Dynamist Blog  

Latest Posts  |  Archive  |  

Week of April 16, 2001
[Note: Some now-dead links have been removed from archived items.]

PATIENT UPRISING, CONT'D: Patient pressure may force the FDA and pharmaceutical maker Glaxo Wellcome to return a drug to market, much to the aggravation of anti-consumer advocate Sidney Wolfe. The drug is Lotronex, an invaluable treatment for irritable bowel syndrome that is also unquestionably dangerous to some patients. USA Today's account works from information supplied by Wolfe, who reportedly fears "that the FDA may bow to pressure from the manufacturer and patient groups." Patient groups—people who, without the drug, can barely leave their homes because they are so stricken with constant diarrhea—don't count for much in Wolfe's paternalist worldview. After all, their health problems won't kill them.

I first wrote about this controversy on February 4, after a comprehensive feature by Denise Grady of The New York Times. As we learn more and more about genetic variation, the FDA's one-size-fits-all approval process is going to become more and more untenable. And patient activism is a permanent phenomenon, sparked originally by AIDS but now supported by Internet-based groups on every disease under the sun.

Looking up my old posting on the subject, I'm struck by how much of that week's material is still of interest. The site's audience was much smaller back then (the subject of one posting). Newcomers should take a look. You can even my early musings on why Amazon will get into the micropayments business—a more-or-less accurate prediction (Amazon's system doesn't support true micropayments) for all the wrong reasons. [Posted 4/21.]

RACIAL PROFILING: OpinionJournal's Best of the Web ran an excellent piece on racial profiling yesterday, a free-standing analysis playing off other articles rather than just linking to them. It points out the obvious problem in the usual defense of the police: Even without law enforcement prejudice, law-abiding black Americans have a wildly disporportionate chance of being treated as suspected criminals. The unbylined author works some numbers, rather than simply making the point:

For the sake of argument, assume [Heather] Mac Donald is right, and the New Jersey police are innocent of any invidious racial discrimination. Assume further that whatever methods they use to determine whom to search are equally accurate with respect to blacks and whites, so that equal proportions of blacks and whites who consent to searches--say, 80%--are guilty. This would mean that 20% of the 21% of motorists in question who are white, and 20% of the 53% who are black, are innocent.

These assumptions leave us with the following numbers: 10.6% of all motorists who consent to be searched are innocent blacks, and 4.2% are innocent whites. The raw number of innocent black motorists who are subjected to this type of encounter with law enforcement thus is 2.5 times as high as the number of innocent whites. If we adjust for the racial proportion of the overall U.S. population (75.1% white, 12.3% black, according to 2000 census figures), an innocent black is 15 times as likely as an innocent white to be involved in a consent search on the southern part of the New Jersey Turnpike.

Granted, these are back-of-the-envelope calculations, and some of our assumptions, though neutral, may be wrong. But the overall point is clear: Law-enforcement efforts that sweep in a disproportionate share of blacks--even if the only reason they do is that blacks have higher levels of crime--are likely to sweep in a disproportionate share of innocent blacks. Is that a price worth paying for effective law enforcement? Maybe, but this is one of those rare cases in which your race would seem genuinely pertinent to your view of the trade-off.

A partial answer may lie in some sort of routine, nontrivial financial compensation to innocent people who are stopped by police—say, $500 for an uneventful stop in which a driver has to get out of a car and be frisked. That raises problems, of course. Some scam artists may deliberately behave in suspcious ways to collect fees. But it would also create incentives for care. And it would tell law-abiding citizens who are stopped that while such stops may be necessary to fight crime, their fellow citizens appreciate the value of their time, cooperation, and dignity. [Posted 4/21.]

STANDARD OF LIVING: In late March, Alan Greenspan gave an important speech that the press paid little attention to because he did not suggest any Fed action about interest rates or say anything about the stock market. Instead, he engaged an absolutely critical economic issue—the inability of economists, including Fed economists, to keep track of what's really going on in the economy. What is a good? What, therefore, is a price increase? An increase in the standard of living? These are basic questions that have a huge effect on both government policy and business action.

Inadequate statistics appear to have have systematically understated economic progress since some point after productivity took its famous dive in 1973. The 1996 Boskin Report made a stab at correcting some of the distortions in the consumer price index, and the government has since made modest adjustments. But economic progress occurs in subtle ways, and many of them are still uncaptured by traditional measurements. Consider this passage from Greenspan's speech:

These latent problems have emerged in full view in the pricing of medical services. Perhaps the inherent complexity of this undertaking is most clearly revealed by posing the question, what do we mean by a standardized unit of medical output? Is it the procedure, the treatment, or the outcome? What does the fee charged for the bundle of services associated with cataract or arthroscopic surgery represent? How does one value the benefits to the patient of shorter hospital stays, more comfortable recoveries, and better physical outcomes? Clearly, the unadjusted fee for a single medical procedure does not adequately represent its "price."

The price indexes for medical services used to be constructed by pricing a variety of inputs—for example, a night in the hospital, or an hour of a physician's time. A few years ago, the Bureau of Labor Statistics began moving toward pricing the treatment paths of particular diagnoses, the better to capture changes in the mix of inputs used to treat a given disease. For example, many surgical procedures that used to require an overnight stay in a hospital now can be performed on an outpatient basis, and the producer price index and consumer price index are now better able to measure the price decline associated with that change. Interestingly, when such techniques are applied to individual medical procedures they appear almost without exception to indicate falling prices at least since the mid-1980s. This has raised significant questions as to whether our current measures of overall medical service price inflation are capturing the appropriate degree of productivity advance evident in medicine.

To translate the Greenspanese, this says that if we measure prices properly—in the way that matters to patients—medical care appears to have gotten cheaper during the period when everyone was panicked over its increasing cost. This has profound implications not only for government policy but also for private decision making.

The turning point in that price trend is also interesting. From the reporting I've done for my New York Times economics column, I've become aware of scattered, but mounting, evidence that the American economy took a sharp turn for the better in the mid-1980s. In January, I wrote about research that shows that the economy has become less volatile, thanks to flexible manufacturing and better supply-chain management practices in old-line businesses such as autos, furniture, aluminum, and machine tools. (To download the striking graph that illustrates this trend, click here.) "New Economy" basher Paul Krugman is as clueless as ever about this trend, because he equates Cisco with manufacturers in general. The research he hasn't bothered to investigate finds its striking results in industries that, well, existed in the mid-1980s.

My latest column looks at evidence that increasing product variety is raising consumers' welfare, a trend whose acceleration also appears to date to the mid-1980s. Economists Pete Klenow and Mark Bils, whose work is featured in the column, had to be incredibly creative to investigate variety increases. They don't have access to the data they'd really like—statistics on the arrival of new products and how well they sell. The government doesn't generally track new products, except when old ones disappear. And buying comprehensive scanner data, not just for a single industry or product line but for everything available, could cost millions of dollars—not the sort of research budget available to scholars. Any foundation that wants to make a serious contribution to knowledge should consider a scanner-data fund at the National Bureau of Economic Research, with which Klenow and Bils (and many other good empiricists) are affiliated.

In the meantime, the conventional wisdom will continue to be shaped by the statistical information that is easily accessible, regardless of how its flaws distort both perceptions and policy. The incentives to pooh-pooh progress are strong, as Krugman's column demonstrates, and there's plenty of precedent for scientific inertia. After all, before Vesalius defied bans on dissecting human corpses, surgeons followed Galen's anatomy, which used animals and assumed they had the same internal structures as people. "It's a gibbon," protested Vesalius (according to my history of science professor). It's looking increasingly probable that economists who saw a 20-year productivity slump were looking at a gibbon too. [Posted 4/20.]

NO LIP BITING: George W. Bush demonstrated his dedication to dignity by not turning a tour of the Holocaust Memorial Museum into a series of self-promoting photo ops. Even Salon's Jake Tapper was grudgingly appreciative, writing:

This White House revels in restraint, and Bush has done a lot to emphasize the importance of dignity and privacy by not attending the welcoming ceremony for the 24 returning crew members of the U.S. spy plane, by not commenting on the racial riots in Cincinnati and by not publicly feeling the pain of the latest school shooting. So the White House didn't let us accompany him and his group of 20 through the museum.

Instead, during his 70-minute tour, the press pool waited for him in the Hall of Remembrance. When you're surrounded by six cold marble walls bearing the names of various concentration camps -- Dachau, Treblinka, Buchenwald -- as well as biblical quotes ("What have you done? Hark thy brother's blood cries out to me from the ground!" Genesis 4:20), it's difficult to be angry that the president isn't as media-accessible as you'd like.

I suspect the president's pursuit of dignity had an unremarked aspect as well. W., like his father, is a tears spigot, and admits as much. Edmund Muskie and Pat Schroeder combined never cried as much in their lives as a George Bush in a single emotion-laden event. The Bushes are, in this regard, the opposites of the stiff-upper-lip Kennedys, who were apparently determined to appear more-WASPy than the WASPs. A bit of a tears spigot myself since puberty, I'm happy to have a president who can be moved to tears at appropriate times. (Clinton's tears famously were fake.) But Bush rightly understands that we don't want to squirm through each and every tear-filled moment. [Posted 4/19.]

BASIC LIBERTIES: One of the annoying things about being a classical liberal is that a lot of people who hate the current government but don't have much regard for liberty claim to be "libertarians"—Timothy McVeigh comes to mind—and some even insist that they get to define the term. In the latter category, Lewrockwell.com, a site pretty much dedicated to equating "libertarianism" with the decidedly anti-freedom policies of the Old South (along with extreme foreign policy isolationism and a misanthropic strand of anarchism inspired by Murray Rothbard), has run an attack on David Boaz of the Cato Institute. David's sin: making the rather obvious libertarian point that "As long as the violence and cruelty of slavery remain a living memory to millions of Americans, symbols of slavery should not be displayed by American governments." (I'm not entirely sure why he needs that qualifying clause.) Defending slavery is not something that libertarians do. That seems like a pretty open and shut case, regardless of how brave and idealistic some Confederate soldiers may have been. A lot of evil causes attract some brave and idealistic people. David is for liberty. Rockwell et al. are just against the government that ended state-supported slavery and Jim Crow. Those are two entirely different things. [Posted 4/19.]

TRAIN TRAVESTY: Amtrak cheerleader Tommy Thompson desperately wanted to be Secretary of Transportation, to the point that he broke normal protocol by telling every reporter within hearing distance of his preference. George Bush wisely made him settle for HHS. It's a good thing too.

Amtrak has long been an offense to fiscal responsibility and consumer service. It lost nearly $1 billion last year, and some optimistic souls actually think it might be in danger of going out of business. Now comes news, first reported in the Albuquerque Journal, that Amtrak has gotten into the drug-enforcement and passenger-profiling business, lining its dwindling coffers with money seized from passengers carrying too much cash (no drugs necessary). I was going to rant about this, but my Reason colleague Michael Lynch beat me to it with a great angry column. Read it. [Posted 4/19.]

STARS AND BARS: What do you expect? It's Mississippi, a state that never took any interest in joining the New South. It's not surprising that Mississippians voted 2-1 against a better looking, more patriotic (assuming your country is the USA, not the CSA), state flag minus symbols of rebellion and racism. Mississippi is a backward place, and Republicans are hurt tremendously by having Trent Lott, who sat out this fight, as one of their primary spokesmen.

Media naif that I am, I did think that overnight MSNBC would have corrected its erroneous report that "Mississippi will remain the last state to prominently display the emblem on its flag after Georgia and South Carolina adopted new flags." [Note: As of this afternoon, the report has been corrected.--vp] South Carolina has the same flag it's always had—a white crescent moon and Palmetto tree on a blue background, with no Confederate emblems anywhere to be seen. And the Arkansas flag is still a reconfigured Confederate battle flag. [Posted 4/18.]

FANTASY RAIL: Fixed-rail transit systems have nothing to do with transportation and everything to do with aesthetic fantasies. As this thorough report from the San Jose Mercury News documents, even successful "transit villages" work not because their residents take the train but because some people (including me) like living in relatively dense neighborhoods. "The vast majority of the 1 million Bay Area residents who live within a third of a mile of a train stop don't regularly ride the rails, according to transit officials," writes Chuck Carroll. He notes that "Getting to work is only part of what snarls Bay Area traffic. Commutes make up just one out of five trips most people take, planners say, and train rides don't work well for errands like bringing home groceries. No shopper is going to schlep a new desktop computer on the light rail, even if it's only a short walk home from the station."

I've been saving that link for a while, waiting for the proper fantasy with which to contrast it. At first, I thought this nonsense from the Dallas Morning News would do. I live near the McKinney Avenue trolley and see it nearly every day; never have I seen more than a half dozen people in a car. Uptown is bustling not because people can take antiquated trolleys but because—as San Jose Mercury News readers might surmise—they can walk to its restaurants and shops, and because there's ample parking for those who drive.

But the DMN piece is hard-hitting, data-driven analysis, compared to what's now circulating in L.A. In Sunday's Westside section of the Los Angeles Times, the paper gave uncritical coverage to a group lobbying for a light-rail line from downtown to Santa Monica. Leaving aside the millions of dollars such a line would cost, the justifications are from cloud cuckoo land. For starters, activist Kathy Seal of Santa Monica imagines commuting by trolley to Pasadena, "chatting with fellow Angelenos en route." She'll have time to tell her life's story, since that ride would take well over an hour. Trolley lobbyists never note that the trains go no faster than cars driving on surface streets. They're just more nauseating.

But the main argument for light rail seems to be—I'm not making this up—that it will, in the words of another advocate, "soften the edge of race relations." Build a trolley line, and peace, love, and understanding will follow. Seal, the story reports, "looks forward to a time when her daughter will count among her friends teenagers from the Crenshaw district, Eastside and Koreatown instead of only meeting Westside girls from the same ethnic and economic backgrounds." Yep, there's nothing like a train. Just ask Boston. Or Chicago. Or New York. [Posted 4/17.]

HOME, SWEET HOME: Greetings from Los Angeles, land of golden light and bad government. New Democrat types, including my friends Joel Kotkin and Mickey Kaus, are worried about the mayoral prospects of Antonio Villaraigosa, whom Joel describes as "a left-wing Democrat" and a "onetime Chicano radical and teachers union organizer." They tend to let his opponent off lightly by comparison. But City Attorney James Hahn is a liberal hack who gained office on the strength of his last name; his father was a popular county supervisor. The main difference between the two candidates isn't ideology; it's charisma and ethnicity. Villaraigosa excites Latinos, who turned out in record numbers—20 percent of the primary vote, compared to 8 percent in the 1993 mayor's race—and gave him 62 percent of their vote, a figure that will certainly go higher in a race with no other Latino candidate. But Villaraigosa also beat Hahn among every other group except African-Americans.

Forty-five percent of primary voters chose someone other than the two finalists, leading both press and candidates to concentrate on these up-for-grabs voters. Both candidates are scrambling for the center, and desperately campaigning to attract Anglo voters, who hold the balance of power. "It comes down to the basic question of who is more in the mainstream of politics in Los Angeles. That is what will determine who will be the next mayor of Los Angeles," Hahn's spokesman tells the

Neither is making much effort to reassure the city's taxpayers that they'll get their money's worth in a new administration. Neither can be expected to rein in the city council, whose members treat their districts as independent fiefdom. Los Angeles is not New York. Its mayor has little power, and only a real operator with clear goals has any hope of accomplishing even modest reforms.

In fact, the next mayor may very well preside over the breakup of Los Angeles. The San Fernando Valley is primed to secede, as is San Pedro and, to a lesser degree, Hollywood. And if the Valley goes, it's hard to imagine that the Westside, liberal though it may be, will stick around simply to be milked. West L.A. is already surrounded by separate jurisdictions—Santa Monica, Culver City, Beverly Hills, West Hollywood—and would be virtually cut off by a Valley secession. A breakup makes a lot of sense. The city is too big for its governing institutions, and the metropolitan area is already full of smaller cities.

And, speaking of bad government, Dan Walters, the state's leading political columnist, has an interesting take on the Gov. Gray Davis' "odd, even inexplicable, penchant for saying things that don't square with either reality or sensibility." Davis makes Bill Clinton look like a damn-the-polls conviction politician (and paragon of modesty). [Posted 4/17.]