Skip the knee surgery

An interesting study recently came out that most surgeries for ACL tears may be unnecessary:

You’re young, fit and in pain after tearing one of the key ligaments that holds your knee together.

What do you do? Patients and their orthopedic surgeons often rush to reconstruct the anterior cruciate ligament, or ACL, figuring that rebuilding it right away is the best approach to stabilizing a creaky knee.

There’s just one problem: Nobody has proved that surgery is better than rehab. And in the U.S. alone, more than 200,000 ACL reconstructions get done each year — to the tune of $3 billion.

Enter some Swedish researcher who persuaded 121 young folks, almost all of whom tore their ACLs playing some sort of sport, to be randomly assigned to treatment with rehab and early surgeryor a rehab-focused approach, with an option for surgery if needed.

Turns out the aggressive surgical approach was no better than then rehab-oriented path. After two years, the results for both groups were about the same when it came to things like pain and functions of daily life. Oh, and there were 61 percent fewer surgeries in the rehab-focused group.

Does anyone think it a coincidence that the treatment which leads to much larger incomes for doctors, hospitals, device-makers, etc., has long been the preferred treatment despite evidence that it is unnecessary most of the time?  One can find case after case like this.  Never underestimate the power of financial incentives in the practice of medicine.


The Wikileaks on Afghanistan

Slate’s Fred Kaplan has the best take on this I’ve read:

Just because some documents are classified doesn’t mean that they’re news or even necessarily interesting. A case in point is the cache of 92,000 secret documents about the Afghanistan war that someone leaked toWikiLeaks

Some of the conclusions to be drawn from these files: Afghan civilians are sometimes killed. Many Afghan officials and police chiefs are corrupt and incompetent. Certain portions of Pakistan’s military and intelligence service have nefarious ties to the Taliban.

If any of this startles you, then welcome to the world of reading newspapers. Today’s must be the first one you’ve read.

I also think Matt Yglesias addresses an interesting aspect.  If we already know all this stuff, why the hell is it classified?

Information should be classified when making it publicly available would put the lives of Americans and our partners at risk. And maybe there’s something in this giant trove of documents that meets that standard. But surely Jones isn’t going to seriously maintain that every document in here meets that standard. This report on an orphanage with no orphans, for example, is clearly benign. Reading its explanation of why the orphanage is empty, however, does give the reading public a somewhat deeper understanding of the country of Afghanistan:

SOCIAL: The PRT visited the Gardez Orphanage to conduct an assessment and drop HA and toys to the center. There are currently no orphans at the facility due to the Holiday (note: orphans are defined has having no father, but may still have mother and a family structure that will have them home for holidays.) Governor ———— states that the Red Crescent fund raiser (donation tickets) for winter relief has begun in the Province and will be collecting funds to aid the unfortunate during severe winter weather.

That’s not a military secret that puts people’s lives at risk. It’s not a scandalous secret that needs to be covered up, either. It’s just a small data point that gives us some greater understanding of Afghan society but that’s being kept secret out of an obsessive and ultimately counterproductive obsession with controlling the flow of information.

Worst student eval ever

It would seem to be trolling for positive comments to put this on facebook, so I thought I’d share my worst ever student evaluation comment for my Criminal Justice class last semester:

Generally, when I fill out these class evaluations, I try to give the professor the benefit of the doubt, because I have respect for the people who are trying to teach me. Unfortunately, I cannot do that for Dr. Greene. Ive found him to be rude, arrogant, condescending, and intolerant. He has absolutely no respect for anyone in that classroom beside himself and possibly a few students who really like him and have taken several classes with him. Combined with that attitude, he constantly pushes his liberal views on everyone in the class. Being in class feels like being an extra on the Bill Maher show. Over the last three months, hes managed to crassly insult a Supreme Court justice (he called him an asshole and derided his rulings as bullshit), the Catholic Church (the class before Easter, no less), and the entire portion of the population who consider themselves conservative (the great unwashed). Hes also openly denigrated his wife and family, which, beyond being none of our business, is absolutely wrong. Ive actually been embarrassed for his wife on a few occasions. This is unacceptable behavior from someone with a bully pulpit and a captive audience. There is no challenging him in class, either, as both he and his “fans” will deride dissenters, passing it off as humor. That is intolerant and it discourages a diversity of opinion in the classroom. I thought college was supposed to be a forum for the open discussion of ideas, not a place to be indoctrinated with a professors personal opinions. Compared with the amount of time he actually spends teaching the material (probably less than 1/2 the allotted time), his tests are entirely too hard and too long. He expects specific details from readings that he never discussed in class, never even mentioned in class. As if the reading on the syllabus was not enough, he bombards you with online articles from websites and blogs, which more often than not tend to have a liberal slant (, etc). As for his use of class time, he spends e

Not to overly defend myself, but 1) I’ll simply remark that I’m fairly certain this student does not at all “get” my sense of humor; 2) many of my biggest “fans” through the years have been quite conservative.

Tax cuts

Jon Chait (who knows taxes as well as anybody) has a really good post about how the Democrats should strategically approach the exentsion of tax-cuts for all but the highest income Americans.  Of course, the Republicans are threatening a filibuster unless rich people get their Bush tax cuts extended to (as always, more evidence that Republicans are more interested in low taxes for rich people than in the budget deficit).  Here’s Chait:

Now, here’s the underlying dynamic. Raising taxes on the middle class is unpopular. But raising taxes on the rich is wildly popular. The truth is that neither party cares very much about the portion of the Bush tax cuts that benefit the middle class. Republicans just threw that in to sell the upper-bracket tax cuts, which is what they care about. Democrats might prefer a more progressive tax code with lower middle-class taxes, but most of them would rather have the revenue instead. But Democrats promised not to raise taxes on people earning less than $250,000 a year — a promise they felt they had to make in order to win. And they can’t break that promise without suffering political consequences.

Republicans, on the other hand, don’t want to pass an extension of the middle-class Bush tax cuts without the upper-bracket tax cuts. That would leave the federal tax code more progressive than it was under Bill Clinton — you’d have a combination of Clinton-era tax rates on the rich and Bush-era tax rates on the middle class. Conservatives have been fretting about such a result for more than a year, warning ominously about a country in which half the population pays no income tax. (They’d still pay other taxes, but the central Republican goal is to minimize the progressivity of the tax code.)

So we’re down to a game of chicken. Here’s why the Democrats hold the whip hand. They can pass an extension of the middle-class Bush tax cuts through the House. If Republicans let the bill pass, then they’ve lost their leverage to extend the unpopular Bush upper-income tax cuts. If they filibuster it, then Democrats can blame them for raising taxes on middle-class Americans…

The key factor here is that, just as Republicans got to frame the debate in 2001 by combining the tax cuts into an up or down vote, Democrats can frame the debate now by separating the policies Republicans pretend to care about from the ones they actually care about. Republicans want to have a vote on the whole collection of Bush-era tax cuts. Democrats shouldn’t give it to them. You hold a separate vote on the middle class portion and dare them to oppose it.

Republicans have followed a strategy of opposing nearly everything the Democrats do. It’s worked very well. But the peculiar dynamic of this debate puts the Republicans in a position where they can’t win, and obstructing the Democrats is probably their worst move.

Chait indicates that the Democrats are looking to do this… here’s hoping they’re actually smart enough to.  My buddy who works as a Senate staffer went to a meeting of the Senate Finance committee last week and said he was jaw-droppingly struck by how utterly aimless and clueless the Senators seemed to be.  If they do manage to play this right we get both better policy (the rich do need to pay more) and good political advantage for the Democrats (the Republicans are forced to show their true colors).

SUNY (it’s all politics)

I’ve always been intrigued by the SUNY system (and not in a good way).  Here you have one of our richest and most powerful states and it has a public university system with no flagship that plenty of people have never even heard of.  When I was in college, I could have told you about the University of Montana or Nebraska or Oklahoma State, but if you asked me about SUNY, I would’ve drawn a blank.  Not till I applied to SUNY-Stonybrook’s PhD in Political Science program had I ever even heard of the university.  Anyway, the Times has a really interesting piece on Sunday that explained how/why SUNY developed as it did and the political difficulties it face going forward.   If you’ve got any interest in higher education issues you should really read the whole thing, but I found the following paragraph the most striking:

But another reason that SUNY has struggled to forge an identity is because that was the idea from the start. New York was the last of the populous states to form a university system. SUNY was not founded until 1948 and over the strenuous objections of the state’s powerful private colleges and universities. And it began with the stipulation that it would only “supplement” the private institutions and not compete with them. State legislators established an unfriendly board of regents and imposed the nation’s strictest regulations on what the university could do. An informal prohibition on raising private funds meant that New York’s state universities for decades grew without the endowments that supported campuses elsewhere. No wonder that a study in 1960 called SUNY a “limping and apologetic enterprise.”

There’s my answer: simple, parochial interest group politics crippled the system from the start.  Just sad that the legislators of New York were more interested in serving these private colleges than their citizens.

The other most interesting part to me was about the lack of a flagship institution:

Virtually alone in the country, there was (and still is) no flagship institution, no Madison, Berkeley or Austin to provide a network of loyal supporters for years to come, no beloved Buckeyes, Huskies or Gators to create a common wellspring of good will. (SUNY’s most conspicuous attempt to play in that league — Binghamton’s one trip to the N.C.A.A.Division I basketball tournament in 2009 — ended in scandal, with arrests of several players, accusations of preferential treatment for athletes and the implosion of the program.)…

But a prestigious flagship or a brand-name research university to some is a quasi-private school with unaffordable tuition to others. Critics in the union, the Assembly and the universities other than the largest research institutions see in this a new, tiered SUNY with higher tuition and campuses perceived to be better for those who can afford them and ones perceived as inferior for those who cannot.

Maybe tuition at UVA is too much, but there’s nothing quasi-private about UNC, Texas-Austin, Ohio State, or many other great (and well-known public institutions).  And, as a product of a great state flagship (Ohio State) and an employee of a co-flagship (our official NCSU status, though we should probably use a smaller font for that than UNC), I can say that their really are huge physic benefits to the university community.   Even Texas Tech, where I taught for my first two years as a professor is probably far better known than any SUNY.  I don’t think New York is doing their system any favors by trying to play to a lowest common denominator.  There’s really something to be said for having your university be known (and, yes, a big part of that is athletics).  I bet your average person in the Midwest or west coast has no idea what SUNY even is.  And for a state like New York, that’s a real shame.

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