Saturday, July 30, 2005

Guns and Trigger Locks: What's the evidence?

This week the senate passed legislation to limit the liability of gun manufacturers for criminal acts committed with their products. An amendment mandated trigger locks for handguns. The medical literature suggests that it's very difficult to convince people to use trigger locks or otherwise store their guns more safely, even with economic incentives. Thus mandated provision of trigger locks with guns may be the only way to ensure their widespread use.

The problem is that there is no evidence whether trigger locks are effective or not. Nada. Zip. But if you hesitate to recommend trigger locks on the basis of this lack of evidence, we should remember the context that gun ownership itself has no evidence to suggest it confers protection from crime. The New England Journal published a controversial and much cited case-control study by Kellermann suggesting that gun ownership increases the risk of homocide in a household 2.7 times, after adjusting for various possible confounding factors. This study has had significant substantive criticisms, the most salient of which I have quoted below with refutations:

1. "99.8 percent of the protective uses of guns do not involve homicides," says Paul Blackman of the NRA. Defensive gun uses include waving the weapon, firing warning shots, wounding the intruder, etc.

It is simply untrue that researchers cannot measure the nonfatal protective benefits of firearms, or that Kellermann's survey failed to detect such a benefit. If firearms deter, scare away or wound intruders, then the murder victimization rate of gun owners should be lower than non-gun owners. The absence of a gun in the home would have been recognized as a murder risk, rather than the presence of a gun.

Kellermann's case-control method was ideally suited to detect such benefits, if they existed. Of course, Kellermann's survey found quite the opposite -- a risk 2.7 times greater.

2. Guns do not emit magic rays that control people's minds, or magnetize murderers to the doorstep.

This strawman argument is based on a false stereotype. Over 76 percent of the homicides were committed by a relative or acquaintance of the victim, and only 3.6 percent were verified as strangers breaking in. Furthermore, arguments and romantic triangles comprised half the homicides. But the most important point here is that a gun in the home only raised the risk of gun homicide -- not homicide by any other means. The most straightforward explanation is that greater gun availability transformed a normal family fight into something much more deadly.

3. People threatened by violence bought guns to defend themselves, hence the correlation between gun ownership and murder.

This is possible, but the number would only be very small, for the following reasons. The study already controlled for domestic violence, so the only way this could happen is if the murderer threatened the life of the victim before things escalated into violence. The victim would then have to buy a gun, which would fail to protect.

Several things make this unlikely. First, we would expect a history of violence to precede any threats or attempts on a person's life, which is, after all, the ultimate form of violence. Second, the study showed that gun ownership resulted in an increased risk in gun homicides only, not any other type of homicides. Why would the murderer restrict himself to a gun, and then only if the victim had a gun? Third, this makes a poor case for gun deterrence, since the correlation is only possible when the gun fails to protect. Again, the researchers found no protective benefits of gun ownership.

6. "These people were highly susceptible to homicide," says Paul Blackman of the NRA. "We know that because they were killed."

If there is an Illogic Hall of Shame, this remark deserves to be emblazoned above its front entrance. By this reasoning, we should not put seat belts in cars, because people killed in car crashes were susceptible to those accidents anyway.

What Blackman is doing here is evoking a general risk for murder, while ignoring its specific risk multipliers. You may, in general, have an antagonistic person in your life given to flashes of murderous temper. But there are specific factors that may increase the risk of murder. Does he drink? Use drugs? Commit crime? Own a gun? Increasing any of these behaviors increases the risk. But it makes no sense to increase the risk multiplier, let someone get murdered, and then argue that the multiplier was not at fault, since the victim was obviously susceptible to murder anyway.

This argument also ignores one of the study's findings, that a gun in the home increased the risk of gun homicide only, and not any other method of homicide.

9. The researchers did not include in their analysis those cases where the home-owner shot a non-resident intruder.

These cases were rare, but even so, this objection is irrelevant. The protective benefits of a gun would have still shown up in the different victimization rates of gun-owning and gun-less households. (See point 1.)

10. This study was conducted by medical doctors who were out of their league; this is an issue best left for criminologists.

Epidemiologists are highly experienced at using the case-control method to determine risk factors. This is how cigarette smoking was linked to lung cancer, for example. The statistical method is the same no matter what the risk factor, be it cigarettes, a virus, a missing vitamin or a gun. A good analogy is that of an astronomer using optics technology to make a breakthrough in optometry.

Hat tip to Steve Kangas

In the setting of a widespread intervention (i.e. guns) with such significant adverse effects, I would argue that the evidence burden for trigger locks doesn't need to be that high.

Thursday, July 28, 2005

Cheney's Annual Physical

How better to mix medicine and politics than by discussing Dick Cheney's physical condition? Straight From the Doc has analyzed the Veep's workup test-by-test.

Basically, he got what anyone else would have gotten with a few exceptions: an upper endoscopy (esophagus, stomach, upper intestine) done for unknown reasons, and a vascular study showing some dilations of arteries in his knees. Also, since he smoked he should have gotten an ultrasound to screen for an abdominal aneurism, though that's not mentioned in the article.

Some such as NCPA have argued that annual physical exams without a medical complaint are a waste of resources:

An expert committee sponsored by the federal Agency for Healthcare Research and Quality found little benefit in many of the tests commonly included in a typical physical exam for symptomless people:

It found no evidence that routine pelvic, rectal and testicular exams made any difference in overall survival rates for those with no symptoms of illness; furthermore, such tests can lead to false alarms, necessitating a round of expensive and sometimes risky follow-up tests.
And even many tests that are useful, like cholesterol and blood pressure checks, need not be done every year.
Other time-honored procedures -- listening to hearts with a stethoscope, thumping chests and looking at eyes, ears and throat -- provide no medical benefit for healthy patients with no symptoms.
Many doctors do a careful physical exam on a patient's first visit to serve as a baseline. But on subsequent visits, say groups like the Agency for Healthcare Research and Quality, patients would be better off if doctors spent their time counseling them on such things as stopping smoking, eating a healthy diet and drinking moderately, using seat belts and having working smoke alarms in their houses.

It is a danger in today's thirst for evidence-based medicine to weight the measurable as more valuable than the unmeasurable. It is very difficult to measure the increased compliance with medications, the lower malpractice suit rates, the efficiencies of continuity of care, and the better patient satisfaction overall that come from a good relationship with one's physician. The annual physical is a key factor in building that relationship, and should not be discarded in the quest for better institutional statistics measuring up to outcome goals devised by nonclinical management.

Wednesday, July 27, 2005

Cosby Republicans?

Booker Rising writes of the coming of Black Republicans, 'old-school' blacks who essentially agree with Bill Cosby's recent campaign. Here's the specific policy positions these folks tend to favor:

support for school prayer: they believe it creates better-behaved children and acknowledges God at the center of humanity

support for school vouchers: they believe enables black parents to choose better schools for their kids

opposition to abortion: viewed as black genocide

opposition to gay marriage: they believe it threatens the already fragile black marriage rate. They also view attempts by (overwhelmingly white) gay activists to link the issue to the Civil Rights Movement as almost blasphemous, racially arrogant, and leeching off black folks' hard work

pro-union: they believe it protects workers from corporate overreach

tax cuts for middle class but keep progressive structure: they don't believe that the rich pay their fair share

support for more African aid & more trade: links to their social gospel ethic

opposition to illegal immigration: viewed as mostly hurting black workers

support for government safety net: linked to their belief that government should care for the needy, but they will also support restrictions to curb irresponsible behavior

are turned off by "blacks are victims" rhetoric: they believe racism exists and will rant against it, but don't buy that it dominates as it did in the 1950s

support for affirmative action: view it as a step up for folks who are willing to improve themselves, and as payback for centuries of black oppression

There are a million reasons that Republicans ought to be more actively courting the Black vote, and I hope they start to see this opportunity. Broadening the Republican tent to better include African Americans would not only moderate the party's sometimes excessive disdain for government, but would heighten the political clout of Blacks overall as each party seeks their support.

Hat tip to The Moderate Voice

Tuesday, July 26, 2005

Victories and Challenges

Let's just recap some of the recent victories for centrists in recent months. From the Gang of 14 Compromise to avert a filibuster battle, to strong showings for the McCain/Graham amendments on POW/detainee treatment, to the Virgina and Ohio Primaries, to Frist's failure today to stop debate on the defense appropriations bill in an effort to pass a bill protecting gun industry interests, centrists have had a good couple of months. Short term challenges like the Roberts nomination and the Rove affair should not distract though from advancing long term goals. As I see them, they include:

1. Redistricting reform. As many congressional districts as possible should be arranged so that they have real contests between Republicans and Democrats, to give people a real choice and encourage candidates to move to the center for the general election. Several groups like this and this are pursuing this goal.

2. Electing centrists at the local and state levels. The Moderate Republican points out that the cultural conservatives effectively pursued a 'salt of the earth' strategy for decades. That is, they recognized that one of them on a school board can color the board's agenda, much like just a pinch of salt is all it takes to define the taste of a soup. What's more, increasing moderates' involvement in local politics builds the 'farm team' for the future, more than simply focussing on the national level.

3. Articulate a vision. Reagan wasn't elected because he could win arguments, he was elected to implement his vision of a 'City on a Hill,' made secure and prosperous by the labor of free men and women. People didn't vote for Clinton because of his pithy writing style; he was elected because he projected a confidence that traditional Democrat programs inspired by concern for the poor combined with a respect for limited government could solve America's problems. Moderates need to project a vision too, and have not yet articulated it well.

We should take heart from legislative successes, but the high-yield work is attaining electoral victories. Building the infrastructure of centrists in office to help elections swing to the moderates more often will take some time.

Monday, July 25, 2005

Clubs in America

The Economist has a special section focussing on the US, and one of the pieces deals with civic and volunteer organizations. It details the forces driving the transition from locally-based clubs like the bowling league and small churches, through the 20th century to where most new organizations are nationally based and run by advocates or professional staff, then through the internet boom, megachurches and

The main lesson is that while the internet can satisfy a piece of our need for community, there are some types of interactions which just have to happen in person to be meaningful--to build the emotional and physical safety of our neighborhoods. We should not let local voluntary organizations erode; history shows that their fortunes wax and wane but they never really fade away.

Sunday, July 24, 2005

Medical Quotations

The American College of Physicians has a nice online library of medicine quotes. Here are some from that site and a few others:

It is extremely difficult for a physician who puts too much trust in what he reads to form a proper decision from what he sees.
- Andrew Boorde

No physician is really good before he has killed one or two patients.
- Hindu Proverb

Don't think of organ donations as giving up part of yourself to keep a total stranger alive. It's really a total stranger giving up almost all of themselves to keep part of you alive.
- Author Unknown

A drug is that substance which, when injected into a rat, will produce a scientific report.
- Author Unknown

Medicine, the only profession that labors incessantly to destroy the reason for its own existance.
- James Bryce

Formerly, when religion was strong and science weak, men mistook magic for medicine; now, when science is strong and religion weak, men mistake medicine for magic.
- Thomas Szasz, M.D.

What Nissl and Alzheimer could find under their microscopes they declared "neurology." What they couldn't find was psychiatry.
- Edward Shorter

Poisons and medicine are oftentimes the same substance given with different intents.
- Peter Mere Latham

All who drink of this remedy recover in a short time, except those whom it does not help, who all die. Therefore, it is obvious that it fails only in incurable cases.
- Galen

A doctor must work eighteen hours a day and seven days a week. If you cannot console yourself to this, get out of the profession.
- Martin H. Fischer

All interest in disease and death is only another expression of interest in life.
- Thomas Mann

"She got her looks from her father: He's a plastic surgeon."
- Groucho Marx.

Wednesday, July 20, 2005

James Doohan, RIP

James Doohan, who played Star Trek's Scotty, has died from pneumonia complicating Alzheimer disease. Scotty was a fun character throughout the franchise, but Doohan really brought depth to his performance in the Next Generation episode Relics. By all accounts a warm, gentle man, he will be missed. Condolences to his family, friends and other fans.

Tuesday, July 19, 2005

Vermont Death with Dignity Act

Following Oregon's lead, the Vermont legislature is considering a bill (HB 168) to offer terminally ill patients the option of a prescription medication to hasten their death.. The law itself, in broad summary, provides that only the patient can initiate a request which must be in writing, there is a 15-day waiting period, two witnesses must attest the patient is acting voluntarily, two physicians must be involved, and counseling is required if the MD feels the pt is depressed or has any psychological pathology. The bill has the support of many people and institutions including the Burlington Universalist Church, the VT Alliance for Ethical Healthcare and others.

I'm not so enthusiastic. I greatly admire Timothy Quill and his work advancing a humane medical approach to the dying patient, but I feel that full-blown legalized physician assisted suicide will do more harm than good. Here's what former Surgeon General C. Everett Koop wrote about the Oregon law legalizing MD-assisted suicide, Measure #16:

As former United States Surgeon General, I have worked first hand in developing health care policies. Many proposed policies at first sound like good ideas, but in fact are very dangerous. Measure #16 is one of those policies...

Measure #16 prescribes suicide as a treatment for disease. A patient's request for suicide is a signal that certain needs are not being met. Most likely, the patient is suffering from unnecessary pain or treatable depression. Doctors too often fail to dispense adequate pain management. The solution is to provide mental health treatment or better pain management, not drugs for suicide. This is the time for the doctor to be the patient's support, not his/her killer.

Measure #16 is ripe for abuse. The so-called safeguards built into Measure #16 are inadequate. Patients remain vulnerable to outside pressures to choose suicide. Physicians are required only to suggest the patient notify family members, leaving many to choose suicide without the support of loved ones.

Measure #16 strikes at the most vulnerable. Cost containment is a positive and necessary step toward health care reform. However, in this environment Measure #16 is dangerous. Poor, elderly, frail and disabled patients will be the victims if the "choice" to die becomes the "duty" to die.

A patient's request for suicide is a signal that certain needs are not being met.

In my own experience, there are two types of relevant situations. In the acutely ill patient with a dismal long-term prognosis from a terminal illness, the wish to control uncomfortable symptoms becomes paramount to any life-prolonging treatment and the patient is treated accordingly--these are patients who might be termed 'actively dying' before your eyes. They routinely recieve pain and sedation medications at doses which may hasten their death, in an effort to provide comfort.

These situations are not where a Death-with-Dignity law will apply. Instead, it mostly will be invoked for the ambulatory patient with uncomfortable symptoms, who despairs of further deterioration. These are the patients that palliative care services can help so much, but often are connected to them too late. Rather than presenting them with the initially appealing option--and perhaps eventually, in some sense a duty--to choose controlled early death, these folks should be referred for hospice and other palliative services. Their needs often involve a desire for control over the circumstances of their death, and assurance they will not be exposed to extreme suffering--we have the means now to meet these needs without assisting them with suicide. And my experience is that when such needs are addressed, the wish for hastened death vanishes.

Sometimes the meaning that patients find in the end of life is as simple yet profound as facing what comes as an example to their families, or as a final task for themselves they wish to do right. These things are not possible while symptoms are not well controlled, but when they can be, the death of a family member surrounded by loved ones and perhaps a minister is part of the cycle that makes up a family's story.

When patients' requests for assisted suicide are understood as a communication that their needs are not being met, setting up a state mechanism to administer lethal prescriptions seems absurd. When the Vermont legislature returns from its recess, I hope this bill does not reach the floor.

Sunday, July 17, 2005

Open Letter to Democrats

Though I hold out hope that Pataki or some other moderate Republican will be able to triumph in the presidential primaries, the extreme right remains a force to be reckoned with. So I thought I'd forward a bit of advice to our Democrat friends, from A Sad American, self-identified as a Southern Republican who would have liked to have voted for Kerry, writing a message to Democrats on how they could have gotten her vote. And she writes so well and insightfully I can't do it justice--please do check out the link. But here's her conclusion:

President Bush won on values, yes, but not hatred of gays or any other
stereotype you have in your head about Bush voters like me.

He won because he has values, clearly defined values, and even though I agree
with little of what he believes, at least I know what he believes. At least I
know that he really does believe in something. At least I know that he will do
what he says he will do.

That's disgustingly little, but unbelievably – you offered me less.

Some of the liberals I've discussed this with focus on the clear differences between her point of view and theirs, or how irrational her reasoning seems--but that is missing the point. She wanted to vote for Kerry and still felt she couldn't; what an indictment of the Democrats as a party!

If Democrats are to ever win again, they need to shed their tendency to simply restate (or 'reframe' a la Lakoff) their own views, and start listening to what swing voters need from a Democratic vision of government in order to be comfortable voting for them--not necessarily the content of the vision, but the functions that vision needs to fulfill. That's the only way to figure out how to get their votes--understanding garners more loyalty than explaining.

Friday, July 15, 2005

Hong Kong: Food for thought

EconLog questions the axiom that democracy and economic freedom must go hand-in-hand, and uses Hong Kong as a case in point. The former colony's history suggests that economic freedom was imposed on an unwilling, or at least indifferent, populace. If the connection between social and economic freedom is not as close as we often assume, this may have implications for US global strategy.

Santorum and the Postmodern Error

Philocrites points out the absurdity of Sen. Santorum's recent comments, namely the implication that the problem with the Catholic Church leading to the sex-abuse scandal was that Cardinal Law, and Boston itself, was too liberal. For those who missed it, here are the senator's words:

It is startling that those in the media and academia appear most disturbed by this aberrant behavior, since they have zealously promoted moral relativism by sanctioning "private" moral matters such as alternative lifestyles. Priests, like all of us, are affected by culture. When the culture is sick, every element in it becomes infected. While it is no excuse for this scandal, it is no surprise that Boston, a seat of academic, political and cultural liberalism in America, lies at the center of the storm.

Santorum's comments as I read them are designed to make his political opponents seem alien and disgusting, without advancing the political discourse in any productive fashion. He ought to apologize.

While on the subject, let's clarify what liberals and conservatives mean by 'moral relativism'. Conservatives usually level this charge at liberals who espouse 'post-modernism,' which they see as ultimately leading to the conclusion that each may do as he pleases. If I may air a simplified understanding (and note that what follows is just one aspect of 'the postmodern'), post-modernists themselves espouse the belief that there is no level playing field between any two different worldviews which allow meaningful discourse. That does not mean post-modernists cannot be utterly convinced of their own western-liberal worldview, just that they believe that someone from a Marxian or Confucian worldview will have no common frame of reference to decide which of the worldviews are 'right'. Postmodernism does not mean that just because I cannot convince you that the crime you are committing is wrong you should escape punishment, but rather it acknowledges that the meaning of the action as a crime is going to be difficult to convey to someone who does not see it as such. Post-modernism is not simple moral relativism, which would in fact say that a criminal has a "right" to commit crimes if his moral system allows it.

This emphasis on a multitude of viewpoints does not logically lead to moral chaos; the problem of pluralism could be, and has been, solved a number of ways around the world--wherever two cultures live in peace. It is intellectually dishonest for academic conservatives (ahem ahem George Will) who ought to know better to level the charges of moral decay they often do against post-modernism. For the record I don't count myself among post-modernists' ranks, but they have something interesting to say and ought not be dismissed outright.

Thursday, July 14, 2005

Lobotomy Revisited

The age of lobotomy was not the golden age of psychiatry.

In The New England Journal Dr Lerner reviews the medical historical literature on lobotomy and writes that with time comes more perspective on this now-defunct practice. In particular, he examines the career of Dr Walter Freeman, the chief US proponent of lobotomy, whose Nobel Prize is the target of a recent campaign to have it revoked.

Although the notion of cutting brain tissue in order to make people submissive is repugnant from our modern perspective, the ability to discharge psychiatric patients even to a limited existence at home was perceived as a therapeutic triumph in the 1940s and 1950s...

But whereas Freeman's later excesses raise obvious red flags, his earlier efforts on behalf of a population of very ill patients pose a more complicated question. To what degree should physicians and researchers "push the envelope" in search of an effective remedy? Here the history of lobotomy offers a somewhat surprising answer. Lobotomy was not, as it was long considered, an aberrant and cruel therapy promulgated by fringe practitioners. Rather, it exemplified a common characteristic of medical practice, in which doctors and patients have often felt the need to "do something" in the face of seemingly hopeless situations. In such cases, some patients have inevitably served as guinea pigs. Radical cancer surgery, artificial-heart implantation, and the early organ transplantations come to mind. Sometimes, the interventions are the first step toward a successful remedy; in other instances, they prove worthless.

There's not much really at stake in the decision of whether to rescind Freeman's Nobel Prize--he practiced by the now-substandard ethical standards of his day, and nobody plans to model a career after his. The broader lesson is that the next time a wonder cure emerges, the medical profession and society at large ought to take our time and involve many people with a multitude of perspectives into the ethical decisionmaking about how to apply it, because we've seen wonder cures morph into monstrosities. Luckily, this is a lesson we've mostly learned.

What Happened to Leptin?

Remember the obese gene that made such a splash a decade ago, with the enormous rats and the promise to cure obesity? The Boston Globe has an update on why we haven't heard much about ob/ob and its hormone product, leptin.

This is the short version: human trials of leptin have been disappointing, and Amgen does not allow other companies or institutions to use its proprietary knowledge to broaden the search for uses of the gene. But the consensus is that obese humans may have a lower sensitivity to leptin, so the search is on for ways to boost the brain's ability to 'see' what leptin is in the blood--it's usually elevated in obese patients. So keep your ears open for news about leptin-related therapies for obesity.

It's certainly true that there are social/environmental trends promoting an unhealthy lifestyle in Americans, and that obesity can be seen as just a marker of those factors. According to the CDC, "30 percent of U.S. adults 20 years of age and older - over 60 million people - are obese.
This increase is not limited to adults. The percentage of young people who are overweight has more than tripled since 1980. Among children and teens aged 6-19 years, 16 percent (over 9 million young people) are considered overweight."

Now there's a good case that if we treat obesity with leptin-sensitizers or some other medication, we're simply chemically compensating for an unhealthy environment. That's true, but not unprecedented. Antibiotics compensate for an environment where people share bacteria more readily than in the wild, and blood pressure medications compensate for an environment where people have more stress than in the wild.

Steering our lifestyle into more healthy habits is a worthy goal and should be pursued; but if medication can be developed to save/extend lives and improve quality of life in the meantime, it's hard to morally object to that.

Wednesday, July 13, 2005

Circular Polarization--Good or Bad?

Some centrists worry that when the extreme right and extreme left find common ground, it undermines the center. An example quoted is religious conservatives and secular environmentalists who both feel a responsibility (for different reasons) to take care of the planet.

Their concern is that these ad hoc coalitions don't amount to 'sustainable' bipartisanship. I would argue that it's precisely because these groups contain members that would be at odds on other issues that such bipartisanship is valuable. Since they do not require and in fact undermine the extremist party leadership, across-the-aisle coalitions keep people talking whom the partisans would like to shore up as a loyal isolated base. By preventing the political opposition to be painted as all-bad, I think such coalitions are a force to keep politics civil and productive.

I certainly believe a strong and vital center is a boon. But it's less likely to succeed by further discouraging what little bipartisan cooperation there is than by facilitating ad hoc coalitions of the extremes in an effort to promote a centrist agenda.

[UPDATE] For an interesting example of circular polarization, see George Will embracing animal rights at The Yellow Line

Monday, July 11, 2005

On a Quaker in the Pentagon

Quaker Loren Cobb spent years planning war.

An analyst for the US military, Cobb has spent a lot of time thinking about how to achieve peace. His essay speaks of the Quakers' excessive focus on personal pacifism, to the exclusion of combating the psychological (abuse, neglect) and institutional (political and economic) causes of strife. He writes of a personal and philosophical journey from orthodox Quaker pacifism to a more 'nuanced' Gandhian non-violence:

In contrast to the stark black-and-white thinking of Quakers on the subject of nonviolence, Gandhi had a subtle and nuanced approach. "Nonviolence of the strong" was his lifelong theme, and by strength he was thinking of several things: spiritual development, psychological fortitude, and political strength. He was certainly not thinking of military strength, but one can extend his ideas into this area. For example, he wrote, "Man for man, the strength of non-violence is in exact proportion to the ability, not the will, of the non-violent person to inflict violence." This is a remarkable statement for any pacifist to make, and it bears close study. On the surface, he meant that the political impact of nonviolence is greatest when practiced by those who could be very violent if they chose. At a deeper level, I think he believed that any movement which gathers political strength, psychological fortitude, and spiritual development simultaneously develops the ability to act powerfully, in either a violent or nonviolent mode. The essential question is how to tip the balance in favor of the more difficult choice: nonviolence.

For Gandhi, the key to this conundrum was spiritual development. Many times he wrote that when oppressed people lack spiritual development, they may use violence to free themselves. In fact (and surprisingly to me when I first read it), he was scathing in his criticism of passive or subservient nonviolence as a response to oppression, which he found unacceptable at any time. He said, "It is better to be violent, if there is violence in our hearts, than to put on the cloak of non-violence to cover impotence. Violence is any day preferable to impotence. There is hope for a violent man to become non-violent. There is no such hope for the impotent." In Gandhi's view, every person and every nation should use active methods appropriate to their level of spiritual development. He hoped that his beloved India would become the first example of a nation to free itself from a foreign oppressor entirely without violence, drawing upon his spiritual doctrine of ahimsa, or nonviolent action. As we know, India did succeed in this sixty-year effort, ridding itself of British colonial rule without warfare...

Pacifism often is chided as idealistic hogwash, and perhaps in its radical form it is. But Gandhi's pragmatic approach emphasizing "potent nonviolence" is not that far from Ronald Reagan's proposition that peace is best promoted by free people occupying a position of strength. Let us each do what we can so that we as a nation continue to develop toward that ideal.

Sunday, July 10, 2005

Reverse Flypaper

Michael Totten writes that there is a lesson for the US in the Israeli experience with Hezbollah.

When Israel withdrew its occupation forces from Southern Lebanon in the year 2000, the Israeli and American right claimed it was a show of weakness, that retreating under Hezbollah's fire would embolden Israel's enemies. They were half right, at least. Hezbollah did, in fact, claim victory for driving the Zionist infidels out. It looked like Israel could be beaten after all.

But Israel can't be beaten. The joke was on Hezbollah.

Years ago the people of Lebanon really did think of Hezbollah as a nationalist resistance group fighting the good fight against a foreign occupier. When the Israelis left they knocked Hezbollah's entire raison d'être right out from under them. The only people inside Lebanon who still seriously support the existence of Hezbollah as an armed militia, rather than a mainstream religious-right political party, are right-wing Shia. Almost everyone else -- Christians, Sunni Muslims, Druze, liberal and centrist Shia -- will only do business with Hezbollah on cynical, tactical, and realpolitik grounds. Hezbollah is widely seen among Lebanese as a reactionary throwback to the era of the civil war. The overwhelming majority of Christians and Sunnis fear and loathe them.

The only reason Hezbollah's disarmament isn't considered a top-priority emergency is because they are, for the most part, in a defensive non-threatening holding pattern. Hassan Nasrallah, Hezbollah's secretary-general, is scrambling to slow the speed of his own marginalization. He has given up the dream of turning Lebanon into an Iranian-style Islamic Republic. The only way Hezbollah can "win" elections even on their own Shia turf in the south is by forging a bogus tactical alliance with the centrist and secular Shia party Amal. No one knows when Hezbollah will be disarmed and integrated into the Lebanese army. But everyone, including Hassan Nasrallah, knows it is going to happen.

Israel's "retreat" condemned Hezbollah to a slow-motion doom. Their doom would have been dramatically accelerated if their Syrian patrons had not occupied Lebanon in the meantime. It's quite likely the Lebanese Cedar Revolution, which ousted the Syrian military, would never have happened if Israel, too, still occupied large swaths of the country.

Every dramatic political development in Lebanon since the Israeli "retreat" has worked to the advantage of Israel. None might have happened had Israel stayed.

Having committed ourselves to rebuilding Iraq, I fully support the idea that we ought to stay until we've done the job right. But that requires the premise that our staying there continues to be more beneficial than the side effects we cause. Eventually that balance will weigh against continued occupation, and it will require vigilance and wisdom to percieve when that time comes, especially if it entails withdrawal under fire.

Friday, July 08, 2005

Gonzales Not a Moderate

A moderate above all else believes that the integrity of the means--the constitution, beneficial economic incentives, international law--must be preserved in the face of any given end.

Alberto Gonzales is not a moderate by this standard. Philocrites cites Gonzales' confirmation hearing testimony from earlier this year, in which he clearly state there are times when Congress may pass a law the President thinks is unconstitutional, and that the President has the right to act accordingly. Philocrites writes:

Karl Rove is quite the magician. Efforts by the White House to quiet down the fundamentalists who are clamoring for a culture warrior on the Supreme Court seem focused on two underlying goals. First, the G.O.P. has to preserve the rousability of the radical right -- a version of Xeno's Paradox in which the Christianists are always getting closer to and yet never quite achieving their goals, making them a perpetually indignant revenue stream. Giving them what they want would seriously undermine Bush's support among non-fundies, and Rove knows it.

More importantly, however, the White House is intent on convincing the media that Alberto Gonzales is a safe, moderate compromise. He's not. Forget the debate about abortion for a moment; the real issue is torture and the president's "authority" to ignore the law.

That's just it: the religious conservatives recognize that Gonzales is not one of them, old-line conservatives emphasizing federalism cannot support his interpretation of the constitution, and liberals deplore his views on torture. The Supreme Court, at its best, is a venue where representatives of different legal philosophies can work out compromise and solutions to the issues of the day; each justice represents a slice of the American political philosophical pie, and his/her authority derives from the ability to speak for that intellectual cohort. Gonzales is a nominee with no natural constituency who should not be confirmed.

Tuesday, July 05, 2005

US Foreign AIDS Policy

The New York Times recently reported on the two sides of American AIDS policy.

In the battle against AIDS, the Bush administration is both savior and scoundrel. Washington is the single largest financier of AIDS programs in poor countries. But the administration uses its muscle to extinguish necessary and successful programs it finds politically objectionable, and to carry out ineffective ideological crusades...

The Times article describes how the US recently approved Indian-made generic nevirapine and efavirenz, two antiviral cocktail components. This move will make the drugs available to millions more. But at the same time the Bush Administration is asking UN-AIDS to drop all references to needle exchange programs from its documents.

Now, free needle exchange for IV drug users is a controversial topic, and it's not necessarily intuitive that it would be effective. But the preponderance of clinical evidence indicates that it reduces drug injection rates, reduces needle and syringe sharing, and reduces AIDS spread.

Needle exchange programs are among the best tools we have for fighting AIDS in populations with high IV drug use; the Bush Administration should continue to support these programs. But I wouldn't put money against the Administration letting ideology get in the way of evidence-based public health policy.

Sunday, July 03, 2005

Passive Censorship at CPB

It's seldom a sign that someone respects your integrity when they have you secretly investigated.

The Moderate Republican has a nice roundup of the issues around Corporation for Public Broadcasting president Thomlinson hiring a partisan firm to assess the content of NPR programs for liberal bias. The crux is this: even avowed and proven conservatives like Chuck Hagel were counted as 'liberal' when they questioned Bush Administration policy.

In medicine, we speak of 'observation bias'. For example, if a patient knows the doctor is doing a study to see how often he takes his medications on time, he'll take them more reliably than he usually would, just because he's being watched. Even if no official policies come out of this study at CPB, journalists in public broadcasting must now realize their careers would not be helped by being consistantly critical of the government--who knows what other secret investigations are still ongoing.

We fought and won the Cold War to prevent this.

Now I have no doubt that the CPB executives have the best intentions of journalistic integrity at heart; that they truly believe that there is a preponderance of liberal content in public broadcasting and wish to bring balance for the public good. In fact, I'm inclined to believe the investigation's findings, having listened to Dianne Rehm for a few years (although I'd like to see a study by a truly impartial firm). But as is often the case, it is the means not the end which has the most potential for harm. When journalists are not treated as professionals by their own employers, the public's distrust is not far behind.

The integrity of journalism has been taking enough hits from the failings of journalists themselves these days. If there were systematic features of newsgathering organizations further casting doubt on the reliability of the news, Americans will have lost a valuable institution and a vital piece of democracy.

Saturday, July 02, 2005

FEC Testimony on Blog Regulation

Over at Red State you can see the prepared remarks of one of its founders, Josh Krempasky before the FEC. He testified:

Our current campaign finance regulations touch nearly every area of political participation by associations, corporations, candidates, political parties and individuals. But one group is notably and, for practical purposes, completely exempt – the news media. The Commission is now considering the proper scope of that exemption. As it has asked, “Should the exemption be limited to entities who are media entities and who are covering or carrying a news story, commentary, or editorial?”

With respect, the question properly formed should have been, “can the exemption be limited?” The answer must be an emphatic no. There is no doubt that bloggers are media entities. Nor is there any doubt that the tradition of citizen journalists is a long accepted part of our national culture. From before very founding of our country, individuals and relative unknowns have contributed to this great conversation...

There is no doubt that the Commission recognizes the difficulty in extending the media exemption to these citizen journalists. It is imperative that it does so. What goal would be served by protecting Rush Limbaugh’s multimillion dollar talk radio program – but not a self-published blogger with a fraction of the audience? How is the public benefited by allowing CNN to evade regulation while spending corporate dollars to put campaign employees on the airwaves as pundits, while forcing bloggers to scour the Record and read Commission advisory opinions?

Right on. The purpose of McCain Feingold was to tighten the reins on 'soft' contributions, but being written with the classic political world in mind, it creates absurdities when applied to the online world. For instance, when reckoning an online contribution (a link to a campaign web site from one's own blog, for instance) it counts the benefit to the campaign as the contribution, not the actual cost to the blogger. This could amount to a substantial sum to count as a contribution from the blogger which could place him in violation of the contribution limit.

But more concerning than the potentially fixable absurdities in the implementation of McCain Feingold is the specter of government regulation of journalism. Certainly most bloggers are 'amateur' journalists, but when acting in that role, I think most people will agree that they serve the public interest best if treated by the law like journalists rather than like elements of a political campaign. If certain specific egregious abuses of blogger status can be identified and prevented (for instance, writing off an official campaign website's expenses as a blog) that is sensible, but the broadest possible definition of a blog should be applied, to produce what Reagan might have called 'maximum freedom of expression compatible with order.'

Friday, July 01, 2005

Roe No More?

Now that O'Connor is retiring from the Supreme Court, it's hard to imagine that there will be a pro-Choice majority on the bench come next session. How great a catastrophe would it be if Roe were overturned?

I strongly support the principle that women ought to have access to safe and legal means to control their own fertility, including surgical abortion. However, I sympathize with those who point out that the constitution does not explicitly guarantee the right to an abortion. Roe itself is based on the idea of a constitutional right to privacy, itself a nebulous inference from the text. I don't think it's a radically 'originalist' (ala Scalia) argument to make that when the right to have a surgical procedure is this many logical steps removed from the text of the constitution, then it falls into the Tenth Amendment category of rights which the people are meant to define and protect via the legislatures of the States.

But constitutional law arguements aside, how likely are the states to take away the right to an abortion if Roe is overturned? Certainly it varies by state, but the political fight would be harsh, and we would end up with a patchwork of pro-Life and pro-Choice states. But remember that the public support for limiting abortion (parental notification, outlawing 'partial-birth') does not extend to outright banning of the procedure. I suspect that most states would revert to something similar to the English common law as it existed for hundreds of years: that abortion is legal only during the first trimester.

What's more, without the centerpiece rallying cry of the Religious Right's culture war, they would lose much of the fervor which spills into other issues and fuels the rise of more extreme-Right candidates. I really don't think that overturning Roe would be an unmitigated disaster, and there may be some tactical benefits.