History lesson, courtesy of Marco Rubio

I once thought that the constraints of writing on Twitter entitled people to a considerable measure of benefit of the doubt.

But this? A man has limits…

Screen shot 2015-05-13 at 19.08.30

What Coase Actually Believed

It’s remarkable how often people are remembered for believing or doing things that they in fact opposed. Professor David Ball recently passed along this gem from the famous economist Ronald Coase.

The world of zero transaction costs has often been described as a Coasian world. Nothing could be further from the truth. It is the world of modern economic theory, one which I was hoping to persuade economists to leave.

Source: The Firm, the Market and the Law, University of Chicago Press, Chicago, 1988. p.174.

A Debate About Prescription Opioids

Are there people in acute pain who could benefit from prescription opioids? Yes.

Are there people who are addicted to and at risk of overdosing on prescription opioids? Yes.

That’s the nub of one of the most challenging problems in current drug policy: How do we regulate prescription opioids in a fashion that maximizes their positive medical impacts and minimizes their risks and harms?

Our most recent Stanford Health Policy Forum featured a civil, spirited debate about this question between Drs. Sean Mackey and Anna Lembke. In addition to being highly interesting, their discussion shows that (hooray!) at least some people can argue about drug policy while still respecting and listening to each other.

Happy Mother’s Day, especially to all of you family caregivers

Today is Mother’s Day. I just want to give a shout-out to all of those family caregivers–usually though not always moms–who should be honored today, as well. Yeah, that is my wife and my brother-in-law in a fairly recent picture.

Screen Shot 2015-05-10 at 10.03.37 PMMore than 800,000 Americans diagnosed with intellectual or developmental disabilities currently live with a caregiver over the age of sixty. That’s usually “Mom,” with spouses, daughters, or others helping out.

Props to all of them. They’re working some serious overtime, in more than one way.

The Lesson of Scotland: Give the People Something to Vote For

Nicola Sturgeon

Nicola Sturgeon, happy warrior

The scale of the electoral slaughter in Scotland yesterday was truly astonishing. The Scottish National Party (SNP) didn’t just take almost every single Labour seat, they took them by swings that have no precedent in electoral history. Turnout was over 80% in some constituencies! Even a 20-year old SNP candidate was enough to sweep aside a seasoned Labour politician. Forgive me for quoting myself regarding what things were like on the ground:

I ran into a Scottish friend recently, a diehard Socialist and Nationalist, who was not in the least discouraged by the recent negative vote on independence. “It was like the old days” he told me, with excitement in his voice “People standing on street corners talking about politics, complete strangers debating each other in the pub about the future of Scotland, the whole country came alive!”. Thinking about the default cynicism and political disengagement in most of the developed world, I had to admit that it sounded vivifying.

The unmistakable difference between Labour Party and SNP supporters this year is how many more of the latter were voting positively. When I asked my friends who supported Labour why they did so, they could almost never speak even two sentences without attacking the Tories. Some couldn’t even get two words out without mentioning them,

Q: “What do you like about Labour?”

A: “The damn Tories…”.

Q: “I know you don’t like them, but what would your party do if it won?”

A: “We’d kick out the damn Tories!”

In contrast, my SNP supporting friends rarely mentioned either of the major parties in explaining their votes. Instead, they talked about what they dreamed a Scottish nation could become under SNP rule, almost always with a smile on their face and hope in their voice.

Parties can certainly win elections entirely by saying what they don’t stand for, who they are against, and how they are not as bad as their opponents. But if all you have going for you is such negative voting motivations, you are completely ill-equipped to handle an opponent whose support comes not from what they aren’t, but from what they are. The positive vision of the SNP drew a huge number of people into the political process who had previously been disengaged and energized long-time voters who were used to pulling the lever while holding their nose with the other hand.

In the U.S., we all bemoan the level of political alienation in the electorate and the negative tone of our politics. The SNP experience shows that there is a possible solution: Candidates and parties that give people something to vote for rather than merely vote against.

Weekend Film Recommendation: The Parallax View

Our month of the cinema of conspiracies and political paranoia continues this week at RBC (Johann kicked it off last week with the disturbing and powerful Conspiracy). The horrifying assassinations of the 1960s generated countless conspiracy theories that continued to rattle about in the 1970s, particularly after Watergate further damaged the public’s faith in once-respected institutions. During this period, Alan J. Pakula was arguably the film maker who most effectively translated the public’s anxieties onto the screen. The two best known of his “paranoia triology” are the Oscar winners Klute and All the President’s Men. This week’s film recommendation is the less commonly recalled but very fine member of the troika: 1974′s unnerving The Parallax View.

The film’s opening sequence, set at the top of Seattle’s space needle, grabs viewers by the throat. What seems a banal political event suddenly turns violent, and through a series of rapid cuts the audience is as disoriented as the terrified characters on screen as they wonder what exactly they just saw. In the ensuing months, many of the witnesses come to premature ends, leading raffish journalist Joe Frady (Warren Beatty) to investigate, against the advice of his hard-headed, fatherly editor (Hume Cronyn, effortlessly at home in his role). Frady discovers that a mysterious corporation is recruiting sociopathic killers, and he goes undercover to investigate them. He seems to be making progress in infiltrating the nefarious cartel, but is he really just walking into the web of a hungry spider who is spinning all the strands?

The Parallax View provides moments of high suspense and also carries off well that essential of paranoia films: The exchanges between the lead character and the trusted friend who thinks the “conspiracy” is all imagined (Nice touch: Cronyn’s office is crammed with memorabilia from his work with the Boy Scouts). The performances are believable throughout, which helps the film survive its more credibility-straining moments.

The late Gordon Willis, one of the most respected cinematographers of the 1970s, gives the film a distinctive look appropriate to its tone. There are many long, lonely shots taken far from the action, along with Willis’ signature fondness for shadows. The opening and closing shots, of government investigatory commissions proclaiming “nothing to see here, move along, there’s no conspiracy” as the camera moves in and out, ultimately arriving at a dark, distorted anamorphic image, are perfect bookends for the film. Combined with the movie’s minimalist use of sound, Willis’ superb work suffuses the movie with a sense of unease.

The film is not without shortcomings. As in some other Pakula films (e.g., Consenting Adults), certain plot elements can’t survive strict logical scrutiny. How is it that second-rate journalist Joe Frady can drive like a NASCAR champion and fight like James Bond? Why doesn’t he ever have deadlines at his newspaper and why, beyond the needs of the script, does his editor keep handing him piles of cash to pursue his story? Another potential weakness: Joe Frady is not that appealing of a person, so if you really don’t like Warren Beatty as a star, you may not feel much sympathy for the protagonist.

Flaws notwithstanding, Parallax View is an effective, disturbing piece of cinema. Its perspective is ultimately gloomy, but that doesn’t diminish its entertainment value or emotional impact one iota. This is a movie that stays with you, like a microphone the CIA has attached to your cell phone.

p.s. For those of you who are not old enough to remember and therefore might find one key scene of this film unbelievable: In the 1970s, you really could board an airplane without a ticket and check luggage onto a flight on which you were not yourself a passenger. Also, there was good service in coach. Really.

Everything old is new again

Several years ago I posted this maximally snarky rant about pod coffee machines, especially Nestlé’s. Soon after, Keurig’s patent apparently ran out, K-pod prices came down a lot,  and it became possible to use them with coffee bought by the bag as Keurig (and others) sold refillable pods to make it possible.  But greed hath no season, and Keurig has done a spectacular faceplant trying to force its customers back into obedience.

How nice to see.

I’m Just a Soul Whose Intentions are Good

…oh Lawd, please don’t let me be misunderstood.

I was a radio show once where a caller blasted me with a long indictment of my alleged opinions. The host and the other guests were all shocked, because I hadn’t said anything like what the caller was railing against. Indeed, the caller and I agreed with each other. When the host pointed this out to the caller, she just repeated her gripe. A friend of mine who listened said to me later “It doesn’t matter what you said, it matters what she wanted to hear as an excuse to rant.”

I had an unpleasant little run lately with my writing that brought that memory back to me. Regarding a post I wrote about the state prison population I got an angry tweet from someone who thought I was writing about the (utterly different) federal prison population. This was followed by someone emailing me to complain that my piece on the Euro was idiotic because I only discussed the psychological failings of the system without mentioning its absurd economic underpinnings. This angry chap couldn’t have known I agreed with him unless he had read all the way to the second sentence of my post (A lot to ask, I realize). The same week, someone wrote a whole lengthy blog post criticizing a methodological approach to research which he attributed to me, when the paper I wrote (nicely summarized by Austin Frakt here) had specifically argued that the approach he was complaining about was flawed and therefore was proposing an alternative.

I can’t personally imagine getting pleasure from attacking people who agree with me as if they were disagreeing with me, so I am not sure what motivates so many people to engage in this behavior. In addition to being rude, it is (or ought to be) embarrassing as it announces to the world that you are comfortable criticizing things that you haven’t troubled to actually read.

Writing for the public really does require a leap of faith sometimes, namely that among your readers are many people who actually want to understand what it says and to agree or disagree with with it honestly. Most days I don’t lack that faith, but a run like this is rather soul-killing for me as a writer.

Job Interview

–Thank you for applying to fill our open position as chief of cardiac surgery, Dr. Hahnemann.

–Well, Dr. Carson, I hope I can bring cardiac surgery here to the high level you’ve achieved in neurosurgery.

–So, Dr. Hahnemann, why do you think you’re qualified for this job?

–It’s Mr. Hahnemann, Dr. Carson.  I’m not a surgeon, or even a doctor. I’m probably never going to be professionally correct because I’m not a surgeon.  I don’t want to be a surgeon. Because surgeons do what is medically expedient — I want to do what’s right.

–Mr. Hahnemann, you’re a man after my own heart. I’m going to give you my strongest endorsement to the hiring committee.

The ACA and Addiction Treatment: Necessary but not Sufficient

The Affordable Care Act has done a remarkable job of expanding the number of Americans who have insurance to cover treatment of substance use disorder. But as our research team reports in the current issue of Health Affairs, many states and treatment programs have yet to build the infrastructure needed to take best advantage of the ACA and thereby expand access to care. Our team leader, Dr. Christina Andrews, describes the challenges in this interview with NPR Marketplace.