When politics turn personal

A Republican senator now favors gay marriage because his son is gay.

He framed his reaction in terms of equality of opportunity: ""It allowed me to think of this issue from a new perspective, and that's of a Dad who loves his son a lot and wants him to have the same opportunities that his brother and sister would have."

The story is similar to how one of the legislators who blocked a bill that would legalize abortion in Indiana later came to my grandfather (a pediatrician), asking for a referral to an illegal abortion for his 16 year old pregnant daughter.  Naturally this politician wanted to ensure that his daughter had the opportunities to succeed, in spite of any mistakes she may have made. 

Same-sex marriage is a wonderful example of where John Rawls' concept of the veil of ignorance applies:  we don't know whether our children will want to marry someone of the opposite sex or same sex, but we all want them to have the opportunity to marry.

About 3-5% of children of conservative politicians are likely to want to marry the same sex --- the same as in the general population --- so we may continue to see evolution like this on same-sex marriage.

It's too bad that conservative politicians are unlikely to have the same experiences for social policy.  Now that social mobility in the US is at a stand-still, the children born in the top quintile of income are likely to end up there themselves, and likewise for the bottom quintile.  Few policy makers make decisions informed by the personal experiences of people who are disadvantaged by the current system.  They are unlikely to know adults trying to support a household on minimum wage, and may truly believe that health and economic disparities are due to personal failings.

About 3-5% of the US population is gay, and aside from some predictors (e.g., having older brothers), gayness is more-or-less randomly assigned.  Not even 3% of children makers are randomly assigned to be socially disadvantaged.  If they were, we would have a situation paralleling Rawls's veil of ignorance, and we might have fewer social disparities.

Hooray for planning

Two years ago, in late March 2011, I gave a talk at the Society for Adolescent Medicine (SAM) in Seattle and flew immediately afterwards to the Society for Research on Child Development (SRCD) in Montreal.  The two conferences were always the same week, often across the country from each other.  SRCD is biannual, and alternates with a similar adolescent-specific conference (Society for Research on Adolescence, SRA.)  This year is no exception: the conferences are the same week in Seattle and Atlanta. 

Just noticed that next year the Society for Adolescent Medicine and Society for Research on Adolescence are still meeting during the same week, but finally holding their conferences in the same city.  It will be the 14th biannual SRA conference --- did it really take them 26 years to figure out this solution? 

Conservatives go soft on crime

photo credit: Chris Devers via photopin cc

For decades, liberals have said that the American criminal justice system is counter-productive.  Minorities and the poor are more likely to be arrested and convicted, and they are imprisoned for longer than comparable white-collar criminals.  The US's highly punitive criminal justice system stigmatizes already marginalized Americans, makes them unable to obtain legitimate employment, and further reduces their changes of social mobility.

My public health concern with prison --- beyond the obvious exposure to violence and disease in prison --- has been gender ratios: with 1/9 young black men incarcerated at any given time, and 1/3 of black men  in their life time, prison has reduced the number of marriageable black men, giving more leverage in the dating market among those remaining, and promoted the spread of HIV.  The increased practice of trying minors as adults has worsened the problem by sending adolescents to adult jails, where they are often victimized, traumatized, and permanently stigmatized. 

Conservatives have lead the charge towards these "tough on crime" policies.  Now some prominent conservatives including Grover Norquist seem to have just realized the enormous social and economic costs of this destructive and highly punitive approach.  The introduction of the article was promising because it noted all of the social and economic costs of prison, including the generations of unemployable men spit out by the prison system, but the authors seem more concerned with reducing the fiscal burden of imprisonment on states than the economic burden on society caused by the waste of human capital.  I was even more disappointed by the partisan slant of the article.  As if to make up for their almost liberal introduction, the authors claim that liberals are at fault, in opposite directions:  1960s liberals "ignored" crime and considered law-enforcement "pointless"; unions (prison guards) caused mass imprisonment; and Republican governors are leading innovation in reducing prison costs, although they did feature a policy by liberal state Hawaii.

The American Conservative has been refreshing in its relative lack of partisanship.  As happy as I was to see a conservative article noting the real problems with our punitive society --- and I am glad that we can all agree that this is a problem --- I was disappointed by its finger-pointing approach.  Many factors have led the US to imprison more of its citizens than any country in history, and it will take a great deal of effort --- including reducing partisan cheap-shots such as "soft on crime" labels --- to dig ourselves out of this hole. 

Seatbelts not only save lives --- they prevent tragedies

photo credit: AlamosaCountyPublicHealth via photopin cc

Everyone in the New York area has by now heard the tragic story of a young pregnant couple killed on their way to the hospital when their car was hit from the side by a hit-and-run driver (now identified as someone with an arrest record including recently driving under the influence of alcohol, but it's still unknown who was at fault.) The baby was delivered but sadly died because he was only 6 months gestation.  As tragic as this story is, the real tragedy is that the woman and possibly her husband and child might be alive today if they had been wearing seatbelts.

The couple was being driven in a 2008 Toyota Camry, a very safe car, but the woman was thrown from the car, meaning that she could not have been wearing a seatbelt.  The IIHS ratings for this car for a side impact give this car this highest rating for both passengers and drivers, and the driver walked away relatively unharmed.  Seatbelts reduce by half the risk of mortality from motor vehicle accidents, and certainly prevent passengers from being thrown from vehicles.

This couple was not alone in not wearing seatbelts in the backseat of a taxi, which is all-too-common behavior, although illegal in New York State.  Police are even allowed to stop cars for seatbelt non-use, but only drivers and front seat passengers can be ticketed.

A paper published last year in the journal Injury Prevention notes that the press often labels events as "freak accidents."  People mourn accidents, but journalists afraid of being seen as blaming the victims fail to communicate that many accidents could be prevented.   

Few accidents are truly freak accidents.  Many injuries, deaths, and tragedies can be prevented through sensible precautions, including wearing seatbelts.  There is no excuse not to wear a seatbelt, ever, even riding in a taxi.  New York State should expand its seatbelt laws to allow ticketing passengers.  If all passengers consistently wore seatbelts, we would have many fewer such tragedies. 

Lead in chicken broth?

After the lead and crime article in Mother Jones last month, I've been more aware of lead in the environment.  Perhaps that is why a paper finding lead in organic chicken stock in the journal Medical Hypotheses alarms me, at least slightly and hypothetically.  The researchers found concentrations of 9.5 mcg/L and 7 mcg/L, still below the EPA's "action level" of 15 mcg/L for drinking water, but the EPA in the same publication says that no concentration of lead is acceptable:  i.e., the goal level concentration is zero. 

As is the nature for a hypothesis-generating publication, the study used only one batch of chicken stock of each type:  one with bones, one with skin and cartilage, and one with meat.  Perhaps they picked a bad chicken, or perhaps it is only chicken from the UK.  It's impossible to know without more tests.  People always ask us statisticians what would have happened if the sample size would have been larger, and it's important to remember that we're statisticians, not fortune-tellers:  we can't know what results would have been without having the actual results.  It's strange and frustrating that with 3 authors on the paper, they couldn't be bothered to get a few more chickens to test.  At least they did a control of plain water boiled for the same period of time, which found near-zero concentrations, under 1 mcg/L.  (Chicken meat broth by contrast was just over 2 mcg/L.)

The authors neglected to mention that the technique of saving bones for stock from every piece of meat you eat is almost universally recommended by cookbook authors including Melissa Clark and Nigella Lawson, to ensure that you always have stock available when it's called for.  Cookbooks say that there is no substitute for stock, and if you don't have stock around, use water rather than canned.  It's disappointing that there might be dangers from what is considered a best practice for cooking, not to mention one that I've just started following myself!  The lentil soup made from homemade beef stock was amazing, and one guest told us that he'd never tasted anything like it. 

I will still use the chicken stock in my freezer, but I'd be reluctant to continue this habit if pregnant or if I had children, given how dangerous lead is during critical formative periods. I do wish that the authors had gotten their act together to get at least an n=10 from geographically dispersed chickens.  How hard would that have been, seriously? 

Beating a dead fish: more reasons to correct for multiple comparisons

Last night, the Ignobel prizes rewarded research using an fMRI on a dead salmon as an extreme case of a null effect.  fMRI machines identify over a hundred thousand of voxels (the tiny pieces they divide the brain into), and by chance some voxels show activity even where there isn't activity simply because of the sheer number of opportunities for a false positive: similar to how a broken clock is right twice a day, and if you looked at the clock 100,000 times, you would see several times when it said the correct time.  The researchers had a dead salmon complete a standard task that would be used on live human subjects and showed that --- without correcting for multiple comparisons --- the salmon appeared to be thinking.  With correction for multiple comparisons, the scientists saw no effects.  This research was published in the Journal of Serendipitous and Unexpected Results.

DNC: Planned Parenthood promotes fertility

We all know that Planned Parenthood is in favor of parenthood at the right time. Giving women a place to address every type of reproductive health needs leaves them in better health, so that they are able to have children when it's their time. I found the story of Elizabeth Ann "Libby" Bruce, whose endometriosis was discovered at Planned Parenthood particularly moving, especially her delivery. Planned Parenthood didn't save her life, but it did make new life possible. There's nothing more pro-life than that. It doesn't hurt that her baby was born just 9 weeks ago, on our country's birthday. In Ohio.

The important issue here isn't access to health care, but access to the right health care. We have all known how scary and frustrating it is to feel sick without answers, even where insurance and health care access are assured. It's scary to think that Ms. Bruce might have never found a doctor to treat her condition, and thus found herself unable to have children.

I don't know whether Planned Parenthood is always better than women's other options, but it is important that Planned Parenthood is always an option. Planned Parenthood has saved the fertility of so many other women, but in ways that are sadly less politically palatable. We've come so far that we can have a woman say "endometriosis" in front of a full political convention, but we'll have come even farther when we can speak openly about chlamydia and other sexual health issues.

The Democrats are obviously way ahead on speaking candidly about women's health. Any guesses on how many decades before anyone will ever say the word "endometriosis" at the Republican convention?