When medical care didn’t contribute as much to improved health outcomes

An interesting piece on the efficacy of medicine and medical procedures (TLDR: they aren’t always effective but doctors and patients feel compelled to try something) ends with this suggestion about the power medicine has over the public:

Historians of public health know that most of the life-expectancy improvements in the last two centuries stem from innovations in sanitation, food storage, quarantines, and so on. The so-called “First Public Health Revolution”—from 1880 to 1920—saw the biggest lifespan increase, predating antibiotics or modern surgery.

In the 1990s, the American Cancer Society’s board of directors put out a national challenge to cut cancer rates from a peak in 1990. Encouragingly, deaths in the United States from all types of cancer since then have been falling. Still, American men have a ways to go to return to 1930s levels. Medical innovation has certainly helped; it’s just that public health has more often been the society-wide game changer. Most people just don’t believe it.

In 2014, two researchers at Brigham Young University surveyed Americans and found that typical adults attributed about 80 percent of the increase in life expectancy since the mid-1800s to modern medicine. “The public grossly overestimates how much of our increased life expectancy should be attributed to medical care,” they wrote, “and is largely unaware of the critical role played by public health and improved social conditions determinants.” This perception, they continued, might hinder funding for public health, and it “may also contribute to overfunding the medical sector of the economy and impede efforts to contain health care costs.”

It is a loaded claim. But consider the $6.3 billion 21st Century Cures Act, which recently passed Congress to widespread acclaim. Who can argue with a law created in part to bolster cancer research? Among others, the heads of the American Academy of Family Physicians and the American Public Health Association. They argue against the new law because it will take $3.5 billion away from public-health efforts in order to fund research on new medical technology and drugs, including former Vice President Joe Biden’s “cancer moonshot.” The new law takes money from programs—like vaccination and smoking-cessation efforts—that are known to prevent disease and moves it to work that might, eventually, treat disease. The bill will also allow the FDA to approve new uses for drugs based on observational studies or even “summary-level reviews” of data submitted by pharmaceutical companies. Prasad has been a particularly trenchant and public critic, tweeting that “the only people who don’t like the bill are people who study drug approval, safety, and who aren’t paid by Pharma.”

We might attribute this overconfidence in medical care among Americans to two cultural traits: (1) a belief that science can and should solve problems and lead to better lives and (2) an interest in efficient solutions to complex problems. Yet, one takeaway from this is that a healthier lifestyle may be boring and be hard work to implement (on both an individual and community level) but could be more effective in the long-term than medical intervention.

Majority of Americans wrong about the decline in global poverty

Nicholas Kristof discusses the role of the media in contributing to incorrect knowledge about global poverty:

One survey found that two-thirds of Americans believed that the proportion of the world population living in extreme poverty has almost doubled over the last 20 years. Another 29 percent believed that the proportion had remained roughly the same.

That’s 95 percent of Americans — who are utterly wrong. In fact, the proportion of the world’s population living in extreme poverty hasn’t doubled or remained the same. It has fallen by more than half, from 35 percent in 1993 to 14 percent in 2011 (the most recent year for which figures are available from the World Bank).

When 95 percent of Americans are completely unaware of a transformation of this magnitude, that reflects a flaw in how we journalists cover the world — and I count myself among the guilty…

The world’s best-kept secret is that we live at a historic inflection point when extreme poverty is retreating. United Nations members have just adopted 17 new Global Goals, of which the centerpiece is the elimination of extreme poverty by 2030. Their goals are historic. There will still be poor people, of course, but very few who are too poor to eat or to send children to school. Young journalists or aid workers starting out today will in their careers see very little of the leprosy, illiteracy, elephantiasis and river blindness that I have seen routinely.

Kristof and a growing number of others have noted that certain aspects of life are getting better for many people – like decreasing violence around the world or lower crime rates in the United States – yet the general public is not aware of this. The media is certainly complicit but they are not the only social forces at work here.

Turning to my own discipline of sociology, several sociologists, including Ulrich Beck, Barry Glassner, and Harvey Molotch, have written books on the topic of fear. Yet, it doesn’t seem to get much attention from the discipline as a whole. Of course, sociologists are regularly pointing out social problems (critics may say even inventing social problems) and often trying to offer arguments for why people and those in power should do something.

If there is positive psychology, how about positive sociology? Here is a rumbling or two

“What McMansions say about Americans: Stupid is as stupid does”

As more mansions are built in Los Angeles, one editorial writer suggests the return of McMansions is misguided.

When the going gets less tough, Americans get stupid.

Stupid means big. During economic booms — or times like now, when the economy still stinks but stinks somewhat less than before — automakers crank out giant gas guzzlers. And home-builders build huge…

My main objection to McMansions is that they, like most post-1960s architecture, are not just  ticky-tacky but really, really ugly. My eyes! They burn!

But there are serious objections on, among other things, environmental grounds.

Well, that is one clear opinion. Common arguments: McMansions are too big, poorly designed, environmentally wasteful, and exhibit the basest consumerist tastes of Americans.

One thing to note in this argument and the data presented: most Americans do not live in McMansions, whether before the economic crisis or now. Some wouldn’t live in one if they could. However, it isn’t clear just how many aspire to live in a McMansion or approve of them. After all, it is a term with many negative connotations. Saying that McMansions speak about all McMansion is a bit broad; it is really about the relative percentage of Americans who are willing to purchase such homes and support the rights of others to do so.

Congressional town halls not necessarily indicative of public opinion

I heard two news reports yesterday from two respected media sources about Congressional members holding towns halls in their districts about possible military action in Syria. Both reports featured residents speaking up against military action. Both hinted that constituents weren’t happy with the idea of military action. However, how much do town halls like these really tell us?

I would suggest not much. While they give constituents an opportunity to directly address a member of Congress, these events are great for the media. There are plenty of opportunities for heated speeches, soundbites, and disagreement amongst the crowd. One report featured a soundbite of a constituent suggesting that if he were in power, he would put charge both the president and his congressman with treason. The other report featured some people speaking for military action in Syria – some Syrian Americans asking for the United States to stand up to a dictator – and facing boos from others in the crowd.

Instead of focusing on town halls which provide some political theater, we should look to national surveys to American public opinion. Focus on the big picture, not on towns halls which provide small samples.

Gans says “public opinion polls do not always report public opinion”

Sociologist Herbert Gans suggests public opinion polls tells us something but may not really uncover public opinion:

The pollsters typically ask people whether they favor or oppose, agree or disagree, approve or disapprove of an issue, and their wording generally follows the centrist bias of the mainstream news media. They offer respondents only two sides (along with the opportunity to say “don’t know” or “unsure”), thus leaving out alternatives proposed by people with minority political views. Occasionally, one side is presented in stronger or more approving language — but by and large, poll questions maintains the balanced neutrality of the mainstream news media.

The pollsters’ reports and press releases usually begin with the asked question and then present tables with the statistical proportions of poll respondents giving each of the possible answers. However, the news media stories about the polls usually report only the results, and by leaving out the questions and the don’t knows, transform answers into opinions. When these opinions are shared by a majority, the news stories turn poll respondents into the public, thus giving birth to public opinion…

To be sure, poll respondents favor what they tell the pollsters they favor. But still, poll answers are not quite the same as their opinions. While their answers may reflect their already determined opinions, they may also express what they feel, or believe they ought to feel, at the moment. Pollsters should therefore distinguish between respondents with previously determined opinion and those with spur-of-the-moment answers to pollster questions.

However, only rarely do pollsters ask whether the respondents have thought about the question before the pollsters called, or whether they will ever do so again. In addition, polls usually do not tell us whether respondents have talked about the issue with family or friends, or whether they have expressed their answer cum opinion in other, more directly political ways.

Interesting thoughts. As far as surveys and polls go, they are only as good as the questions asked. But, I wonder if Gans’ suggestions might backfire: what if a majority of Americans don’t have intense feelings about an issue or haven’t thought about the issue before? What then should be done with the data? Polls today may suggest a majority of Americans care about an issue but the reverse might really be true: a lower percentage of Americans actually follow all of the issues. Gans seems to suggest it is the active opinions that matter more but this seems like it could lead to all sorts of legislation and other action based on a minority of public opinion. Of course, this may be it really works now through the actions and lobbying of influential people…

It sounds like the real issue here is how much public opinion, however it is measured, should factor into the decisions of politicians.

Pew again asks for one-word survey responses regarding budget negotiations

I highlighted this survey technique in April but here it is again: Pew asked Americans to provide a one-word response to Congress’ debt negotiations.

Asked for single-word characterizations of the budget negotiations, the top words in the poll — conducted in the days before an apparent deal was struck — were “ridiculous,” “disgusting” and “stupid.” Overall, nearly three-quarters of Americans offered a negative word; just 2 percent had anything nice to say.

“Ridiculous” was the most frequently mentioned word among Democrats, Republicans and independents alike. It was also No. 1 in an April poll about the just-averted government shutdown. In the new poll, the top 27 words are negative ones, with “frustrating,” “poor,” “terrible,” “disappointing,“ “childish,” “messy” and “joke” rounding out the top 10.

And then we are presented a word cloud.

On the whole, I think this technique can suggest that Americans have generally unfavorable responses. But the reliance on particular terms is better for headlines than it is for collecting data. What would happen if public responses were split more evenly: what words/responses would then be used to summarize the data? The Washington Post headline (and Pew Research as well) can now use forceful and emotional words like “ridiculous” and “disgusting” rather than the more accurate numerical figures than about “three-quarters of Americans offered a negative word.” Why not also include an ordinal question (strongly disapprove to strongly approve) about American’s general opinion of debt negotiations in order to corroborate this open ended question?

This is a possibly interesting technique in order to take advantage of open ended questions without allowing respondents to give possibly lengthy responses. Open ended questions can produce a lot of data: there were over 330 responses in this survey alone. I’ll be interested to see if other organizations adopt this approach.

Pew using word frequencies to describe public’s opinion of budget negotiations

In the wake of the standoff over a federal government shutdown last week, Pew conducted a poll of Americans regarding their opinions on this event. One of the key pieces of data that Pew is reporting is a one-word opinion of the proceedings:

The public has an overwhelmingly negative reaction to the budget negotiations that narrowly avoided a government shutdown. A weekend survey by the Pew Research Center for the People & the Press and the Washington Post finds that “ridiculous” is the word used most frequently to describe the budget negotiations [29 respondents], followed by “disgusting,” [22 respondents] “frustrating,” [14 respondents] “messy,” [14 respondents] “disappointing” [13 respondents] and “stupid.” [13 respondents]

Overall, 69% of respondents use negative terms to describe the budget talks, while just 3% use positive words; 16% use neutral words to characterize their impressions of the negotiations. Large majorities of independents (74%), Democrats (69%) and Republicans (65%) offer negative terms to describe the negotiations.

The full survey was conducted April 7-10 among 1,004 adults; people were asked their impressions of the budget talks in interviews conducted April 9-10, following the April 8 agreement that averted a government shutdown.

I would be hesitant about leading off an article or headline (“Budget Negotiations in a Word – “Ridiculous”) with these word frequencies since they generally were used by few respondents: the most common response, “ridiculous,” was only given by 2.9% of the survey respondents (based on the figures here of 1,004 total respondents). I think the better figures to use would be the broader ones about negative responses where 69% used negative terms and a majority of all political stripes used a negative descriptor.

You also have to dig into the complete report for some more information. Here is the exact wording of the question:

PEW.2A If you had to use one single word to describe your impression of the budget negotiations in Washington, what would that one word be? [IF “DON’T KNOW” PROBE ONCE: It can be anything, just the first word that comes to mind…] [OPEN END: ENTER VERBATIM RESPONSE]

Additionally, the full report says that this descriptor question was only asked of 427 respondents on April 9-10 (so my above percentage should be altered: it should be 29/427 = 6.8%). So this is a smaller sample answering this particular question; how generalizable are the results? And the most common response to this question is the other category with 202 respondents. Presumably, the “others” are mostly negative since we are told 69% use negative terms. (As a side note, why not separate out the “don’t knows” and “refused”? There are 45 people in this category but these seem like different answers.)

One additional thought I have: at least this wasn’t put into a word cloud in order to display the data.

The silent Supreme Court judge

The New York Times examines the five year silence of Supreme Court Justice Clarence Thomas in cases that have argued before the court. While there are a number of possible reasons given for this silence, I want to know two things:

1.  Does this silence improve his standing in front of others (in the legal community, the general public) or does people dislike him because of this?

2. How does this silence affect the workings or camaraderie among the Supreme Court justices? Do they lose something in their court proceedings when Thomas is silent?