It’s hard to beat that title of this interesting David H. Freedman/The Atlantic article (H/T John Goodman) about medical researcher, John Ioannidis, who has made a name for himself establishing that most medical information that physicians commonly rely upon is largely flawed:
. . . can any medical-research studies be trusted?
That question has been central to Ioannidis’s career. He’s what’s known as a meta-researcher, and he’s become one of the world’s foremost experts on the credibility of medical research. He and his team have shown, again and again, and in many different ways, that much of what biomedical researchers conclude in published studies-conclusions that doctors keep in mind when they prescribe antibiotics or blood-pressure medication, or when they advise us to consume more fiber or less meat, or when they recommend surgery for heart disease or back pain-is misleading, exaggerated, and often flat-out wrong. He charges that as much as 90 percent of the published medical information that doctors rely on is flawed.
His work has been widely accepted by the medical community; it has been published in the field’s top journals, where it is heavily cited; and he is a big draw at conferences. Given this exposure, and the fact that his work broadly targets everyone else’s work in medicine, as well as everything that physicians do and all the health advice we get, Ioannidis may be one of the most influential scientists alive. Yet for all his influence, he worries that the field of medical research is so pervasively flawed, and so riddled with conflicts of interest, that it might be chronically resistant to change-or even to publicly admitting that there’s a problem. [. . .]
We could solve much of the wrongness problem, Ioannidis says, if the world simply stopped expecting scientists to be right. That’s because being wrong in science is fine, and even necessary-as long as scientists recognize that they blew it, report their mistake openly instead of disguising it as a success, and then move on to the next thing, until they come up with the very occasional genuine breakthrough. But as long as careers remain contingent on producing a stream of research that’s dressed up to seem more right than it is, scientists will keep delivering exactly that.
“Science is a noble endeavor, but it’s also a low-yield endeavor,” he says. “I’m not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life. We should be very comfortable with that fact.”
Given the regularity of gully-washers in Houston, flood control is something near and dear to the heart of any Houstonian.
So, the Renew Houston organization reasons, who could possibly be against Proposition 1 in the upcoming election? That’s the referendum that seeks to raise about $8 billion of dedicated taxes over the next couple of decades to fund flood control projects and other infrastructure improvements.
Well, I doubt many Houstonians oppose improving flood control and other reasonable infrastructure improvements. But reasonable folks can certainly differ over how to pay for it. And more precisely, whether local governments have already committed limited tax dollars to boondoggles such as the Metro light rail system that should have been used for the more beneficial projects that Proposition 1 proposes.
Metro’s defenders – many of whom are supporters of Proposition 1 – typically rely on the 2003 referendum as the primary basis for their continued support of the light rail boondoggle.
But the problem with the 2003 referendum and Proposition 1 is that they ask voters to approve large public projects in a vacuum while ignoring Peter Gordon’s three elegantly simple questions regarding economic choices:
1) At what cost?
2) Compared to what? and
3) How do you know?
For example, let’s assume that voters in 2003 had been informed that the expenditure of a billion or so of public money on building a lightly-used light rail system has real consequences, such as leaving inadequate funds available to make the improvements to Houston’s flood control system and infrastructure that Proposition 1 now proposes.
No one knows for sure, but my bet is that voting results would have been dramatically different if the foregoing alternative had been a part of the 2003 referendum.
Unfortunately, the relatively small groups that benefit from urban boondoggles have a vested interest in preventing the voters from ever examining those threshold issues. The primary economic benefit of such public projects is highly concentrated in only a few interest groups, such as representatives of minority communities who tout the political accomplishment of shiny toy rail lines while ignoring their constituents need for more effective mass transit; environmental groups striving for political influence; engineering and construction-related firms that profit from the huge expenditure of public funds; and real-estate developers who profit from the value enhancement provided to their property from the public expenditures.
As Professor Gordon wryly-notes “It adds up to a winning coalition.”
Once such coalitions are successful in establishing a governmental policy subsidizing boondoggles such as the Metro light rail system, it is virtually impossible to end the public subsidy of the boondoggle and deploy the resources for more beneficial projects.
How do these interest groups get away with this? The costs of such boondoggles are widely dispersed among the local population of an area such as Houston, so the many who stand to lose will lose only a little while the few who stand to gain will gain a lot. As a result, these small interest groups recognize that it is usually not worth the relatively small cost per taxpayer for most citizens to spend any substantial amount of time or money lobbying or simply taking the time to vote against a boondoggle such as a light rail system.
But would the citizenry react differently if they knew that their lack of action in the face of an urban boondoggle might prevent the funding of much more beneficial projects?
Writing about Phoenix’s new light rail system, which is just as uneconomic as Houston’s, Warren Meyer analogizes the funding of these systems to dubious household purchases:
[The] Phoenix light rail reminds me of a home I visited recently that had a $50,000 super-size 100-inch flat screen TV. That TV was gorgeous. Everyone who saw it immediately fell in love with it. It worked flawlessly, and everyone at the party wanted one. In fact, it was probably the greatest, most sensible and successful purchase of all time . . . as long as one never considered the cost. This is exactly how light rail seems to get evaluated.
In building a light rail system, did Houston buy an expensive flat-screen TV with funds that would have been better utilized taking care of the drainage problem in the back yard? Or are things going so well at work for Houston that it can do both?
We will soon find out.
The genius of Tina Fey – the best of Liz Lemon.
Who would have thought that Ben Crane is the PGA Tour’s budding comedian?
If you are interested in golf, don’t miss this Golf Digest 60th Anniversary article (slideshow here) on the most important American golf courses of the past 130 years.
Organized by decade, the list only includes a few Texas courses, including Houston’s venerable Champions Golf Club.
Given the dire financial condition of many courses these days in the face of a soft golf market, Golf Digest chose one old course in Florida as a lesson in real estate development that is frequently forgotten:
Whitfield Country Club, a residential development in Sarasota, Fla., was built in the mid-1920s by Donald Ross, the country’s premier course architect. To sell memberships and home sites, Whitfield’s developers hired the great amateur player Bobby Jones as spokesman. And yet Whitfield failed within a year, a victim of Florida’s real-estate bust that struck well in advance of the stock-market crash. Whitfield proved that even a marquee designer and a celebrity endorser don’t guarantee success, a lesson with resonance even now. . . .
The troubling overcriminalization of American life has been a frequent topic on this blog, but this Jack Chin/Balkanization post explores an underappreciated cost of the overcriminalization policy – the collateral consequences of a criminal conviction:
Conviction and punishment, it is said, are the ways defendants “pay their debt to society.” But it turns out that criminal conviction is a debt that can never be paid. In every state and under federal law, there are hundreds of collateral consequences that apply automatically or on a discretionary basis, to people convicted of crimes. Most of these apply for life, apply based on convictions from other jurisdictions, and can never be removed, or can be relieved only through virtually unavailable methods like a pardon from the President. The rise of computer databases means that factual disclosure of convictions is inescapable.
These collateral consequences, depending on the crime, include such things as deportation for non-citizens, ineligibility for public benefits, and government licenses, permits, and public employment, ineligibility for private employment requiring security clearances or contact with vulnerable populations like children and the elderly, loss of civil rights like voting, office-holding and jury service, and loss of parental rights or ability to adopt or be a foster parent.
These collateral consequences are particularly harsh on the young, many of whom believe that they will never be able to overcome the adverse impact of a youthful indiscretion.
In short, the collateral consequences of our federal, state and local governments’ overcriminalization policy inhibits hope. How does that make sense?
Check out the University of Arizona College of Medicine’s well-done video and discussion (see also here) of a new approach to CPR.
