Apr 27, 2009

Report Ignores Revealed Preference [LINK]

A letter in response to a report on my local NPR station:

Tonight WBUR aired an engaging report by Rachel Gotbaum on palliative care, one that focused on the diminishing returns end-of-life medical interventions often bring, especially as medical advances extend lives further and make people more likely to die of long-drawn-out chronic diseases.

I found one aspect of the report questionable, however: its conclusion that patients are ill-served by the medical establishment's focus on doing everything in their power to keep their older patients alive. Instead, the report cited a "national survey" that people would prefer to die at home, surrounded by family, and with no pain -- a preference we're clearly not meeting because 80% of us die in institutions.

The problem with such survey data is that it's far less reliable than data on how people actually behave. Of course, when asked, people will naturally respond that they don't want to die in pain, but that's not necessarily a realistic option if your goal is to live longer. Those who value a pain-free death so highly would commit suicide well before their chronic conditions caused such discomfort. A proper survey should mirror such real-life constraints, e.g., by asking: "which would you rather do, die peacefully at 80, or more painfully at 85, but at least be able to see your grandchildren grow a few more years?"

By ignoring the manifest preference expressed by the behavior of health care consumers, the report instead focuses exclusively on the role of health care providers. It refers to a "health care system determined to keep everyone alive," as if patients have no choice in that determination. The report hints that increased rationing of health care is the appropriate response, which only seems natural given its narrow focus on cost-efficiency.

It's certainly appropriate to consider alternate systems that deliver a lower level of health care, especially when the costs of such expensive end-of-life care are not internalized. However, the suggestion that we'd prefer not to avail ourselves of such care is a dubious one.

This argument based on "revealed preference" reminded me of a similar one I posed concerning the death penalty.
UPDATE: Sure enough, the following day's report told the heart-wrenching story of a man who wanted to die from a chronic condition at home, but who after collapsing there was taken to an emergency room, where he was force-fed with a feeding tube, and tied down to prevent him from yanking it out of his mouth, until finally he died. This truly horrifying story was taken to mean health care providers should not go to great efforts to keep patients alive. But this seems a simple issue of communicating the patient's wishes. Assuming the patient is competent, the decision is his.

Apr 23, 2009

Is Craigslist Responsible? [LINK]

Another letter to the Globe:

Editorializing on the murder of Julissa Brisman, the Globe concludes that unless Web firms such as Craigslist "take more responsibility for how their sites are used," Americans may "need to get used to a lot more risk in the spaces where they gather." This is both vague and incorrect in this instance. Craigslist does nothing to increase the risk a young woman offering herself as a prostitute already faces when going into a hotel room with a total stranger. There is no risk whatsoever of bodily harm to other Americans. If the phrase "spaces where they gather" encompasses online virtual spaces, the only risk is seeing such a classified posting, akin to seeing a print ad for "escort services."
Is it worth pointing out that web sites like Criagslist are the primary reason the Boston Globe is failing as a business?
UPDATE: It made it, along with two editorial changes.

First, they changed "prostitute" to "provider of erotic services," leading to a far more awkward sentence. The original editorial features the word "prostitution", even if not calling any one person a "prostitute." While the change could be a routine PC filter, it's possible the Globe was trying to be sensitive to the possibility that Brisman may not have been engaging in prostitution, in the strict legal sense of a direct exchange of sex for money.

Second, they removed the phrase in this instance, which significantly alters my meaning. That is, I consider it a truism that when compared with other crimes aided by traditional communication technologies, the Web increases the overall risk of such violent encounters due to increased opportunities for interaction.

Apr 7, 2009

Is Globe Dying Because of its Bias? [LINK]

Hurry! There may not be many more letters like these to the Globe left!

I disagree with various letter writers pointing to liberal bias as the main source of the Globe's financial problems. Newspapers are in trouble across the board, primarily due to migration of readers and advertising revenue towards the Internet. If liberal bias were costing the Globe widespread circulation, the Herald would be expected to benefit from the error, but instead we find that paper is also struggling to stay afloat.

That said, the Globe clearly does display a leftward bias, and you wouldn't need to look further for an example than today's article by Peter Canellos titled: "In a stroke of brilliance, Obama defies easy caricature." [National Perpective, 4/7/09] It is the sort of highly opinionated, insubstantial "analysis" that would ordinarily belong in a paper's editorial pages, if even there. Asserting that President Obama "floats above the fray," Canellos fails to reference any "stroke of brilliance" that would immunize him from routine criticism other than his "calm, serious manner" and "air of persistence."

While reinforcing a hazily favorable opinion, Canellos shies away from any substantial criticism. In particular, the president's comments -- "We haven't immediately eliminated the influence of lobbyists in Washington. We have not immediately eliminated wasteful pork projects" -- are transparently laughable considering the stimuluating effect the coursing of trillions of additional dollars through Washington has had on lobbyists. Any self-respecting journalist should lunge at the opportunity to highlight such an absurdity. Canellos's point that criticism doesn't stick to this president is made far easier by ignoring such criticism rather than evaluating its merits.

If the Globe is to survive in an on-line world, it will be based on the credibility of its primary reporting operation now that opinions are so easy to generate. To that extent, the Globe's bias matters.