Showing posts with label death panels. Show all posts
Showing posts with label death panels. Show all posts

Tuesday, January 29, 2013

The Open and Closed Mind

More than three years after Sarah Palin made the false claim that the Affordable Care Act included “death panels” that would decide whether people would receive life-saving medical treatment, 40% of Americans still believe it. A new experiment by Brendan Nyhan, Jason Reifman and Peter Ubel considers the death panel myth in the context of the perseverance effect, a cognitive error in which people's beliefs about reality persist even though the evidence on which they were based has been discredited.

In one perseverance study, participants tried to distinguish between real and fake suicide notes. In fact, regardless of what they said, half the people were told they were right most of the time (the “success” condition), while the others were usually told they were wrong (the “failure” condition). Later, the participants were debriefed. It was explained that the feedback was false and that they had been randomly assigned to success and failure conditions. Even though they understood the debriefing, the “successful” people still believed they were better at the task than those who had “failed” thought they were.

Perseverance affects people's reactions to scientific studies that support or contradict their beliefs. Another experiment involved students with contrasting attitudes, some who believed that capital punishment was a deterrent to murder and others who rejected this claim. People in both groups read summaries of two fictitious studies, one which supported the deterrence hypothesis and one which didn't. You might think reading mixed evidence would lead people to moderate their beliefs. However, both pro- and anti-deterrence participants became more convinced of their original beliefs—a backfire effect. The two groups' beliefs became more polarized.

Perseverance studies seem to suggest that fact-checking politically biased claims is a losing effort. Recent research suggests that more educated and well-informed people show greater perseverance, since having more information allows them to explain away contradictory findings more easily. The Nyhan study is in that tradition. Here is Dr. Ubel explaining the study.


The chart below shows the results. On the left are the low knowledge participants. Without the correction, those who liked Palin believed the death panel myth, but the rebuttal was effective in disabusing them of this belief. However, the high knowledge Palin supporters believed the death panel myth more with the correction than without it. The correction backfired.


Just a word of caution. I was fully prepared to believe this study; however, the more I thought about it, the more I sympathized with the high information Palin supporters. The rebuttal to Palin's claim read (in its entirely) as follows:

However, non-partisan health care experts have concluded that Palin is wrong. The bill in the House of Representatives would require Medicare to pay for voluntary end-of-life counseling sessions, but there is no panel in any of the health care bills in Congress that judges a person's “level of productivity in society” to determine whether they are “worthy” of health care.

Should a well-informed Republican really be satisfied with this rebuttal? If I were in their shoes, I might want to ask some additional questions. Who are these “non-partisan experts?” The correction addresses Palin's claim about end-of-life counseling, but what about the Patient-Centered Outcomes Research Institute, which is charged with evaluating the effectiveness of medical treatments, and the Medicare Independent Payment Advisory Board, which is supposed to refuse to pay for expensive but ineffective treatments? How much indirect control will they have over the treatment patients actually receive? I personally hope these groups will help to eliminate wasteful procedures, but since they haven't met yet, we don't really know.

I'm not questioning the existence of perseverance, or that it makes researchers' lives a lot more difficult. However, another way to read this study is that well-informed people may require more detailed counterarguments than these authors provided.

Sunday, March 11, 2012

Imitate Debate


For me the recent bruhaha over the Rush Limbaugh/Sandra Fluke brings back memories of another one from 2010 in which Sarah Palin (who was teasing with running for the GOP Pres nod at the time) was calling for President Obama to fire then White House Chief of Staff Rahm Emanuel.  Emanuel called critics of the Affordable Care Act who favor the public option/single payer and expletive related to the developmentally disabled (the politically correct term for the mentally retarded) which shall not be repeated here but is in the funny clip below. 


This was one time where I had to agree with Palin that Emanuel should be fired.  Not only because I sympathize her because of her son with Down's Syndrome but because it is also simply bad politics which former community organizer Obama should know.  Many of these liberal activists worked very hard to get Obama elected.  Rush Limbaugh also reiterated Emanuel's comments (Palin excused Limbaugh for being "subtle" as can be seen in the clip above).  Emanuel did apologize to Sargent Shriver, head of the Special Olympics, but not to any healthcare activists and he is now mayor of Chicago.

For him to take the same attitude as Limbaugh toward Obama's most loyal supporters is the epitome of bad politics.  Is it any wonder that the Democrats lost the US House in 2010?  Colbert can get away with calling Palin the expletive that Emanuel and Limbaugh used on activists because they are not on the same team.  Bill Maher can get away on Real Time with calling Bristol Palin worse than what Limbaugh called Fluke because his HBO show doesn't have sponsors.  Imagine if Limbaugh calls Bristol Palin or one of her other children a sexually derogatory term on his radio show?  Sarah Palin could raise a tizzy and possibly get him fired because she has pull with his base. 

Bill Maher, Glenn Beck, Keith Olbermann, and Don Imus all lost their shows after making controversial public statements and are now continuing to make them in less high profile shows.  All of this pseudo debate inhibits any discussion of real issues, such as health care and single payer, which keeps the public sufficiently distracted.  (This post originally appeared on CSI without Dead Bodies and has been modified here.) 

**Related Posts**


Why does the right demonize Nancy Pelosi?


Bullying & Society

 

Auf Wiedersehen Glenn Beck, Hello Merv Griffin 

Friday, February 10, 2012

Check out this great MSN video: How America got into birth control mess

Two nights ago MSNBC's Lawrence O'Donnell discussed why the whole birth control/Catholic Church "controversy" would be moot under a Single Payer system.  (Obama just announced that religious employers won't have to provide contraceptives, insurers will) Why didn't he say this when these deals were being made?



I saw this image on Facebook posted by a staunch Ron Paul, an Obstetrician, supporter and had to post it because it's so silly.  It resembles a WWI propaganda poster.  Yes what happens in the womb is important for the child's well being but what happens after birth is at least as important.  Mississippi Gov. Haley Barbour, when a Presidential candidate in March 2011, declared that his state was the "safest to be an unborn child."  As Jon Stewart points out his state is the least safe to be a newborn child.  Most of this "debate" is really just petty pandering to people deepest fears, like death panels, to prevent them from enacting the very thing that can improve their lives.
 

Wednesday, December 28, 2011

Questioning Effectiveness

To save both lives and money, most countries with single payer health care systems support, or at least monitor, research on the cost-effectiveness of drugs and medical procedures. One of the less well known provisions of the Affordable Care Act is a plan to support comparative effectiveness research. The bill creates a Patient-Centered Outcomes Research Institute, a nonprofit organization charged with conducting research on the comparative cost-effectiveness of various medical treatments and making recommendations to health care providers.

An Associated Press article reports that, beginning in 2012, the government will collect a fee of $1 per person from health insurance companies to cover the cost of the new agency. The fee goes up to $2 in 2013, and rises with the inflation rate in subsequent years.

I can remember a time when virtually everyone agreed that program evaluation—now called comparative effectiveness research—was an important scientific endeavor. Why should anyone suffer through and pay for a drug or medical treatment that doesn't work? If two treatments are equal in effectiveness, shouldn't only the cheaper one be covered by insurance? By coincidence, today's newspaper has two articles implying that current evaluation research is inadequate. All-metal hip replacement implants are breaking down after a few years, causing endless suffering to those who have received them. And Chantix, a quit-smoking drug that is only slightly better than a placebo, apparently has adverse side effects that include violence, depression and suicide. (“The good news, Mrs. Obama, is that your husband has quit smoking . . .”)

But the consensus over evaluation research began to break down when American corporations and their friends in the Elephant Party declared “war on science.” Although its origins can be traced to the 1960s “debate” over the health effects of cigarette smoking, the war began in earnest about a decade ago. As a result, many Americans believe that scientific research is inevitably biased, that scientists discover non-existent problems just to supplement their incomes, and that the consensus conclusions of experts are just another opinion, no better or no worse than, say, Rush Limbaugh's opinion.

Combine this with a distrust of government and you get claims like that of the Elephant beauty queen Sarah Palin that the Jackass Party is trying to set up “death panels” to ration medical care. (Yes, Gov. Palin, health care is being rationed, but not by the government.) In the current political environment, there is a very real possibility that this new agency's research will be wasted because every conclusion it draws will be endlessly disputed.

A second problem is evident in the Elephant-friendly way the AP article presents the fee—as a tax. Obviously, the research institute has to be funded. But couldn't the Obama administration have found a way to pay for it out of general revenue, without making the source of funding so explicit and obvious? You can bet the insurance companies will publicize this fee for all it's worth, hoping to get consumers to blame their next $1000/year rate increase on the government's $1/year “tax increase.”

Gail Wilensky, a former Medicare administrator who supports the agency, is paraphrased in the article as saying that it “should focus on high cost procedures and drugs on which the medical community has not developed a consensus.” I disagree. The most important thing to do is to support research with maximum potential for saving lives. By emphasizing the cost-cutting implication of their research, Ms. Wilensky probably hopes to keep the agency from being trampled by a bewildered herd of Elephants. But you can't pacify this species. If you try to save money, you will almost certainly be accused of rationing care.

One of my resolutions for 2012 is to do an occasional series of posts on the values and pitfalls of health care evaluation research.