Ouch, my back hurts!

Okay, not really.  Ever since I started sleeping with a pillow under my hips (while sleeping on my stomach), that’s been 95% effective in alleviating any back pain.  When I do get the ocassional back pain, though, I still exercise.  Why, because that’s what’s good for your back.  Really enjoyed this PBS Health article nicely titled, “How the back pain industry is taking patients for an unhealthy ride.”  Basically, this being America, everybody wants a quick fix through surgery (especially surgeons!!) or drugs.  What actually works?  Exercise and physical therapy:

But searching for solutions can lead sufferers into an expensive and sometimes dangerous maze of ineffectual treatments, procedures and pills, as journalist and investigative reporter Cathryn Jakobson Ramin found…

Ramin recently spoke about her investigation with Eric Westervelt on KQED’s Forum program. Here is some of what she said…

Ramin says the fee-for-service payment system in the U.S. incentivizes unnecessary and potentially damaging spine surgery, where in other countries, spine surgery is rare. [emphases mine]

And beware the surgeon who agrees to operate on you after other reputable doctors have turned you down. She gave the example of author, physician and marathon runner Jerome Groopman, who, after five surgeons had told him there was nothing they could do for his back injury, found a sixth who claimed he could operate and get him up and running in six weeks.

“He spent the next 19 years in extraordinary pain,” Ramin says.

Beware the surgeon who agrees to operate on you after other reputable doctors have turned you down.

Ramin also warns against taking the description “minimally invasive spine surgery” literally, calling it a marketing term.

“These are sexy buzzwords,” she says. “Perhaps the incision is small — and it isn’t always. If in fact you do have a small incision, good for you, you might look better in a bathing suit. The damage beneath the skin will be exactly the same as it would be in regular, traditional, conventional spine surgery.” …

However, “If you see a chiropractor more than one or two sessions, you are wasting your time if you are being cracked, adjusted or walked over. Study after study after study has shown that long-term visits to chiropractors don’t help patients. They don’t prevent back pain; they don’t solve back pain.”

She said the World Health Organization has come up with a long list of all the diagnoses for which chiropractic is contra-indicated.( See page 20 here.) “And it’s probably anything that would take you to a chiropractor.” …

Doctors often started out with short-acting pain killers, such as Vicodin, a potent and addictive narcotic. This was often followed by longer-acting, extended-release painkillers, such as the opioid-based Oxycodone — which has led thousands into heroin addiction.

But, Ramin says, opioid painkillers don’t work well for people with back pain…

So What Does Work?

Two things: Exercise and changing the way you think about back pain.

“Understanding that hurt does not mean harm,” Ramin says. “You can continue to live an active life. The most dangerous thing you can do for yourself is take to the couch or take to your bed or take to pain management. But of course that is what most people do.“

Ramin recommends finding a “back whisperer”–someone who understands the musculoskeletal system and is able to help people build strength, balance their gaits and move effectively.

Moving is the key. Our bodies are not built to sit or stand in one place for hours at a time, she says. “The best posture is your next posture.”

So, there you go.  Exercise and changing your thinking.  And, in my case, a well-placed pillow.

Republicans looking still poor people’s health care

There had been much talk that Republican “moderates” if ever there was a relative term would balk at dismantling the Medicaid extension.  Lately, they seem plenty willing to take it away.  Sarah Kliff  (of course) on the very real dangers the ACA is currently facing in the Senate:

The Senate repeal plan is coming together — and looks a lot like the House repeal plan

Behind closed doors, Senate Republicans have worked out a path toward Obamacare repeal. The plans under discussion would end Medicaid expansion, causing millions of low-income Americans to lose health coverage. They may allow health insurance plans to charge higher premiums to people with preexisting conditions, too.

In other words: The emerging bill looks a whole lot like the unpopular bill the House passed last month. It creates the same group of winners (high-income, healthier people) and the same group of losers (low-income, sicker people).

The Republican plan is coming together because moderate senators are beginning to drop some of their initial repeal objections. Sens. Rob Portman (R-OH) and Shelley Moore Capito (R-WV), for example, now back a plan to end the Medicaid expansion.

Both were ardent critics of the House bill’s deep Medicaid cuts, which would cause 14 million Americans who rely on the public program to lose coverage. Portman put out a harsh statement the day the House passed its health care bill.

“I’ve already made clear that I don’t support the House bill as currently constructed because I continue to have concerns that this bill does not do enough to protect Ohio’s Medicaid expansion population,” Portman said plainly.

But now Portman has endorsed a plan to phase out the Medicaid expansion entirely, just to do so on a longer timeline than the House bill. Portman and Moore Capito want a seven-year phase out, rather than the House bill’s three-year off-ramp.

At the end of the day, though, phasing out Medicaid expansion over seven years has the same effect as three years: You end coverage for millions of low-income Americans.

There are still major issues that divide Senate Republicans on repeal. There is disagreement, for example, over how much to cut the Medicaid program and what kind of subsidies to give people in the private market. But the fact that Republicans are coalescing around ending Medicaid expansion — once thought to be a major sticking point — suggests the path to repeal may be easier to find than initial expectations.

I especially like Drum’s response on this:

Ah, the fabled moderate Republicans. They hated the old repeal plan, which phased out Medicaid expansion in three years. But they love the new plan, which phases out Medicaid expansion in seven years. It turns out that taking health coverage away from millions of people was never really their problem. They just didn’t want it to happen so quickly that anyone would blame them for it. They’re real profiles in courage.

How Republicans turned against science

The Koch brothers paid them too.

Kidding.  Sort of.  Sadly, there’s a lot of truth in that simple explanation.  A little while back, NYT ran a great article on how the Republican Party turned against climate science and I’ve finally gotten around to it here (too important to be lost among the quick hits).

Anyway, it is truly amazing– and depressing– the degree to which selfish and short-sighted corporate dollars have basically bought off the entire GOP:

Since Mr. McCain ran for president on climate credentials that were stronger than his opponent Barack Obama’s, the scientific evidence linking greenhouse gases from fossil fuels to the dangerous warming of the planet has grown stronger. Scientists have for the first time drawn concrete links between the planet’s warming atmosphere and changes that affect Americans’ daily lives and pocketbooks, from tidal flooding in Miami to prolonged water shortages in the Southwest to decreasing snow cover at ski resorts.

That scientific consensus was enough to pull virtually all of the major nations along. Conservative-leaning governments in Britain, France, Germany and Japan all signed on to successive climate change agreements.

Yet when Mr. Trump pulled the United States from the Paris accord, the Senate majority leader, the speaker of the House and every member of the elected Republican leadership were united in their praise.

Those divisions did not happen by themselves. Republican lawmakers were moved along by a campaign carefully crafted by fossil fuel industry players, most notably Charles D. and David H. Koch, the Kansas-based billionaires who run a chain of refineries (which can process 600,000 barrels of crude oil per day) as well as a subsidiary that owns or operates 4,000 miles of pipelines that move crude oil… [emphases mine]

Unshackled by the Supreme Court’s Citizens United decision and other related rulings, which ended corporate campaign finance restrictions, Koch Industries and Americans for Prosperity started an all-fronts campaign with television advertising, social media and cross-country events aimed at electing lawmakers who would ensure that the fossil fuel industry would not have to worry about new pollution regulations.

Their first target: unseating Democratic lawmakers such as Representatives Rick Boucher and Tom Perriello of Virginia, who had voted for the House cap-and-trade bill, and replacing them with Republicans who were seen as more in step with struggling Appalachia, and who pledged never to push climate change measures.

But Americans for Prosperity also wanted to send a message to Republicans.

Until 2010, some Republicans ran ads in House and Senate races showing their support for green energy.

“After that, it disappeared from Republican ads,” said Tim Phillips, the president of Americans for Prosperity. “Part of that was the polling, and part of it was the visceral example of what happened to their colleagues who had done that.”

What happened was clear. Republicans who asserted support for climate change legislation or the seriousness of the climate threat saw their money dry up or, worse, a primary challenger arise.

“It told Republicans that we were serious,” Mr. Phillips said, “that we would spend some serious money against them.”

Lots of good stuff here.  On the downside, the article is almost a casebook study of misguided “both sides!” journalism.

The Republican Party’s fast journey from debating how to combat human-caused climate change to arguing that it does not exist is a story of big political money, Democratic hubris in the Obama years and a partisan chasm that grew over nine years like a crack in the Antarctic shelf, favoring extreme positions and uncompromising rhetoric over cooperation and conciliation…

After winning re-election in 2012, Mr. Obama understood his second-term agenda would have to rely on executive authority, not legislation that would go nowhere in the Republican-majority Congress. And climate change was the great unfinished business of his first term.

To finish it, he would deploy a rarely used provision in the Clean Air Act of 1970, which gave the Environmental Protection Agency the authority to issue regulations on carbon dioxide.

The result was the Clean Power Plan, which would significantly cut planet-warming emissions by forcing the closing of hundreds of heavy-polluting coal-fired power plants.

The end run around Congress had consequences of its own. To Republican (and some Democratic) critics, the Clean Power Plan exemplified everything they opposed about Mr. Obama: He seemed to them imperious, heavy-handed, pleasing to the elites on the East and West Coasts and in the capitals of Europe, but callous to the blue-collar workers of coal and oil country.

Whether the Clean Power Plan was executive overreach or not– and there’s a reasonable case to be made that it was– to put this anywhere on par with right-wing money as a causal factor in the dramatic rightward shift of Republicans on the issue is logically ludicrous and false equivalence journalism at its worst.

Couldn’t let that go, but, short-version: the story of right-wing fossil fuel billionaires turned the GOP into the ant-science party.

So what happened with the 2016 polls anyway?

Short version: national polls were actually really good.  State polls did have a number of problems, mostly due to the fact that education became more associated with presidential vote and state polls were less likely to correct for over-sampling more educated voters.

First, a nice review from Nate Cohn:

Education was a huge driver of presidential vote preference in the 2016 election, but many pollsters did not adjust their samples — a process known as weighting — to make sure they had the right number of well-educated or less educated respondents.

It’s no small matter, since well-educated voters are much likelier to take surveys than less educated ones. About 45 percent of respondents in a typical national poll of adults will have a bachelor’s degree or higher, even though the census says that only 28 percent of adults (those 18 and over) have a degree. Similarly, a bit more than 50 percent of respondents who say they’re likely to vote have a degree, compared with 40 percent of voters in newly released 2016 census voting data.

This was a big deal in 2016, since Mrs. Clinton fared very well among well-educated voters. Her lead might have increased by around four percentage points in a typical national survey that wasn’t weighted by education. The effect shrinks in polls weighted more heavily, including by party registration or past turnout, but there were virtually no public polls that were weighted this way…

What’s very clear is that several typical sources of polling error, in addition to the education issue in lower-quality state polls, contributed to a pro-Clinton bias in pre-election polls. It may or may not explain all of the error, but it probably explains most of it.

That seems to be positive news for pollsters. Without a good explanation for the misfire, it would be understandable to wonder whether lower response rates had degraded the political survey research to the point where our metaphorical field goal kicker ought to consider retirement.

But the education gap among supporters of Mr. Trump and the eventual Democratic nominee will probably persist into 2020, and it will be especially challenging to pollsters in the Northern states that had a relatively high percentage of working-class whites and that may again play an outsize role in the Electoral College.

The lack of high-quality state polling will also be tough to fix, especially if the cost of polling rises further or if local newspaper budgets continue to shrink or vanish. The failure of many state pollsters to even ask respondents about education does not inspire much confidence in their ability to stave off less predictable sources of bias.

Many of the challenges that pollsters faced in 2016 aren’t going away. Next time, the challenges could easily be greater.

Also, a really good thorough look at things from an impressive group put together by the American Association of Public Opinion Research.  Here’s some good stuff from the executive summary:

National polls were generally correct and accurate by historical standards.  National polls were among the most accurate in estimating the popular vote since 1936. Collectively, they indicated that Clinton had about a 3 percentage point lead, and they were basically correct; she ultimately won the popular vote by 2 percentage points. Furthermore, the strong performance of national polls did not, as some have suggested, result from two large errors canceling (under-estimation of Trump support in heavily working class white states and over-estimation of his support in liberal-leaning states with sizable Hispanic populations).

State-level polls showed a competitive, uncertain contest…  In the contest that actually mattered, the Electoral College, state-level polls showed a competitive race in which Clinton appeared to have a slim advantage. Eight states with more than a third of the electoral votes needed to win the presidency had polls showing a lead of three points or less (Trende 2016).[2] As Sean Trende noted, “The final RealClearPolitics Poll Averages in the battleground states had Clinton leading by the slimmest of margins in the Electoral College, 272-266.” The polls on average indicated that Trump was one state away from winning the election.

but clearly under-estimated Trump’s support in the Upper Midwest.  Polls showed Hillary Clinton leading, if narrowly, in Pennsylvania, Michigan and Wisconsin, which had voted Democratic for president six elections running. Those leads fed predictions that the Democratic Blue Wall would hold. Come Election Day, however, Trump edged out victories in all three.

There are a number of reasons as to why polls under-estimated support for Trump. The explanations for which we found the most evidence are:

  • Real change in vote preference during the final week or so of the campaign. About 13 percent of voters in Wisconsin, Florida and Pennsylvania decided on their presidential vote choice in the final week, according to the best available data. These voters broke for Trump by near 30 points in Wisconsin and by 17 points in Florida and Pennsylvania.
  • Adjusting for over-representation of college graduates was critical, but many polls did not do it. In 2016 there was a strong correlation between education and presidential vote in key states. Voters with higher education levels were more likely to support Clinton. Furthermore, recent studies are clear that people with more formal education are significantly more likely to participate in surveys than those with less education. Many polls – especially at the state level – did not adjust their weights to correct for the over-representation of college graduates in their surveys, and the result was over-estimation of support for Clinton.
  • Some Trump voters who participated in pre-election polls did not reveal themselves as Trump voters until after the election, and they outnumbered late-revealing Clinton voters. This finding could be attributable to either late deciding or misreporting (the so-called Shy Trump effect) in the pre-election polls. A number of other tests for the Shy Trump theory yielded no evidence to support it.

So, there you have it.  What was really blown was people over-interpreting the polls in their prediction models (something the AAPOR report also discusses– here’s looking at you Sam Wang).  But, as far as the pollsters in 2016, yes, there were some errors in state polls especially, but really, on the whole an entirely reasonable performance.

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