Quantity or Quality?

During the national health care debate (and I hesitate calling what we had an actual debate, as opposed to shouting epithets at each other), one of the topics that briefly surfaced was end of life counseling.   There was a short-lived attempt to allocate Medicare funds to provide for comprehensive counseling on end of life issues, such as whether to continue treatments.  This devolved into the shouting over "death committees," among other untruths.  

Some health policy groups say cancer patients, as well as people with failing hearts or terminal dementia, should get better end-of-life counseling. Last year, a plan that would have let Medicare pay for doctors to talk about things like living wills was labeled "death panels" and was dropped.

This Associated Press article is an interesting report on the state of affairs with end of life treatment in the U.S.  What it says is that despite our "rational" desires to accept a terminal illness with some measure of grace, the facts show that we are not entering hospice care until way too late, and in many cases, desperately choosing very expensive experimental treatments to prolong "life."   The result can be a few more weeks, but at a horrible cost in quality of life.  A couple of sad facts:

—The average time spent in hospice and palliative care, which stresses comfort and quality of life once an illness is incurable, is falling because people are starting it too late. In 2008, one-third of people who received hospice care had it for a week or less, says the National Hospice and Palliative Care Organization.
—Hospitalizations during the last six months of life are rising: from 1,302 per 1,000 Medicare recipients in 1996 to 1,441 in 2005, Dartmouth reports. Treating chronic illness in the last two years of life gobbles up nearly one-third of all Medicare dollars.

The denial that Americans seem to undergo (although you might choose to call it "hope") is a good part of the reason that "health care costs" are continuing to skyrocket.  If you don't have insurance, you probably don't have the opportunity to consume multiple, experimental chemotherapy treatments for terminal cancer.   If you do have insurance, you might be able to get those $10,000 treatments, but the rest of us are paying for it.

What this comes down to is a tug of war between acceptance of the inevitable versus the good old American "never give up" reliance on "hope."  It's difficult to pick one side in this debate.  Even simply leaving it up to the individual and his/her family isn't a clear solution; if they opt to continue treatments indefinitely, the individual isn't the one footing the bill, we are.

We should really try to have a rational, calm discussion in this country about quality vs. quantity when it comes to end of life treatment.  Before we truly do go bankrupt.

Free Speech & The Internet

I'm a long time member and supporter of the Electronic Frontier Foundation (EFF), but I have to say I  disagree with the organization's position in a lawsuit involving anonymous speech at a newspaper web site in Illinois.   The case and EFF's position are covered here.  Essentially, the son of a local candidate engaged in a heated "discussion" with an anonymous poster, and the candidate felt that the poster had gone too far in his/her comments.  The candidate has sought the identify of the anonymous poster through a court case, which is now at the Appellate level in Illinois.

While I think I understand EFF's First Amendment arguments, I think that there are other factors that should be heavily weighed.   The biggest issue to me, is that there are thousands of people who post mindless, unintelligible, drivel via electronic postings that never would have seen the light of day before the Internet.   In the past, when people wrote letters to the editor of a newspaper, they may or may not have gotten their views printed.  If they were printed, they had to attach their name to their thoughts and others could write challenges in response. There was some accountability involved in making public comments.

In today's electronic world, anyone can say anything about anything, on newspaper web sites, as well as other online media outlets, many of which allow anonymous comments.  The ability to make anonymous postings adds nothing whatsoever to the quality or benefit.   Perhaps a pure reading of the First Amendment doesn't distinguish between useful speech and heated nonsense, but in past years, the ability to spew nonsense was limited to standing on a street-corner.   Whether the speaker could attract listeners depended on their speech.   And it's not generally feasible to stand on a street corner and speak anonymously.  

I've commented previously on the proliferation of ignorant commentary on the Web and this case seems to cut to the core of the matter.   Do we as a society benefit from enabling anonymous comment in public forums on the Internet?   Should we hold people accountable for their opinions?  What does society gain from unaccountable and anonymous public comment?

I just can't buy EFF's argument that anonymous online comments deserve Constitutional protection.

Welcome To The New Dark Age

Two newspaper articles this week highlight a growing problem: lots of people with opinions, but not necessarily much information. One is a local story and the other is a global one. And underlying this issue is the fact that a growing number of organizations, both mass media outlets (newspapers, television, and their web presences) and what I'll call non-media (everything else), feel compelled to give voice to every "Tom, Dick, and Harry" out there. And some are way out there.

The AP article starts by talking about the shouting going on at the climate change conference in Denmark this week. The author points out that there is little of traditional debate left in the mix, with both sides largely shouting at each other, beating each other with opinions. Facts, and science, are left in the dust. "And public debate shifts from the provable and the empirical toward the spectacle of argument."

There has long been a bias on the part of the public against intellectuals and science, and some feel this was because the public simply didn't trust intellectuals and scientists. This carries over to public perception of intelligence in general, and spawned those bumper stickers that read "My kid can beat up your honor role student." The pursuit of mediocrity at best.

The spawn of the Internet has made things even worse. Our electronic communications encourage the expression of opinions, whether or not the opinions are based even a little bit on fact. Facts and information are kicked to the curb in favor of "beliefs" and judgments, and truth is irrelevant.

"What you have is the (presumption) of expertise by ordinary people who feel their opinions are as valuable as anybody else's. And at the same time, you have experts behaving like gods beyond what they know," says Frank Furedi, a sociologist at the University of Kent and author of "Where Have All the Intellectuals Gone?"

The second article is a story about a library in the Chicago suburbs that implemented a new online catalog of its holdings. Part of the new software provided for patrons to "tag" books "with terms they think other readers might find useful." All patrons have to do is sign up with a user name and email address and they can tag to their heart's content. The "news" in this case is that someone tagged the library's collection of Anne Coulter's books with the term "hate speech." This in turn, made another patron very upset. The upset patron felt that the library was letting people make "political statements" on the library's site and felt that was wrong. The library doesn't closely monitor the tagging and will only remove tags that are "explicit materials or racial slurs."

My question is why does the library feel it's a good idea to have patron tagging of books in their online catalog? Just because the new software enables this, what point is served? Does the library really thing it's a good idea for patrons to peruse one or two word "tags" in order to decide if they want to read a particular book? Not only is this not encouraging critical thinking skills, it's pandering to the lowest denominator. Other libraries allow tagging, but require the submitter to also provide a book review, which might at least be an indication the commenter actually read the book.

What makes a patron qualified to recommend or criticize a book or author with word tags? What makes a newspaper article reader qualified to expound about why the article is all wrong? What qualifications do either bring to the table?

My 11/22/09 post also dealt with this issue of ignorant opinions and news outlets.

The ignorant comments of the public after news articles (about ignorant comments of politicians) are even more worrisome than the politicians' statements. The anonymous public vitriol tends to discourage rational discussion, and is little more than online bullying. For an excellent post on what's wrong with the public comment sections of news related web sites, read Steve Dahl's excellent 11/11/09 article "Everybody is a know-it-all these days."

This issue is not going away and I remain convinced that society needs to find a way back to the process of debate based on facts. We need to abandon our apparently growing penchant for encouraging ignorant shouting by people unconcerned with knowing anything about the topic at hand. I'm not very hopeful.

Greil Marcus, an American cultural historian and co-author of "A New Literary History of America," remembers watching TV in the 1950s, "when there were all these TV dramas about science vs. religion." And, he says, "science always won."

No more, Marcus says. Instead, cacophony now prevails and the right to be heard trumps what is being said. "Welcome to the new Dark Ages," he says.

Politics and Global Warming

I'm not sure what to make of the fact that there seems to be a vocal minority in the US that still doesn't believe than humans created the world's pollution levels and that the pollution has caused global temperatures to rise over the years and that this temperature rise is a threat to us. If you use the commentary section on newspaper web sites as an indicator, it would appear that there are an awful lot of these folks out there; more on that later.

In a recent news report on the current Governor's race in Illinois, the Daily Herald reported that five of the seven candidates for the Republican nomination don't "believe" that humans have caused global warming. One candidate allowed that humans "contribute" to global warming, but wasn't sure how much. The seventh candidate hedged his bets and stated he believes global warming research is "still evolving." I'm surprised he was brave enough to use the word "evolve."

The question was raised to elicit comment from the candidates on their views of "cap and trade" legislation at the Federal level. As such, it's really of small importance to the potential Governor of Illinois, but these candidates felt the need to explain their opposition to cap and trade. Rather than simply stating that they felt that a cap and trade approach to reducing pollution would have an unacceptable detrimental impact on business and employment (presumably because they think cap and trade will add costs to doing business), these politicians felt that they needed to attack the very notion that humans caused the climate changes scientists are observing. The public comments these people made are positively stunning in the depth of ignorance they displayed:

"I don't accept the premise that man is the cause of global warming, if global warming even exists," Kirk Dillard, a state senator from Hinsdale, said at a candidate forum last week.

"Global warming is not created by man and anybody who says that, it's just bad science. It's not true," said Bob Schillerstrom, chairman of the DuPage County Board.

Dan Proft, a Chicago-area public relations consultant, said Al Gore and other global warming activists are "kind of enviro-terrorists."

The State of Illinois is staggering under huge budget deficits, a regressive state income tax that hasn't been changed in a generation, more corrupt politicians than you can shake a stick at, and a public education system that is going bankrupt due to its reliance on property taxes. One could argue that the position of a potential Illinois Governor on global warming, climate change, and whether humans or polar bears caused these problems is of little relevance to the Chief Executive of the State. One would probably be mostly correct.

On the other hand, the fact that five candidates for statewide office had no compunction making such patently ridiculous statements in a public forum is disturbing for another reason. These politicians are so busy pandering to the "GOP base," that they can't accept what every middle school student knows is true; there's no explanation for global warming and its impact on climate besides humans and the pollution we have generated.

Now back to the online comments made by newspaper readers. This article generated the same kind of vitriolic and ignorant rants that cause me to generally avoid reading such commentary. Virtually all of these comments are posted by people using pseudonyms and their anonymity empowers them to make broad assertions as if they were facts. While they lambaste other commenters for making unsubstantiated or false "liberal" or "left-wing" statements about global warming, these posters make just as unsubstantiated claims masquerading as fact. Some of them make simple blanket statements about how well wildlife is faring in the Arctic, as if to settle the fallacy of global warming for everyone.

The ignorant comments of the public after news articles (about ignorant comments of politicians) are even more worrisome than the politicians' statements. The anonymous public vitriol tends to discourage rational discussion, and is little more than online bullying. For an excellent post on what's wrong with the public comment sections of news related web sites, read Steve Dahl's excellent 11/11/09 article "Everybody is a know-it-all these days."

In the end, it's impossible to debate with these folks and expect that they will ever be able to modify their viewpoint. If they don't "believe" in global warming by now, they never will.