succumbing to peer pressure

Saturday, November 17, 2007

Further proof that we're all getting old

In addition to me falling asleep embarrassingly early at the Halloween party, tonight at Public Health Prom we 1) knew practically no one, 2) complained about how crappy the DJ was, and 3) were much more interested in just spending some quality time together, the few of us close friends. Wait, that third one is nice. Maybe that one is an indication that we're growing up rather than old. "Prom" tonight was bittersweet, for a multitude of reasons, but mostly lovely nonetheless. We haven't had much time for each other, as a result of dissertations and job interviews and significant others. It's a cyclical thing - second year we also rarely saw each other, because school was sucking our souls out. So we're understanding, and don't blame each other when we have to bail on plans, which is nice. But it's nicer when we do manage to carve out some time to sit around, drink a bit, and tell stories.

Thursday, November 15, 2007

That's not my job

I wish I could think of a way to educate the rest of the members of this school about what exactly it is we do here in the biostats department, and what is and is not our job. Or more specifically, what is an appropriate way to request our help. Someone (presumably a student, sent down here by his advisor) just poked his head in my door, asked, "um...are you guys the TAs?" I glance around my office, which at the moment contains just me. "Well, I am, but it depends on what class you're looking for." Him: "Oh, ah, it's not for a class, I just have this SAS question, for a database thing...I'm just looking for some help." Which is fine, we love to collaborate and help out non-statisticians. But his is not a trivial question and therefore, in my opinion, requires a more formal request for help, and, oh, I don't know, making an appointment! This sort of thing happens all the time, and it just drives me nuts. I would never in a million years consider wandering the halls in another department, sticking my head in offices and going, oh, hey, could you drop what you're doing to explain to me how medicare works? No, I'm not your student, but, you know, you study health policy, so it's your job to answer all my questions whenever I come up with them, right?

Sunday, November 11, 2007

This is why I love going to conferences

because they're the perfect antidote to all that imposter bullshit from last week. Not only did I get some lovely reminders that I do, occasionally, rock, but I got confirmation that there are lots of other statisticians out there who are interested in and value and make a living doing the sort of work that I want to grow up to do. Hell, the sort of work that I'm already doing. So I got some much-needed validation and inspiration from interesting, passionate people doing excellent research.

And, of course, I picked up all sorts of great factos about non-statistical public health stuff:

  • According to The Commonwealth Fund, the administrative overhead for healthcare in the United States has more than doubled over the past 7 years. Now, I know we need some sort of bureaucratic system to keep everything running, but seriously? Have we somehow doubled our benefits from overhead over the past 7 years? This is precisely where we should be looking to reduce the cost of healthcare in this country.

  • Len Nichols, from the New America Foundation had this great quote, "Some Republicans believe things that are not true and some Democrats want things that cannot be. And it's my job to piss them both off, and keep them talking to each other." He also sounded like a preacher (in a nice way) as he reminded us that in the Bible landowners are admonished to leave something in the fields for widows and orphans and strangers. That it has always been our job to look out for the less fortunate, in a way that combines personal and shared responsibility - we have to structure the marketplace so that it works for everyone and enables everyone to take personal responsibility. When we are responsible for stacking the deck against certain members of society, then we are also responsible for somehow helping them back out of that situation. So we can either continue to complain about charity and covering the costs of healthcare for the poor through government systems like medicaid and our own rising insurance prices to pay for all those emergency room visits by the uninsured or we can start seriously restructuring the marketplace. As Nichols reminded us, in the Bible landowners weren't told to harvest all their land and provide meals for widows, orphans, and strangers. Rather to leave open the opportunity for them to provide for themselves.

  • It's not often that I agree with a Republican, but I just love this quote from Senator Grassley (from Iowa!) (in regard to renewing and expanding SCHIP): “This bill is not socialized medicine…Screaming ‘socialized medicine’ is like shouting ‘fire’ in a crowded theater. It is intended to cause hysteria that diverts people from reading the bill, looking at the facts.”
Of course, this was a public health conference (emphasis on the public) so there was much discussion of universal healthcare. There's too much to get in to here, but I highly recommend visiting Physicians for a National Health Program and reading Krugman's excellent debunking of the waiting game myth:

A recent article in Business Week put it bluntly: “In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems.”

A cross-national survey conducted by the Commonwealth Fund found that America ranks near the bottom among advanced countries in terms of how hard it is to get medical attention on short notice (although Canada was slightly worse), and that America is the worst place in the advanced world if you need care after hours or on a weekend.


Besides, not all medical delays are created equal. In Canada and Britain, delays are caused by doctors trying to devote limited medical resources to the most urgent cases. In the United States, they’re often caused by insurance companies trying to save money.


On the other hand, it’s true that Americans get hip replacements faster than Canadians. But there’s a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare.

That’s right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare (yes, that’s what they call their system) because it has more lavish funding — end of story. The alleged virtues of private insurance have nothing to do with it.

The bottom line is that the opponents of universal health care appear to have run out of honest arguments. All they have left are fantasies: horror fiction about health care in other countries, and fairy tales about health care here in America.

Lastly, there is this excellent quote from the WHO's Commission on the Social Determinants of Health to remind me to keep my stats grounded: “Evidence is rarely if ever sufficient by itself to catalyze political action. In political terms, what might be at least as crucial as the evidence itself is the ‘story’ in which it is embedded.”