Democracy’s Soldiers

In a review of Armageddon, a book on WWII by Max Hastings, James Sheehan makes the following bizarre remark.

Hastings recognizes that the generals’ failure to knock Germany out of
the war in late 1944 reflected the kind of armies they led as much as
their own deficiencies as leaders. The British and American armies were
composed of citizen soldiers, who were usually prepared to do their
duty but were also eager to survive.

The corollary being that citizens of non-democracies were not eager to survive and therefore made better warriors.  Uh huh.  I could go on but Brad DeLong has a great smackdown.

Something smells fishy

I share with Tyler a high opinion of Jared Diamond’s work but at least part of his explanation for the collapse of the Norse settlements in Greenland does not pass the smell test.  As relayed by Malcolm Gladwell in his review, the Norse used inappropriate farming techniques which stripped the land bare.  Fair enough, mistakes happen.  But a key part of the morality lesson that Diamond wants to tell is that cultural straitjackets doomed the Norse to failure.  The most important piece of evidence being, in Diamond’s telling, that even as they starved the Norse refused to eat the fish that were there for the taking.

Frankly, I think this part of the story is absurd.  As Diamond notes, the evidence from bones is that at the end the Norse were eating their pets.  A cultural norm against eating fish that is stronger than eating pets?  I don’t think so.  A few martyrs might refrain but thousands of people?  No way.  We know that starving people eat insects, they eat dirt, sometimes they even eat each other.  I reject this one from my armchair.

Addendum: Matt Yglesias gets up from his armchair, at least far enough to reach Google, and casts further doubt on the fish story.

In praise of impersonal medicine

Many people complain that medicine is too impersonal.  I think it is not impersonal enough.  I have nothing against my physician (a local magazine says he is one of the best in the area) but I would prefer to be diagnosed by a computer.  A typical physician spends most of the day playing twenty questions.
Where does it hurt?  Do you have a cough?  How high is the patient’s
blood pressure?  But an expert system can play twenty questions better than most people.  An expert system can use the best knowledge in the field, it can stay current with the journals, and it never forgets.

Consider how many people die because physicians forget the basics. Gina Kolata reports on a Medicare program to rate hospitals on the quality of care provided in the treatment of  heart attacks, heart failure and pneumonia – these three areas chosen because there are standard, clinically proven, treatments that everyone agrees are highly beneficial.

At Duke University’s hospital, for example, when patients arrived
short of breath, feverish and suffering from pneumonia, their doctors
monitored their blood oxygen levels and put them on ventilators, if
necessary, to help them breathe.

But they forgot something:
patients who were elderly or had a chronic illness like emphysema or
heart disease should have been given a pneumonia vaccine to protect
them against future bouts with bacterial pneumonia, a major killer.
None were.

All bacterial pneumonia patients should also get antibiotics within four hours of admission. But at Duke, fewer than half did.

The
doctors learned about their lapses when the hospital sent its data to
Medicare. And they were aghast. They had neglected – in most cases
simply forgotten – the very simple treatments that can make the biggest
difference in how patients feel or how long they live.

…[Similarly, the] hospitals were asked how often their heart attack
patients got aspirin when they arrived (that alone can cut the death
rate by 23 percent). When they were discharged, did they also get a
statin to lower cholesterol levels? Nearly all should, with the
exception of patients who have had a bad reaction to a statin and those
rare patients with very low cholesterol levels. Did they get a beta
blocker?

Once hospitals learned their score, it was up to them what to do.
Over the next year, ones that improved in these measures saw their
patient mortality from all causes fall by 40 percent. Those whose
compliance scores did not change had no change in their mortality rate,
and those whose performance fell had increases in their mortality rates.

"Those are the most remarkable data I have ever seen," said Dr. Eric
Peterson, the Duke researcher who directed the study and has reported
on it at medical meetings.

Unfortunately, we (doctors and patients) have a model in our head of the nearly omniscient doctor carefully attending to the needs of every patient on an individualized basis – medicine as craft.  Instead what we need is medicine by the numbers.  But doctors don’t like being told what to do.

"We tried to come up with a standardized order set," with all the
measures that Medicare was asking about, Dr. Gross said. "But the
doctors didn’t want to use the sheet," insisting they would just
remember those items. Then they forgot.

The solution, Dr. Gross said, was to assign specially trained nurses
to see what care was provided and remind doctors when important steps
were omitted. The result was immediate improvement, Dr. Gross said,
even in items not on Medicare’s list.

The nurses, in effect, are being trained to follow standardized procedures, just as does an expert system.

Thanks to the John Palmer, The Econoclast, for the link.

Politically Incorrect Chef

Here from Anthony Bourdain’s Les Halles Cookbook is the glossary entry for foie gras.

Foie Gras: The fattened liver of a goose or duck.  Unfortunately, an endangered menu item with the advent of angry, twisted, humorless, anti-cruelty activists who’ve never had any kind of good sex or laughed heartily at a joke in their whole miserable lives and who are currently threatening and terrorizing chefs and their families to get the stuff banned.  Likely to disappear from tables outside France in our lifetimes.

Iraq Economic Policy

Just what Iraq needs, more angry people.  From The Economist:

THE queue of
angry motorists stretches for miles. Baghdad’s petrol stations are
drier this month than they have been since just after the American-led
invasion of Iraq in 2003. Some drivers wait for as much as 24 hours,
sleeping in their vehicles. When told that there is no petrol, some
have lost their tempers and started shooting. How, asks a furious
driver, can an oil-producing country run out of fuel?

Ask an
insurgent, and he will assure you that the American army steals the oil
for its tanks. Others might blame the lack of capacity at Iraqi oil
refineries or the fact that the insurgents keep blowing up the
pipelines. But the most important reason is that the government has
fixed the price of petrol at approximately zero–barely one American
cent a litre.

ShortageOfficials and
petrol-station owners with access to subsidised petrol have a choice.
They can do the proper, legal thing and give the stuff away. Or they
can let it leak onto the black market, where prices are between ten and
100 times higher. Or they can smuggle it out of the country where,
global oil prices being rather steep at the moment, it sells for a tidy
sum. Many have chosen the more lucrative options.

Iraqis may
imagine that their situation is unique, but it is not. Other oil-rich
nations, such as Nigeria, also have governments that try to keep petrol
artificially cheap and therefore suffer chronic shortages. Iraq has
additional supply constraints, however, in the form of fanatical
saboteurs.

Thanks to David Theroux for the pointer.

Tivo Blues

I am on holiday in Canada.  Never having known anything different, the children are terribly confused and distraught to find that at Nana’s house their shows are not on whenever they want them to be on.

I use the opportunity to tell them about progress – when Daddy was little he had to get off the couch just to change the channel! – I refrain from further explaining that the CPI does not adequately account for improvements in the quality of life.  Tivo is great.    

(un)Real Estate

An island has just been sold, it consists of 6000 acres, a castle, a mine and the right to subdivide and sell ocean-view lots.  The price, a mere $26,500.   Cheap?  Maybe if it existed in the real world but this island is the most expensive piece of unreal estate yet to be sold – it exists only as part of the computer game Project Entropia.

I must admit to still being surprised by stories like this but I cannot imagine that I will think so in another few years, even less that my sons should not think this all perfectly normal.  My prediction: within two years expect to see a bitter divorce battle fought over who gets the house – the virtual house.  And within four years expect a bitter divorce battle fought over who gets the kids.

Thanks to David at Cronaca for the link.

Paying for Kidneys

In a new paper, Gary Becker and graduate student Julio Elias estimate that for a price of $15,000 the shortage of kidneys could be eliminated from live donors.  The risk of death to a live donor is no more than 1 in a 1000.  Combine this with a value of life estimate of $3 million and add in some costs for time off work and so forth and you get the Becker/Elias figure of $15,000.

$15,000 seems too low to me but it probably would since my income is above average. As a robustness check, the authors note that in India a kidney can be had for about $1000 and US per capita income is about 15 times that in India so $15,000 looks to be in the right ballpark.  A similar calculation from Iran, where kidney sales are legal, is also consistent.  In anycase, even if they are off by a factor of 2 the point is well taken that for a modest sum many lives could be saved.  (In fact, dollars would be saved also because transplants are cheaper than dialysis.)

Becker and Elias have a useful response to (so-called) moral objections. Take any argument against kidney sales and apply it to the volunteer army.  Do kidney sales "commodify the body?"  Perhaps, but then the volunteer army commodifies life.  Would kidney sales eliminate altruistic donation?  As the example of Pat Tillman and many others demonstrate people still volunteer for the military for non-monetary reasons.  Are there difficulties for donors to calculate risks?  Again, perhaps, but these also apply to joining the military (and if so we could allow for a cooling-off period for both donating an organ or joining the military, as we do in some states for auto purchases).

If you are not in favor of the volunteer army then Becker and Elias don’t have any knock down arguments but I suspect that many people who are against kidney sales also favor the volunteer army and for these people Becker and Elias are posing a consistency challenge.

Markets in Everything – law school

Jay Wilson, a second-year law student at New York University, was
desperate to register for a popular course in constitutional law.

Unfortunately for him, the course, taught by the youthful Daryl
Levinson, was completely booked for the upcoming spring semester.
Fortunately, Mr. Wilson had some money to spare. In a posting on an
online bulletin board at the law school, Mr. Wilson offered $300 to any
student willing to drop the course to make room for him…

Students interviewed at the law school said the practice of
exchanging course spots is common at the school. As a kind gesture,
some cash-strapped students have promised to bake cookies for willing
traders or pass them invitations to exclusive parties.

Mr. Wilson, they said, took things to a new level: a no-nonsense
business deal, the sort of financial transaction that they expect to
deal with only after graduation.

Of course, the authorities soon moved to quash such deals.  The dean, however, did not explain why paying to get into a class is wrong but paying to get into law school is good.  Hmmm….perhaps Mr. Wilson would have had better luck had he offered to pay the dean rather than another student.

I have pioneered this approach even further.  Students in my classes have been known to offer payment to get out. 🙂

Thanks to Ray Lehmann for the link.

Jail Mail

I edited a book, Changing the Guard, on private prisons and crime control.  Last week I received an interesting letter from an expert in the field….a prisoner in Tennessee.  Frankly, I was expecting a crank but in fact the prisoner, who shall remain anonymous, had a lot of intelligent things to say about how the prison system operates.  Here is one observation:

A privately owned and publicly traded company like CCA has no incentive to rehabilitate criminals.  It is in the best interests of the company for even more criminals to exist.  Unfortunately, the same is true of government run prisons.  And contrary to what you may have been told, prisoners are not paroled because they have indicated by their actions or behaviors while inside that they are less likely to reoffend; they are let go because the Parole Boards believe that will commit another crime.  This way the prison lobbyists can then "prove" that parole doesn’t work.  The Department of Corrections gets less money from paroled prisoners than it does for those kept inside.  And also, "good" inmates are less trouble (less labor) than the trouble-makers, and so trouble-makers get released.

Good analysis.  I hope, however, that he does not test his theory on how to gain early release.