Health selection bias: A choose your own preposition contest

Back when I was in ninth grade, we were given a worksheet where we were supposed to fill in the appropriate conjunction in sentences where it had been left out. One sentence was “The baseball game was tied 0 to 0, ——– the game was exciting.” Not having any interest in spectator sports, I guessed “but”, assuming that no score probably meant that nothing interesting had happened. This was marked wrong, because those who know the game know that no score means that lots of exciting things needed to happen to prevent scoring. Or something.

With that in mind, fill in the appropriate preposition in this sentence:

Death rates in children’s intensive care units are at an all-time low ————— increasing admissions, a report has shown.

If you chose despite you would agree with the BBC. But a good argument could be made that because of or following a period of. That is, if you think about it, it’s at least as plausible — I would say, more plausible — to expect increasing admissions to lead to lower death rates. The BBC is implicitly assuming that the ICU children are just as sick as ever, and more of them are being pushed into an overburdened system, so it seems like a miracle if the outcomes improve. Presumably someone has done something very right.

But in the absence of any reason to think that children are getting sicker, the change in numbers of admissions must mean a different selection criterion for admission to the ICU. The most likely change would be increasing willingness to admit less critically ill children to the ICU, which has the almost inevitable consequence of raising survival rates (even if the effect on the sickest children in the ICU is marginally negative).

When looking at anything other than whole-population death rates, you always have the problem of selection bias. This is a general complication that needs to be addressed when comparing medical statistics between different systems. For instance, an increase of end-of-life hospice care, it has been pointed out, has the effect of making hospital death rates look better. (Even for whole-population death rates you can have problems caused by migration, if people tend to move elsewhere when they are terminally ill. This has traditionally been a problem with Hispanic mortality rates in the US, for instance.)

Is “shrill” gender-coded?

The Dish recently quoted a correspondent who, on his or her way to making a point about Chinese tourists wrote

This all has a cogent economic explanation. Paul Krugman, before his current role as shrill liberal attack dog, used to explain…

I found this comment irritating, for reasons that were not immediately clear to me. I have enormous respect for Paul Krugman, both in his earlier incarnation as a populariser of economic theory — particularly trade theory, but also macroeconomics — and as a blogger and twice-weekly columnist who occasionally veers away from economic issues. I think he has a healthy appreciation for his own intellectual strengths, but that he mostly stops short of egotistic attachment to his pet theories, whether defending past statements or being overly sure of his predictions. But I can’t say that there is no basis for someone to think that his tone is overly aggressive, that his political analysis is weak, that even his economic analysis may be distorted by political wishful thinking or antagonism. Those aren’t my opinions, but they’re widely held, and don’t seem to me outrageous.

But what is the role of shrill in that sentence? It’s not a word I hear often, but maybe it’s common in some circles. What does it mean? It’s clearly a free-floating insult, which somehow suggests derangement due to becoming overly emotional, and as such merely replicates “attack dog”. And yet “shrill” seems more contemptuous. What does it mean? Imagine replacing it by strident. It has the same signification with regard to the strength of advocacy, but the contempt is gone. So, is the contempt associated with high-pitched speech? Is this something like bitch, or the dialectical equivalent of “he throws like a girl”? Or is it taking the place of the free-form homosexual slurs that used to be ubiquitous, but are now no longer permitted?

“Could be of benefit to terrorists”: Theresa May channels Al Franken

One of the more ingenious bits of political satire that I have seen in recent years was a Saturday Night Live sketch (apparently conceived by Al Franken) that parodied the use of out-of-context quotes or intentional misunderstanding of words in political advertisements. This was during the 2008 US presidential election, and was directed at John McCain, but there was no shortage of alternative targets; and Mitt Romney’s 2012 presidential election campaign exceeded even the satire.

The sketch showed McCain in a sound studio, recording the “I approved this message” message, purely as a frame for showing a succession of increasingly ridiculous ads. In one, an ominous voice says,

Barack Obama says he wants universal health care. Really? Health Care for the whole universe? [pictures of spiral galaxies] Even for Osama bin Laden? [pictures of Obama and bin Laden next to each other]

It proceeds to my favourite, the same ominous voice intoning that “Barack Obama says he wants to provide tax breaks to child molesters”. At that the McCain character asks, is that true? The advertising executive explains that Obama has proposed giving tax breaks to all Americans, and that would certainly include child molesters.

I thought of this when I heard about this recent BBC interview with Home Secretary Theresa May, explaining why the police were justified in using anti-terrorism laws to interrogate David Miranda, who was suspected of nothing other than ferrying documents that the UK wanted to keep secret between two journalists. Despite the fact that the law seems to allow detention only for the purpose of ascertaining whether the person detained is a terrorist, May argues that the information he was carrying “could be of benefit to terrorists”. Of course, as William Saletan has pointed out, this is a climb-down from the Home Office’s earlier language that Miranda carried “information that would help terrorism”, and that many people believe — and certainly the journalists and their publishers seem to believe — that publishing this information would help everyone. If it helps terrorists, then only incidentally.

Or, as Theresa May would have rewritten the SNL sketch,

Glenn Greenwald and Eric Snowden say they want to provide secret information about US and UK espionage activities to al Qaeda.

The Home Office strikes back

The UK government has been aggressively defending its decision to interrogate Glenn Greenwald’s partner David Miranda for his links to Edward Snowden’s purloined NSA files. The Guardian reports

A Home Office spokesperson said: “The government and the police have a duty to protect the public and our national security. If the police believe that an individual is in possession of highly sensitive stolen information that would help terrorism, then they should act and the law provides them with a framework to do that. Those who oppose this sort of action need to think about what they are condoning.”

Notably lacking from this utilitarian justification is a legal justification. As I remarked here, schedule 7 of the Terrorism Act 2000, which they seem to be using as their legal framework, interrogation is permitted only to determine whether the person is a terrorist, where a “terrorist” is specifically defined as a person who “is or has been concerned in the commission, preparation or instigation of acts of terrorism.”

Absent from this list is “possessing information that would help terrorism”. The rest is just a smear, and the insinuation of what the journalists are “condoning” is just disgusting, reminiscent of the “fellow traveller” smears of the 50s.

Billions or millions?

Screen Shot 2013-06-18 at 11.41.23

This headline is on the Guardian home page at 11:30 PST (no link, because it’s presumably going to be changed). I thought $3.6bn seemed like an unimaginably large sum for copyright infringement related to a single photo, and indeed, when I clicked through I found

A photographer who failed to see the funny side of a Buzzfeed post on “The 30 Funniest Header Faces” is suing the site for $3.6m (£2.3m) over claims it breached his copyright.

Billions or millions? It seems important… And that’s not even mentioning the fact that I thought British billions were actually American trillions, which would push the error up by another factor of a thousand.

Not the Lake Wobegon Hospital

From the front page of the West County Times:

Death rates at Bay Area hospitals vary widely, new report reveals

While some hospitals excelled at keeping patients alive, more than half of institutions around the Bay Area had worse-than-average death rates for at least one medical procedure or patient condition in 2010 and 2011, a new state report reveals.

“Legal reasons”

The British press is legally somewhat more hemmed in than the US press, both by law (for instance, the and various arbitrary gag orders) and the threat of libel suits. (Fun fact: The truth defence against libel charges was eliminated in 1606 — at least as regards the sovereign, unpleasant claims are likely to be more damaging if they are true than if they are lies. An exception was made for “good motives” in 1792, but for the public interest in 1843. A more general substantial truth defence was reinstated last month.)

This leads us to this weekend’s blockbuster news. The Guardian has reported that the Mail on Sunday has reported

David Cameron has held crisis talks at Downing Street after being told of allegations of a sensational love affair which has potentially significant political implications for him.

For legal reasons, the Mail on Sunday cannot disclose the identities of the people involved or any details of the relationship – even its duration – other than that they are middle-aged figures. The affair has now concluded.

Hilarious! Like a Mad-Lib sketch for a political sex scandal. Details presumably to follow soon on Twitter.

Continue reading ““Legal reasons””

New frontiers in cost-benefit analysis

Headline in the online edition of the Toronto Star

Finding the ‘sweet spot’ on transit taxes: where benefit and cost match up.

I’m no expert on the subject, but I think that when the costs and benefits “match up”, you’ve gone too far…

More seriously, the article is based on weird analysis like this:

“It’s unfair to tax people for parking their cars when there is no real alternative (to driving),” he said.

That sounds superficially fair, but does it correspond to any principle that is more generally followed? How about: It’s unfair to tax people (i.e., charge them) for riding a bus when there is no real alternative. Or, it’s unfair to tax people for getting a passport when there is no real alternative. Why is it that services provided by the government ought to be free by default? Conversely, if “fairness” (defined as not charging people for necessities) is an important principle for the public sector, then why not for the private sector?

Will small hospitals kill you?

Disquisition on medical statistics in The Guardian

A recent front-page article in The Guardian claimed to show that small NHS hospitals are killing people. “Huge disparity in NHS death rates revealed” was one headline. “Patients less likely to die in bigger hospitals“. “Safety in numbers for hospital patients” is another headline. The article makes no secret of its political agenda: “The results strongly suggest that smaller units should close. This presents a major challenge to the health secretary, Andrew Lansley, who has stopped all hospital reorganisation.” Online, Polly Toynbee decries “Hospital populism”, saying “Local hospitals may be loved, but they can kill.” Wow. That’s pretty bad. Here’s the schematic of the story: Smart and selfless experts want to save lives. Dumb public clings to habit (in the form of community hospitals). Evil politicians pander to dumb public, clings to campaign promises. “The health secretary, Andrew Lansley, has now put the project on hold, in line with his election promise to halt hospital closures, to the dismay of experts who believe that lives will continue to be lost.”
Continue reading “Will small hospitals kill you?”