• A sad episode in the HIV epidemic offers lessons for Penn State

    I don’t have much specifically to add about the sad pedophilia scandal now unfolding in Penn State. Don Taylor and I did a bloggingheads recently that touched on the economic exploitation and hypocrisy in college sports.  What happened at Penn State is a much more profound failure. I don’t believe it’s fair or wise to conflate this different order of things. Yet this scandal does have some instructive parallels to another scandal.  I looked back at something I wrote years ago, and saw more than a few parallels.  

    In the early days of the HIV epidemic, the American blood supply became tainted with infected blood and blood products. By 1985, the problem was largely addressed through the development of reliable testing. By then, though, about ten thousand hemophiliacs, including 90 percent of Americans with severe hemophilia, were infected. Twelve thousand other Americans were infected through whole blood transfusions or other blood products. It was the most dramatic institutional failure in the history of this terrible epidemic.  Read the rest of this entry »

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  • Super-committee Democrats cutting Prevention and Public Health Fund

    (Cross-posted at the New Republic.)

    It’s disappointing but unsurprising to read that Super-committee Democrats may cut the Affordable Care Act’s ten-year $15 billion Prevention and Public Health Fund. The Obama administration had already signaled a willingness to scale back the initiative, having previously proposed of a 25 percent cut as part of one of its deficit reduction deals. Super-committee Democrats have now called for cuts roughly twice as big, or $8 billion.

    The Fund is less than two percent of new spending initiated under health reform. The idea is popular with voters. Yet the Fund has proved politically vulnerable. Sarah Kliff reported last year that Republicans regarded the Fund was one of the “top three” items in ACA to cut. In that same story, a Senate aide quipped that the Fund was a “slush fund for jungle gyms.” Previously, Republicans had sought (unsuccessfully) to eliminate this fund altogether, most memorably when they proposed using the savings to pay for elimination of more stringent tax collections from small business.

    This  fight highlights two verities about the politics of American public health policy….. Read the rest of this entry »

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  • Point-Counterpoint: Restricting personal belief exemptions for childhood vaccination

    I edit the Journal of Health, Politics, Policy, and Law’s new section: Point-Counterpoint. In this issue, public health experts discuss what to do about intentional non-vaccination.

    It’s a pressing issue. CDC reports that there were more cases of measles in the U.S. during the first half of 2011 than in any year since 1996.  Eighty-nine percent of those who got the disease were unvaccinated. Some were simply too young to have been vaccinated. Most, however, were left unvaccinated due to the decision of a parent.

    The rising prevalence of deliberate non-vaccination poses a risk to the individual. It also compromises herd immunity, particularly within communities in which religious or cultural values lead concentrated numbers of people to make this decision. Experts agree that personal belief exemptions are one aspect of the problem. Experts don’t agree about what to do next.

    John Lantos, Mary Anne Jackson, and Christopher J. Harrison would strongly restrict such exemptions when these facilitate non-vaccination for contagious diseases with high childhood mortality rates. Douglas Opel and Douglas Diekema aren’t quite so sure this is a wise idea.

    Within the same issue, Anna Kirkland has a terrific piece about vaccine critics and the autism hypothesis. If you’re a real glutton for punishment, you can read my own views on vaccines, autism, and public trust in medical and public health authorities.

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  • A foster parent’s account

    Foster parent (and fellow Chicagoan) Benjamin Dueholm hits it out of the park with his article in the Washington Monthly, Taxing the Kindness of Strangers:

    It’s a major bureaucratic process to remove a child from her home and family. The state insures the child, pays for daycare, investigates the claims of abuse, and retains legal custody, but it cannot actually put a baby to bed at night. And so, on the other side of this most intimate public-private partnership are usually people like us, left alone with a stranger’s child and a garbage bag full of clothes and wondering what’s going to happen next. And what happens next depends, to a stomach-churning degree, on the state’s willingness and ability to keep up its half of the bargain….

    It’s a beautiful essay. And it describes the pernicious effects of our state’s low Medicaid reimbursement rates on getting care for needy kids. And as Dueholm observes, Medicaid has been rather protected during the “supercommittee” budget negotiations. Yet many social services and benefits important for foster kids and for foster parents are likely to be cut. We’re burning out good people by not providing needed support. Not smart policy.

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  • What the history of cancer treatment might teach us about social policy

    I once delivered a guest lecture concerning policies to prevent adolescent tobacco use. Halfway through, a public health student raised his hand to suggest that we must understand why young people choose to smoke before we can design effective interventions. That’s not a stupid perspective. Indeed we often take this perspective for granted: When we want to solve a problem, we often start by investigating its causes. Yet it’s worth asking ourselves when this perspective is always useful or wise.

    I noted one problem in a recent post on the Blog of the Century: Our causal understanding is very poor in many areas of social policy.  The available data and conceptual models are often poor.  If you ask why some people commit crimes, or why some young people misuse intoxicating substances, the social science literature surely provides useful information. Yet identifying risk-factors and root causes may or may not provide specific or useful guidance for feasible interventions.

    Suppose a reputable study establishes that low IQ scores are a risk-factor for engaging in crime. That could certainly be helpful… Read the rest of this entry »

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  • Bill Gates vs. Steve Jobs

    It’s an irresistible comparison. At first glance, Jobs benefits enormously from the comparison. A charismatic design visionary, he built two great companies with great products. The Apple II, the Mac, the iPod, the iPad, the iStore, the iPhone, and Pixar films enrich our lives. Gates forms an almost comically anti-charismatic and corporate contrast to Jobs’ rebellious genius. Gates built a great company by developing and selling undeniably useful, generally less original or beautiful products.

    Still, in my book, Gates wins by a mile. To understate things, Jobs was a mercurial and difficult man. To paraphrase George Steiner’s take on Albert Einstein, the bright light of Jobs’ genius cast its shadows on many surrounding lives.  

    More to the point, Gates has used his huge wealth to save literally millions of lives and to attack America’s tremendous difficulties in our education system. He’s done so in an admirable, evidence-based way that has altered the fields of philanthropy and global health. Perhaps Jobs might have done the same, had he been granted a few more creative decades on this earth. In what we got the chance to actually see, Gates was the more visionary figure in this domain.

    The New Yorker’s Barry Blitt paid tribute with an inspired and touching cover of Steve Jobs at the pearly gates, with Saint Peter referencing Jobs’ records on an iPad. When Bill Gates’ own time comes to pass, St. Peter may not have access to an equivalently inspired Microsoft product. Then again, Saint Peter will have less reason to look things up. I’m told that God cares a lot more about the new malaria vaccines than he does about the iTunes store.

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  • Weekend Edition: Neighborhoods, obesity, and diabetes

    Thanks, Austin, Aaron, Don, and Kevin for letting me occasionally share your masthead. As Austin mentioned, I’ll be putting up the occasional weekend blog posts here. Although I have strong political and policy views, my TIE postings will have more of an academic bent. My research concerns public health services to disadvantaged populations. I’ll focus on substance abuse, violence prevention, and disability policy to help round out the great work that others do here. Sometimes I will write about a substantive policy issue. Other times, I will try to unpack a specific article in the research literature.

    My long offering today concerns a recent article on a policy experiment. If you want to see how excellent empirical social science is done and why it’s important, devote an hour or so to the article by my SSA colleague Jens Ludwig and his co-authors that just appeared in the October 20 edition of the New England Journal of Medicine.

    It’s one of many papers to emerge from the Movement to Opportunity (MTO) study, one of the most important urban policy experiments ever conducted. MTO is a multi-million experiment that been running for many years, with major funding from the Department of Housing and Urban Development, NIH, leading foundations, CDC, and others. (The Center for Health Administration Studies, which I help to run, kicked in a little money to help with this particular analysis. It’s been a good investment.)

    To simplify things a bit, MTO families living in high-poverty majority-minority urban communities were randomly assigned across services designed to promote residential mobility. In five cities between 1994 and 1998, 1,312 families were issued traditional Section 8 housing vouchers. Another 1,788 families was offered Section 8 vouchers that were restricted for the first year to be used in neighborhoods with poverty rates below ten percent. This last group also received mobility counseling to help them make this potential move. Meanwhile, a control group of 1,398 families did not receive housing vouchers from MTO. Some members of the control group received housing aid from other sources or otherwise ended up in low-poverty communities.

    MTO is one effort to untangle some important and messy questions that fall under the rubric of “neighborhood effects.” One might suspect that a neighborhood with a high concentration of employed college graduates would have good schools. These same employed and educated neighbors might have valuable job contacts. More affluent neighborhoods might have the resources and social cohesion to reduce crime, too. Read the rest of this entry »

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