Saturday, November 30, 2013

Death By Anecdote, Part 2

Please read the first part of this article.

When a story is false, we run into a third problem: Even when misinformation is corrected, many people continue to believe it. For example, in one study, participants from Australia, Germany and the United States were asked about arguments made by the US government favoring the invasion of Iraq which were subsequently retracted, such as the claim that Iraq possessed weapons of mass destruction (WMDs). The Australian and German students were sensitive to retraction; that is, when they knew a claim had been retracted, they tended not to believe it. The Americans, however, were insensitive to retraction; on the whole, they tended to believe statements that they knew had been retracted about as much as statements they did not know had been retracted.

Paradoxically, attempts to correct misinformation can lead to a backfire effect, in which people are more likely to believe false information after it has been debunked. Sometimes this is due to increased familiarity with the claim as a result of its being repeated during the retraction. However, backfire effects are most likely to occur when the original claim is consistent with the ideology of the person who believes it. Not surprisingly, Republicans were more likely than Democrats to continue to believe that Iraq had WMDs even after the Bush administration admitted they didn't. When ideological backfire effects occur, people can be suspicious of the motives of the person or organization doing the correcting (often the news media) and discount the retraction.

Lewandowsky and others make three suggestions for successfully correcting misinformation: (1) warn people at the time of initial exposure that the information is suspect, (2) repeat the retraction several times, focusing only on the new, correct information, and (3) provide a plausible alternative explanation for the previous false belief. In the case of ideologically motivated false beliefs, they make a fourth recommendation: Affirm the target's ideology before attempting to correct the false belief. The first two remedies require news media cooperation that the Obama administration is unlikely to receive. Since no single alternative explanation accounts for all the anti-ACA anecdotes, providing plausible explanations for false beliefs requires extensive investigation of individual cases. The fourth suggestion would seem to require a statement like this: “We agree with you that Obamacare is a disaster, but in this case, you are wrong because . . .” 

Here is Lewandowsky discussing misinformation and its correction in the important area of climate change.


I see no magic bullet here. The best solution for the administration may be to appeal to the value Americans place on self-reliance and encourage them to explore their health care options for themselves. But they can't do that until their website is fixed. If they lose the cooperation of young people, the market will suffer from adverse selection—not enough people paying into the system, and too many older, sicker people drawing it down. Insurance rates could increase dramatically next year, just in time for the 2014 elections. Then Obama will see how much fun it would be if the Tea Party controlled the Senate as well as the House.

The HealthCare.gov fiasco is bad news for single payer advocates too. I'm afraid most people don't realize that it was Obama's reliance on an "overly-complicated, market-based Republican health care plan" that made the website so difficult to set up. They may simply conclude that government can't do anything right.

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Friday, November 29, 2013

Death By Anecdote, Part 1

You can lie with statistics, but a well-chosen anecdote is much more effective.

Here's something to look forward to, right along with your next colonoscopy.  The New York Times reports that the Republican Party plans to carry out a sustained, organized attack on the Affordable Care Act (ACA) for the next year, in the hope of gaining an advantage in the 2014 elections. The Republican campaign, described as a “multilayered sequenced assault,” is outlined in the House Republican Playbook, a 17-page strategy document prepared by their House leadership. It lists a series of talking points such as: “Because of Obamacare, I lost my insurance,” “Obamacare increases health care costs,” and “The exchanges may not be secure, putting personal information at risk.” House members are advised to collect anecdotes from constituents in support of these talking points through social media, letters and visits to their home distract. A new website, gop.gov/yourstory, centralizes the collection of these anecdotes. Republicans are instructed in the use of “messaging tools” for disseminating the stories, for example, a sample op-ed for submitting to local newspapers.

The idea is to flood the media with anecdotes in support of a particular talking point. If there is an effective counterresponse from Democrats, they will shift immediately to a different talking point. Topics waiting in the wings for possible use include insurance “rate shocks,” threats to being able to keep your doctor, and possible changes to Medicare Advantage policies.

The Republicans recognize that anecdotes can have a powerful influence on public opinion. When making inferences, people use judgmental heuristics, or mental shortcuts to make decisions quickly and easily. The use of heuristics is automatic and unconscious. They usually lead to correct inferences, but they sometimes lead us astray.

One inference we often make is to estimate the size of a category or the frequency of an event. For example, how many Americans are being harmed by the ACA? The availability heuristic suggests that the size of a category is judged by the ease with which examples can be brought to mind. Examples are more easily retrieved from memory if they are concrete rather than abstract, if they are dramatic and interesting, or if they happened recently or nearby. Personal experiences are particularly salient. When people are asked to estimate the frequency of various causes of death, they overestimate homicides and auto accidents, but underestimate strokes and diabetes. Clearly, their estimates are influenced by media coverage.


The problem gets worse when you consider the base rate fallacy, which states that people are inattentive to population statistics, and their judgments are not sufficiently affected by them. In one study, participants were given vivid stories about misbehavior by prison guards or welfare recipients. Attitudes toward these groups were equally negatively affected regardless of whether they were told that the anecdotes were typical of the population, not typical of the population, or they were given no base rate information. In another study, college students' intentions to take courses were affected by single brief face-to-face comments from a stranger, but hardly at all by statistical summaries of the course evaluations of much larger numbers of students who had previously taken the course.

The availability heuristic and the base rate fallacy suggest that even if people are given accurate information suggesting than the story is unrepresentative, their false impression is unlikely to be corrected. There was heavy media coverage of the first wave of anecdotes from people who claimed that their insurance costs went up due to Obamacare. When critics examined them more closely, many of these anecdotes were found to be misleading. Insurance companies cancelled policies and raised rates long before the ACA. The percentage of people whose policies were cancelled was small. Some of these people were able to get equal or better insurance through the exchanges without paying more. However, the corporate media can't be counted on to investigate anecdotes before airing them, and the debunking stories seldom receive anywhere near the attention given to the original report.

The Obama administration has apparently decided that the best defense is a good offense, so they are responding with anecdotes of their own—so-called Obamacare “success stories.” While this may be the best they can do under the circumstances, they are unlikely to get much cooperation from the corporate media in publicizing these stories. The media don't cover successful airplane landings--unless you land it in the Hudson River. Meanwhile, the administration and the media have largely overlooked another potential source of much more tragic stories: the 5.2 million people who are being denied health insurance entirely because they happen to live in states where Republican governors and legislatures have blocked Medicaid expansion. But to the corporate media, an upper middle class person losing a few dollars a month is much more newsworthy than a poor person losing his or her life.

But remember, the plural of anecdote is not data. To be continued.

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Saturday, November 23, 2013

Are You Feeling Lonely?

Outlier (noun): (1) a person whose residence and place of business are at a distance; (2) something (as a geological feature) that is situated away from or classed differently from a main or related body; (3) a statistical observation that is markedly different in value from the others of the sample.

The Organization for Economic Cooperation and Development (OECD) has released Health at a Glance, its 2013 report on the performance of health systems in its member nations. Here is one of the charts.


The vertical dimension is life expectancy in years. On the horizontal is health care spending per person in US dollars. The line is the curve which best fits the data. It has both a linear component—as health care spending goes up, life expectancy increases—and a quadratic component—as spending increases, each dollar spent has diminishing returns. The United States is an outlier. We are spending quite a bit more (about $2400 per person more) than any other country, but our life expectancy is 26th out of the 40 countries, almost one year lower than the international average. Another way of looking at it is that the two countries closest to us in life expectancy, Chile and the Czech Republic, are spending less than a quarter of what we're spending per capita on health care.

We're spending lots of money, but not getting a good return on our investment. A substantial portion of the money is being spent not on improved health care services, but rather on ever higher profits for private insurers, drug companies, and giant hospital chains.

The next time a politician says we have “the best health care system in the world,” you are free to burst out laughing.

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Wednesday, November 20, 2013

"Based on a True Story," Part 2

The Fifth Estate

Feature films are the most powerful and insidious shapers of public perception, because they fly under the radar of conscious exclusion.
                                                                                          Julian Assange

Journalists refer to the media as “the fourth estate,” since they presumably serve as a check on the integrity of the three branches of government—executive, legislative and judicial. But it is apparent—as shown by the propaganda buildup to the invasion of Iraq—that the corporate media serve primarily as “stenographers to power,” passing along without evaluation false statements from politicians and passively maintaining state censorship. Julian Assange proposed that, since the “fourth estate” wasn't doing its job, a “fifth estate” was needed to expose important information withheld from the public by governmental and corporate censorship.


I went to this film with low expectations. It is based on two books hostile to Assange. Inside Wiki-Leaks: My Time with Julian Assange at the World's Most Dangerous Website, by Daniel Domscheit-Berg, is the memoirs of the former Wiki-Leaks volunteer who became Assange's second-in-command, and whose falling out with Assange supplies the personal drama of the film. Wiki-Leaks: Inside Julian Assange's War on Secrecy, is by David Leigh and Luke Harding, two Guardian reporters whose newspaper prospered when it released information obtained by Wiki-Leaks, but who later broke with him for the same reason as Domscheit-Berg. They contend that Assange was reckless in releasing unredacted versions of documents leaked by Bradley (now Chelsea) Manning. With these two books lined up against him, it is not surprising that Assange assumed the worst and refused to cooperate with actor Benedict Cumberbatch, who portrays him in the film. (The quote above is from Assange's letter to Cumberbatch, which deserves to be read in its entirety.) The fact that the film was produced by Dreamworks, a division of the Disney corporation, was hardly reassuring.


I went into the film with two concerns. First, I was afraid it would turn into a character assassination of Julian Assange, which would turn the audience against him and distract from the substantive issues raised by Wiki-Leaks. Secondly, when debating whether governments should be allowed to keep vast numbers of classified documents, including evidence of war crimes, secret from the public, I was afraid the film would come down firmly on the side of the US government.

My first concern was not entirely justified. Assange is portrayed as an eccentric, but his character is sympathetic in many ways. Benedict Cumberbatch has an uncanny resemblance to Assange, an accomplished Aussie accent, and brings real complexity to the role. He deserves an Oscar nomination, although he probably won't get it. Daniel Bruhl, fresh from his role as Formula-1 driver Niki Lauda in Rush, provides stalwart support as the dedicated introvert, Domscheit-Berg. The film is at its best when conveying the excitement of Wikileaks' early successes in releasing a variety of secrets, such as the records of the Swiss bank Julius Baer, than embarrassed and sometimes incriminated corporations and governments.

Cumberbatch presents Assange as so completely driven by his mission of transparency that he is insensitive to the feelings of those around him. This is dramatized, for example, in a painful scene in which he insults Domscheit-Berg's well-meaning parents when they invite him to dinner. At one point, Assange diagnoses himself as falling “somewhere along the autism spectrum,” which seems like a reasonable possibility. The film goes off the deep end, however, when it speculates about childhood origins of his behavior. The film rightly ignores recent allegations of sexual misconduct made against Assange.

Assange is shown to be concerned about the safety of his whistleblowers. In a foreshadowing of the film's central theme, two Kenyan men whose expose of their government's corruption was released by Wiki-Leaks are murdered. Assange is extremely upset despite the fact that the men chose to sign their names to the document. This dramatic scene sets up an expectation in the audience that when Wiki-Leaks releases documents, people are going to be killed. There is some danger that the audience may conflate this incident with later events.

The central dilemma of the film is the disagreement between Assange and Domscheit-Berg, The Guardian, and the US government over the costs and benefits of releasing the Manning files. The government painted a dire picture of their potential impact, arguing that the lives of American troops and informants working undercover for the US would be endangered. Assange refers to this as a “canard” that has been used for over 50 years to justify government secrecy. He counters by saying that the release of the documents could do significant good. They reveal evidence of US war crimes, such as the infamous “Collateral Murder” video showing the aerial killing of innocent civilians in Iraq, and the “Afghan War Logs,” documenting the extent of civilian deaths in that country. Assange argues that these revelations might ultimately save lives, since governments might hesitiate to behave so heinously if they knew such incidents might become public knowledge.

To the film's credit, both sides are given opportunities to state their case. (The government is represented by Laura Linney and Stanley Tucci as two anonymous CIA or State Department operatives.) The central question then becomes: Are the arguments presented fairly, or is the playing field tilted to favor one side? This is a subjective judgment, no doubt influenced by my general agreement with Assange. I think the script subtly favors the government position.

The film dramatizes the danger to US agents by creating the composite character of a Libyan spy working undercover to overthrow the Gaddafi regime. Of all US undercover operations around the world, this is one that might have had the most public approval. Both the character and his American handler (Linney) are presented sympathetically. Early in the film, he is offered a chance to come to America, but he chooses to remain in Tripoli, since it is his home. Later in the film, when it's known that Assange may release the documents, he and his family are forced to leave Libya on short notice.  This leads to a mini-thriller as they pass through a border checkpoint.

The people Assange claims might be helped by the release of the Manning files are largely abstract subjects of dialogue. The "Collateral Murder" footage (featured prominently in the official trailer) is the only case in which American wrongdoing is shown. How different would this film have been if one of its recurrent themes had been a dramatization of the fate of an Afghan village in which civilians were killed by American bombing?

It was revealed at Bradley Manning's trial by retired Gen. Robert Carr, head of the $6.2 million, 125-person Information Release Task Force, that the government was not aware of any American or foreign national who had been harmed by the release of the documents. (There was some talk of an Afghan man who was killed, but he was not mentioned in the Manning files.) The film makes this point, but it is presented as a claim made by Assange rather than an admission by the government, which may lead the audience to discount it.

I think the film subtly lowers the bar for what potential consequences might justify censorship. Unable to present evidence of anyone having been killed or injured, the filmmakers seem to argue that Wiki-Leaks should not have published the papers if there was a chance that someone, such as a semi-fictitious Libyan informant, might be seriously inconvenienced by their release.

What counts as a “harm” serious enough to send Manning—and potentially, Assange—to jail for decades for releasing classified documents? Why should they be sent to jail, while the perpetrators of the rampant torture and assassination they revealed go free? The Fifth Estate raises these questions, but in order to give an informed answer, you have to seek out more than is revealed in this film.

You may also be interested in reading:

"Based on a True Story," Part 1

Zero Thirty Darkness

Sunday, November 17, 2013

Where's the Outrage?

Drs. Peter Ubel, Amy Abernethy and Yousuf Zafar, all medical doctors, published an editorial in The New England Journal of Medicine entitled “Full Disclosure—Out-of-Pocket Costs as Side Effects.” An abbreviated version by Dr. Ubel appeared as an op-ed in The New York Times as “Doctor, First Tell Me What It Costs.” They argue that, just as doctors typically discuss negative side effects of drugs and medical treatments with their patients, they should also discuss the financial cost of drugs and medical treatments before the patient makes a decision. These costs should be treated as a potential side-effects because stress from the threat of financial ruin can adversely affect the patient's health. They note that cost is sometimes not discussed because both patients and doctors are too embarrassed to bring it up.

  • Bevacizumab (or Avastin), a drug which extends the lives of colorectal cancer sufferers an average of five months beyond chemotherapy alone, has a median price of $44,000. A patient on Medicare would be responsible for 20% of that cost, or $8800.
  • A breast cancer patient with a high deductible health insurance policy faces average out-of-pocket costs of $55,000—obviously, more than the life savings of most Americans. A person with a high deductible plan faces a bill of $40,000 for myocardial infarction, and $4,000 per year for management of “uncomplicated” diabetes. (Meanwhile employers are increasingly shifting workers to insurance policies with higher co-payments and deductibles.)
The authors state four reasons it would be beneficial for doctors to inform patients in advance of the cost of treatment. My comments on each are in parentheses.
  1. Informing the patient of the cost of treatment may cause some patients to switch to a less expensive alternative treatment that is just as effective. (Why would a doctor ever recommend a drug or treatment if there is an equally effective and less expensive alternative?)
  2. Some patients may be “willling to trade off some chance of medical benefit” in exchange for lower cost. (This possibility, which the authors refer to as “complex and ethically charged,” gets to the heart of the matter. Some patients may choose to forego treatment rather than leave themselves or their families bankrupt. It is implied that knowing the full cost of treatment may persuade some folks to commit passive suicide.)
  3. Patients could attempt to obtain financial assistance in advance of the treatment. (An example is given of someone who was able to obtain help from a charity—a rare event, at best.)
  4. “A growing body of evidence” suggests that if patients take cost into account, it “might reduce costs for patients and society in the long term.” (However, there is no citation to this body of evidence and the authors do not elaborate. They may mean that if everyone became more cost-conscious, prices might come down, but does the health care industry operate the same way as other more competitive markets?)
It seems so obvious that doctors should discuss costs with patients that it hardly seems necessary for NEJM to publish an editorial suggesting that they do so. But the most revealing thing about this article is the issues Ubel and his colleagues don't even mention.

First of all, they don't ask why the costs of drugs and medical treatment are so much higher in this country than in other industrialized countries. Medical costs are treated as if they were merely an uncontroversial feature of the natural environment, and no mention is made of how they might be reduced.

My colleague Paul Ricci has blogged frequently—for example, here—about how we're spending much more per person on health care than other countries, and getting mediocre results. Ezra Klein has posted 21 graphs with comparative data on the costs of specific drugs and medical treatments. Medical bills account for over 60% of U. S., bankruptcies, and 75% of people with medically-related bankruptcies had health insurance.  A 2013 survey of 11 countries by the Commonwealth Fund found that Americans were more likely than residents of the other ten countries to forego health care because of cost and to have difficult paying for care even when they were insured.


There is some objective data comparing the causes of our higher prices. A 2012 study by the Institute of Medicine, a division of the National Academy of Sciences, estimated that the U. S. health care system wastes $750 billion a year, roughly 30% of the money spent. The report identified six major areas of waste: unnecessary services ($210 billion annually), inefficient delivery of care ($130 billion), excess administrative costs ($190 billion), inflated prices ($105 billion), prevention failures ($55 billion), and fraud ($75 billion). Our doctors are more highly compensated than doctors in the rest of the world. Our hospitals attempt to maximize their profits, regardless of whether they are legally registered as for-profit or nonprofit corporations. Part of the problem is political corruption. For example, when Congress expanded Medicare to include prescription drug coverage, Medicare was forbidden to use its purchasing power to negotiate for lower drug prices.

More importantly, the authors don't even question why it is necessary for so many Americans to choose between financial ruin and illness or death when they suffer from common medical conditions. They fail to mention that the rest of the world's developed countries have largely solved this dilemma by establishing government run single payer health care systems. If this were merely a matter of money, we could talk about the vast sums this country wastes on overseas military misadventures, or the way our billionaires grow increasingly rich while paying lower tax rates than their secretaries. But these outrages are irrelevant, since a single payer system will save money. All the countries with single payer spend less per capita on health care than we do.

To be fair, Ubel does say, “No one should have to suffer unnecessarily from the cost of medical care.” But he fails to pursue any of the implications of this remark. The authors never make the point that single payer would almost certainly solve many of the financial problems they agonize over in these articles. I suppose it's possible Ubel and his colleagues are secretly hoping to build momentum for single payer by encouraging doctors to empathize more with their patients, but there's nothing in the article to support this speculation.

To paraphrase a point frequently made by Noam Chomsky, no one becomes a tenured professor at an elite university, or is invited to write an editorial for The New York Times, unless he or she has completely internalized the world view of the ruling class, and in the process learned to ignore all the really important issues facing our society.

Saturday, November 16, 2013

Geithner Goes to the Trough

I've written this piece before, when Allegheny County Executive Dan Onorato took a job as a lobbyist with the health insurance firm, Highmark. But Onorato is a small time player compared to former Treasury Secretary Timothy Geithner.

It was quietly announced yesterday that Geithner will become President of Warburg-Pincus, the country's fifth largest private equity firm—similar to Bain Capital, the ninth largest private equity firm, formerly headed by Mitt Romney. These are the vulture capitalists that buy up troubled companies and either close them and sell off their assets, or attempt to revive them by seeking loans and imposing austerity measures, then selling them at a profit. Either way, layoffs are an almost certain result. Economist Robert Reich explains how private equity firms work.


Geithner takes his place behind previous Treasury Secretaries like Robert Rubin and John Snow, who, after accepting several years of poverty-level wages in “public service,” walked through the revolving door between business and government to cash in for all the favors they had done for Wall Street while they were in office.

As Treasury Secretary, Geithner supervised the Troubled Asset Relief Fund, aka, the bank bailout, which ensured that banks and investment firms made huge profits following the 2008 recession, even as the rest of the country lost money. Here's future Senator Elizabeth Warren in 2009 quizzing him about where the money went.


Geithner is known for institutionalizing the idea that some banks are too big to fail, and in fact, the financial sector is more concentrated now than it was before the recession. He is also credited with ensuring that there would be no meaningful reregulation of the financial sector—for example, no separation between commercial and investment banking, and no meaningful changes in the trading of derivatives—thereby making it likely that we will have another recession before long.

Geithner had previously stated that he was “extremely unlikely” to take a job in the private finance industry. Maybe he didn't realize how grateful the 1% would be for the services he had rendered.

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Friday, November 15, 2013

Public Getting Warmer

Rep. Henry Waxman (D-CA) and Sen. Sheldon Whitehouse (D-RI), co-chairs of the Bicameral Task Force on Climate Change, released some surprising new public opinion data earlier this week. The data were prepared by social psychologist Jon Krosnick of Stanford's Woods Institute for the Environment. Krosnick did a secondary analysis of 21 random-digit telephone surveys and internet surveys conducted, mostly by Stanford, between 2006 and 2013, with a total sample size of almost 20,000 respondents. Krosnick's mathematical model looked at changes over time, and the data he presented are his best estimate of public opinion today.

The results show that there is broad consensus among the American public that climate change is happening and that government should do something about it. Here are the percentages in each state who believe global warming is happening.


The overwhelming majority agree, not only in liberal states like New York (84%) and California (82%), but also in conservative states like Mississippi (82%) and Texas (84%). At least 75% of residents in every state surveyed believe in the existence of climate change. (There were a couple of states for which Krosnick lacked enough data to make a reliable estimate.) Sixty-five percent or more in every state believe that global warming is caused by humans, and 58% or more believe that it poses a serious problem for the United States. Krosnick believes that personal experience with hot weather is primarily responsible for these opinion changes. 

There was only slightly less agreement on whether the U. S. government should take action to address climate change. In only four sparsely populated Western states (ID, MT, NV, UT) did the majority not agree that the government should do more. Here are the percentages by state who believe government should limit greenhouse gas emissions from U. S. businesses.


Similar majorities favor limiting emissions of greenhouse gases from power plants, tax breaks to produce renewable energy, and a cap-and-trade system to limit greenhouse gas production. You can go to this site to check out the maps for all the questions that were reported. If you would like to take a closer look at Pennsylvania's results, they are here.

Where did the public draw the line? In only five states did bare majorities endorse tax breaks for nuclear power. And in no state did a near-majority endorse consumption taxes on gasoline or electricity, or government support for all-electric cars.

These data are not new, but they seem to be sharply at odds with previous statements about American public opinion on climate change made by politicians and the corporate media. The consistency across states is particularly surprising. Here is Krosnick's take on how American public opinion is represented politically.

I have often heard legislators in Washington express the belief that there is considerable variation in opinions about global warming across parts of the country, and that most of the people in their state or district are skeptical about global warming. When I ask about the polling they have done that led them to this belief, I have routinely been told that they had not done polling and, instead, base their impressions on phone calls, emails and conversations with and from constituents on the issue. Our findings suggest that the balance of those direct communications from constituents to elected representatives may have created a misimpression of the public's opinions on the issue.

My guess is that Krosnick is trying to be diplomatic. This is not the first time politicians have been show to misperceive voter attitudes. Not only do Congresspeople not hear from a random sample of constituents, the ones they do hear from are primarily large campaign contributors.

Now that these data are available to Congress, we will have yet another opportunity to observe whether the American political system is responsive to public opinion. Would you like to estimate the chances of these surveys having an impact?

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Wednesday, November 13, 2013

Situation Alarming--But Not Serious

It's sometimes said that liberals are concerned about violence in the mass media but not sexuality, while conservatives are concerned about sexuality but not violence. If so, then a new study by social psychologist Brad Bushman and his colleagues suggests that the Motion Picture Association of America's (MPAA) rating system is a system of conservatives, by conservatives, and for conservatives.

The PG-13 rating was introduced in 1984 to solve a financial problem for the film industry: Too many popular films were being rated R, and an R rating meant that children under 17 could not attend unless accompanied by a parent or guardian. According to the MPAA, a PG-13 film “may go beyong the PG rating in theme, violence, nudity, sensuality, language, adult activities or other elements, but does not reach the restricted R category.” With respect to violence, they say, “There may be depictions of violence in a PG-13 movie, but generally not both realistic and extreme or persistent violence.” So, how's it going?

First, the methodology. Bushman drew up a list of the 30 top-grossing films of each year from 1950 to 2012 (1890 films), from which they randomly selected half, or 945 films. Trained coders watched the films and identified violent sequences, defined as “physical acts where the aggressor makes or attempts to make some physical contact with the intention of causing injury or death.” This definition excludes natural disasters, accidents and sports injuries. A sequence refers to the continuous action of a character, regardless of the number of discrete acts in the sequence. This solves an important practical problem, because it is not necessary to count the exact number of violent acts, i.e., punches, gunshots, which is a major source of unreliability in measuring violence. Using this approach, they achieved a reliability of α = .80, which is pretty good.

(I have very few questions about this approach, but one problem that concerns me is the scoring of scenes with large numbers of participants, such as battle scenes. Since there is one violent sequence for each character, how do you measure the number of participants? And how do you prevent such scenes from skewing the data?)

Next, they divided the films into 5-minute segments. The number of violent sequences in each segment was counted, and each film was given a score representing the rate of violent sequences per hour. In case you're wondering, 94% of all films between 1950 and 2012 had at least one violent sequence.

Bushman also counted the number of sequences involving guns, a gun being defined as “a weapon that can be carried with one or both hands that fires a bullet or energy beam with the intention of harming or killing a living target.” Hunting and target shooting were excluded. The reliability in scoring these sequences was even better (α = .91). A violent scene involving a weapon is less ambiguous than other forms of violence.

For purposes of analysis, films after 1984 were divided by rating into three categories: G and PG, PG-13 and R. G and PG were combined because there were fewer films with these ratings among the box office hits.

First, Bushman looked at the overall trend from 1950 to 2012. Not surprisingly, there was an increase. The level of violence more than doubled. The rate of increase was not simply linear, but gradually accelerated over the 63-year period.

Then they looked at gun violence during the period from 1984 to the present. Again, there was an increase, but there were important differences by rating. The G- and PG-rated films averaged 1.26 gun sequences per hour, and the overall rate declined slightly. The R-rated films averaged 2.15 sequences per hour and the rate did not change. However, violence in PG-13 films increased significantly, more than tripling over the 29 years. It started at near-zero, but accelerated sharply in recent years. From 2009-2012 the rate of gun violence was higher in PG-13-rated films than in R-rated films, flatly contradicting the MPAA guidelines.

The study does not report any measures of nudity or sexuality in films, but one of the co-authors, Daniel Romer, said that they measured sexuality, and it is much more likely to get an R rating than violence. I presume these results will appear in a future publication.

The relationship between filmed and televised violence and aggressive behavior is one of the strongest findings in social science, replicated in hundreds of experimental and correlational studies. The American Psychological Association and several other professional organizations have issued position papers highlighting these findings and recommending public policy changes. When you statistically combine the results of these studies in a meta-analysis, the relationship between filmed violence and aggressive behavior turns out to be almost as strong as that between smoking and lung cancer, and higher than many other statistical relationships that society takes very seriously, i.e., exposure to lead and IQ, homework and academic achievement. Exposure to media violence also makes participants less likely to help a person in need.

Daniel Craig as the PG-13-rated James Bond
Gun violence is a particular concern due to the weapons effect. Experiments show that the mere presence of a weapon—or a picture of a weapon—in the environment increases aggressive behavior in both angry and non-angry participants, which is probably why the presence of a gun in the home increases homicides.

While preparing this blog entry, I read at least a dozen reports about Bushman's study in the corporate media. Sadly, most of them contained false balancing (such as this one and this one). That is, they “balanced” Bushman's findings with comments from skeptics who dismissed the idea that violence in films might influence real-world aggressive behavior. (Science Daily was a notable exception.) The most common argument was that homicides have declined in this country in recent years, even as filmed violence has increased. This reasoning is, of course, completely fallacious, since there are many other variables that influence the homicide rate.

False balancing creates the mistaken impression that “experts disagree” over whether gun violence in movies really matters. Considering the popularity of violent films and television shows, this may be exactly what their audience wants to hear. Bushman has recently written an article suggesting several ways people rationalize away these findings. It is also worth noting that most of these news organizations are owned by larger media corporations that profit from the sale of filmed and televised violence. Bushman and Anderson have found that as the findings linking media violence and agression have gotten stronger, the news media have become more assertive in dismissing them.

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Monday, November 11, 2013

Symbolic Racism and Gun Ownership

In the past, I've mentioned the fact that a correlation between two variables does not necessarily mean that one causes the other. I'm usually reluctant to report correlational findings in this blog. However, since some variables are difficult or impossible to manipulate experimentally, simply disregarding correlational research is not an option. The question then becomes: How well does this particular correlational study control for alternative explanations? I think this one is worthy of our consideration.

I've also previously explained the difference between old-fashioned racism and modern or symbolic racism. Old-fashioned racism refers to the endorsement of statements that are obviously and blatantly racist, such as the belief that blacks are genetically less intelligent than whites, or that black and white people should be segregated. Because it is not socially acceptable to express these attitudes, whites typically score low in old-fashioned racism and it usually does not predict behavior very well--although it does predict membership in the Republican party.

Modern or symbolic racism (sometimes also called racial resentment) refers to prejudice that is revealed in subtle, indirect ways. In the present study by Kerry O'Brien and her colleagues, symbolic racism was measured using these four items from the Symbolic Racism 2000 Scale:
  1. Irish, Italian, Jewish and many other minorities overcame prejudice and worked their way up. Blacks should do the same.
  2. Generations of slavery and discrimination have created conditions that make it difficult for blacks to work their way out of the lower class.
  3. Over the past few years, blacks have gotten less than they deserve.
  4. It's really a matter of people not trying hard enough; if blacks would only try harder, they could be just as well off as whites.
As you can see, it is possible to endorse these items and still believe that you are not a racist. However, symbolic racism predicts policy preferences that whites (sometimes erroneously) think are harmful to blacks, such as opposition to welfare or support for punitive crime policies. These items were scored on a 5-point scale from “strongly agree” to “strongly disagree,” with items 2 and 3 reverse-scored. A participant's symbolic racism was his or her average score on the four items.

The data come from the American National Election Study, a large, representative panel study of Americans conducted in 2008 and 2009. Only participants who identified themselves as white were included. Three gun-related questions were analyzed: having a gun in the home, opposition to a ban on having guns in the home, and support for permits to carry concealed weapons. Of the literally hundreds of questions that were asked in the survey, the following were deemed to be relevant to the research question and were included in the analysis as control variables: gender, age, education, income, region (the South vs. other states), political party, conservatism, and anti-goverment sentiment.

There was a significant relationship between symbolic racism and having a gun in the home, even after statistically eliminating the effects of all the control variables. For each 1-point (out of 5) increase in symbolic racism, there was a 50% increase in the likelihood of owning a gun. Symbolic racism also predicted support for concealed carry, after eliminating the effects of the control variables and gun ownership. In this case, a 1-point increase in symbolic racism was associated with a 28% increase in support for concealed weapon permits. The question measuring opposition to a handgun ban, however, turned out to be highly correlated with gun ownership. If you own a gun, you don't want it taken away. Therefore, if you eliminate the effect of gun ownership, opposition to gun control is not related to symbolic racism.

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What are we to make of the relationship between symbolic racism, on the one hand, and both gun ownership and opposition to gun control, on the other? Correlation does not mean causation. Whenever two variables, A and B, are correlated, there are three possibilities: A causes B, B causes A, or both A and B are jointly caused by a third variable, C. 

It is certainly plausible that being a racist might cause you to buy a gun for protection from black people. The association between symbolic racism and support for more punitive crime policies is consistent with these results.

Although it may be less obvious, I think there's a real possibility that gun ownership is a cause of racism. Most gun owners claims that their weapons are needed for protection. Could gun owners be trying to justify being armed by exaggerating the extent to which they are under threat by blacks, for example?

As noted, it's possible that some unmeasured third variable explains these results. The number of potential third variables is theoretically infinite. However, the authors have covered the variables that are traditionally associated with gun attitudes, and most of these control variables actually are associated with opposition to gun control or owning a gun. Being a male, from a southern state, a Republican, a conservative, and having anti-government views all individually predict opposition to gun control. Having less education means you are more likely to have a gun in the home. But symbolic racism has an effect over and above all these other variables.

Whites have twice the rate of gun ownership as blacks. As the authors note, the irony of these results is that whites seldom use handguns for self-protection, from blacks or anyone else, but are more likely to use them to commit suicide or shoot someone accidentally—usually a friend or family member. While white racists may think they are protecting themselves from hostile black people, they may actually be thinning their own herd.

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Thursday, November 7, 2013

Conceptualizing Health Care Policy

Mike Konczal has written an important article in which he asks: (1) What parts the Affordable Care Act (ACA) are not working well, and why?, and (2) What does this imply about future developments in health care policy? Will government abandon the effort to provide health care for all, or will we move toward a single-payer system?

Paul Krugman has described the ACA as a “kludge.” It is too complicated, and those complications are making the system inefficient and expensive, while depriving many Americans of health insurance. Konczal notes four specific problems:
  1. The process of signing up for health insurance in the federal exchange (HealthCare.gov) is complicated because everyone must be means tested. The government must be able to confirm virtually every datum the applicants enter: their identity, their citizenship, their income, their eligibility for coverage through other federal or state programs, etc. All this is necessary to determine whether each applicant is entitled to a subsidy, and if so, the amount.
  2. A further complication is that each applicant must be matched to a private insurer. The government must check that all of the thousands of insurance plans meet their minimum standards. They must clearly communicate the important characteristics of each policy to consumers, even though the insurance companies deliberately try to confuse them. They must contend with insurance company sabotage such as canceling plans abruptly and arbitrarily raising rates.
  3. The ACA faces the threat of adverse selection—the possibility that the oldest and sickest among us will patiently navigate the exchange and eventually purchase a policy, while the youngest and healthiest will ignore the law and hope the penalty for not buying insurance is unenforceable. If Americans in poor health are more likely to buy insurance, the costs go up and there is a very real possibility that the system will collapse.
  4. Finally, the federal government has to deal with attempted sabotage by states controlled by Republican governors and legislatures, exemplified by their refusal to set up state exchanges and to participate in Medicaid expansion, which is denying coverage to over 5 million low income Americans.
Summarizing these problems, Konczal describes two approaches to social insurance, which he calls Category A and Category B.

Konczal describes Category A as the “neoliberal” approach to public policy. Neoliberalism has, in recent years, become a synonym for conservatism. It refers to policies that reduce the role of government in public life through strategies such as privatization and deregulation. Category A social insurance sees the government as “an enabler to market activities, with perhaps some coordinated charity to individuals most in need.”

Category B, on the other hand, encompasses progressive programs such as the New Deal and the Great Society. It sees certain goods and services, such as food, shelter and health care, as basic human rights, and attempts to remove them from the marketplace by providing them to everyone.

There are very few pure examples of Categories A and B; most policies fall somewhere along a continuum between these extremes. However, the ACA falls clearly into Category A. This is not surprising because it is a plan devised by a conservative think tank which was promoted for decades by the Republican party. Social Security and Medicare, on the other hand, fall into Category B. Medicaid is a hybrid, since it is means tested and administered (and regularly sabotaged) by the states.

In the last three decades, we have seen a gradual rollback of Category B programs. This is not surprising, given the extent to which the political system is controlled by corporations and wealthy individuals. In the old days, the Republicans favored Category A and the Democrats Category B. As both parties have shifted to the right, the Democrats have shifted their allegiance to the Category A policies favored by their corporate donors, while many Republicans advocate eliminating social insurance entirely.

Whenever a public service is privatized, it moves from Category B to A. This is what happens, for example, when you turn over tax dollars to charter schools, so that corporations can make profits by educating children as cheaply as possible. Of course, the ultimate disaster for the country would be the Republican plan to privatize Social Security, since another Great Recession—a virtual certainty in the absence of financial reregulation—would have the potential to impoverish our elderly population.

PA Governor Tom Corbett's proposal to expand Medicaid would move this program further toward Category A through a combination of stricter means testing and turning the program over to private insurance companies. Dave Steil, President of Healthcare 4 All--PA, has written an op-ed critizing the Corbett plan. He rightly notes the waste of money that would result from turning Medicaid over to private insurance companies. However, he overlooks the hardship that increased means testing, premiums and copayments will impose on working class Pennsylvanians.

Advocates of single payer health insurance—obviously a Category B program—are going to be urinating into a stiff wind for the foreseeable future. However, there is some hope. It is the four Category A characteristics noted above that are turning the ACA into a “kludge.” While Republicans will argue for repeal, pragmatists are likely to notice that if you drop some of these characteristics, you can improve health outcomes while saving money. And if you drop all four, you have single payer.

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Wednesday, November 6, 2013

"Based on a True Story," Part 1

Captain Phillips

Captain Phillips is about a 2009 incident in which an American cargo ship, the Maersk Alabama, was boarded in the Indian Ocean by four armed Somali pirates who held Captain Richard Phillips (Tom Hanks) and his crew hostage, demanding millions of dollars in ransom. When a U. S. Navy destroyer, the USS Bainbridge, and a frigate, the USS Halyburton, came to the Maersk's rescue, the pirates took Phillips aboard a lifeboat to transport him to Somalia. Phillips was eventually rescued by Navy SEALS, who killed three of the four pirates. Their leader, Muse (Barkhad Abdi) had been tricked into boarding the Bainbridge to “negotiate” with the Navy. He is now serving a 34-year sentence for kidnapping.


Captain Phillips is a traditional American military propaganda film. Ever since World War II, Hollywood and the Pentagon have had a mutually advantageous arrangment. In order to make the film appear realistic, the filmmakers need access to military equipment, locations and personnel. In exchange, the film studios are required to give the military final script approval.

Since the film was adapted from A Captain's Duty, Captain Phillips' book about the incident, he behaves admirably throughout. If reality, he is being sued for $50 million by members of his crew for “willful, wanton and conscious disregard for their safety.” The Maersk was boarded 240 nautical miles (nm) from the Somali coast, after being warned by the U. S. Maritime Administration to stay at least 600 nm from Somalia due to the danger of piracy. It would be interesting to know whether real or imagined pressure from the ship's owners to take the shortest route played a role in his decision.


It's likely that Tom Hanks has already cleared his February calendar in preparation for his next Oscar nomination. The director, Paul Greenglass, is known for his technically competent, exciting semi-documentary action movies. His previous films include Bloody Sunday (about a 1972 British army massacre of Irish protesters), United 93, and The Green Zone (about the Iraq War). He excels at describing what happened, but carefully avoids questions about why. 

The film makes no serious attempt to explain the motives of the Somali pirates. All we get are some opening scenes set in a poor village and a line of dialogue from Muse about there not being as much economic opportunity in Somalia as in America. It would be interesting to know more about the relationship between the four pirates and the Somali bosses from whom they take instructions. At one point, Muse boasts that he extorted $6 million during a previous act of piracy. Phillips asks the obvious question, “Then why are you here?” This potentially interesting point is not pursued.

In the absence of an explanation of the behavior of the Somalis, it is likely that the audience will assimilate this film to the racist narrative of Hollywood's traditional melodrama in defense of colonialism—the one about, for example, the wagon train under attack by hordes of mindless Indians. In this story, the “human beings,” i. e., white people, are presented as victims of an attack by “aliens,” i. e., people of color, who are presented as the embodiment of pure evil. This narrative was used successfully in a previous film about Somalia, Black Hawk Down.

In the last third of the film, we are treated to one of the oldest cliches of the colonialism melodrama: The arrival of the cavalry just in time to rescue the trapped settlers. Cue the patriotic music. Presumably, the audience is expected to cheer as two heavily armed battleships take to the high seas to attack a lifeboat containing four emaciated Somalis. “We're number one!”

The only dischordant note occurs when the captain of the Bainbridge is told that he is not, under any circumstances, to allow the lifeboat to reach the Somali coast. In other words, Captain Phillips' life is to be sacrificed rather than to allow this to develop into a more serious international incident. Fortunately, that was not necessary.

The clearest example of the role of military script approval in preparing this film is the portrayal of the Navy SEALS who came to Captain Phillips' rescue. The film shows the SEALS, who have a reputation for excellent marksmanship, killing three men with (by my count) four shots. Imagine my surprise when I read that, in reality, 19 rounds were fired. Shocking!

But that's not all. There was $30,000 aboard the lifeboat, money that Phillips took from the ship's safe and gave the kidnappers in the hope they would take it and leave. This money disappeared and was never recovered. The kidnappers were all dead. Captain Phillips was exhausted, injured and helpless. The most likely explanation is that it was stolen either by SEALS or other naval personnel who boarded the lifeboat. The Navy investigated the incident, giving polygraph tests to several individuals. They concluded that there was insufficient evidence to bring charges against anyone and, according to the Navy, “The case was ultimately closed without evidence of wrongdoing.”

The incidents that are left out of “true stories” are sometimes more interesting than those that are included.

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"Based on a True Story," Part 2