It's All In Your Head

As you may have noticed, we at the Snark are interested in authoritarian behavior and the methods people use to justify that behavior. Sometimes the lengths that people will go to in the service of satisfying their emotional needs are funny, sometimes they are frightening. Sometimes they are just repugnant.

Apparently, the administration has issued rules requiring parity for mental health treatment with other illnesses. They'll take effect July 1st. If you want to know why health insurance costs keep marching upward seemingly uncontrolled, this is why: mandating new benefits is always popular, and the government doesn't have to pay for them.

Why do our costs keep rising? Megan McArdle believes it is because we use more health care than other nations because we're richer. She is wrong, of course; McArdle does not pay attention to facts when she can ask her guts for advice and information instead. Let's see what Ezra Klein had to say about the same subject: (not that we trust Klein, but at least he uses verifiable facts)

There is a simple explanation for why American health care costs so much more than health care in any other country: because we pay so much more for each unit of care. As Halvorson explained, and academics and consultancies have repeatedly confirmed, if you leave everything else the same -- the volume of procedures, the days we spend in the hospital, the number of surgeries we need -- but plug in the prices Canadians pay, our health-care spending falls by about 50 percent.

In other countries, governments set the rates that will be paid for different treatments and drugs, even when private insurers are doing the actual purchasing. In our country, the government doesn't set those rates for private insurers, which is why the prices paid by Medicare, as you'll see on some of these graphs, are much lower than those paid by private insurers. You'll also notice that the bit showing American prices is separated into blue and yellow: That shows the spread between the average price (the top of the blue) and the 90th percentile (the top of the yellow). Other countries don't have nearly that much variation, again because their pricing is standard.

The health-care reform debate has done a good job avoiding the subject of prices. The argument over the Medicare-attached public plan was, in a way that most people didn't understand, an argument about prices, but it quickly became an argument about a public option without a pricing dimension, and never really looked back. The administration has been very interested in the finding that some states are better at providing cost-effective care than other states, but not in the finding that some countries are better at purchasing care than other countries. "A health-care debate in this country that isn't aware of the price differential is not an informed debate," says Halvorson. By that measure, we have not had a very informed debate.

Where Megan McArdle operates, we will always have uninformed debates, because she sees no need whatsoever to become informed when she can just toss off a fact-free post and go shopping. She was not taught to think by her parents; she was taught to accept their prejudices and assumptions without question. She was taught that she is superior by virtue of birth (which is humble) and breeding (which is non-existent), and therefore she is more intelligent that those who actually felt the necessity to develop and train their minds. She was not taught to think at her exclusive elite universities and prep schools--or if she was, she was mentally absent on those occasions. She was not taught to write persuasively at Reason or The Atlantic, as her editors were only interested in the dispensation of right-wing talking points in the service of global corporations. She can't think, can't write, and can't feel, yet she feels perfectly free to tell the rest of the world her medical and political opinions.

I am very sympathetic to the plight of the mentally ill. Unfortunately, most of the people who will tap the benefits are not severely ill people who need intensive care; they're people who are unhappy. Unhappiness is not a condition for which psychotherapy, or antidepressants, have been shown to be very effective. (Severe clinical depression, yes. But contrary to the belief of people who felt awfully down the time their boyfriend left them, these two conditions are not the same thing.) Since the moderately unhappy and dissatisfied are much more prevalent than those with serious disorders, that's most of what we'll be paying for: someone to listen to complaints. That's what Senators are supposed to be for.

No proof. No facts. No argument. Just a declaration that unhappy housewives and love-lorn men will bilk the insurance companies and taxpayers so they can feel better about themselves. That most people who say they are mentally ill are, in fact, just dissatisfied. She has the arrogance, the unmitigated gall, to say that real people with real problems, medical problems and emotional problems that affect the mind and body, are just complainers. You thought schizophrenia was a problem? Dumbass. Oh, sure, maybe a few people have a problem but most don't, so don't care for any of them. Depression? Doesn't exist. Severe clinical depression, maybe that exists, for a few people, but unless you're 100% incapacitated, you're just a big old faker. Bipolar disease? Anxiety? Post traumatic stress syndrome from growing up in poverty, in horrendous abuse, in war? Silly housewives, you just need to buck up and quit whining.

Diseases of the brain don't exist, people. It's the Magic Organ, that never malfunctions or is damaged. Because Miss Megan McArdle says so.

On a more serious note, I feel like we could have achieved the laudable goal of ensuring that serious mental illnesses are not left untreated (at least, in cases where the patient wants to get treatment), without guaranteeing cheaper psychotherapy for America's ennui-laden affluent classes. Of course, then we'd have to recognize the fact htat this stuff has to be paid for, rather than pretending that benefits can somehow be magically generated for free with just a wave of the regulatory pen.

People do enjoy mental illness so. They don't even want treatment some of the time.

For some bizarre reason, McArdle thinks she's an expert on depression, without actually knowing anything about it, and always with the motive of denying corporations any expense. It's not that she wants people to be unable to get health care. She just wants health insurance and drug companies to have as much money as possible.

From the comments:

jegmont (Replying to: David Cohen) January 29, 2010 4:49 PM
I didn't mean to imply that any one who feels sad is in danger of developing clinical depression. The point I intended to make is that when someone does have a mental illness, it often progresses, so if there isn't early treatment, things can get very, very bad. The spirit of the post seemed to be that it is so easy to distinguish between someone needing treatment and someone just feeling down.

Reply

Megan McArdle (Replying to: jegmont) January 29, 2010 5:41 PM
As far as I know, that's not really true. People don't start out feeling sad, and then progress to severe clinical depression, except perhaps in cases of severe trauma. People who become severely clinically depressed have usually been struggling with fairly severe episodes of depression that go way beyond feeling sad since at least late adolescence. It may progress from severe to psychotic. But the majority of people who say they're "depressed" are in no danger of developing severe depression, and mild depression doesn't seem to be all that responsive to treatment.

[snip]

Nimed (Replying to: Skullberg) January 29, 2010 5:19 PM
Skullberg, this is pretty basic - Megan, not Martin, made the claim that most future beneficiaries are people who are just unhappy. It's up to her to back it up, not Martin to disprove it.

Reply

Megan McArdle (Replying to: Nimed) January 29, 2010 5:43 PM
Sigh. Look at the incidence of mild depression, which shows limited response to either treatment or drugs that is actually distinguishable from a placebo effect, and moderate-to-major depression. This isn't even vaguely controversial, as far as I know: mild depression doesn't actually respond to drugs in a way that is easy to distinguish from placebo, talk therapy has very dubious benefits except for CBT, and mild depression is much, much more prevalent than the kind that ends in suicide or a locked ward.

[snip]

alkali (Replying to: DBN) January 29, 2010 5:37 PM
Medication is pretty cheap too, relative to 24/7 hospitalization of a seriously-afflicted schizophrenic

Reply

Megan McArdle (Replying to: alkali) January 29, 2010 5:50 PM
Yeah, except the number of seriously afflicted schizophrenics who are holding down jobs, and thus eligible for employer-sponsored private health insurance (or able to afford their own) is very small. http://www.schizophrenia.com/szfacts.htm With people who have schizophrenia or similar illnesses, Medicaid, Medicare, and state insurance programs are more important. People underestimate just how disabling it is--just because we can control the hallucinations, doesn't mean we can restore people to a normal life.

For that matter, the severely clinically depressed are also fairly likely to exit the private insurance market, because one definition of severe clinical depression is that you're so impaired that you have difficulty carrying out major life activities. If it's persistent, it's probably not being covered through private insurance unless you have a very supportive spouse.

The New York Times must have run an article about depression, in between articles about young Park Slope matrons and trophy banker girlfriends. Now Dr. Megan knows all about the subject, and with the full authority of The Atlantic and David G. Bradley's hundreds of millions behind her, feels free to tell the anguished and suffering that they can just go curl up in a ball and die. The fakers.

Play That Funky Music, White Girl

Kathryn Jean Lopez twitters:

whoa. frank luntz gets ditzed. how does he know fox news cut away?
about 2 hours ago from web

Breitbart's Big Government Demands Correction from Atlantic Blogger

Economics blogger Megan McArdle of The Atlantic is being targeted by Andrew Breitbart's Big Government web site for publishing incorrect information about the arrest of political agitator James O'Keefe. A "senior fellow at Breitbart" named Retracto, the Correction Alpaca, quoted a recent post by McArdle that discussed O'Keefe, who is employed by Breitbart, and demanded a retraction.

In Megan McArdle’s piece “A Tape Too Far” of January 26th, 2010, Ms. McArdle repeatedly refers to an alleged wiretapping plot by James O’Keefe at the offices of Sen. Mary Landrieu:

James O’Keefe, the guy who did the ACORN sting, doesn’t seem to understand the difference between a completely legal recording of an interview between you and someone else, and a completely illegal and reprehensible wiretapping of someone’s phones. Journalists are not spies, and there are very good reasons that you need a warrant to bug a telephone system or otherwise eavesdrop on third-party conversations.

Like many 24-year olds, he may not have fully appreciated why what he was doing was wrong, but if the allegations are true, I hope that the judge explains it to him while handing down a stiff penalty.

There are no allegations of any wiretap plot in the FBI affidavit, and a law enforcement official has conceded that the four men were not attempting to wiretap or intercept calls. Furthermore, legal representation for the accused has gone on record stating there were no intentions to bug phones in the Senator’s office. The Atlantic’s own Politics blog recently published a post acknowledging there was no attempt to wiretap.

We kindly ask you to issue a correction/retraction to the story.

We have been/will be making similar requests of other news sources to correct similar errors. Some, such as the Washington Post and MSNBC’s David Shuster, already have posted corrections or retractions.

In addition, Mr. O’Keefe is 25-years old.

Retracto did not mention McArdle's second post on O'Keefe, in which she softened her criticism by stating that O'Keefe's excuses had "the ring of possibility," although they did not nullify breaking the law, and what he did "was not right."

As of this time, McArdle has not responded to the demand for a retraction.

Jobs

Megan McArdle is dreadfully worried about all the people thrown out of work by our economic crash and the bursting of the housing bubble. All those construction workers, granite salesmen, interior decorators, window manufacturers, landscapers, restaurateurs, and other workers who depended on cheap credit and the credit boom to survive are losing their jobs, and the jobs won't be back. McArdle is worried sick.

In 1930s, when FDR was trying to combat mass long-term unemployment, all he needed to do was create a construction project; most of the men in the country did some sort of hard physical labor. It was relatively easy to create jobs that they could fill.

But what kind of public works projects would absorb mortgage brokers or mid-level managers? As jobs have gotten more skilled, more human capital is specific to firms, industry, and job classifications.

That means it's going to take longer to transfer those workers into other areas of the economy. Either they need to search harder to find a job that meets their skill set, or they need to get new skills. Either way, that high unemployment number is probably going to be very stubbornly persistent well into next year.

Oh, my bad. She was talking about the bankers.

Jonah Goldberg in Skirts

Megan McArdle (among others at The Atlantic) live-blogged Obama's State Of The Union address, sharing her wit and wisdom with the masses, and telling us all that it was a waste of time.

Preview
Let us not mince words, nor even chop them loosely: most State of the Unions are, well, completely useless. As useless as the human appendix. As useless as the six layers of weapons-grade saran wrap in which all convenience foods now come encased. And frankly, almost as time consuming. What does a president say in a State of the Union? Mostly, that the State of the Union is swell--or at least, a heck of a lot better than it would be if you'd elected that mouth breather who opposed him last November. He introduces artfully picturesque "ordinary citizens" hand-selected by his political operatives after months of careful screening. Platitudes about America's commitment to democracy are mouthed. Freedom is praised, in the most general terms, but with a thundering delivery that suggests that many of the people in the room might disagree. Uncontroversial policies, so anodyne that they could be opposed only by an Objectivist psychopath, are unveiled. Oppositions are chided for, um, opposing the president's policies. The particulars hardly matter.

But this one is a little bit different, isn't it? These days the Democrats are feeling, well, a little under the weather. I don't know whether America is looking to see whether Obama can muster a rally out of the doldrums that have lately afflicted his party. But the chattering classes certainly are. Can he do it? Unlike the previous occupant of the office, Obama is a master of soaring oratory.

His name was George W. Bush. You voted for him twice, remember? Or does that name bring back bad memories of war, economic destruction and global humiliation?

But State of the Unions are not a super vehicle for the presidential agenda any more. Gone are the days when a president could command the attention of virtually everyone in this vast republic of ours, merely by getting the broadcast networks to air him speaking for an hour. Most Americans will not be watching. The ones that are tend to be the highly informed voters who already have pretty set opinions. No State of the Union has delivered a poll bounce since 1998--and that was the year that America was watching, fascinated, to see whether Bill Clinton would address the issues raised by Ms. Lewinsky. Unfortunately for Obama, he's only been caught with a naked business recession. His speech may be worthy, but it will not likely be worth much at the polls. Nor will it tell us very much that we didn't already know.

Because it's all about the polls, not governance. Like many conservatives, McArdle has reduced democracy to a pissing contest.

The Meet and Greet
We are now in my favorite part of the SOTU: the part where the President walks through an adoring crowd and is applauded either for his ability to shake hands with the men and kiss the women, or for just being, well, Mr. President. There is no better guide to our political culture than this: our president gets the most applause when he is doing nothing but beaming for the camera.

McArdle graces us with more of her undergraduate-level cynicism, and her belief that governments should do nothing but kill foreigners and keep the peasants happy enough to prevent revolt.

The Opening
Obama leads with D-Day, and how we didn't know back then how it was all going to turn out. In fairness, he came into office at a most unpropitious time. But I think the faster the Democrats get over the notion that Obama is FDR 2.0, the better off we'll all be.

The only one who said Democrats think or want Obama to be FDR 2 is McArdle.

Washington is Broken?
Marc [Ambinder] suggests that the theme of this speech is "Washington is Broken". Is this a wise move? That was, after all, the theme of most of his prior speeches, indeed, the theme of his whole campaign. Obama convinced millions of voters that he could fix the broken-ness, something not in his power to do. Now they're all furious with him, and the rest of us are just as skeptical as we were before. So what good does it do to complain that DC is broken? He is president of the country we have, with the political system we have, not some other place with more felicitous rules.

Yes, pointing out the country has problems that need to be solved during a depression is a stupid, useless idea. Ignoring the economic situation would have been much, much better, and not garnered any criticism at all from facile, antagonistic pundits.

The Stimulus and Jobs
The first of the Amazing Political Whoppers That Cannot Actually Be Disproved emerges: the administration has saved 2 million jobs. That's supposed to vindicate the rather unpopular stimulus bill, which cost about $860 billion. If my math is correct, that means that instead of doing the stimulus, we could have given two million people $400,000 apiece to tide them over while they looked for work--and still come out ahead.

McArdle hates the stimulus and loved the bank bailout. Money for banks, not jobs! That's just what the average tax-payer wants to hear, as her tea-bagger fiance can tell her. I could check her math, but math and McArdle are natural born enemies, and the odds of her success are so low that they can be ignored.

The Jobs Bill
The jobs bill is coming! What the jobs bill might actually look like, however, is depressingly vague. Obama wants a jobs bill on his desk without delay . . . but what will be in it? We can't all develop lucrative new businesses designing windmills or insulating homes. All presidents keep these things to broad outlines, of course, but Obama seems to be delegating any actual details to Congress. That didn't turn out to be a winning strategy with the health care bill, and I'm not sure it will with jobs, either . . . the kind of compromises that legislators make to get things passed then take front and center in the political narrative about the bill. Obama's main contribution cannot simply be bashing the scary Germans and French and Japanese who are going to steal our clean energy jobs unless we pour massive subsidies into the sector.

Government doesn't work and nobody can do anything ever.

The Nuclear Presidency
Nuclear energy . . . opening up offshore oil and gas development . . . clean coal . . . if Obama keeps tacking right, I'm going to get seasick.

No praise for Obama's embrace of McArdle's beloved free market? How ideological of her.

Protectionist Sops
Now Obama gets into the part of his candidacy that I most hated: bashing foreigners and their tricksy imports. But it could be much worse . . . indeed, he said much worse on the campaign trail. It's just confirming what we already knew, which is that the Obama adminstration is not going to meaningfully enhance trade freedom.

He's also not going to embrace unicorns or fairies, which are just as real as McArdle's free markets.

On Health Care
I might be biased, but I don't think this part of the speech is particularly strong. This is a classic professor move that will be well known to the children of academics: I am very smart, so if you disagree with me, it must be because you are very stupid, or I have been insufficiently clear. This doesn't go down with the public at large any better than it does with the children of academics.

Arguing from authority is, of course, McArdle's modus operandi, and she doesn't like it when others steal her schtick.

Financial Reform, The Hard Way
As Josh [Green] notes below, the most interesting part of the speech is where he threatens to veto any financial bill that doesn't really take on the banks. The proposals he unveiled last week to limit the size of bank liabilities, and dismantle their proprietary trading desks, were greeted with acclaim by many financial journalists, but it is widely believed that legislators like Senator Dodd will simply kill them in committee. If he's willing to risk ending up with nothing, that may be smart politics--and perhaps smart regulation. But that's a very daring move for a president who has so far proved extremely reluctant to take on his congress.

You see, when a Democrat hands the banks everything they want he's weak and hypocritical. When a Republican does the same thing, he's saving the free world and global financial system.

It's All Someone Else's Fault, Except for Where I Didn't Make it Sufficiently Clear That it's All Someone Else's Fault
Weakest part of the speech by far is where he claims that anything you dislike about our financial state is the fault of George Bush. Not to defend the Bush deficits, but by the end of 2007, they were down to 1% of GDP, which is basically manageable indefinitely. The big deficit that Barack Obama inherited was the result of a financial crisis that crushed tax revenues, and stimulus/bailout policies that were enacted when one Barack Obama was a Senator.

That's so dishonest I don't know whether she's being clever or stupid.

Yeah
I'm talking about the part where he indicates that disagreement with his policies is simply due to the fact that he hasn't explained them well enough.

Didn't the right just spend ten years telling us that if you believe hard enough you'll succeed, even when you fail?

Hail Mary Pass
Obama is arguing that legislators should be governing, not setting themselves up for re-election. The era of the permanent campaign is certainly wearying . . . but it's also true that the more details emerge about his health care plan, the less the citizenry likes it. It cannot be true that legislators are supposed to govern entirely without reference to the wishes of their constituents. Also, it is easy to say, as Nancy Pelosi has, that she's willing to lose twenty seats in the house, or for Barack Obama to tell legislators to ignore the electorate, when neither of them is in danger of losing their jobs in November.

It's all about elections, winning and losing, being a failure or being a success, not running the country.

Water Cooler it Is!
But in a parting shot, I will ask how he could have explained his policies, when Congress hadn't written them yet? By the time the policies emerged, people had seen too much of the sausage-making process . . . and involved substantially reneging on important promises he'd made about things like transparency, and the mandate for health care.

She had nothing to do with the sausage-making, of course. It's Obama's fault that he must deal with the Party of No. And lets utterly ignore the fact that Obama is giving the health care industry whatever it wants, just like he did with the banks. But Obama is pretending to be against the banks, and McArdle doesn't like even fake criticism of her Daddy authority figures.

Woo Reagan!
Foreign policy is not my beat, but props for name-checking Reagan on his efforts to speed nuclear disarmament. Very smart politics, and might quiet the sort of Republicans who view anything except bristling aggression as a wimpy metrosexual cop-out.

Because people who automatically call their enemies effeminate are reasonable people who can be mollified with a few flattering words.

Right Makes Might
We also do it because it is right. Best, most passionate line of the night. First glimpse I've seen of the Obama of yesteryear.

The Obama she routinely trashed at the time.

Barack is Back!
Finally he gets to the stirring rhetoric we remember . . . urging America to pull together and try to be a little bit better, as a nation. I kind of want to go out and hug someone, and/or join the Peace Corps. That sounds sarcastic, but I'm not really kidding.

She's a Randian, you know--the former Jane Galt.

Good Question
Why do we put our whole government in one room where they could all be taken out by a nefarious terrorist attack?

Because it's kind of hard to carry out a massive, planned terrorist attack, unless a lazy moron like Bush is in charge.

Republican Response Preview
Responses to the State of the Union are almost uniformly awful. In recent history, Katherine Sebelius looked and sounded like an early-model Cylon. Then responding to Obama's Not-quite-state-of-the-union address last year, the normally quite personable Bobby Jindal was so wooden, he was practically petrified. This is thought to be an artifact of the format, in which a politician who does, in fact, know how to talk, tries to do so while speaking at length to a round glass circle. So tonight, Virginia governor Bob McDonnell will be giving the response in front of a live audience in the Virginia legislature building. That may mitigate the awfulness, but unfortunately for him, Obama is a very, very tough act to follow.

She's Fair and Balanced.

Republican Attack Machine on Mute
A friend notes that there were fewer boos than usual from the opposition side. And the speech is pretty friendly, which is smart politics. Obama is still personally pretty popular, and his speech didn't turn on the Republican-bashing that it might have. If the Republicans break out the heavy weaponry, they'll just alienate the audience.

Doesn't this contradict everything she just said?

Response Better Than Expected, But Not Actually Good
Fiance tweets: GOP roboresponse surprisingly lifelike. Indeed, much better than the usual show. If only I could actually remember something the good Governor had said for longer than two minutes. The actual content sounded like the sort of talk that local politicians give to girl scout troops.

Would that be the tea bagging fiance that she mentions every five minutes? I thought "my husband, the doctor..." went out of fashion in the seventies. But she can sound cynical and contrarian again, so for her it's a win.

Roundup: No Game Changers
Like Josh, I think we saw two serviceable speeches tonight. Obama was his usual, excellent caliber. Bob McDonnell did not utterly humiliate himself, which is a big win for a SOTU response. There were a couple of minor "That's interesting" moments with financial reform and gays in the military, but mostly it was both sides saying, "I wish you'd help me enact my agenda, America." Which is not exactly surprising. In the end, maybe Obama gets a transitory bump on the strength of his delivery, but I don't see it really moving the needle on any issues. Nor do I think that the Republicans are going to rally behind McDonnell's stirring rhetorical presence and storm the nation's capitol. So everyone sleep easy . . . the world will still be much the same when you wake up tomorrow.

Do nothing. Nothing matters. Go back to sleep. Eat. Reproduce. Consume.

And we're done, thank all the imaginary gods and goddesses.

Honeymoon Hints

Folks, Megan McArdle needs our help. She is trying to decide where she will take P. Suderman for their honeymoon and is asking for advice. Should they go to Hawaii or Turkey? Let's discuss.

Hawaii is a very traditional honeymoon destination, due to the beautiful beaches and other fascinating natural features such as volcanoes and tropical forests. But that is its problem--any common Megan, Dick or Harry can go to Hawaii, and when one is relating the fascinating tales of one's honeymoon to one's rapt social circle, one will excite neither awe nor envy. And what is the point of traveling unless you can brag about your expensive and exclusive vacation, exciting others' envy and resentment? It's like a sundae without the cherry and whipped cream! Let the hoi polloi go to Hawaii--McArdle and P. Suderman deserve better by virtue of their superior birth.

On to Turkey, then! But alas, Turkey, while exotic and adventurous, is, well, full of inferior people who don't even speak English or understand the superiority of the American Way of Life. Will they have Himalayan Rock Salt? Will the maids turn down her bed and leave a mint on the pillow while modestly keeping their eyes downturned as a recognition of their fiscal inferiority? Can you stiff your waiters while telling yourself that you're going galt for their own good? It's one unknown after the other.

True, you can haggle the natives down while shopping, carefully calculating their degree of poverty to gauge how little you can pay them. (Hint--buy rugs at a shop where the proprietor has lots of little kiddies running around. He might be more desperate.) Since the acquisition of possessions is the main goal in life and the only gauge of its quality, the shopping might make up for all the stupid historical sites and Islamic influence.

I have a better suggestion, of course.



Come to beautiful Baghdad!

It's very close to Turkey but without all its boring archaeological sites. Sure, they preserved our mutual human history for centuries, history that told us how civilizations rose and fell and gave us the origin of our religions, priceless, utterly irreplaceable means of increasing the total of human knowledge, the most exalted goal of mankind. But now they are gone, having made way for American bases and battlefields, so McArdle need not be concerned with them. Unlike Turkey, everything is privatized on the American bases, and she can rest assured that Halliburton and KRB will take very, very good free market care of her.

Some might hesitate to honeymoon in Iraq because of its infrastructure and violence, but McArdle knows better. She says that the the country is better off than before Saddam Hussein was executed, and quite safe. Best of all, she can visit our troops in person to show her support for all they have sacrificed for her, for their own good.

By the way, I still haven't received my invitation to the wedding, hint hint.

The Pimp's Hooker Throws Him Under The Bus

'Shocked' [NRO Staff]

From Hannah Giles, in regard to news coverage of James O’Keefe’s arrest in Louisiana:

I am shocked by the reports of this behavior. I am well aware that following the law is an integral part of being a good investigative journalist. I take that responsibility and accountability very seriously. I certainly hope these reports are untrue.

Miss Giles is the daughter of Toownhall wingnut Doug Giles.

Doug earned his Bachelor of Fine Arts degree from Texas Tech University and studied for his Master of Arts in Christianity and Culture from Knox Theological Seminary. [Didn't graduate, did he?]

He’s the author of ten books on Christianity, masculinity and cultural insanity. His latest book, If You’re Going Through Hell, Keep Going is published by Bridge-Logos (Oct. 2009) and yet the little voices inside his head still will not go away.

Doug and his wife of 20 plus years have two daughters. Giles’ interests include guns, big game hunting, big game fishing, fine art, cigars and being a big pain in the butt to people who dislike God and the USA.

It looks like Miss Giles, despite being raised by a Rush Limbaugh wannabe, has enough shrewdness to run away from the latest generation of Young Republican dirty tricksters.

Grow Up

Miss Megan McArdle scolds that little scamp, James O'Keefe, who was arrested for attempting to monkey with a congresswoman's telephone system, in a federal building. McArdle notes that O'Keefe, disguised as a pimp, taped the ACORN interview that set off a firestorm in public.

In three posts on ACORN's perfidy, Miss McArdle has declared that ACORN is hopelessly corrupt and must be thrown off the bus, to be run over by the wheels of justice.

I don't see how ACORN survives at this point; the IRS is the latest to pile on, severing ties with ACORN, and slapping a tax lien for unpaid payroll taxes on top of that blow. The lawsuit seems like an even worse attempt--less of a Hail-Mary Pass than an own-goal. At best, it keeps this distressing story in the news, more firmly impressing it into peoples' consciousnesses and making it therefore more difficult for Democrats to quietly let the organization back on the government gravy train at some future date. At worst, the lawsuit opens up ACORN to discovery, during which the defense can plunder their records. ACORN appears to be trying to avoid this fate by suing for intentional infliction of emotional distress rather than defamation (for which truth is an absolute defense). But that just makes it more likely that the case will be removed to federal court and dismissed. When that happens, the public mind will not make fine distinctions about legal doctrine. They'll just remember that a judge thought ACORN was in the wrong.

Liberals have legitimate reason to be mournful--they think ACORN does good work. But no organization is irreplaceable. Voters can be registered, tax advice proffered, and federal monies disbursed without ACORN's dubious help.

Naturally McArdle advocated for the throwing of Mr. O'Keefe under the nearest bus as well.

A Tape Too Far
James O'Keefe, the guy who did the ACORN sting, doesn't seem to understand the difference between a completely legal recording of an interview between you and someone else, and a completely illegal and reprehensible wiretapping of someone's phones. Journalists are not spies, and there are very good reasons that you need a warrant to bug a telephone system or otherwise eavesdrop on third-party conversations.

Like many 24-year olds, he may not have fully appreciated why what he was doing was wrong, but if the allegations are true, I hope that the judge explains it to him while handing down a stiff penalty.

You knew that going to happen, didn't you?

When my father was 24, he was married and had two children. He was in the service and within a few years had won the Silver Star and Distinguished Flying Cross, which were sent to his widow. It is more than a little distasteful to excuse O'Keefe's actions because of his youth. Not everyone is an eternal adolescent.

Dishonesty in Action

One of the key ways dishonest hacks get away with being dishonest hacks is by ignoring facts. Let's look at one recent example: Megan McArdle responds to Nate Silver:

Health care's popularity drops any time Congress discusses it. With respect to Nate Silver, who argues that the bill would be popular if they ever passed it and could discuss what's in it, you cannot "prove" that voters like a bill because various bits of it poll well on their own. Do I want a sous vide machine? Certainly! I could take a poll that would show nine or ten wonderful things I would love about owning a sous vide machine. Am I going to buy one? No I am not, because it costs hundreds of dollars I need for other things.

McArdle dismisses some parts of the poll and ignores others . But let's go back to the beginning. Nate Silver stated:

[David] Brooks' analogy to the debate over health care, then, is somewhat ironic: once again, one side has told a lot of lies to help alter the course of public opinion. Some of these lies, like death panels or the government takeover meme, are not very subtle. Others are a little more clever: the notion, for instance, that we could easily require insurers to cover all people with pre-existing conditions without either adopting an individual mandate or substantially escalating premiums.

And those lies have had an impact.

McArdle responded:

People aren't responding to "lies". They are saying that they do not believe administration claims that this program will reduce the budget deficit without impacting quality of care--a pretty safe bet, to my mind. But even if you disagree, it is not crazy and delusional to believe that government programs often do not deliver what the politicians who enacted them promised. It's a pretty safe reading of history, actually.

Silver:

With due respect to Megan, however, the debate over health care is not playing out like the one in elite circles of public opinion, in which Ezra Klein and I represent the pro-bill coalition and she and David Brooks the opposition. As this month's tracking survey from the Kaiser Family Foundation makes clear, there are a lot of beliefs the public has about the bill which are objectively wrong.

[snip]

What we see is that most individual components of the bill are popular -- in some cases, quite popular. But awareness lags behind. Only 61 percent are aware that the bill bans denials of coverage for pre-existing conditions. Only 42 percent know that it bans lifetime coverage limits. Only 58 percent are aware that it set up insurance exchanges. Just 44 percent know that it closes the Medicare donut hole -- and so on and so forth.

"Awareness", by the way, might be a forgiving term in this context. For the most part in Kaiser's survey, when the respondent doesn't affirm that the bill contains a particular provision, he actually believes that the bills don't include that provision. 29 percent, for instance, say the bill does not contain a provision requiring insurers to cover those with pre-existing conditions; 20 percent think it does not expand subsidies.

How would public opinion change if people were fully informed about the content of the bills? It's hard to say for sure, but on average, the individual components of the bill are favored by a net of +22 points. An NBC poll in August also found that support went from a -6 net to a +10 when people were actually provided with a description of the bill.

[snip]

Lastly, it's much harder to read the opinion polls as a "mandate" against the health care bill when much of that opinion is based on demonstrably false beliefs, some of which have been perpetuated deliberately by opponents.

Silver looks at the evidence: support for the bill (not health care reform in general--support for the actual bill) increased from -6 to +10 when people saw what was on the bill. The poll questions include questions on cost; the price tag is unpopular, but people still regard the bill with favor. Few people enjoy paying for what they need, but most people who are not tea baggers realize that you have to pay for services, even if you don't want to pay. McArdle's response:

Health care's popularity drops any time Congress discusses it. With respect to Nate Silver, who argues that the bill would be popular if they ever passed it and could discuss what's in it, you cannot "prove" that voters like a bill because various bits of it poll well on their own. Do I want a sous vide machine? Certainly! I could take a poll that would show nine or ten wonderful things I would love about owning a sous vide machine. Am I going to buy one? No I am not, because it costs hundreds of dollars I need for other things.

Almost everything polls well on its own, except tax increases. But as in my example, deciding whether you want something is not a matter of simple addition of positives and negatives. Some negatives, like price tag, can outweigh even a stunning array of positives. The things that poll badly: price tag, excise tax, individual mandate. These are crucial components that can't be gotten rid of.

An intelligent person might conclude that if health care polls well when the bill itself is presented and polls badly when Congress describes it and people are being lied to about health care, then Congress is lying about health care. Which is actually happening. Instead, McArdle states that people don't believe the positive aspects of the bill will be enacted, the price tag outweighs the benefits, and people hate the health care bill. She offers no proof whatsoever, of course. That is how she responds to facts--with her opinion. Then we are graced with sermons such as this one:

Obviously, Nate believes that the bill will improve things like out-of-pocket costs and choice of doctor. That's why he supports it. But those aren't scientific facts; they are opinions. In fact, in Massachusetts, the new system has led to considerable bottlenecking of health services which has reduced access for those who already had care--it's harder to get a doctor's appointment, etc.

If you make the mistake of thinking that your opinions are scientific facts, then it's obviously going to be mysterious and not a little scary that people believe otherwise. Then you have to start inventing shadowy conspiracies against The Truth.

McArdle calls Silver's facts opinions. She then calls her opinions facts. Ipso facto, McArdle is right and Silver is wrong! Mirabile dictu!

And all you have to do is ignore reality for the fantasy land in your head. No wonder David Brooks loves McArdle's work. His latest column is based on the lie that America is the land of opportunity. All you have to do is ignore the facts and you can say whatever stupidity you want. McArdle can't think logically or make good decisions and choices because she ignores facts in favor of self-flattering or self-aggrandizing opinions. It makes her stupid, and it makes her dangerous.

Double Standards

We are pointing out the obvious, but it's pretty funny to see Megan McArdle report on the Stuyvesant Town's default without mentioning its owners' moral duty to keep making their payments. McArdle's example for her moral lecture was a woman with a comparatively high income who could not afford to keep all her property, so she walked away from her residence, just like the Tishman Partnership walked away from Stuyvesant Town. Tishman Speyer has property all over the US and the world. In fact, they have multiple properties in DC. Should they be allowed to keep all those properties or sell them to afford payments on Stuyvesant Town? The answer is simple. Corporations do not have to honor contracts. Individuals do.

Progressive Fascism: What is It?

Many people are just hearing about progressive fascism for the first time, so let's have a quick review of the phenomenon.

To understand liberal fascism, we need to understand some basic logic, using an example provided by Jonah Goldberg, the author of Liberal Fascism.

First, the logic:

A=B

B=C

Therefore, B=D

Perhaps you have seen this before under a different guise:

A=B

B=C

Therefore, A=C

This is not right. If A and B are the same, anything else under A or B (D) must be the same. For example:

Hitler liked puppies.

Liberals like puppies.

Therefore Liberals are Fascists.

The logic is inexorable.

Liberals don't want you to know about their Fascism because they don't know about their Fascism. By denying the historical roots of their party, they fail to understand fruit of its fascist flowering. Goldberg realized that when liberals call conservatives fascist, they are merely using the well-known Hitler technique called "Retroactive adhesion post hoc preventative accusation."* In other words, the only way to stop liberals from calling Goldberg's father a fascist was to call liberals (alias "progressives") fascist in return, only for real and not for made-up. This brilliant stroke of scholarship paved the way for others like Glenn Beck to spread the word that liberals are fascists.

But what is a fascist? According to Liberal Fascism, fascism is telling others what to do. Since liberals love to tell others what to do, of course they are fascist. Anyone who is part of the government and tells others what to do is therefore a fascist. That is why conservatives can't be fascist--they never want to tell anyone else what to do. Whether it's regulation, taxation or congressional oversight, you will never find a conservative telling anyone else what to do.

Some people mistakenly think conservatives want to tell others what they can and can't do in the bedroom, but that is not fascism because God tells conservatives what to tell everyone else to do, and everyone knows that God can't be fascist because he's not a liberal. QED.

But what do liberal fascists want? Goldberg says that fascism is a "progressive social movement," so logically any signs of social progress, such as a decline in unemployment, poverty or oppression, is fascist. Conservative philosopher Edmund Burke, the founder of conservative philosophy, declared:

We fear God, we look up with awe to kings; with affection to parliaments; with duty to magistrates; with reverence to priests; and with respect to nobility. Why? Because when such ideas are brought before our minds, it is natural to be so affected.

Unlike liberals, conservatives want everyone to know his place and stay there. Kings should be looked upon with awe, your government representatives with affection, and your social betters must be treated with great respect. Likewise the elite must insist that the lower orders stay in their place, for progress leads to change and change leads to fascism.

*"whatever my enemy says will be cast forth from him and return, always stuck to him"

Oops

Megan McArdle is just thrilled that corporations can spend as much money as they want to get out their political message. Why not, she trills merrily. After all, any money corporations spend to make more money is a good thing for the corporations, and what is good for corporations is good for America. And they already spend millions anyway, what's a few hundred million more? The only possible drawback she can find is the possibility that corporations might suffer from spending more money on political advertising and less on corporate advertising.

It does not occur to the little miss that the money won't be taken away from tv ads aimed at consumers. It'll come from the middle men who passed on the corporation's political message in a consumer-friendly form. It'll come from Megan McArdle.

Lying

Nate Silver says that people lied about health care, an indisputable fact. Megan McArdle is perturbed.

If this becomes the party line, the Democrats are in big trouble. Every time something goes wrong with their electoral fortunes, Democrats seem to revert to the same defense mechanism: they are victims of crafty and vicious Republicans who use their secret mind control machines to spread a particularly powerful brand of lies.

No, they just lied.

You know what doesn't build a powerful electoral message? Telling each other that everyone actually loves your program, except for the fact that the other guy tells so many lies about it! I mean, this is particularly rich coming out of an election where your candidate assured voters that your opponent supported a law to turn rape victims away from emergency rooms (maybe the problem is that Republicans pick believable lies?) But it's never a good strategy.

She's lying. Silver links to proof that most people want health care reform when they are not being lied to about it.

First of all, your perception of what constitutes a lie, versus what constitutes an uncharitable interpretation of your policies, is bound to be somewhat skewed. I quote the normally extremely astute Mr. Silver:[snipped quote]

We don't have to depend on perception. The facts tell us when someone is lying or not. In McArdle's head, lies are the same as facts if you believe in them hard enough.

And those lies have had an impact. Let's look at, for example, at what opponents of the bill believe, according to the latest Pew poll:

Among those opposed to the health care bill, majorities think that their choice of doctors would be impaired, their out-of-pocket costs would go up, their wait times would increase, and the quality of their care would suffer. Meanwhile, only 27 percent of Americans opposed to the health care bill -- and only 39 percent overall -- believe that their ability to get coverage would improve if they had a pre-existing condition.If that's what people believe, then forget a majority -- it's amazing that health care has even the 40 percent support that it does. But these beliefs range from mostly or probably wrong to completely and demonstrably untrue....

Now, on one item, the "anti's" are pretty obviously wrong--the program was pretty clearly better for people like me with pre-existing conditions. But all the rest of it is debatable.

If you're a liar.

Obviously, Nate believes that the bill will improve things like out-of-pocket costs and choice of doctor. That's why he supports it. But those aren't scientific facts; they are opinions. In fact, in Massachusetts, the new system has led to considerable bottlenecking of health services which has reduced access for those who already had care--it's harder to get a doctor's appointment, etc.

Ironically, she gives no proof of her opinion.

If you make the mistake of thinking that your opinions are scientific facts, then it's obviously going to be mysterious and not a little scary that people believe otherwise. Then you have to start inventing shadowy conspiracies against The Truth.

Also known as "pointing out that they are lying."

But while I do see categorical errors like people believing that thibill will make it worse for those with pre-existing conditions, when I look at the polls, most of the concerns are pretty reasonable.

Liar.

People aren't responding to "lies". They are saying that they do not believe administration claims that this program will reduce the budget deficit without impacting quality of care--a pretty safe bet, to my mind.

Says the liar.

But even if you disagree, it is not crazy and delusional to believe that government programs often do not deliver what the politicians who enacted them promised. It's a pretty safe reading of history, actually.

That, and all the lies.

So A Man Can Stand Up

Let me point out the obvious: Ezra Klein is not our friend. Like The Atlantic, the Washington Post has become a conduit for corporations to control the media message. Klein was hired by the Washington Post. They give him all his money, power and prestige. He routinely encourages Democrats to settle for less and less health care reform. He is emotionally tied to the elite and its wannabes, not the common person. Which is us.

We are not running this country. We do not have power over our elected representatives. We do not have enough money to counteract corporate bribes. We, as a people, state, and nation, are broke and in debt, and it will get worse.

There is such a thing as too late.

The democratic process, let alone the Democratic process, is broken and we are not powerful enough to fix it. That does not make us powerless, however. We have millions of people who are afraid and angry. The more we concentrate on middle class goals, fantasies and aspirations, the sooner we will lose the poor and disenfranchised. Which is us.

It is not just in our best interest to declare a movement of the working poor, for the working poor--it's the moral thing to do, and if we do not have the the sense of righteousness, energy and optimism that comes from knowing what you are doing is right, then we have nothing to offer at all.

Or we can keep looking for an authority (or party of authorities) to lead us, and express shock and disbelief when he proves to be allied with the elite.

Either way, we will be run over by the consequences of the last ten years. The only question is how we will react. Will we cower and accept our inferiority in the hopes of benefiting from the exploitation of the poor, or will we stand up like men and women and fight? Because fighting over the crumbs the elite is willing to throw our way is getting kind of embarrassing.

My Country, 'Tis Of Thee

Land of the free.

A new professional basketball league boasting rosters made up exclusively of white Americans has its eyes set on Augusta, but the team isn't receiving a warm welcome.

[yap yap]

Don "Moose" Lewis, the commissioner of the AABA, said the reasoning behind the league's roster restrictions is not racism.

"There's nothing hatred about what we're doing," he said. "I don't hate anyone of color. But people of white, American-born citizens are in the minority now. Here's a league for white players to play fundamental basketball, which they like."

Lewis said he wants to emphasize fundamental basketball instead of "street-ball" played by "people of color." He pointed out recent incidents in the NBA, including Gilbert Arenas' indefinite suspension after bringing guns into the Washington Wizards locker room, as examples of fans' dissatisfaction with the way current professional sports are run.

"Would you want to go to the game and worry about a player flipping you off or attacking you in the stands or grabbing their crotch?" he said. "That's the culture today, and in a free country we should have the right to move ourselves in a better direction."

Home of the brave.

A U.S. Airways jet was diverted to Philadelphia International Airport Thursday after a praying Jewish man's religious item was mistaken for a bomb, police said.

[snip]

Officials said a passenger had become alarmed by seeing a man with phylacteries — boxes containing verses from the Bible — which observant Jews strap around their arms and heads as part of morning prayers.

"Someone on the plane construed it as some kind of device," said Christine O'Brien, a spokeswoman for the Philadelphia Police Department.

A man was escorted off the plane by law enforcement officers while the other passengers also disembarked. O'Brien confirmed that no one had been arrested and no one had been charged.

Senior law enforcement officials told NBC News that they believe the man was a "nervous flier" and said they did not believe the incident was related to terrorism.

Since they were going to Kentucky, I'd be a lot more worried about their fellow citizens.

Bonus Racism:

When Haitians leave Haiti for the U.S. they get richer almost overnight. This isn’t simply because wages are higher here or welfare payments more generous. Coming to America is a cultural leap of faith, physically and psychologically. Arnold Kling and Nick Schulz note in their phenomenal new book, From Poverty to Prosperity, that low-skilled Mexican laborers become 10 to 20 times more productive simply by crossing the border into the United States. William Lewis, former director of the McKinsey Global Institute, found that illiterate, non-English-speaking Mexican agricultural laborers in the U.S. were four times more productive than the same sorts of laborers in Brazil.

Why? Because American culture not only expects hard work, but teaches the unskilled how to work hard.

That's dimwit Jonah Goldberg, the laziest man in all of Christendom.

I had high hopes for a McArdle/Goldberg alliance, until she went and got herself engaged to a go-getting tea bagger. Their offspring would have been utterly---unique.

The Inner Voice

Dear me. Megan McArdle has been driven to a frenzy by the prospect of letting people with previous medical conditions get health insurance. (Remember, this includes her as well.) One minute she's giving directions on how to steam carrots and the next minute she's in a posting frenzy, cranking out seven posts about the Coakley/Brown race and the future of health insurance reform.

First, McArdle warns Blue Dog Democrats that they might lose their seats if they pass health insurance reform.

There's been talk of delaying either the certification or the seating, but while this is possible, I don't think the Democrats dare do this (nor do I know that they want to commit a fairly outrageous breach of the electoral process). Moreover, it may be moot: apparently, the Senate precedent is that Kirk loses his ability to vote the day of the special election.

Of course, the Senate could violate its own precedent. But you can be damn sure the Republicans would turn it into a circus akin to Bush v. Gore, and the political cost would be appalling; I'm not sure it's too much to say that any Blue Dog who voted for such a procedural shift would probably lose their seat come fall. I'm sure it's a price that Pelosi is willing to pay--but I'm not sure the Blue Dogs are.

[yip yip yip]

The problem with Brown's election is not just that it would the Democrats of a seat in the Senate. It's that it would send a chill down the spine of every Democrat who is not sitting in an ultra-safe, ultra-liberal seat.

McArdle has said several times (after making especially stupid political predictions) that she's no expert in politics, yet she seems to be able to both predict elections and read the minds of people she knows little about. But soon she is declaring Coakley is in "free-fall," and wondering if she should have bet against her.

And even if I thought those numbers were about right, it might make sense as a way to hedge my net psychic wealth. If Scott Brown wins, I'm happy--and if Martha Coakley wins, at least I get $50 or so to drown my sorrows.

I'm a great believer in hedging emotional risks. Betting against an outcome you really want is an excellent way to manage downside disappointment. But in the case of the whole future of our nation's health care policy, I can't quite bring myself to do it. Some risks are better off unhedged.

Only McArdle would think of shorting her own happiness. I hate to think of the odds she's assigned P. Suderman, considering his tragic lack of a trust fund.

Because she has decided that the nation does not want to get the health services they are already paying for, McArdle next advises Democrats to throw in the towel on reforming health insurance. Sunk costs fallacy leads to looking like a doofus when you can't get legislation passed that nobody wants and then you commit suicide. I gather that's bad for Democrats.

Of course, one could say that the political argument [for health care reform] is cold and inhuman, and that's not how politicians should be making this decision. Perhaps so.

In my mind, she is filing her nails while saying this.

In fact, McArdle says, Democratic politicians should be terrified.

Hell, If I were Blanche Lincoln, anyone in the leadership who wanted to get me to the floor for a health care vote would have to pry me out of the darkened room where they'd find me huddled in the corner, rocking back and forth and crying. Maybe Cohn's right and the thing's too far gone to save, so you might as well vote for it anyway. But that's not exactly soothing, is it?

Not exactly sturdy, pioneer stock, is she? I hope to heaven she never ran for class president. Children can be so cruel.

Speaking of cruel, McArdle works herself up into an unpleasant froth in her next post. It's unusually shrill for McArdle because it's personal. I hardly know where to start quoting--it's hysteria and self-justification from one end to the other.

Hold your breath. We're going in.

In 2004, the day after George Bush was re-elected, New York was a sullen place. At lunch, I sat next to one of my favorite New York liberals in brooding silence for a while, and then her sadness and rage suddenly erupted.

"I just didn't realize," she said, "that America hated me."

What do you say to that? America didn't hate her; America didn't know her. America mostly wasn't thinking about her. Yes, I've no doubt that the more tribal political partisans were cackling at the thought of grieving New York liberals (and in 2006, their liberal counterparts were prowling the internet for pleasurable nuggets of schadenfreude--no, don't deny it, I physically watched them do it.) But most people hadn't been thinking about my companion when they voted. They'd been thinking about themselves. They'd been trying to do, in their own hamfisted and probably ignorant way, the best thing for themselves and their country.

"Tribal"? Has McArdle been talking to a liberal? Someone set her off. Now a liberal is all liberals, all New Yorkers are liberal, and all liberals are self-obsessed. That would make McArdle a liberal narcissist, which would only be half right.

I've got a fine sense of deja vu after reading this on Andrew's page:

[...]The past year has been a very difficult one for me, personally and professionally. I've been up a lot more than I've been down, and I've been angry and frustrated with life, as we all are at times. But I can't remember the last time I felt such overwhelming rage toward a group of people as I have felt toward the Republican Party and the conservative movement since President Obama's election.

I simply cannot grasp what motivates these people, what compels them to thwart even the smallest attempts to clean up the enormous destruction they wrought under Bush and Cheney. Irresponsible, hateful, mendacious, sleazy, destructive - these words do not even begin to describe them.[...]

Saying that you "cannot grasp" what motivates others is supposed to indicate their utter moral turpitude, I suppose. And in the case of say, people who rape children, yes, it's true: I cannot grasp it. Can't imagine. Don't want to.

Her comparison is in very poor taste, but McArdle is defending her entire world view here. She has allied herself with failure too many times and is just a tiny bit sensitive about her decision-making process.

The next time you are trying to imagine why the people who disagree with you are actively promoting the destruction of all that is good in the universe, grab a soothing cup of mint tea, put your feet up on a comfy pillow, and then close your eyes and imagine what those people would look like campaigning against something that is a very bad idea. 99 times out of a hundred, you'll find that they look . . . well, exactly like they look when they're campaigning against your idea. And suddenly the whole thing is no longer so inexplicable, isn't it?

I mean, we all know that that's ridiculous, because you have never in your life been wrong about any major question, or had a bad idea of your own, which is why you are so fabulously wealthy and married to the first person you ever dated, who is even now smiling at you in blissful perfection from the arms of your four flawless children. But they don't know that, you see. As I think I've mentioned, they haven't met you. They won't know anything about you until you finally accept that Nobel Peace Prize. So you'll have to content yourself with understanding that while you, personally, may never be in error, other well meaning people sometimes are. And then still other well-meaning people have to get up off the sofa and point this out, lest they lead the entire nation astray.

This does not require arguing that the people who oppose you are right. Obviously, if you thought that, they wouldn't be opposing you. It just requires a little more empathy, a little less tribalism.

In other words, McArdle made indefensibly stupid decisions based on wrong facts, lack of understanding of human nature, inability to reason, vanity and hubris. When others demanded that she accept responsibility for her actions, she refused. Now she must spend the rest of her life telling herself that they just don't understand and they're just meanies and anybody could have made the same mistake. When, in reality: they do, they aren't, and you wish.

When I realized that health care was probably going to pass, I was, as you can imagine, sort of unhappy. I thought that this was, over the long run, very likely to result in the untimely deaths of lots of people, maybe including me. I may have been in error about this belief--but it was sincerely held.

Had I gone off into a despairing and rage-filled rant about how I just could not understand how all those people could be so determined to kill millions and millions of innocent people with their stupid central planning schemes that never work, haven't they seen what happened to the Soviet Union, ferchrissakes . . . should my views get a respectful hearing? I think not. Had I said anything like that, I would have sounded like an idiot. As, indeed, some of the more benighted conservative commentators kind of did.

I'm sorry, but just because she used to pretend she was Ayn Rand doesn't mean McArdle suffered through the Russian Revolution. Nor is national health care the equivalent of a Soviet program, as every other major nation can attest. Surely an elitist like McArdle understands that not all fears (or ideas) are equal.

Because it's not that hard to understand why the people on the other side want what they want. They look at people without insurance, and they want to help them. I'd like to help them too. They believe, as I do not, that the government will be able to muster the political will to control costs. They believe, as I do not, centralized government planning will improve the health care system rather than being hijacked by special interests within it. They believe, as I do not, that there is so much fat and waste in the pharma and medical technology industries that they can considerably reduce reimbursements without reducing useful innovation and thereby condemning those who might have been saved to an early death. These are not unreasonable beliefs. Neither are mine.

She's never going to admit she was wrong. Never.

In a situation like that, it is natural to despair that those who oppose you have made a tragic error. But if you want to rage, rage against the universe that provides us too little information, and too limited brains, to make perfect choices every time. If Coakley wins (or Brown does and the Democrats manage, against my expectation, to pass something anyway), I won't be happy about it. But I don't need to go inventing evils where none exist, for the sheer joy of venting my unhappiness on a person. Life is too short for me to spend any time manufacturing hatred for strangers.

Someone made McArdle feel bad for supporting policies that hurt other people.

Maybe there is just the tiniest bit of justice in the world.

A short finger-biter follows, in which McArdle, oddly enough, warns everyone not to panic. It's followed by a post that states blithely that Democrats will be sure to drag out the procedure as long as possible, because they're just silly that way. Then she mentions suicide again. I think she's hoping to brainwash through repetition.

No, she does not mention Al Franken.

Mercifully, she has only one more post, a deeply concerned and sorrowful account of how Democrats, having lost the Brown/Coakley race,* will not get to have a New Deal after all and they should have known better from the start. Nyah nyah.

LATER: There's more, but this is more than enough.

*The race was not over yet, by the way.

Ride, Sally, Ride!

This is Ben Bradlee. He is a billion years old.



Heh. No, he's "only" 89.

This is his wife, Sally Quinn. She's 69.



This is Scott Brown, who posed for this Cosmo centerfold when he was 22. He's 49 or 50 now.



Sally thinks Scott is "really cute" and "a hunk." Mmmmm, hunky politician. Growwwwwl, Cougar Sally, growwwl! After all, elections are about who pleases Sally and who doesn't please Sally. And my goodness, is Sally pleased!

God Forgive Us

McArdle is McBoring me today, so let's see what's happening elsewhere.

Ross Douthat's old column on Tiger Woods' lamentable lack of Christianity was predictably stupid, but there is one especially interesting paragraph.

Christians believe in a personal God who forgives sins. Buddhists, as a rule, do not. And it’s at least plausible that Tiger Woods might welcome the possibility that there’s Someone out there capable of forgiving him, even if Elin Nordegren and his corporate sponsors never do.

Why should Woods use the Christian model of sin, forgiveness and repentance? It's not exactly the most successful model in the world. Tell someone he is born bad and can't overcome his bad nature. Tell him is is absolutely bound to sin because of the sinful actions of his earliest fictional ancestor. Tell him that his loving, all-powerful god will hand him over to his enemy in the fiery pits of hell where he will suffer for all eternity. Then say that all he has to do is beg his god for forgiveness and his sins will be wiped clean and he will have eternal life as a reward. Finally, tell him he is a sinner who is bound to sin again, and must be ready to ask for forgiveness again.

That's a nice soul there. Be a shame if something happened to it.

The underlying reason for the bad actions is almost an afterthought. It's not that Tiger Woods was controlled and molded by his father into the image his father wanted him to have. It's not the obvious issues with power, self-respect, pleasure and human dignity that Woods has. No, he breaks the Christian laws and therefore must beg the Christian god to forgive him. And when he breaks the Christian laws again he can be forgiven again, just like a good Christian--over and over and over.

But at least he honors his father. It would have been terribly sinful for him to do anything else.

Standards of Living

Did you know that the quality of your life is determined by how many consumer goods you own? It's quite true. Megan McArdle, the economics blogger of The Atlantic, said so.

I don't want to sound as if I'm saying Britain's a terrible place--it's lovely, and I miss it. But the amount that people are able to consume is much less than the amount Americans are able to consume, and many of the things they forego make real difference in things like personal comfort.

Some people think rising income inequality is a problem, but as long as the American consumer can buy consumer goods, the poor are just lucky duckies with slightly smaller tvs.

I broadly agree with Will [Wilkinson] that consumption inequality, not income inequality, is what matters. If the rich have access to broad classes of goods that the poor can't have, I find this worrying. On the other hand, if the problem is that Bill Gates has a really awesome 80 inch flat panel television, while the poor have to be content with a 32 inch CRT, well, I can't say my heartstrings are plucked very tight by this injustice. So it's important to know what the real differences are.

This theory was very popular with conservatives and libertarians over the last few years; I'm sure I referenced it myself. But of course, as Ezra points out, some of that consumption inequality may well have been due to rising credit inequality: people borrowed money from their houses to buy consumption goods.

But I think it's easy to overstate the contribution of debt, for two reasons. First, many of the discussions on consumption equality focus on the poor, who were still relatively credit constrained even at the height of the bubble. And second, income inequality figures exclude both taxes and government benefits. Things like the EITC and Section 8 vouchers really have made a quite substantial improvement in the ability of the poor to consume.

So I don't think we actually know how much of a difference consumer credit made to equalizing consumption between rich and poor. I suspect that the continued mechanization of formerly labor-intensive tasks has made a greater difference, but then you'd expect me to say that. The data we want will not be available for several years, especially since period immediately following the financial crisis will be very atypical*, and therefore not useful in assessing the longer term trend.

Because America is the land of consumption and the ability to buy consumer goods is a gauge of our personal worth, America is better than socialist Europe. Everything depends on our money and credit and what we can buy with it.

We're the children of the middle class. And ever more, a clean credit report, a good FICO score, are the standards of a life well lived.

McArdle lives in horror of being unable to buy things.

While I was buying the iPhone, they pulled me aside for a credit review. Since I have good credit, this was shocking--and humiliating. For a middle class American, telling your two friends in the store that the AT&T folks are having second thoughts about giving you credit feels a little like confessing that you're a criminal. This is even though I know plenty of journalists with bad credit, the vicissitudes of the industry being what they are. I found myself earnestly protesting to the store clerk that seriously, I really do pay my bills on time, and I don't run a credit card balance.

It turns out they just wanted to look at the activity on my account, since I've just applied for a car loan, and bought a Verizon broadband modem. But in a way, it's a reminder of just how obsessed our society has become with borrowing money. The worst thing that happens to you if you borrow too much money is--it gets hard to borrow still more money. Yet during the recent financial crisis, commentators refer to bankruptcy, or foreclosure, as something akin dying of cancer, rather than losing your credit cards and moving to a rental flat. This may be because we so often confuse credit rating with moral virtue: good people have good credit, and bad people . . . well, best not say the "B" word out loud, lest the dread disease should spread to you.

I can't say that I've noticed that a good credit report is an obvious testimony to sterling character. I've known plenty of people with A+ ratings who I wouldn't trust to take care of my goldfish. And I don't even have a goldfish.

Of course there are irresponsible profligates who borrow money they've no intention of repaying. But most of the people I know with awful credit histories have rather more understandable explanations: a divorce. An unexpected illness. Trouble finding a job when they emerged from graduate school with hefty loans. Freelance jobs that took too long to pay--or went bust without reimbursing sizeable expenses.

The worst part is that the profligates are immune to the shame (or seem to be). It's the decent people, the ones who were overtaken by events, who cringe when the store clerks motion them aside.

You see, once upon a time McArdle herself was unable to buy things. She had trouble finding a job when she emerged from graduate school with hefty loans.

But that doesn't mean I don't understand how awful and terrifying it is to have expected a certain life, and have it stolen away from you by a fate you do not very well control. In June 2001 when I graduated from business school, I had a management consulting gig that was scheduled to pay over $100,000 a year and had just moved back to New York. Two months later, two planes crashed into the World Trade Center, killing a number of people I knew and leaving the rest of us traumatized. Four days after that, I was working at the World Trade Center disaster recovery site, trying to come to grips with what had happened. Four months after that, the consulting firm, having pushed back my start date twice, called my associate class and told all of us that our services would not be required.

For the next eighteen months, I struggled to find a job, in the teeth of a recession that kicked MBAs especially hard. It was awful in a way that is difficult to describe to anyone who hasn't been unemployed long term; the thing makes you question everything about your life. I remember going to see Avenue Q on a date, and writhing in humiliation, thinking that my date must be identifying me with the aimless failures on stage. I was 29 years old, and living at home. I had money--I always managed to work. But as far as I could tell, I had no future.

When I finally did get a job, with The Economist, it paid about a third of what I'd been expecting as a consultant. I had about a thousand dollars in loan payments, and of course, I had to live in New York, where my job was. For the first time in my life, I understood what Victorian novelists meant when they described someone as "shabby". Over the years since I'd had a steady income, my clothes had stretched out of shape, ripped, become stained, gone out of style. I couldn't afford new ones. And I wasn't one of those whizzy heroines who can make over her own clothes. Instead, I frumped around in clothes that never looked quite right, and felt the way my clothes looked.

It took me a long, long time to crawl out of that hole. I'll never make what I expected to make as a consultant. I'll never have the job security that I had learned to expect in the pre-9/11 world. The universe will always seem a potentially malevolent place to me, ready to unleash some unknown disaster at any moment.

And as God is her witness, Miss Scarlet will never be without material possessions again. But McArdle didn't always feel this way.

Many of the things on the list [of privileges of wealth] have nothing to do with "privilege", and in fact, I didn't get them, because my parents poured pretty much all of their disposable income into educating me: vacations, for example. Many of the other things on that checklist--getting a new car from your parents, going on a cruise with your family, having a television in your room--were rare among my ultra-privileged private school classmates because they were seen as vulgar; not having those things was a sign of higher social class. (I think some of that's changed now, though, from what I gather, not the disdain for cruise ships.) This list reeks of academics confusing their petit-bourgeois disdain of ostentation with actual privilege. Having a television in your own room is a sign of poverty mostly to the less well remunerated castes of the lower-middle class, who always feel they should be pouring the money into something more worthy; it is not an uncommon sight among welfare families in New York City.

Vacations with hotels are an even less reliable indicator of "privilege". Aside from a youthful trip to Niagara Falls, I can't remember any family vacation that did not involve visiting relatives, or did involve an airline flight. I can think of no way in which this hampered my development as a fully actualized human being, or an economically productive member of society; nor do I think that the fact that I have not been to Disneyland1 materially affected my chances at Harvard2. I'm a child of privilege not because my family gave me fantastic leisure opportunities, but because the circumstances of my birth and upbringing made it relatively easy for me to choose my path in life. Every one of those professors' kids is more privileged, in that sense, than the child of the median car-dealership owner.

McArdle went, as she has said several times, to a prep school that cost $38,000 a year. Those extremely wealthy students were not modest about their wealth either, and McArdle, as she says, was not in their economic class.

I went to school with a fair sample of the most obnoxiously rich people in the country.

As a teen, we can only guess what being one of the poorer of the rich kids did to her social position in her school. She has stated that being the tallest girl around was difficult and dealing with students who unthinkingly lived a lifestyle that McArdle couldn't compete with must have been difficult as well. We know exactly how she felt about being poorer than her social circle as an adult because she tells us.

[Writers] spend their twenties, and often their thirties, living paycheck to paycheck. They are extremely well educated, and all that education is not only expensive, but builds expensive habits. You end up with a lot of friends who make much more money than you--who don't even realize that a dinner with $10 entrees and a bottle of wine is an expensive treat, not a cheap outing to catch up on old times. Our business is in crisis, and we lose jobs often. When we do, it's catastrophic.

This is what David Brooks calls "status-income disequilibrium", and unless you are among that happy breed of writers who is married to someone with a high-paying job, or who has a trust fund, you feel it keenly. Everyone you write about makes more than you. Most of the people you know make more than you. And you come to feel that shopping at the farmer's market, travelling to Europe, drinking good coffee, are minimum necessities. Your house is small, your furniture is shabby, and you can't even really afford to shop at Whole Foods. Yet you're at the top of your field, working for one of the world's top media outlets. This can't be so.

So you insist on an elite lifestyle that is affordable. You buy expensive salt and read Gourmet, buy the biggest tv, buy clothing from the right stores and catalogues. You swallow the corporate propaganda that buying yet more consumer crap will make you one of the elite. You believe that as long as you can go shopping like the elite that you are one of them. Because somehow, somewhere, you have to still the nagging voices inside that say the rich kids really are better, that your education was wasted on a low-paying career, and that your parents sacrificed everything for you (and said so repeatedly) for absolutely nothing.

And you say that the American standard of living is much better than Europe's despite any evidence to the contrary, because to you, human beings are nothing but consumers to be exploited for personal profit, and whoever does the most shopping wins.

Death Comes For The Blogger

It seems that once again the Grim Reaper rests its cold, bony hand on the shoulder of our silent, brave asthma sufferer, Megan McArdle. Unfortunately McArdle does not tell us if her most recent doctor visit was paid for by her poor, put-upon employer, unfairly coerced by his socialist government to pay for the majority of Megan McArdle's health insurance payment, or if McArdle happily paid the full amount out of her and P. Suderman's own pockets, going Galt good and proper, the way good Galts go. Alas and alack, we shall never know.

Back to McArdle's bed of pain---

On the Pharma Gravy Train
Today, I became a big beneficiary of the enormous marketing budgets of pharmaceutical companies. I know many of y'all suspected it all along. But sadly, there was no massive check waiting for me in the mail today.

I don't think her readers think anything of the sort. Most tend to agree with everything McArdle says and disagree with anyone who contradicts her. Most liberals ignore her except when she is more egregiously and amusingly wrong than usual. If she is reading the two or three blogs that regularly call her corrupt, she is performing feats of self-absorption usually reserved for the likes of Ann Althouse. Why read unpleasant rebuttals when you refuse to respond to them or learn from them? To validate your existence, to feel important, to enjoy the sensation of attention being paid, no matter how negative? How awful.

No, what happened is, I went to the pulmonologist for a lung function test, because my asthma has been steadily getting worse for months.

And she is telling us this because---?

The bad news is what I already knew--I am no longer well controlled enough with Singulair and a rescue inhaler, and I need to go on inhaled steroids. The good news is that I left with an armful of free samples, so that I can figure out which inhaled steroid works for me most cost-effectively. That's courtesy of those bloated marketing budgets you hear so many complaints about, more than half of which go to free samples.

I hate to butt in and be a hater, but based on past experience I'm going to have to ask McArdle for a cite on her health care numbers. Remember when McArdle said that health care innovation will be destroyed if we have national health and then was forced to admit she made up her statistics? It's rather dispiriting to see McArdle pull out the same trick again but it is not surprising. What happened to innovation in hack journalism?

The authors focused their study on the United States because it is the only country in which information is available for all of the major promotion categories, and it is also the largest market for pharmaceuticals in the world, representing approximately 43% of global sales and global promotion expenditures.

Gagnon’s and Lexchin’s new estimate of total promotional costs is also consistent with estimates of promotional spending by the U.S. pharmaceutical industry from other sources they scrutinized, including reports by Consumers International, a non-governmental organization which represents consumer groups and agencies worldwide; Office of Technology Assessment, which extrapolated results from the cost structure of Eli Lilly, a global pharmaceutical company; Marcia Angell, former editor-in-chief of the New England Journal of Medicine, who extrapolated data from Novartis Inc., a company which distinguishes marketing from administration expenditures in its annual reports; and the United Nations Industrial Development Organization.

As well, note the authors, the number of meetings for promotional purposes has dramatically increased in the U.S. pharmaceutical industry, jumping from 120,000 in 1998 to 371,000 in 2004, further supporting their findings that the U.S. pharmaceutical industry is marketing-driven.

Thus, the study’s findings supports the position that the U.S. pharmaceutical industry is marketing-driven and challenges the perception of a research-driven, life-saving, pharmaceutical industry, while arguing in favour of a change in the industry’s priorities in the direction of less promotion, according to Gagnon and Lexchin.

Their study, “The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States,” appears in the January 3, 2008 issue of PLoS Medicine, an online journal published by the Public Library of Science.

The Push Strategy: Promotion to Physicians and health-care professionals [pdf]
“Despite the boom in consumer ads, doctors are still king” Maguire (1999)
However enormous the implications of DTCA of drugs and the budgets devoted to this, the issue of physician targeted promotion is significantly greater on all fronts, both financially and in terms of eventual outcomes. Komesaroff and Kerridge (2002) state that promotion and marketing to doctors makes up a quarter to a third of their annual budgets “… totaling more than US$11 billion each year in the United States alone).There are no comprehensive figures available, but it is estimated that, of this, about US$3 billion is spent on advertising and US$5billion on sales representatives, while expenditure per physician is believed to be over US$8000.” As mentioned earlier in this article the Canadian Medical Association Journal in 2002 estimated the US promotional spend to be even higher at approximately $19 billion dollars. This activity includes advertising, gift giving and support for medically related activities such as travel to meetings and support for conferences.
Why do firms spend so much on promotion to doctors? Essentially because they rightly see that doctors are the gatekeepers to the success of individual brands. To quote Barnes (2003) “Prescribing ‘events’ such as a physician swapping one brand for another …. Can make or break a brand’s success.”
Doctor-targeted promotion takes a variety of forms:
• Gifts, such as free samples, small stationery (Riccardi 2002), travel to conferences and educational events, and, some argue, cash (Medical Marketing & Media 2003, Prawirosujanto 2001, Strout, 2001)
• Sponsorship of conferences and educational events
EJBO Electronic Journal of Business Ethics and Organization Studies Vol. 9, No. 2
7 http://ejbo.jyu.fi/
(Moynihan 2003, Hayes et al 1990, Komesarroff and Kerridge 2002)
• The use of key opinion leaders – i.e. senior clinicians and medical educators as speakers at learned conferences Lerer (2002) Burton and Rowell (2003)
• Funding of medical journals through advertising. Pharmaceutical companies use medical journals to advertise their products, and frequently advertising revenue is the only source of funding of these journals, which are often sent free to doctors. Smith (2003), the editor of the British Medical Journal, writes thus of advertising by Big Pharma “To attract advertising these publications have to be read by the doctors whom the advertisers want to reach. So the free publications work hard at making themselves attractive, relevant, interesting, and easy to read – in contrast to journals, which are often delivering complex, difficult to read material of limited relevance.” Davidoff et al 2001 write of a decision among the editors of some of the world’s largest medical journals to adopt a common policy of disclosure of information about the source and validity of articles submitted for publication, and possible conflicts of interest. Hence, for example, contributors to the British Medical Journal must disclose any potential conflicts of interest that might arise. This policy does not however apply in the non-medical press and women’s magazines, and many of the world’s broadsheets carry thinly-veiled info-mercials for medical conditions, such as Revill’s coverage of female testosterone deficiency in the United Kingdom national newspaper The Observer in Jan 2003.
“ We doctors are shamelessly manipulated by drug companies in all sorts of ways. ..the methods cover the whole spectrum from subliminal to brazen, from little pens that don’t work to pushy reps” (Farrell 2000).

McArdle tells us that the scrappy little drug companies are willing to do what it takes to win her heart.

This isn't such a great deal for the pharmaceutical industry, since otherwise I'd be paying full freight for one of their products. All it does for the pharma firms is buy them a seat at the table--a chance to win my business. But it's a great deal for me, and millions of consumers like me who get a chance to try multiple products before we commit to one.

McArdle looks at the free sample in her hand and is filled with a warm glow at the thought of drug companies' beneficence. Then she stops thinking. Everything else is unimportant, for McArdle has what she wants.

About 90 percent of the pharmaceutical industry's $21 billion marketing budget is directed at physicians, according to JAMA. There are more than 90,000 pharmaceutical representatives that visit U.S. physicians, providing free lunches, gifts, marketing paraphernalia and free medication samples. These enticements are designed to influence doctors to prescribe more drugs and more expensive drugs and have often become a substitute for objective medical evidence.

"These marketing practices, including the growing number of "ask your doctor" commercials, has led to over-medicating of the U.S. population," says Michael Ehlert, M.D., AMSA national president. "There is substantial evidence that marketing shapes physician prescribing habits. By eradicating pharmaceutical companies from all medical schools, hospitals and academic medical centers, physicians will be able to go back to practicing evidence-based medicine."

Over the last decade, 70 percent more prescriptions have been written; though the population has only grown by nine percent. By "creating" illnesses, the pharmaceutical industry remains one of the most profitable industries on the Fortune 500.

As marketing to physicians and consumers increases, so does the price of medications. The pharmaceutical industry claims that high priced pharmaceuticals are essential to offset the expense of research and development, yet the number of research jobs has remained virtually the same since 1995, while the marketing staff has increased by more than 50 percent.

"AMSA wants to cure healthcare's addiction to the pharmaceutical industry and envisions a day when drugs are used because they are effective in treating disease, not because they are successfully marketed," says Anthony Fleg, AMSA PharmFree coordinator. "Our patients deserve the best care; and that means not prescribing a specific drug because the drug rep was attractive or because the physician's closet is full of free samples."

Back to McArdle:

One of the things that bugs activists about this practice is that the pharmaceutical companies record the cost of the marketing as the full price of the product, not the cost of producing it.

Yes, that's what enrages activists--accounting rules. I have no idea what she is saying here.

But this is actually the right accounting rule, precisely because of what I outlined above: the samples cost them a full price sale. One could argue that it should be slightly lower, because I might have insurance which would pay a discounted rate for the product. But whatever the exact right price is, it's closer to the market price of the product than to the production cost. Keep that in mind the next time you hear someone complaining that pharma spends more on marketing than development; if it weren't for all those free samples, and the reps who bring them to the doctors, they'd spend considerably less.

What? The cost of a sample is the cost of manufacturing a sample. They are pills made by the millions and given away by the thousands. You won't sell millions of those pills unless thousands of doctors decide to prescribe them. The free sample is a tiny part of the co-option of the doctor.

Drug companies spent more than $7 billion (not including drug samples) in 2003 on one-on-one marketing to doctors. This works out to about $8,400 to $15,400 per doctor per year. Studies show that such marketing works: interaction with drug company representatives were associated with changes in doctor’s prescribing patterns. There are several problems with this type of marketing. First, drug marketing emphasizes the latest and most expensive drugs even though these drugs may not be the best in their category according to the medical evidence. When marketing rather than objective and unbiased information shape prescribing patterns, the cost of prescription drugs for consumers, government and health insurers will continue to rise far faster than the general rate of inflation. Second, gifts to doctors also undermine the doctor-patient relationship by creating the appearance of impropriety.

[snip]

The Problem:

The $7 billion drug companies spent in 2003 on one-on-one marketing to doctors represents a 78% increase over 1999 levels. This amount includes direct gifts to doctors, such as expensive meals, entertainment, tickets to sporting events and travel, as well as the practice of “detailing.” “Detailing” refers to the practice of pharmaceutical companies sending representatives – essentially lobbyists for their drugs – into doctors’ offices. In 2001, the industry employed 90,000 drug company detailers – a ratio of 1 salesperson for every 4.7 office-based physicians. The purpose of detailing is to influence prescribing behavior. Companies often buy data about the prescribing patterns of individual physicians, and then use detailers to shift those patterns.

A former detailer explained that gifts:

“buy you time with a doc, time that might change his mind. . . .Money is the big resource. The pads and pens are great for access, but the dinners and what costs money—CDs, handheld computers, everything given in the name of research—this is what's thrown at docs to get them to change their minds."
A New York Times article reported that gifts can include five- and six-figure checks that arrive unsolicited in doctor’s offices.

These marketing efforts do influence behavior. In an analysis of several studies, drug company marketing efforts were associated with changes in prescribing patterns and requests to include particular medications on formularies, sometimes counter to existing efficacy evidence. In a study of residents, 84% thought that their colleagues were influenced by drug company detailing. In a June 2003 report, Forrester Research provided results from its survey of physicians who have expressed an interest in online detailing. Of respondents indicating they had participated in some kind of e-detailing, 67% had ordered samples and 58% prescribed more of the featured drug – all as a result of direct-to-physician marketing.

I read six articles and a report to refute these miserable four paragraphs. It's like pushing against the tide.