Author: bill

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Science Journal – WSJ.com

We all make mistakes and, if you believe medical scholar John Ioannidis, scientists make more than their fair share. By his calculations, most published research findings are wrong.

Science Journal – WSJ.com

This is an interesting article which repeats the research findings of Dr. Ioannidis and others. I carry a healthy respect for the difficulty that scientists face find in their search for verifiable science. Mother Nature grudgingly gives up nuggets of knowledge only after a lot of work and rework. Below is the link to the original report by Dr. Ioannidis and another link that was provided as recommended reading in the WSJ article.

Dr. John Ioannidis argued that false findings may be the majority of published research claims, in “Why Most Published Research Findings Are False,” in the PLoS Medicine journal, in August 2005.

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In another PLoS Medicine article earlier this year, Ramal Moonesinghe and Muin Khoury at the U.S. Centers for Disease Control and Prevention demonstrated that the likelihood of a published research result being true increases when that finding has been repeatedly replicated in multiple studies. The article is: “Most Published Research Findings Are False — But a Little Replication Goes a Long Way.”

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FactCheck.org: Bush’s False Claims About Children’s Health Insurance – Fact or Fiction

Since I previously read the GAO report on SCHIP, I found the allegations made by Factcheck in this article to be fascinating. So I decided to read the GAO report again and see if I agree with their assessment. Maybe I missed something. Let me start out with the first false claim that FactCheck makes in the second paragraph.

He said it “would result” in covering children in families with incomes up to $83,000 per year, which isn’t true. The Urban Institute estimated that 70 percent of children who would gain coverage are in families earning half that amount, and the bill contains no requirement for setting income eligibility caps any higher than what’s in the current law.

This is an interesting rebuttal to Bush’s claim that the SCHIP program will result in covering children up to $83,000. They are saying that the administrators of the SCHIP program are not “required” to expand the program the coverage limits. The point about the Urban Institute estimate is interesting but not relevant to the discussion of expanding the income coverage limits. The GAO report does show that the SCHIP program has a history of expanding coverage beyond the recommended levels and until recently the SCHIP program had a surplus of funds available. The GAO also says that SCHIP administrators allowed some states to spend funds than they were not allocated. This resulted in the situation as described in the second paragraph of the GAO report.

some states have consistently spent more than their allotments, …

Since the present spending trends threaten to exceed available funding, the option to further expand the coverage limits at this time is a moot point. Despite the funding problems this did not stop several states from attempting to expand the coverage further. Several states have a history of expanding coverage limits and they have shown the motive to further expand the coverage limits. The only ingredient they are missing is the opportunity. It is reasonable to assume that once the funding is attained, New Jersey or New York will quickly ask for higher coverage limits and the SCHIP program will start covering children in families making up to $83,000. This is not a big step for New Jersey since they allow families with incomes of $72,275 already. Since funding appears the limiting factor to expanded coverage, I think FactCheck is stretching the truth more than George Bush. In fact I would be quite comfortable in arguing that every politician fully expects that the coverage limits will be expanded once the expanded funding is passed.

The second false claim that FactCheck points out is about the differences between “poor” and “low income”. I find that the quibbling over this statement to be particularly annoying. I regularly volunteer with Habitat for Humanity and out of necessity I know the difference between poverty and low income definitions. The importance of this subtle distinction is something only politicians can love. This debate on the semantics of poverty classifications does serve the purpose of not talking directly about whether the SCHIP program has lost its sense of direction. Is improved health care for children still an important issue for SCHIP? Is it necessary that a government health insurance program have a defined sense of direction? How bad does a government health care program have to be before we say that we need something better rather than just larger? These questions are the proverbial elephants in the room and are not lost to the folks who wrote the GAO report. If you look at the GAO report you will find:

  1. In Table 5 the present SCHIP program provides coverage for a large number of adults. Several states cover more adults than children. One of the most common scenarios I see in working with low income people is a single mom with several children. Huh, how does this happen?
  2. In Figure 2 of the GAO report you can see that Florida and Texas have the largest percentage of uninsured children. Since these states are two of the more populous states, there are a lot of uninsured children. How is the increased funding supposed to help these states? I don’t ever hear those states campaigning to increase the income limits. Do they have problems with children’s health care that are significantly different than other states?
  3. 87% of the people enrolled in the Minnesota SCHIP program are adults. Minnesota also has one of the lowest rates of uninsured children. What does additional SCHIP funding mean for Minnesota?  If children’s health care problems are the same in every state, maybe we can get Texas and Florida to out source their children’s health care to Minnesota.
  4. At the end of the report, the GAO questions the “financial sustainability of public commitments”. In laymen’s terms, the GAO is asking if it is good public policy to allocate federal funds to the states who consistently overspent their allocation? Is this good government? They also ask whether the federal government is responsible for the states who have over-promised future health services? Is this the model for a sustainable universal health care system?

Generally I find FactCheck to be a welcome addition to the debate on a variety of subjects but this was a weak piece. It is just that I expected to see more convincing evidence of false claims from the fact checkers.

FactCheck.org: Bush’s False Claims About Children’s Health Insurance

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The most important lesson I have learned about statistics

Recently I saw an article on the Register that caused me to think about the basics of statistics again. Although I have learned a lot about statistics in the class room, that is not enough. It is through the frustrations of real life applications that you learn the true nature of statistics. As Benjamin Disraeli said,

There are three kinds of lies: lies, damned lies, and statistics.

Many years ago I supported a quality control laboratory at a chemical plant. One day a senior engineer came to me with a request for laboratory data. He was working on a chronic problem in one of the units and was hoping that the laboratory data would help him. He had an idea of what was wrong so he was hoping that the laboratory data would not only confirm what he thought was the problem but also justify the capital investment to implement the solution he was already working on. Unfortunately there were several problems with the data.

The first problem was that the procedure used to collect the sample varied from shift to shift. This was an unintended effect of the sample being low priority data point. Important data points came from analyzers directly connected to the process control system. Most of the samples processed in the laboratory were used to verify that the online analyzers were working properly. This was one of those data points that did not have an online analyzer. Since the plant would normally run for three years without shutting down, the plant was manned by three different shifts. The training on how to collect the sample varied from shift to shift. One shift was very good at collecting this sample while another shift was very bad. To further complicate this problem, some laboratory technicians were not good at running the test for this sample and the technicians running the plant did not care if the test was run properly. When the senior engineer looked at the data he found good data, obviously bad data, and questionable data. He tried dropping the bad data but it still did not give him the result he desired. He tried to selectively drop or adjust some of the questionable data but the whole process quickly got to subjective. The people he needed to convince on the viability of his project were engineers. Engineers are a pretty straight forward group about quantitative data. Quantitative data should be quantitative and there are three answers. The data either confirms your hypothesis, rejects your hypothesis, or tells you nothing. After a considerable amount of angst the senior engineer accepted that the data told him nothing about his problem and he went about searching for another way to prove his point.

The article at the Register tries to convince the reader that the process of averaging can overcome measurement problems. The author sees a “haystack” of data that overwhelms the “needle” of measurement errors. I see it differently. If you look closer at the “haystack” of data you see that a large percentage of the data is derived from a much smaller source of measurement data which includes the errors and a variety of adjustments for missing and erroneous measurements. In this case the problem is that there is only a hundred years of temperature measurements of primarily urban sites and it is being used to derive two thousand years of global temperatures. Climate scientists are facing a similar problem to the one the senior engineer in my story faced. They wish they could go back in time and do a better job of measuring temperature in more places and more consistently. Things would be so much easier if scientists placed a higher priority on temperature measurements and the threat of global warming a hundred years ago. Unfortunately temperature measurements have always been a low priority task and the data that has been collected shows that. Adjustments and temperature proxies are the norm. The resulting data is uncomfortably subjective. It may be saying something important or nothing at all. To carry the haystack analogy of the Register author to its logical conclusion, is this a stack of hay or of something else? Once again I am reminded that the most important lesson I have learned about statistics is the quality of the raw data. If you have good data, statistics is your friend and will help you solve many problems. If you have bad data, statistics is your enemy and will probably create more problems than it solves.

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Crawfish Étouffée and Black Snake Moan

Several years ago I worked on a bayou that drained into the Gulf of Mexico. We were about ten miles from the nearest town so we were relegated to cafeteria food most of the time. So it was pretty exciting when a restaurant opened only a couple of miles away. It looked like the typical road side cafe along a lightly traveled country road. It had picnic tables out front and the inside was authentically rustic. I seem to remember that it had checkered table cloths. The place was run by a Cajun couple. The wife worked in the kitchen and the husband worked the tables. They were just another couple trying to make a buck in the restaurant business. It was at this humble restaurant that I ate the best crawfish Étouffée. It had the look, the smell, and the taste of the classic Gulf Coast dish. It was cheap, too!

The restaurant did not stay open for long. I heard that the local police were called in to settle a domestic dispute. The wife pulled out a shot gun on the husband during the dinner service. I do not know what triggered the dispute or whether she shot him but we never ate in the restaurant again.

Recently I watched the movie, Black Snake Moan. From the trailer I thought the movie was going to be another comedy set in the South. It is not a comedy but I was not disappointed. The plot is well written because of the ease it draw you into the story without resorting to stereotypes. The South does have its fair share of stereotypes so it took some discipline on the part of the writer to steer away the obvious plot hooks. The characters start out being fairly obvious stereotypes of the South. Early on in the movie I found myself wanting to really like or dislike certain characters but the plot did not cooperate with my plans. By the end of the movie I found these same characters to be complex individuals with serious personal problems they could not solve alone. Probably the most fascinating aspect about this movie is that it explores many of the same issues that Christianity and marriage find so important. We have greater freedom by being restrained by those we love. Like the movie it is not complete freedom but we are a lot better off than going it alone. I have a qualified recommendation for the movie since it has a lot of sex. However, the movie was entertaining and it made me think. It reminded me about the good and the bad in the people I have known from the South like the couple that served me the Étouffée I liked so much. It is our willingness to remain connected to each other that allows us to handle adversity.

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Shrimp from the US making a comeback

Yesterday I bought a package of frozen shrimp at Krogers that said it was caught wild off the coast of Key West. I had noticed that all of the Chinese shrimp had been removed from the shelves several weeks ago and replaced with shrimp from Thailand. This is the first package of shrimp I have seen from the United States in recent memory. The interesting part is that it was being sold for the same price as the shrimp from Thailand. Hmm…

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Hot news: NASA quietly fixes flawed temperature data; 1998 was NOT the warmest year in the millenium

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Hot news: NASA quietly fixes flawed temperature data; 1998 was NOT the warmest year in the millenium

Oops!

The interesting thing about this “news” bite is that Oprah just played her Al Gore show on climate warming this week. My wife was swayed by the show and I found myself explaining to my wife why I believe there is less certainty in the climate numbers than Al Gore portrays. I was not successful at getting to her to look at both sides of the question until I asked her to think about our local temperature records. Like most of the United States we are having some hot weather. This is likely the hottest week we have experienced here in the last ten years. You would think that with all of this global warming we would have been regularly setting record temperatures in the last ten years. Hmm… the weather man says the record was set in 1941 and the most recent high temperature for this day was 1998.My graph of the NASA U. S. Temperature Data

Now we get this “news” bite that says “5 of the 10 warmest years on record now all occur before World War II”. Since the revised temperature graph no longer looks like a “hockey stick”, the link of global warming to human activity is much more tenuous. From the data it looks like there is a recent warming trend but there is a significant warming cycle in the 1930-1960 data. It will be hard to convince people to accept a dollar a gallon tax on gasoline to combat global warming with this data. Though the case for global warming is a bit weaker, we are once again reminded that climate science is a fuzzy science.

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TCS Daily – The Universal Distraction

“Nobody is talking about a free-market approach in health care. The spectrum today is between fascism and Communism.”
–John Graham

The Pacific Research Institute’s John Graham offered this glum assessment during a brief chat recently when he came to Washington, DC for a meeting. He points out that the focus of health care policy is on how to get to “universal coverage.” In this context, the conservative approach involves mandatory health insurance. The liberal approach involves expanding government coverage. Hence, it is either fascism or Communism.

TCS Daily – The Universal Distraction

An interesting article that goes to the heart of the universal coverage debate but it ignores the biggest health care problem, rising health care costs. “Universal coverage” and mandatory health insurance are health care supply issues and I just do not see these issues as the biggest problem. It is my belief that we will not make progress toward better health care until we get smarter about managing the demand for these programs. From an economic perspective the biggest problem is that there is too much demand for health care services. There are a variety of easy to see symptoms such as obesity and drugs. It is easy to be critical of something as simple as obesity but it is at the core of several of our health problems and we are doing little to control it. Then there are the ads for drugs on television. We are constantly being bombarded with ads to fix symptoms I never knew were a problem. It seems we have drugs for everything. Despite Roger Moore’s allegations that the health insurance industry is at the root of the health care problem, “someone” has to restrict the health care demand and tell the patient/doctor there is a better way. Sixteen years ago when my son was born I was amazed at how clueless doctors were at billing and understanding the health care cost issues. Doctors have become more knowledgeable about cost issues over the years but they still have a long way to go. Although I do not think the doctors and the health insurance industry has done a particularly good job at managing the health care cost issues, I have slightly more faith in their existing partnership than a partnership with a newly created government bureaucracy.

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Bridges, Healthcare, and the War: The Coming Storm

Recently the National Review and the Wall Street Journal have been trying to rouse support against the Democratic plan to expand the State Children’s Health Insurance Program(SCHIP). It is widely viewed that that Democrats view the expansion of SCHIP as the down payment for universal healthcare. Their plan is to start with a bad “universal” health care system and then when it fails replace it with the health care system they really wanted. The original objective of SCHIP was to help insure children and their parents who earn too much for Medicaid and too little for private insurance. It is pretty obvious that the program achieved as much success as they are ever going to attain with children’s healthcare some years ago. From the Congressional report it is obvious that some states, Florida and Texas, have persistent problems with children’s healthcare despite the subsidy. Lower health insurance costs is just one part of the children’s health care issue. Other states without serious children’s health care issues have taken advantage of the program to expand the program to cover adults without children and to provide insurance children of middle class parents. This is not what Congress intended but the result is not surprising. New Jersey has a health care crisis due to their own bungling so it is not surprising that they are leading the pack in this area. A government health care program can be cheaper for a middle class family due to the subsidy but I doubt it is better or more efficient than private insurance alternatives. Expanding SCHIP has all of the characteristics of a program that is spirally out of control, more service from an inefficient program with ambiguous objectives. I view the SCHIP program and most of the health care reforms a various forms of a “free lunch”. Most of the programs promote their service and down play their financial oversight. Universal health care attempts at the state level have failed because they are unable or unwilling to control health care costs. Inevitably the state programs fail because they cost more for less service and are widely viewed as a poor way to transfer wealth from one group of people to another. Despite the budget failures of universal health care at the state level, I doubt that Congress will ever get rid of a health care system even if it is inefficient and costs more money than expected. SCHIP is no longer about children’s health care.

With the recent bridge collapse in Minnesota it is not hard to see the coming budget conflict. Assuming that the war in Iraq will be winding down in the next year or so, the next budget conflict will be between health care subsidies and infrastructure repairs. The Defense Department budget will gradually decline to historic norms while health care subsidies and infrastructure earmarks duke it out for their slice of the budget pie. Let the games begin!