Month: February 2007

Welcome to the world.

How many more stories like this must we read? I’m certainly frustrated seeing them because they wouldn’t occur in a sane world. This time, from the U.K.:

Detectives are investigating the death of a seven-day-old baby after he was circumcised.

Stunned relatives at the Jewish ceremony saw the toddler experience breathing difficulties.

He was taken to hospital but died eight days later. A post mortem found the infant died from cardiac arrest and oxygen starvation.

Forget the religious aspect of this particular story; it has no bearing. The risk is the same, regardless of the reason the surgery is performed, so the implication is broad enough to cover every male infant circumcision.

Is there some threshold for the number of baby boys who must die before we become outraged at this unnecessary procedure? We’re not there yet?

__________________________________

In explaining the background of circumcision for this story, The Mirror provides a precise example of the kind of “balanced” coverage too many take with circumcision. No one wants to offend because male circumcision is seen as normal. Parents who do it are somehow justified in putting their child through the risks of surgery for non-medical reasons. I reject that, as everyone should.

In a connection clearly missed by the The Mirror in its effort to be unbiased, it presented this:

Circumcision of boys is an operation in which the foreskin is removed from the penis. With small babies, local anaesthetic is often sufficient and avoids the risks of a general anaesthetic.

Local anesthetic is “often” sufficient, except it’s not. It takes no leap to realize that cardiac arrest and oxygen starvation might result from surgery on an inadequately anesthetized patient. This would be offensive in nearly every circumstance, but is particularly so when the surgery is unnecessary.

Contrary to a common misconception, babies feel pain. Lest anyone doubt this, listen to the end of this podcast. In the segment titled The Horror of Circumcision, you’ll hear nothing but the baby’s screams as his foreskin is removed¹. If you doubt what I say about circumcision, listen. You won’t come away disagreeing with me.

Also in the article:

Some people believe the skin is redundant and gets in the way of hygiene.

Those people are ignorant.

This back-and-forth nonsense of presenting all sides is maddening. All sides do not warrant equal presentation. Circumcision is wrong. Parents do not have the right to impose such a decision on a child for any reason other than immediate medical need. If newspapers can’t admit this, they should stay quiet and let the facts speak rather than furthering illegitimate excuses.

Update (02/25/07): Based on comments to this entry, I’ve altered this post to better reflect what I meant. I’ve replaced “those people are stupid” with “those people are ignorant“. I know that word can also be seen as a pejorative, but I intend for the word to be taken in the specific context of its definition, “lacking knowledge or comprehension of the thing specified”. In the future I will aim to be more precise.

¹ The use of effective anesthetic should be mandatory as long as we’re going to perpetuate the mistaken view that infant circumcision is acceptable. That is an argument for minimum decency. The use of effective anesthetic does not miraculously erase the basic, serious unacceptability of routine infant circumcision.

If Oliver Stone¹ analyzed health care.

Because yesterday turned into a snow day with double-digit-hours of Xbox 360 time, I missed Steven Pearlstein’s essay dissecting America’s health-care system. There are too many ridiculous statements to fully fisk Mr. Pearlstein’s biased ideas. Instead, I want to address (in more detail than I expected) a couple of his essay’s more egregious flaws. First, his premise:

Or, put another way: Although doctors, hospitals, insurers and drug companies say they, too, want things to change, any comprehensive reform would reduce their incomes and their profits.

All this becomes quite clear from a new study on the U.S. health-care system released without fanfare last month by McKinsey Global Institute, the independent research arm of the giant consulting firm, which counts many health-industry giants among it clients.

There’s the usual talk of expensive college loans and so forth. He (weakly) addresses the counter-point, so I’ll just add that there’s a difference between the level of precision needed to correctly code software to produce accurate financial statements and the level of precision needed to operate on a human heart and keep the patient alive. This should be obvious to dismiss the misconception that doctors and medical care are mere commodities that can controlled by the government.

The study aimed to determine why the United States spends nearly double the average of other industrialized countries on health care — with no better, and in some cases inferior, medical outcomes. Even after adjusting for wealth, population mix and higher levels of some diseases, McKinsey calculated that we spend $477 billion a year more on health care than would be expected if the United States fit the spending pattern of 13 other advanced countries. That staggering waste of money works out to 3.6 percent of the nation’s entire economic output, or $1,645 per person, every year.

It’s interesting that we spend more money, but why should we expect that the United States will or should fit the spending pattern of 13 other advanced countries, all with at least some degree of socialized health care? How many stories of long delays and surgeries denied do we need to hear about before we decide that we should analyze our spending based primarily on our needs and wishes? The notion from this study, as Mr. Pearlstein states repeatedly, is that this $477 billion excess is wasted and unnecessary. Perhaps it is, and Mr. Pearlstein provides a useful explanation or two. Unfortunately, he fails to notice these explanations as a cause for this waste, instead assigning the blame squarely on a “greedy” medical system. For example:

What we have here is pretty good circumstantial evidence of Pearlstein’s First Law of Health Economics, which holds that if you pay doctors on the basis of how many procedures they do, and you leave it to doctors and their insured patients to decide how much health care they get, consumption of health services will rise to whatever level is necessary for doctors to earn as much as the lawyers who sue them.

Universal health care will fix this problem, of course. Public money means some procedures and tests will be deemed unnecessary. I’m willing to theorize that this will cost at least one patient her life in the course of any future socialized health care system in America. Of course, it would be foolish for me to pretend that it won’t or can’t happen under private health care insurance. But who should bear the responsibility of making the decision on what might be appropriate, the patient or a bureaucrat?

But that’s not the point of that excerpt. Notice Mr. Pearlstein’s flawed theory of economics. Physician greed will lead to an excess. The fact that the patient is insured to an extent that he will never see the full cost of these procedures means nothing. Ignore that there are few incentives for the doctor or the insured patient to discriminate in choosing a test. That’s just silly. It must be physician greed, carried through their investments in medical labs. I would change his pet theory to Pearlstein’s First Law of Progressive Health Economics.

He continues:

Don’t be distracted by arguments that American doctors need to make more because they have to pay $20 billion a year in malpractice insurance premiums forced on them by a hostile legal system, or an equal amount for all the paperwork required by our private insurance system. The $58 billion in what the study defines as excess physician income is calculated after those expenses are paid.

Excess income. The patient is paying those fees that lead to “excess” income, no? He can refuse, of course, but why would he? He’s not paying the bulk of the bill. I wonder what his analysis would be if he were paying the bill. Let’s not forget a fundamental fact here, either. These patients are letting doctors make decisions that assess and propose fixes for their health. Should we fault them for being cautious? Again, who is the better judge for how much testing he wants done?

Proponents of a government-run “single-payer” system will certainly home in on the $84 billion a year that McKinsey found that Americans spend to administer the private sector portion of its health system — a cost that national health plans largely avoid. But as long as Americans continue to reject a government-run health system, a private system will require something close to the $30 billion a year in after-tax profits earned by health insurance companies. What may not be necessary, McKinsey suggests, is the $32 billion that the industry spends each year on marketing and figuring out the premium for each individual or group customer in each state. Insurance-market reform could eliminate much of that expense.

This is the heart of the debate, isn’t it. Government can run the system better, to the tune of $84 billion in eliminated² waste. Right. Show me one government-managed program that has managed such a task. Just one.

¹ I watched the end of Wall Street last night. I still enjoy it tremendously, but Oliver Stone’s assumptions about capitalism and wealth creation are preposterously amateurish. However correct his analysis of the finance in the 1980s may be, resting underneath the entire premise is that making money is a dirty deed. This is obscenely lacking in nuance, as evidenced by most every line Martin Sheen uttered in the movie.

² The basic issue here is how much of that $84 billion is wasted trying to comply with a myriad of absurd, interventionist government regulations. I guess the argument is sound that government-run health care would eliminate this, but creating the burden is not a justification for nationalization to eliminate that burden.

Come back when you conform (and prevent HIV).

Yesterday, I found this frustrating article from an e-mail list I’m on. It’s in French, which I don’t speak, so I relied on a rough translation from the e-mail list member who sent it. Danielle verified that the translation I received is accurate as a literal translation. Any errors are as I received them, but I accept responsibility for any inaccuracies.

A Kenyan secondary school dismissed 20 pupils because they were not circumcised, fearing that they should be the object of mockery or violence on behalf of comrades, in this country where certain communities estimate that keeping ones foreskin is not hygienic, one learned Sunday from official sources.

The persons in charge for the secondary school for boys of Kiriani (Eastern Province) addressed to the parents of the 20 pupils a letter announcing their exclusion to them and asking them to proceed to the circumcision of their children so that they can take again the way of the school.

“This to inform you that your son may not present himself at school under the condition where he happens to be. You succeeded in registering your son in our school without informing us that he was different from the others, i.e. non-circumcised. You are requested to do the necessary within two weeks and to present yourself at school with your son as soon as he recovers” (after the operation), can be read in the letter of which AFP obtained a copy.

The circumcision is not compulsory to register in a school, but the headmaster of the college of Kiriani, F. NR. Githinji, explained that the pupils had been dismissed to prevent them from being the object of harassing on behalf of older pupils.

That kind of conformity, even if it’s more extreme than would occur here, is no different than the basic mentality in the United States among parents who circumcise to avoid any locker room embarrassment. It’s easier to teach children to conform through forced bodily modification than to disregard the opinion of another, future teenager. In any other context, we would see this for the fallacious joke it is. But we accept incorrect ideas about the male foreskin without question because we refuse to reject old ideas.

Here’s an idea: if the intact boys will be in a situation where their intactness will be apparent and subject them to harassment, the school has an obligation to protect those boys. It can’t shirk this obligation by sending them home for unnecessary genital cutting.

The related English-language version, courtesy of the BBC, is much shorter, without some of the critical details. That could be an editorial decision to present “just the facts,” but I don’t think so. One daft deft addition to the original article shows that there’s a bias. I’m not sure it’s designed to be “balanced” or to not present this school’s decision as the obscenity it is, but it exists.

Circumcision is not obligatory for admission to secondary school, but a study released in December said it reduced the risk of contracting HIV/Aids.

That’s not related to this story in any way. The BBC’s editors decided that this nonsensical mantra should be repeated. This is how irrelevant scientific ideas get pushed. The logic against circumcision as an HIV preventive and any cost-benefit analysis based in reality is simply inconvenient and not appropriate for the article (or any BBC coverage, for that matter). The BBC skewed the story in its attempt to provide a justification for the school’s irrational action instead of presenting the facts. Now people will read this story without thinking and agree that, yeah, the school’s action is a bit extreme, but it’s okay. They boys will be protected from HIV, in addition to the ridicule they’ll allegedly now avoid.

This is bullshit. The BBC should be ashamed.

Update: A Kenyan newspaper published an editorial against the principal’s decision. Kenya’s education minister George Saitoti said that the principal will face disciplinary action.

¹ Not incorrect, just irrelevant. It’s relevant to adult males, if they choose it for themselves. Until baby boys start having unprotected sex with HIV-positive women, or circumcision reduces HIV transmission through blood transfusions and intravenous drug use, circumcision is not indicated for the limited future possibility of a disease with a specific, identifiable sexual behavior.

Treat adults like adults.

I looked into a few policy recommendations coming from the Center for Responsible Lending, based on yesterday’s post. My initial hunch proved correct. Consider its stance on “Debit Card Danger”:

Banks stand back as debits and ATM withdrawals cause high-cost overdrafts for their customers

Rather than linking their customers’ checking accounts to their savings or other resources to cover overdrafts, many banks and credit unions are automatically covering their customers’ shortfalls with expensive short-term loans.

More overdrafts are happening when customers swipe their debit card or make an ATM withdrawal than when they write a check. In these cases, banks can warn customers or merchants when they have insufficient funds—but most do not. They can also decline the transaction and save the customer the overdraft fee—but most do not.

See, we should blame the banks because people don’t manage their money. Someone should be looking out for the customer who can’t keep track of his checking account. Someone should look out for him, even though he signed up for the account with “expensive” short-term loans. Remember, banks are in the business of giving away money to customers. That’s the purpose of banks. They have money. They give it to people who don’t have it.

I never use my bank card as a debit card, instead opting for the credit card feature. Perhaps I just have better credit than most Americans, but I doubt it. My brother got it on his card when he opened a checking account at 18-years-old. As you could expect, the Center for Responsible Lending’s stance doesn’t get any better when looking at credit cards:

While some cardholders use their credit for occasional purchases, working families have come to rely on plastic to weather economic downturns or to make essential purchases: groceries, medical expenses, home repairs. Even though most households pay more than the minimum each month, more and more people find themselves perpetually indebted to the credit card industry. College students and other minors have also become attractive targets for the marketing of cards that contain hidden transfer charges, exorbitant late fees and exploding interest rates.

Any public policy that starts with the premise of “working families” and “weathering economic downturns” will most likely be garbage. I suffered through years of credit card debt that I brought upon myself. I ended up using my cards to make essential purchases like groceries. This was my fault. I’m not saying that people are to blame for every bad incident in their life, but placing this at the feet of credit card companies is silly. They offer a service. People can buy that service or not.

It’s just as possible to say that people use credit cards to manage economic downturns so that they don’t have to rely on others, including the government, to bail them out. They know that their situation will change, and they’ll repay the debt. Again, tighter regulation, which is what I suspect is the ultimate policy recommendation, cuts both ways. Consumers will suffer. The ability to manage their present and future is limited as much as their opportunity to screw it up. This is about who knows best, individuals or central planners.

Naturally the Center has an opinion on Tax Refund Anticipation Loans.

Tax Refund Anticipation Loans (RALs) are short-term cash advances against a customer’s anticipated income tax refund. But the loans are offered at high interest rates, ranging from about 40% to over 700% APR. Also, they speed up the refund process by as little as one week, compared to what consumers can expect by filing online and having their refunds deposited directly into their banking accounts. There were over 12 million RAL borrowers in 2003.

Tax preparers and lenders strip about $1.57 billion in fees each year from the earned-income tax credits paid to working parents, according to a 2005 study by the National Consumer Law Center.

There are few worthwhile angles here. Taxpayers shouldn’t be getting refunds hefty enough to justify such fees. Teach people to adjust their withholding exemptions to come much closer to their tax liability. They’ll have more cash throughout the year. (By extension, that might also impact the debit and credit card “problems”.)

The last sentence is the real kicker here. Tax preparers and lenders strip these dollars in fees. Why not just say that they rape customers if you’re going to implicitly accuse them of thievery? Teach people to manage their money, if that’s the problem. Teach them to read their contracts, if that’s the problem. Teach them to …

You get the drift. The Center for Responsible Lending seems more interested in being the Center for Lending Regulation, with a healthy disrespect for the abilities of “working families” to manage their money. Whatever evidence exists to support such a belief is not sufficient justification to punish with more regulation those who can do what the Center for Responsible Lending believes is impossible, or worse, unnecessary.

You don’t get a vote, mate.

We’ve heard versions of this in every election since 2001. I see no reason to believe it won’t continue for years to come, but I’m amazed that it’s crossed oceans.

Australian Prime Minister John Howard on Monday denied having a political motive when he said that terrorists in Iraq should be praying for Sen. Barack Obama (D-Ill.) to become president of the United States.

Howard, a supporter of President Bush in the Iraq war, insisted his criticism of Obama was in Australia’s national interest because Obama’s plan to withdraw U.S. combat troops in Iraq by March 31, 2008, would represent a defeat for Australia’s most important military ally.

In an interview Sunday, Howard said that Obama’s plan meant al-Qaeda leaders in Iraq should “be praying as many times as possible for a victory, not only for Obama but also for the Democrats” in presidential elections in November 2008.

Prime Minister Howard has a point to make. I disagree with it, but there is room for debate. Let’s have it.

Instead, he chose the easy, sound-bite route. The terrorists want Obama! Vote for right-thinking candidates, you left-leaning liberty-hating Americans! That’s a smear tactic straight out of the authoritarian handbook. Pretend like there’s no debate to be had, declare the truth, and admonish anyone who disagrees. When confronted on it in a free-thinking society, deny that you actually smeared anyone. And you certainly didn’t intend to smear anyone.

I’m not buying it.

People should be free to act against their best interest.

Those newfangled mortgages from 2005, they’re threatening to negatively impact some individuals. But don’t worry, government wants to save everyone.

… But as mortgage defaults rise, the new Congress and several state legislatures are contemplating enactments that would require mortgage brokers and lenders to make sure a loan is “suitable” for a borrower–just as stock brokers have to make sure an investment is suitable for a client. Your loan officer would be required to ask a series of detailed questions about things like your financial goals and your tax status. And if the loan was inappropriate, the lender would be open to a lawsuit–and even a prison term.

That should work wonders on the mortgage (and by extension, the housing) market. Screw up according to some bureaucrat’s unclear standards and whammo, prison bars for you. Wonderful.

I’m all for fair disclosure requirements, but I also understand that that’s what contracts are for. I understand enough finance from my education that I could walk my way through buying my first house with little trouble on the specific terms. Adjustable versus fixed rates, interest only, whatever. I faced all of those questions. The answers were obvious enough to me because I did my homework. But I also hired an attorney to work through everything and verify that the contracts matched expectations.

I don’t pretend like everyone has that knowledge, or even that every mortgage broker has any scruples. I can’t believe that those require this level of anti-market glee:

The mortgage industry doesn’t object to the congressional intrusion, since a federal law might be preferable to a patchwork of state laws (though the industry would have preferred a Republican-run Congress). Consumer advocates are now happily taking their case to a Democratic Congress, and they don’t deny that what they propose could crimp profits of lenders and of investment banks that securitize home loans. “It would eat into returns and presumably investors’ appetites, too,” says Keith Ernst of the Center for Responsible Lending in Durham, N.C.

Presumably.

The ramifications are simple, really. Reduce the profitability, and the providers will disappear. Then that low-income family that could just barely afford a house will be stuck renting. That middle class family looking to trade up? Maybe next year. Even if they can properly assess their risk and potential to repay the loan(s), they won’t be able to do so because the government cares so much.

Remember, of course, that the logic works the other way. Lend without common sense and your borrowers will go kaput. If the lack of judgment is large enough, the company will go kaput. This is how the market works to achieve balance. Lenders and borrowers alike have a built-in incentive to behave responsibly, even if they ignore that incentive. Beyond the basics of honest disclosure, handcuffing the market is just meddlesome misbehavior that will fail to protect people from themselves.

Stranglehold on 20th Century Business Models

Some of the criticism directed at Steve Jobs’ call for an end to DRM is a bit strange and simple.

Mitch Bainwol, chairman and chief executive of the Recording Industry Association of America, said the move would eliminate technology hurdles that now prevent fans from playing songs bought at Apple’s iTunes Music Store on devices other than the company’s iPod.

“We have no doubt that a technology company as sophisticated and smart as Apple could work with the music community to make that happen,” Bainwol said in a prepared statement.

I have no doubt that an eight-year-old with a blank CD could break Apple’s DRM by putting that blank CD in her PC, burning her iTunes songs to the cd, and ripping the resulting disc to mp3 format. I suspect Mr. Jobs is closer to the wise solution with his third of three alternatives. Not that, as my example proves, making FairPlay more available won’t change how easy it is to bypass it. Individuals only need a willingness to invest a bit of time and effort, along with a few blank discs. DRM is already dead, no matter how long music companies attach its corpse to most legally downloaded songs.

Instead of fear, which has been the record industries modus operandi surrounding digital music since the inception of the mp3 format, it should imagine a future based in reality. People will sidestep DRM and illegally trade music. Preventing that shouldn’t punish everyone, though. Don’t treat customers like criminals waiting to undermine the business. For example:

Britain’s EMI Music is experimenting with releasing music in the DRM-free MP3 format. In the past few months, the company has released tracks by Norah Jones, Lily Allen and the band Relient K.

“The feedback from fans (has) been very enthusiastic,” EMI spokeswoman Jeanne Meyer said.

Leigh believes older music could be made available without copying restrictions.

“I think the labels will release selected back-catalog stuff, to see what happens,” he said.

Low risk, potentially high return. That’s a company that’s trying.

Now, Mr. Jobs, about those restrictions that prevent me from buying music on iTunes from other countries…

Irrational Behavior at the Expense of Another

One more this week on circumcision. This time, I’m amazed that people think this way.

Bo’s updated chest x-ray shows improvement but it is not clear, and his ears have not improved at all (and this is after trying two different antibiotics, b/c the first one wasn’t doing anything after 3 days.)

The pediatrician decided to give Bo a shot of Rophin (sp?), this is intended to help not only his ears, but what pneumonia remains in his lungs. He is totally against, as are we, waiting until June, (next available surgery date for Bo’s circumcision), so is doing everything possible to clear up those little lungs BEFORE Friday morning. The ear infections are in no way a hindrance for this surgery, but they are a whole other issue.

We will return in the morning to the ped. for another Rophin shot and if needed an x-ray. We will do what keeps him safe, but at the same time we want this surgery over with on Friday!!! If it clears up his ears in the mean time, that would be great too.

The boy has pneumonia, and the parents’ primary concern for healing it quickly is so that they can circumcise him tomorrow instead of waiting until June? I do not, and will not, understand that. I’m taking only the information I have here, of course, so there may be information that suggests it’s medically indicated. I doubt it. Also, based on the available evidence I have, this doctor is anxious to heal a child so that he can perform unnecessary cosmetic surgery on the child. That’s absurd. His priority is to his patient, Bo, but he wants to heal him so that the parents, who are not his patient, can be satisfied with their son’s penis.

I also have an alternate take on this parent’s conclusion:

PLEASE just pray that God’s will be done. Bo just needs to get better, and if that is first priority, so be it; we will just reschedule the surgery. But we would also like the surgery DONE. SO, may God’s will just take over and Jake and I just be at peace with whatever God’s decision is.

This is a reason why I don’t go off on people with name-calling and targeted swearing. There is some glimmer of reason there. That’s reassuring because I generally assume that parents who circumcise are well-intentioned, even when they embrace the irrational norm far too easily. I think that’s the case here. If these parents believe so strongly, I’m not sure why the possibility that God’s will is that Bo’s penis not be cut is absent from consideration. Circumcision is at least an implicit statement that the natural, normal human male form is unacceptable. If Man is created in God’s image, circumcision should be seen as a direct insult to God, proclaiming Him not perfect.