointing to the right and the legend "Quiet," and another sign with an arrow pointing to the left, this one with the legend "Silent."
I can take a hint. So I will be posting only enough to keep my devoted fans from going into frank withdrawal.
Acrobatics
The Bush attack machine has invested substantial effort, not without success, in convincing the country that John Kerry "flip-flops" on the issues. Mickey Kaus has spent a large number of bytes elaborating on the distinction between a "flip-flop" and a "straddle" (usually concluding that Kerry is simultaneously guilty of both).
So I'm trying to see how that analysis might apply to George W. Bush's record on the "patient's bill of rights": a law that would require insurers and HMOs to pay for all "medically indicated" treatment, which in effect means whatever the doctors, chiropractors, etc., want to do and get paid for. I'm not sure such a law is a good idea, but that's not the point for the moment.
I'm doing this mostly from memory, so don't hold me to every detail, but here's the outline as I understand it:
As Governor of Texas, George W. Bush was publicly "neutral" on a patient's bill of rights, while lobbying behind the scenes to kill it. I think that's a "straddle."
Having allowed the bill to become law without his signature, he then claimed credit for it, and promised to support such a bill if elected President. That, I suppose, must be a "flip-flop."
As President, he says he's in favor of the bill but again has lobbied, this time successfully, to keep it from coming to a vote in Congress (e.g., attached to the Medicare bill). Another straddle.
His administration intervened on the side of the HMOs in the Supreme Court case that just struck down the Texas law as inconsistent with federal law. Is that a flip-flop, or a staddle? And if the latter, is it part of the same straddle, or is it a new straddle? (You can see this stuff is really hard; good thing Mickey is so smart.) I think I'm going to call this a new straddle, but I'm open to correction.
So having helped kill all state laws that do the thing he says he's for, and having refused to support a federal law that would do the thing he says he's for, or even a lesser law that would allow the states to do the thing he says he's for, the President's spokesman says the President is still for a patient's bill of rights. I think it's hard to call that either a flip-flop, since the President's actual position remains what it has always been, or a new straddle, since the President's rhetorial position also remais what it has always been. It's just that the actual and rhetorical positions are opposite to one another.
So I think this latest move has to be called neither a flip-flop nor a straddle, but simply a lie.
To recapitulate: The President has executed a straddle to a flip-flop to a double staddle to a lie. That sequence of moves has a degree of difficulty of 2.8. DO NOT TRY THIS AT HOME.
Just remember this the next time someone tells you that, agree with him or not, at least you know where Mr. Bush stands.
June 21, 2004
Drezner on staffing the CPA
Some time ago, Daniel Drezner commented on the "bipartisan piss-offedness" among people who actually know something about foreign and security policy at the sheer amateurishness of the Bush Administration in (among other things) the occupation of Iraq. Yesterday Dan followed up on one of his own earlier posts about the politicization of the hiring process at the Coalition Provisional Authority, which led to the staffing of that crucial agency with people who held the approved views about, e.g., abortion, but didn't, e.g., speak Arabic or know anything technically relevant to the jobs they were hired to do.
Read Dan's piece, follow the links, and reflect on the high cost of "strategery," Mayberry-Machiavelli style. Even when it comes to things we absolutely positively can't afford to blow, the Bushites will always choose loyalty (to the President, not the country) over competence. (Recall, for example, that the White House version of the Homeland Security operation was staffed the same way; I haven't seen any follow-up on patronage hiring within DHS.)
Dan Drezner is the sort of person who (once he gets tenure) might easily be considered for senior foreign-policy jobs in Republican administrations. He must know his frankness isn't doing him any good in career terms. He deserves enormous credit for his courage in saying what others are thinking.
Slander by photograph?
A newspaper photograph of a political figure is less an image of the politician than it is of the editor's political prejudices.
That said, the picture below is a truly alarming one. (Yes, that maniacal face actually belongs to the Commander in Chief; I had to check the caption to make sure.) Either someone at AP really and truly hates the President, or GWB has really and truly started to lose it.
Or, of course, both.
(Hat tip: William Blaze at American Dynamics.)
Two kinds of suicide
Gregg Easterbrook makes an argument about suicide and the selective serotonin reuptake inhibitors (SSRIs -- the class of antidepressants including Prozac and Zoloft) that seems plausible, though I'm not qualified to judge the underlying factual claims:
1. The use of SSRIs precipitates suicide in a small but non-trivial number of patients.
2. But widespread SSRI use has coincided with a decline in the overall suicide rate.
3. Untreated depression is a major cause of suicide.
4. Therefore, SSRIs probably prevent many more suicides than they cause.
5. Therefore, scaring people into no using them, or scaring manufacturers into not making them, with a combination of publicity and lawsuits would result in more suicides, not fewer.
Again, I'm not sure that's right, but it might well be right, and it shows how poorly adapted our existing journalistic and legal mechanisms are to making policy about health care.
But Easterbrook segues from that sensible argument to what seems to me a not-very-sensible assertion:
Suicide should be viewed in public-health terms--as a disease with symptoms and treatment, requiring programs, awareness campaigns, and public outreach.
That assumes that suicide is one bad thing; in fact, it's at least two things, only one of them bad. (See Update below.)
The bad suicide -- the part of suicide that can reasonably be conceived of as a public-health problem -- is the impulsive suicide, committed by a person who didn't want to kill himself last week and who won't want to kill himself next week if his current attempt is prevented or fails. Victims of that sort of suicide tend to be younger and to be suffering from various diagnosable mental health conditions, especially depression and anxiety. This class of cases ought to be managed with suicide prevention combined with treatment for the underlying disorders. (In addition, there are impulsive suicides stemming from sudden disasters; for these, prevention is still in order but there may be no underlying disorder to treat.)
But some suicides don't look like that at all. They're committed by people who, due to intense and prolonged misery, have decided that their lives would be happier if they ended now rather than later. The subjects -- I see no reason to call them "victims" -- of such acts of voluntary termination tend to be older, have more physical and social problems, and to have fewer psychiatric problems than those who submit to a transient impulse to kill themselves.
These suicides -- call them "considered," in contrast with the bad "impulsive" suicides -- don't look to me like a public health problem, or indeed a problem of any other kind. Suicide is indeed forbidden by most of the world's religious traditions, but that doesn't make it a medical problem. (Hume makes what seems to me a convincing case that the arguments offered in support of a supposed divine ordinance against suicide don't hold water.)
That's not to say that suicide may not point to real problems. If chronic pain victims commit suicide at high rates, which they do, that's a convincing critique of our existing mechanisms of pain treatment. But when someone decides, after reflection, that his or her life is more trouble than it's worth, it shouldn't be the job of the public health community or the state to overrule that decision.
There are reasons to worry that a relaxation of the suicide taboo and of the laws that support it -- in particular the "Kevorkian" laws that criminalize even the provision of the means by which someone else can kill himself -- might over time create social pressure for those whose illness and debility make them a burden on others to do away with themselves. The existence of such social pressure would constitute a problem, and one worth attending to through public policy.
But adding considered and impulsive suicides together to make a suicide problem comparable to the problem of automobile accidents seems to me a mistake. So does using the fact that some people kill themselves with guns as an argument in favor of restricting gun ownership, without first deciding how many of those gun suicides were impulsive rather than considered.
Keeping people from doing away with themselves on impulse or under social pressure is a valid goal for public health and public policy. Meddling in people's considered decisions not to go on living isn't; there, the role of the state ought to be to get out of the way. The distinction between the two classes of cases probably isn't a sharp one even conceptually, and it's certainly hard to draw empirically. But that doesn't give the public health folks a license to treat decisions as diseases.
Update A reader points out that the distinction between considered and impulsive acts is at least partly misleading, since someone in the grip of depression or anxiety disorder may plan a suicide carefully over a long period. A suicide committed not on impulse, but with impaired decision-making capacity, can be just as tragic and just as preventable as an impulsive act. So the right distinction is between "well-considered" acts, planned over time with relatively unimpaired mental faculties, and "poorly-considered" acts done either rashly or under the burden of mental illness.
Ideally, those judgments would be made looking only at the form of the decision rather than its content. In fact our judgment about whether a suicide is well-considered or not will have to depend to some extent on the substance of the reasons assigned for it.
The same reader suggests that anti-suicide policies are largely harmless, because those truly intent on taking their own lives will likely succeed. I strongly doubt it. Loss of strength and motor control, loss of mobility, and confinement to a nursing facility all make successful suicide much more difficult.
