Reviews


Today Vox had an article about a new study of health insurance in America that annoyed me in a number of ways, and highlighted both Vox’s patronizing know-it-all style, and the simplistic economics-worship of some of its writers (in this case Ezra Klein). It’s one of those Economics-101 “Yes, you think A but really this [insert shallow confounder] means not A! Wow!” arguments that are beloved of pop economists, and it’s really frustrating to see it being trotted out now by Vox at a time when the USA is going through a major ideological battle over universal health coverage.

This post may turn out to be a bit long and kind of technical, depending on how frustrated I get reading further on the topic as I write …

The basic argument

Klein has taken a new working paper by Finkelstein et al and used a few of its apparently central findings to build up a story around a question. Finkelstein et al analyzed the Orgeon Health Insurance Experiment to find out how much money medicaid recipients were willing to give up in exchange for medicaid, and how much utility they get from their health insurance. As part of this they found that the uninsured actually don’t pay for much of their treatments: only 20% of their out-of-pocket expenses are paid by them, the rest being shouldered by someone else. This is a central part of Klein’s discussion and, in my opinion, a terribly uninformative finding. Klein has a whole section of the article about how the uninsured are actually “kinda-insured,” which is kinda-true but also kinda completely misses the point, in a very important way that, in my opinion, says a lot about the reasons Americans are having so much difficulty with this whole universal health coverage (UHC) thing. He then moves on to a discussion of the findings of the original Oregon Health Insurance Experiment paper in the New England Journal of Medicine, which found that medicaid wasn’t actually that good for a lot of its recipients; there is a lot wrong with this paper and a lot of reasons its findings need to not be over-stated, but Klein doesn’t really consider them, and gives the study findings more weight than (in my opinion) they deserve. He then goes on to one of those discussions that only economists have, which I guess they expect the rest of us to take seriously, that are deeply poisonous in their basic assumptions, and often wrong: “is health insurance worth it?” This is like the classic economics paper on why voting is a waste of time: superficially appealing but absolutely and completely wrong. He finishes with an important statement, that health insurance should be assessed in terms of the value it offers people, but then juxtaposes value with cost-control as if the two things are mutually contradictory. Pretty much everything in this Vox article is superficially right but deeply wrong, and I want to talk about why it’s wrong and what this means for the health insurance debate.

The Oregon Health Insurance Experiment

The Oregon Health Insurance Experiment (OHIE) is at the heart of the findings in this Vox article, but it’s probably not something we should put too much faith in. Basically, the Oregon state government expanded medicaid places a few years ago, but it could only expand to 30,000 so it ran a lottery for the 70,000 potentially eligible people. The 30,000 potentially eligible people then applied for medicaid, with many getting rejected, and Finkelstein cunningly convinced the government to let her study the results. This is a joyous opportunity for health insurance research because it offers a randomized controlled trial (RCT) of access to health insurance: the gold standard of medical research, enabling us to eliminate a whole bunch of confounders and explore only the effect of health insurance.

Unfortunately there are many problems with the Oregon Health Insurance Experiment and the original paper which launched it to fame. First and foremost, although 30,000 people won the lottery, winning the lottery only increased the probability of accessing medicaid by “25 percentage points” because many didn’t apply or were ineligible, and many non-winners somehow finnagled their way into medicaid. Thus the “Experiment” suffers from massive contamination of the kind that usually renders an RCT ineligible for publication, because most of the intervention group ended up as controls and some of the control group ended up as interventions. While the process of assignment to these two groups was random, the process of transition between groups and final allocation was not, and in fact is decided by a very clear set of factors with a high risk of confounding, such as age, unemployment, etc. The second big problem with the OHIE is that the follow-up period was only 2 years, but lottery winners went on a waiting list, so the actual follow-up time from starting medicaid to study end was less than 2 years, but many of the outcomes they studied (blood pressure awareness, treatment and control, for example) require long follow-up, and key outcomes such as financial catastrophe (see below) are dependent on much longer follow-up times and/or retrospective analysis. Note that the non-medicaiders received a full 2 years follow-up, another minor source of bias. The third problem is that many lifestyle and consumption variables that are crucial to understanding the home-financing impacts of health insurance were obtained from a mailed survey with 15,500 respondents (out of 70,000 in the original study!), one of the most infamous ways of introducing bias into studies (respondents to mail surveys are even less normal than you, dear reader(s)). In contrast, surveys of health financing issues in developing nations (which in my opinion are the gold standard of health financing surveys) routinely get 95-98% follow-up in detailed, complex door-to-door interviews. I have said before on this blog that I think American health finance researchers could learn a lot from what the developing world is doing, and this is another example. The fourth problem is the choice of outcomes: even in systems that are completely free (such as the NHS), health outcomes that can be analyzed over just two years of follow-up are heavily dependent on health-seeking behaviors and non-financial access barriers (e.g. work and time off), and the best measure of health success in a health insurance plan is in serious but often rare outcomes – all-cause mortality, hospitalization, that sort of thing. Also, the OHIE didn’t do much analysis of financial outcomes, which are the main point of health insurance programs. Finally, the study is only ethical if you squint and tilt your head: randomizing people to receive health care is not ethical, and the only reason this study gets grace on that count is that America’s system is insane, but the general ethical view of the medical establishment is that just because the state does something convenient, that doesn’t mean it’s ethical to participate in studies of that thing (see e.g. debate in the British Medical Journal for the Godwin-level examples). Regardless, most people accept the validity of the OHIE, so let’s run with it for now, bearing in mind its flaws: flawed papers often still have a lot to tell us.

The uninsured are “kinda-insured”

In my view the central flaw of the Vox opinion piece lies with its uncritical acceptance of the working paper’s finding that only 20% of expenses were paid for by people without insurance, and the implications of this. The Vox article states:

It’s perhaps easiest to explain this through example. Imagine John breaks his leg. If John is uninsured, his brother, Mike, pays for his medical care. But if John has Medicaid, then the government pays for his care. John got medical care either way. So in this case, Medicaid’s money actually didn’t go to John so much as it went to his brother, because it was his brother who actually would have ended up paying the tab.

This is the kind of superficial gotcha that economists like Ezra Klein love, and it’s annoying and … superficial. There is a large body of research on the health financing aspects of health insurance, and a key concept used in that literature is distress financing. In developing nations, distress financing is defined variously as using any of the following strategies to pay for medical care: selling assets from the home or family business, using savings, calling on family members for financial support, or withdrawing children from school to work [yes, you read that right: this is what lack of health insurance does]. What John did was distress financing, and one of the goals of universal health coverage is to reduce or eliminate the incidence of distress financing. Sure, Mike is better off if John gets medicaid, but in health financing we don’t care about Mike, Tom, Dick or Harry: we are designing a system that protects John from financial catastrophe and distress financing. This is because it is of no interest to us if Mike spends his money on a plasma-screen tv or his brother’s appendix or indeed his own, the purpose of health insurance is to pool risk, that is to ensure that no person – whether directly afflicted or not – has to spend unexpected amounts of money on health care. No doubt there are people out there whose monthly premiums are paid for by friends, sugar daddies or family. We don’t care. The important point is that we have established a universal risk pool into which everyone pays, and everyone draws. It’s no concern to us whether Mike pays for John or John pays for John or John’s sugar daddy pays for John, and typically health insurance research doesn’t ask about how premiums are paid, so why should we care how out-of-pocket expenses are paid? So Klein’s example completely misrepresents the moral purpose of health insurance, by assuming the wrong things about why we have health insurance, and misunderstanding the tools that are available to understand how health insurance works.

I also think Klein has misunderstood the working paper on this issue, because I don’t think the working paper makes as big an issue of this distribution of costs as he does. Finally, if John and Mike are sharing the cost of their health care, then really what’s happening there is that they are establishing a very inefficient, unregulated risk-pooling mechanism – a private version of medicaid. When John gets medicaid we aren’t seeing a situation where suddenly Mike is better off because John can pay for his own care, we’re seeing a situation where Mike is better off because John has been drawn into a larger, better-managed, better-regulated risk pool.

Estimating the utility of health insurance

The working paper is largely aimed at estimating the utility of health insurance, and it uses techniques from economics that I’m definitely not qualified to critique. I know nothing about utility functions or their optimization, so a lot of the language and techniques are a mystery to me. However, there seem to be a couple of aspects of their analysis that insert strong biases. For starters, their assumption 3 on page 8:

Individuals choose m and c optimally, subject to their budget constraint

which is explained as:

The assumption that the choices [of some functions] are individually optimal is a nontrivial assumption in the context of health care where decisions are often taken jointly with other agents (e.g., doctors) who may have ddifferent objectives and where the complex nature of the decision problem may generate individually sub optimal decisions
This assumption ignores the possibility that individuals choose not to consume health care, a common problem amongst the uninsured. It’s also a particularly dubious assumption about the poor, who are often not able (through resource constraints and e.g. work situations) to make optimal decisions. A good example of this is abortion: the welfare-maximizing decision might be to have a legal abortion, but there are many states in the USA where this is becoming increasingly difficult for poor people to do for non-financial reasons (travel requiring time off work, the risk of humiliation in small towns, etc.), while for the wealthy it remains a simple utility-optimization decision. A poor person might make the extremely risky decision to have an illegal abortion, which has stochastically-varying risks (mostly none, occasionally many). It’s not enough, in my opinion, to talk about this as a limitation: it needs to be carefully modeled.
The working paper also uses an unorthodox method for assessing income, basically dividing household income by family members[1], and doesn’t consider the issue of disposable income. Typically studies of this kind use the family’s disposable income (or some similar measure of available consumption) during analysis, because people have other fixed expenses (most especially, a house) that they can’t fiddle with.
As a result of these assumptions and estimation processes the working paper comes up with a finding that individuals would be indifferent to giving up medicaid or consumption of about $1000 – $1500. This seems to be actually an astounding finding, given that average income in the people receiving medicaid is $3800. Would you give up just under half of your income for health insurance? Is this an indication that the health insurance is of low utility, as Ezra Klein concludes? Note also that there is no assessment here of financial catastrophe, which is important because these people only need to spend about $700 a year on health care to be in the catastrophe zone (usually about 25% of disposable income, which seems to be about $2800 in the assumptions of this study, though I may have misunderstood it). In order to understand the benefits of health insurance properly in this community we need to understand what their risk of financial catastrophe and distress financing is and what proportion of that risk they are protected against by medicaid; but we are instead treated to a completely irrelevant estimate of what amount of money they are “indifferent to”, based on income and expenditure information from a very small sub-sample of the people originally eligible for the trial.
I’m not convinced that the OHIE is capable of answering the questions we need to know about health insurance coverage, or that this study adds anything except to tell us that poor people will use up to nearly half of their income to purchase health insurance.
Vox’s conclusions
Klein concludes that maybe health insurance isn’t that great, and we need to make it more appealing, or something:
That isn’t to say health insurance is useless, or that medical care doesn’t help. But we’re probably paying too much and getting too little, and now that we’re a lot closer to a world where every American who wants health insurance can afford it, we should be focusing on making sure that all that health insurance we’re buying is actually delivering the health we’re expecting.
Much of this paragraph is based on the published NEJM paper from the OHIE, which as I showed above is not very informative about the health benefits of health insurance. The subsequent working paper hasn’t told us much about its health insurance benefits either, because it was misdirected. So how can Klein conclude from this study that we’re probably paying too much and getting too little, and why would anyone conclude that from medicaid, which is a specific system for the very poor in America? The reasons why medicaid is ineffective are probably closely related to social determinants of health; the reason why standard health insurance plans (or the Obamacare bronze plans) are ineffective probably has a lot more to do with access issues, arbitrary payment systems, and high overheads. This seems like really weak sauce to conclude with, and as a remarkable economic finding it also seems kind of empty. If you went out to buy a plasma-screen TV, I’d tell you to find the best one you can for the lowest price you can, and definitely make sure it works. Klein’s conclusion in this article is that … the community should buy the best health insurance it can for the lowest price, and make sure it works.
So somehow Klein has gone from a gotcha based on a flawed study (oooh look! you thought health insurance works but this study showed it doesn’t!) to saying … we need to make sure we spend money on health insurance wisely. While the rest of the world continues with its process of spending less money than the USA on health insurance, and getting better results.
It’s not really a very helpful conclusion is it?
What is the relevance of this to America’s health debate?
Assuming Vox has any relevance America’s health debate, or to anyone anywhere, that is. This whole article seems to me to be a representation of the strange atmosphere of debate about health insurance and health care in America. First of all it is a discussion of a set of studies trying to find out whether health insurance works, something that the rest of the world takes for granted. Secondly, it buys into a strange economists’ logic of who benefits from health insurance that is almost completely ignorant of a large body of research on health insurance outcomes, and also seems to see health insurance as a consumer good rather than a risk-pooling strategy – i.e. it frames the entire health insurance debate in terms of something that people want to buy, rather than something society thinks everyone should have. It’s another example of how America’s intellectual elite seem to be really clueless when it comes to health care, and it’s a real worry that a site that is supposedly informative is publishing articles by a major economic pundit about one of America’s central social reform issues that are largely clueless about the central debates in that issue. How is the general American public meant to understand a fractious, long drawn-out healthcare debate if public intellectuals like Klein are missing the key issues and presenting the framework of that debate in a completely erroneous and misleading way? Healthcare policy is far from simple and there’s no reason to think ordinary people should understand it without help, but here we have a major public intellectual and economist completely misrepresenting the core elements of the debate, running his readers off down the wrong track into a loopy set of conditions on health care (and a really weird definition of who benefits and who we want to benefit) before ending with a completely uninformative and vapid conclusion (we need to buy more for less!) Is this really the standard of public debate on healthcare in the USA?
Let’s hope the Supreme Court don’t read Vox, and be glad it wasn’t around when Obamacare was first developed!
Fn1: The correct method is to scale the household size to consumption equivalents using a power law, the value of the power being estimated from a regression model: for the USA the consumption-equivalents scale as approximately the square root of household size. This is perhaps not a very important flaw in the paper but it points to a bigger flaw: none of the standard experts on health financing from the broader health financing field are referenced and Ke Xu, the world-recognized expert on this, is not included in the reference list. Once again: researchers in the USA could learn a lot about the best methods to study health financing from those who are doing very serious work on UHC in developing nations.

 

 

 

Getting out of that fridge is hard

Getting out of that fridge is hard

Mad Max: Fury Road is a masterpiece of Australian cinema, that makes the rare achievement of building on its predecessors in the series to bring post-apocalyptic film-making to what must, surely, be its apotheosis. Visually stunning, with a brilliant sound-track, incredible pace, and a simple joy in hedonistic old-school road wars violence that is deeply infectious, this movie immerses you in its insane world from the very beginning and doesn’t let you escape until the credits roll. It is thorough in its vision of a grim, wartorn post-apocalyptic wasteland, unrelenting in pursuit of heady, dizzying action and absolutely frantic. But beneath its simple patina of gorgeous landscapes, sweeping chases and exciting stunts, it is also a movie of many layers, combining an uproarious vision of a freakshow post-apocalyptic death cult with a powerful homage to Australia’s alternative and bush culture, and a subtle nod to an eco-feminist critique of the societies that are driving to their own destruction. This is one of those movies that you can appreciate for its visual splendour and action sequences, but also that you can enjoy for its crazed Aussie clowncar humour, and contemplate afterwards in the light of its ecological and feminist politics. This, in my opinion, is the perfect balance of themes for a post-apocalyptic movie. It doesn’t make the mistake of unrelenting hopelessness that characterizes some movies like The Road; it doesn’t dull you to sleep with the empty spaces and silences of an empty world, like The Last Man on Earth or Legend; and it offers something more uplifting than the empty survivalism or post-human cynicism of much of the zombie survival genre. Through the post-apocalyptic setting it offers both excitement, gore and social critique, all couched in such a spirit of over-the-top, raucous and invigorating fun that surely only a zombie couldn’t help but at least slide into the scene and get that rev-head spirit going.

The introductory scenes of the movie leave us with a bewildering array of visions of craziness and freakish people that are confusing and overwhelming, as the scenes of Max’s capture are played through the tunnels and byways of what looks like a massive underground punk/skinhead garage. It will be some time before we figure out what’s happening to him or why, but before we do we’re given a sumptuous feast of the sick, the freakish and the mad as we watch the elite of the citadel lording it over their filthy crazed masses. This 10 minutes is like Peter Greenaway on speed, without purpose or sense, but then we hit the open road and get a few minutes to start putting it all in place – oh, that‘s why the women are being milked, that‘s why the freaks are running the circus, those women are running away from him! Then the trouble starts again and we’re back into chaos, but with a few sentences of expository dialogue (finally!) and the dawning realization of the trouble Max is in, and all of it set against a backdrop of classic 1990s Aussie sub-cultural monuments: the punk styling, the rev-heads worshipping V8 with their elaborate steering wheels, the skinhead warboys who’re whiter than Aryan and go all chrome and shiny to die on the Fury Road … In a couple of minutes of frantic action we’re shown an ecosystem, the skeleton of an apocalyptic death cult, and an entire aesthetic to go with it. Then the chase starts and we’re still absorbing it as Mad Max is roaring (or, more accurately, being roared) onto the Fury Road, which in this world is basically anywhere wheels can turn. But the freakshow doesn’t subside – just when you think you’ve seen it all, come to terms finally with the internally consistent madness of it all, new craziness pops into the scene, and tears up the desert with more chaos, and then makes sense again. What you see on the trailer – some dude in a harness with a flame-throwing guitar, a gigantic dude with oxygen tanks, that scary dude with the mask – that seems so over the top and stupid, it all makes its own brand of crazy sense before you’re even twenty minutes in, and you haven’t even met the object of all this craziness, or even the worst of it all yet. Then when it’s all said and done and you’re reading the credits and seeing who these people were – the Doof Warrior, Rictus Erectus, the Organic Mechanic, Nuks the Warboy – you realize you still didn’t get all of it because nobody told you their full name but every detail of their names is a homage to Aussie subcultures, especially the doof scene but also punk, hardcore and all the tattered, dreadlocked, bullet-studded chaos of the 1980s and 1990s underground. Here it is, flying out of your cinema screen in one last glorious death rattle of insanity, road-rage and revhead joy.

Beneath this infectious ecstasy of the open road the main characters are laying out an ecofeminist thesis. The basis of the story is a group of women – called the Wives – who are apparently genetically perfect (and very beautiful!) fleeing from their tyrannical husband Imortan Joe, with the help  of his best road warrior, a one-armed woman called Imperator Furiosa (played by Charlize Theron). Joe hopes to have healthy babies by these women, and keeps them locked up for his use until he can get a male heir to rule after he is gone. But they don’t want to be things, so they leave, and his warboys have to chase them. This is a pretty basic feminist plot, made stronger by a couple of narrative devices. First of all, the alleged hero of the show gets fridged at the very beginning – as in literally, nearly – and only gets drawn into the story by accident. He manages to fight his way to Furiosa’s side but his role in the story is just luck, he was meant to be just another thing back at the citadel and it’s pretty clear first, at least, that Furiosa isn’t particularly comfortable with the idea of bringing him along. He’s the passenger for much of the first quarter of this movie, and the chicks are driving the car. Then, these women are not helpless – they are agents of their own destiny, and act with all the tools, strengths and wiles at their disposal to make their getaway. They don’t know how to fight and they aren’t strong (and one is about to give birth) but they don’t let any of that stop them doing all they can to take charge of their situation. These women are also the expositors of the film’s ecofeminist thesis, using their few moments of dialogue (no one in this movie wastes breath speaking!) to drop a few choice eco-feminist koans. The crux of it all comes when one of the Wives is trying to push Warboy Nuks out of the truck, and they are arguing about whether she is one of the citadel’s folk or not. Nuks says that he is not to blame, but she demurs, and yells “Then who killed the world!?” before tossing him overboard. At another point one of the women is credited with calling bullets “anti-seeds”: you plant one and watch something die. These are classic tropes of eco-feminist thought, being delivered by strong women whose presence on the screen is inextricably tied to their femininity and their fertility, and a war being fought to control their powers of birth, that are so precious on this planet that (the implication is) was blighted by men like Imortan Joe. They don’t stand up to expound on a manifesto or to make demands or philosophical claims but every time these girls speak they say something linked to an eco-feminist creed. Even the first time we meet them, one of them is cutting off a chastity belt with teeth built into it, freeing herself of patriarchal sexual shackles, and the perverse vagina dentata fears that the patriarchy brings with them.

I must confess I love it when a good movie works an ideology into its very bones, but does it so well that even though you know it’s there you just get sucked along with it anyway. I have no care for Mal’s simplistic libertarianism in Serenity but I did love watching him righteously defend it; I can’t stand the authoritarian violent message underlying 300, or the way it elided Spartan slave-holding and paedophilia, but I loved watching those men fighting for their worthless cause. When a movie saturates itself with an ideology but does it so well that you either don’t notice or don’t care, or – best of all – everything makes sense in the context of that ideology, that is when you know a movie is well crafted. And Mad Max: Fury Road has carried this off brilliantly, with the rollicking plot and the rollercoaster of stunts and enemies and explosions and madness carrying you all the way to the eco-feminist oasis – and back again.

With this movie I think George Miller has drawn together a few ideas he was playing with in the first three Mad Max movies, but wasn’t quite able to pull off. We see hints of a feminist agenda in Beyond Thunderdome, with the powerful Aunty Entity running the town and trying to use Max as a pawn in her schemes. We see here too the role of oases and lost places as signs of hope, but in Fury Road Miller has been able to better combine them with the narrative of judgment on those who brought the world down that he played with in Mad Max 2. The whole thing is also carried off with a remarkable creative continuity: the names, the punk styles, the language of speech have a certain similarity to them, as do the baroque car designs and the hard scrabble economics of theft and hyper-violent rent-seeking. Even the actors are in some cases the same: Imortan Joe is Toecutter from Mad Max 1. This is a full campaign world Miller has created over the past 30 years, leavening it over time with better production values and now a much stronger environmental message, and maturing some other themes (like the role of power-mongers), but that campaign world has been remarkably consistent across all that time.

For all of these reasons, Mad Max: Fury Road was a movie well worth waiting 30 years for. Later this year Star Wars 7 will come out, and we have to hope that there, too, we will finally see continuity with the original legend after 30 years of lost chances. I am not holding my breath on that, but I can assure you, dear reader(s), that Mad Max: Fury Road is something special, and will redeem this year of cinema – and possibly this decade – no matter what happens at christmas. Watch it, and ride eternal, shiny and chrome!

 

Full of terrors ...

Full of terrors …

This is a level 7 cleric spell that does 10d10 damage per round (no save) to a single target. It also instantly grants the caster a profound insight into the psychology of everyone who witnessed the death of the target. After receiving this insight, the caster must make a save vs. death to avoid losing all respect for those whose mind she now knows.

[Warning: this post contains spoilers for both the TV show Game of Thrones and its associated books. Don’t read on if you haven’t yet got to season 5 episode 9]

So last night Stannis Baratheon did what any sane viewer of this show should expect him to do, both on character grounds (he’s a murderous arsehole) and metaplot grounds (George RR Martin is a murderous arsehole). But reading around the traps this morning it appears that a lot of people are shocked that Stannis – the man who killed his little brother with an abomination born through adultery to a psychopathic witch, and cut off his advisor’s fingers, and burnt Mance Rayder alive for shits and giggles – is willing to sacrifice his own daughter to the lord of light’s [insatiable] blood lust just when his entire life’s goal is going pear-shaped. Others are shocked that a show that threw a kid from a window in episode 1 – and allowed the incestuous arsehole who did it to redeem himself later! – and burnt two farmboys to death because of reasons, should somehow murder a noble child that everyone loves.

The Guardian has an excellent episode-by-episode blog of the show, with generally excellent above-the-line posts and great below-the-line banter, including by some dude who writes only in the voice of Stannis Baratheon. The blog writer, Sarah Hughes, declares that burning a child to death may be a step too far for her, in the same episode that we are shown another character paying to fuck a child and making it pretty clear that the child is going to be severely damaged by the affair (“you’ll have another one for me tomorrow,” he warns the brothel madam). This is not the first child we’ve seen burnt to death, or thrown from a window; it’s not the first barely-adult teenage girl we’ve seen murdered (though usually they’re raped first) and her fate is hardly special against the general backdrop of violence and murder in this show. What about that horrible little tete-a-tete north of the wall, where a bunch of men in black find a community in which a single man rapes all his daughters, murders their male children and raises the girls as sex slaves; and what do the crows do? They rebel against their leader so they can take the guy’s place. But burning some girl you were starting to like is a step too far? Lots of people in comments are complaining that this is outrage for the sake of it, suggesting that it’s just done to lure public attention or something (because the most pirated TV show in history really needs more press!) Have these people been watching the same show as me or is there some kind of politically correct, heavily pixelated version that Guardian readers can download? Because I can’t comprehend how anyone would be surprised that a man as cold, driven and vicious as Stannis Baratheon would burn his own daughter at the stake, or that burning a child at the stake is somehow a step further in any direction for this show. In response I can only think of that great Raul Julia line from Streetfighter: “For you it was the most important day of your life, but for me it was just … Tuesday.” This is not a show where a single extra dead child is going to tilt the scales.  Especially when you consider that the week before everyone was singing the praises of a 20 minute long battle scene in which multitudes of children died and were reanimated, and one excellent character was attacked and murdered by undead children.

There’s an obvious class analysis to be had here: how is it that some rich, educated girl in a dress dies and we are all up in arms about it; but no one notices the way that Sansa was completely relieved and happy to learn that two boys burnt alive were not her brothers. They’re just two farmkids, irrelevant in the scheme of things, their deaths a hapless accident that brings her joy because it confirms her brothers (real people!) are still alive. And of course wildling children aren’t even human, right? By now we’ve all become so complicit in the vicious intrigues of the elite that we’re now thoroughly indoctrinated into their code of combat: only rich people matter, and though their lives are expendable they should only be expended for a purpose. To channel Drew’s dialectical ephemeralist for a moment, quoting the Falcon:

Little people they liquidate. And time and again they cream your liquidation, your displacement, your torture and brutal execution with the ultimate insult that it’s just business, it’s politics, it’s the way of the world, it’s a tough life, and that it’s nothing personal.

In my opinion one of the great joys of this show is that it gets us complicit in the brutality and bloody-mindedness of the ruling elite that we should be despising, so that we even feel horror and indifference when they do. Sure, you burnt a few farmboys but I’m much more well-disposed towards you now I know they weren’t important; and sure, you raped and murdered a girl but rich boys will be boys, eh?

Which brings us to the obverse of this, which is the shock that many people on the ASOIAF reddit are apparently feeling that the show would lead Stannis to this bitter and barren path. I can’t read the reddit, because it contains spoilers (I tried and I think I just found out Jon Snow’s fate which is really annoying) but the word on the Guardian blog (and expressed by a few people directly there too) is that the reddit is up in arms about how the show “broke” Stannis’s character and goes against his character in the books. The latter argument is easily dismissed since apparently the show’s makers have revealed they got this little bbq party straight from George RR Martin; but the former is interesting. There are actually people out there who believe that it’s out of character for this murderous, devious, sinful man to kill his own daughter if it suits him – and worse still they don’t like him anymore. They’ve been led so deep into the psychology of the books that, I guess, they actually think his previous horror shows – the mass burnings, the satanic rituals, the fratricide, the prisoner-killing and the ruthlessness of his war tactics – are all signs of a good man. Presumably if he had just ordered all the guards on the picket tortured and hanged (which he did) and then held off burning his daughter everything would be a-okay … The truth, of course, is that there is nothing about Stannis’s conduct that is morally acceptable, and he is a deeply evil man. His daughter even said this, that picking sides was the reason for all the trouble in the first place and if everyone just stayed home none of this shit would hit the fan in the first place. I guess we’ll never find out where this logic would take her, since her dad decided to burn her alive in order to ensure the side he picked won.

It’s interesting that the readers of these books seem to be prone to picking up the psychology of the psychopathic ruling class to the extent that they can accept Stannis despite his many evil deeds; but they haven’t picked up the cosmology of the show that they can accept that the sacrifice of Shireen is obviously essential to the success of his mission (because of magic reasons). Because once you accept his religious fanaticism and the undoubted efficacy of his red witch’s powers, it’s obvious that when you’re in a bind you should burn whoever proves handy to her. It’s only morally beyond the pale for a man of Stannis’s sterling qualities if it’s useless, and it’s clearly not useless. But many people on the Guardian blog were protesting that it was senseless savagery, and many on the ASOIAF reddit appear to have the same view, and they can get behind a man who commits deeds too foul for words if they’re useful but they can’t accept a man who murders his own daughter because they think it’s useless. Is this ability to engage readers in the psychology of the books, but fail to bring them into the cosmology, a failure of George RR Martin’s? Or is it a failure of his readers’? Having not read the book I don’t know but I’m inclined to the latter because the people protesting this “senseless” savagery on the Guardian blog hadn’t all read the books, and so presumably had also managed to accommodate the ruthless logic of the TV show but not its magical cosmology. Is it a problem of the low-fantasy genre that we don’t believe the power of magic? Or is it just a problem when lots of people not steeped in the fantasy genre watch a fantasy show?

I think it takes special skill to get people to accept a deeply flawed and immoral world view so completely that it takes the burning alive of a schoolgirl to get us to snap back to our normal frame of reference. This is great work by the TV show’s creators, and really shows how far they’ve sucked their viewers into the horrible world they’ve created. Let’s hope next week they reward us for our complicity with a river of noble blood.

I’ll finish by quoting someone from the Guardian blog:

Guess i’m rooting for the Night’s King now then….

I have never been able to argue with authorial authority

I have never been able to argue with authorial authority

In a recent discussion with my regular role-playing group one player was complaining about the plethora of super-hero movies being released recently, and her increasing exhaustion with this genre. Another defended it partially on the basis that he has always really enjoyed superhero comics so seeing good movies of them is fun, but yeah maybe there are a few too many. I chimed in to this essential conversation to observe that I’ve never been able to get into super hero comics by Marvel and DC (and I guess Vertigo too) because I find the text so incredibly frustrating to read. The way they put bold/italic emphasis on almost random words in the text – in almost every piece of text – really distracts me from what I’m actually reading and drives me crazy. The original complainer agreed that she, too has always found this off-putting.

As an example, consider this blog post at Lawyers, Guns and Money about what a superb comic artist some guy is. It gives a long, detailed dissertation about how the action within the frame is juxtaposed with the flow of the panels to inculcate in the reader the same sense of discomfort and challenge experienced by the character the panels are about. This seems like a fairly plausible interpretation of the effect of this particular set of panels but I just can’t care about how great this makes the artist because the entire scene is so devastatingly annoying. What is with all that emphasis in all the text? Why emphasize the word “lightning bolt” and the names? It’s distracting and annoying.

I’ve felt this way for years of course but never really investigated, so I tried a bit of googling to see if I could find anything on the topic, and a brief search revealed nothing – possibly because including the words “Marvel”, “DC” or anything similar in a search term drowns out the rest, but possibly also because no one writes about this stuff. So what is going on? Why do they have to put emphasis in comic book text at all, let alone randomly throughout every second speech bubble? Is it something about the reading age of the audience? Is it meant to add dramatic tension? Is there no one in either of these quite large companies who reads this stuff, finds it annoying, and occasionally considers maybe not doing it? Are there two types of people in the world? As far as I know the method isn’t used in manga, at least not in Japanese and I don’t remember it in English either. Why do these comics do it? And is there a legion of haters of this stuff out there? If you do hate it, is it possible to enjoy the comics at all or are is it always overwhelming?

Inquiring MINDS want to KNOW.

Those bastards!!

Those bastards!!

I ran into more problems trying to run OpenBUGS on a Bayesian spatial regression model today. The problems are laid out pretty simply in the picture above: I ran into an illegal memory write. I know this is not the fault of my model, as it runs smoothly for 50, 500 or 1000 iterations. This illegal memory write happens somewhere between 6000 and 6100 iterations.

This model is a simple version of a larger model I’m building. It has data on about 1800 small areas collected over four time points, with age and sex covariates, with a Poisson distribution for the outcome and an adjacency matrix for the 1800 areas. The data are laid out with the time points and age- and sex-values as separate records, so for one municipality I have 4*6*2=24 observations. I can’t use other packages for this because they assume one observation per municipality (i.e a very simple relationship between data structure and adjacency matrix). So I’m using OpenBUGS or WinBUGS. The ultimate goal is to extend to 30 time points and 18 age categories, with a more complex time and age structure, but I want to get this simple model running first because I’m running into major computational issues.

Today I identified that these computational issues can’t be solved. The reason for the illegal memory write is that OpenBUGS has a 1.6Gb RAM limit. People say this but it’s hard to confirm; however, in digging through critiques of BUGS I discovered it is written in Component Pascal and compiled in BlackBox, and a bit more digging reveals BlackBox has a 1.6Gb RAM limit.

This is frankly ridiculous. It’s understandable that there would be a RAM limit in a 32-bit system, but OpenBUGS has been around for about 9 years now and no one has upgraded it to handle either multi-core computers or 64 bit architecture. Given that OpenBUGS is designed to handle complex, processor-demanding simulation-heavy Bayesian models, the decision to write it in such a restrictive framework is ridiculous. I’m a strong critic of open source systems but if it had been written for R it would at least be able to use the 64-bit architecture, even though R has been late to the multi-core party. I bought a PC with 128 Gb of RAM specifically for this big project, and I might as well have bought a laptop with the minimum RAM. For the model I ultimately aim to build I expect I will need about 100,000 iterations to get stability, which means that OpenBUGS will never get there. The only way to run this model without a workaround is to either 1) write the full adjacency matrix by hand and implement it directly [something I am considering] or 2) recompile the source code (which I think might not be available) in a different Pascal compiler. I have no idea how to even start with that.

I have considered two workarounds, however, though I don’t know whether either of them might work.

  1. Save and rerun: the reason that OpenBUGS hits its RAM limit is that it saves all iterations in RAM, but I think this is possibly bad design. So one option could be to run the model to 5000 iterations, then save the results, shut down OpenBUGS, reopen OpenBUGS, load the model file, and then use the update functions to run another 5000 iterations on what has already been run. I think this can be done (running additional updates on a past model) but I’m not sure. If this works I just need to run one set of runs a night for about 3 weeks, and I’ll get my model.
  2. Rerun with sequential initial values: If method 1 doesn’t work, another option that I am very sure will work is to run the model for 5000 iterations, extract all estimated values from the model, then start a new model of 5000 runs with the past estimated values as the initial values for the next model. I’m pretty sure it will start off where it left off, assuming I correctly specify them all, although there might be small jumps in the trace, but ultimately it’ll get where it needs to go. But restarting the model is going to take a lot of time unless I can find a way to loop through and extract values automatically (I think I can’t). So probably a month to run the model.

Ridiculous! And even if I had a supercomputer I couldn’t speed it up …

Today Stata 14 was released, and it finally has built in functionality for a wide range of Bayesian statistical tasks. I’m hoping that they’ll introduce conditional autoregression and the BYM model in version 15. Really, if you have a grant that can afford a single Stata license, it’s really worth getting. You just can’t rely on open source statistical packages. Only use them when you must!

Another perfect moment in British colonial development

Another perfect moment in British colonial development

I am in London for a week doing some research with small area analysis, and on the weekend had a brief opportunity to actually see the city. As is traditional by now on my annual trips to London, I visited the World Wildlife Photography Exhibition (which was a bit weak this year, I thought), and having a bit of time to kill wandered up the road to the Science Museum. Here I stumbled on a small and interesting exhibition entitled Churchill’s Scientists, about the people that worked with Winston Churchill before, during and after the war on various projects, and Churchill’s powerful influence on British science.

This year will see the 70th anniversary of the end of the war, and you would think by now that popular culture of the victorious countries would finally have got to the point where it is able to handle a more nuanced analysis of the politics of that time than mere hagiography. It’s clear that the allied powers were uncomfortable about some of their actions during the war: the careful elision of Arthur “Bomber” Harris and his fliers from peacetime awards is an example of British squeamishness about the morality of the bomber war, but this squeamishness doesn’t seem to have manifested itself in any kind of clear critical reevaluation of the behavior of the allies at war, at least in popular culture. This silence is starting to be broken by, for example, Antony Beevor’s uncomfortable discussion of rape in Berlin, or his discussion of the treatment of collaborator women in Normandy; but it is generally absent from public discussion. Churchill’s Scientists is, sadly, another example of this careful and deliberate overlooking of the flaws of wartime leaders and their politics when presented in popular culture.

The exhibition itself is small and interesting, walking us through various aspects of the scientific endeavours of the pre-war and post-war eras. It describes the scientists who worked with Churchill, their relationship with him and the public service, and how science was conducted during the war. Churchill was very close friends with a statistician who advised him on all aspects of war endeavours, and also was very supportive of operational research, which was basically an attempt to revise wartime strategy on the basis of evidence. The achievements of these scientists given their technological limitations are quite amazing: drawing graphs by hand on graph paper to attempt to explain every aspect of the statistics and epidemiology of rationing, conducting experiments on themselves to understand the effects of low-calorie diets, and feverishly working to improve tactics and technologies that were valuable to the war. The post-war efforts were also very interesting: there is a life-size installation showing the original model of myoglobin, which was studied using x-ray crystallography and then built by hand using cane rods and beads to create the three-dimensional structure. There is a telling quote about how scientists became used to asking not “how much will it cost” but “how quickly can we get it done and what do we need?” There are also some interesting examples of how the wartime expectations of scientists translated into peacetime success: they had contacts in the ministries from their wartime work, they were used to having funds and knew how to raise money, and they had access to hugely increased resources as the ministries dumped wartime surplus in universities and research institutes. In the 1950s this translated into rapid advances in medicine, genetics, nuclear power and astronomy, all of which are documented in the exhibition.

There are, however, some political aspects that are overlooked. Currently in the UK there is an ongoing debate about whether to stop conducting the Census because it costs too much, and it is clear that since the war there has been a shift in funding priorities and a move away from the idea that science should be funded at any cost. I would have been interested to find out how this happened: did Churchill change his attitude towards funding for science or was this a post-Churchill trend? Was Churchill the last of the Great Investors? What did subsequent conservative party leaders make of his legacy and how do they talk about it? Why is it that the country that invented radar, that perfected antibiotic production, and that contributed more than any other to modern geographical statistics and demography, can no longer “afford” the census? Was the war a high point and an aberration in the history of British science funding? Did its successes distort the post-war scientific landscape and expectations? None of this is really described in the exhibition, which limits itself to Churchill’s positive legacy, and doesn’t seem to want to explore how it was undone. There is also a bit of attention paid to female scientists in Churchill’s war efforts, including women who developed X-ray crystallography and did important nutritional epidemiology research. But we know that much of the computational work done in the war and immediately after was also done by women, but they were slowly squeezed out of the industry after the war. I would have been interested in some description of what happened to all those female scientists and ancillary staff after the war – were they forced out of science the way women were forced out of factory work, or did Churchill’s support for women in science during the war permanently change the landscape for women in science? It seems clear that Watson and Crick’s work – initially sparked by x-ray images of the DNA that are shown in this exhibition – must have been built on the work of crystallography’s pioneers, who were women. But where did those women end up when the war effort wound down?

The other aspect of this exhibition that is sadly missing is a discussion of Churchill and his scientists’ darker sides. We are introduced to the exhibition through Churchill’s love of flying; the website for the exhibition quotes him talking about new technologies in aerial bombing; and the exhibition itself talks about his support for a British nuclear weapon. But nowhere in the exhibition is his enthusiasm for terror bombing discussed, nor the unsavoury way in which he developed this enthusiasm, running terror bombing campaigns against Iraqi tribespeople in the 1920s. Arthur Harris is only presented once in the exhibition, dismissing a biologist who proposed a campaign of tactical bombing of railway junctions (he “wasted his time studying the sexual proclivities of apes,” was the dismissal); but nowhere is the corollary of this position – Harris’s lust for destroying cities – mentioned, or the extensive scientific work that went into developing the best techniques for burning civilians alive. In the year that western governments will demand Japan apologize for its wartime atrocities (again!), one would think they could at least mention in an exhibition on wartime science the extensive research that went into perfecting the practice of burning Japanese civilians alive.

In case one thinks this might have been just an oversight on the part of the curators, later we see a more direct example of this careful elision, when the exhibit focuses on Britain’s post-war nuclear weapons program. Again, we have been presented with Churchill’s direct interest in blowing stuff up; here we are shown video of a nuclear test, and discussion of the research that scientists were able to do on the environmental and physical effects of the bombs. The exhibition doesn’t mention that many of these tests, conducted in Maralinga in Australia, were conducted on land that Aborigines had been expelled from and were unable to return to. It also doesn’t mention the contamination of Aboriginal customary lands, any possible harmful health effects for Aborigines living in the area, and the controversies of the Maralinga inquiries and subsequent compensation for soldiers and workers. Not even a one sentence reference.

Given that we know Churchill was a deeply racist man who supported colonialism and had no interest in the rights of non-white British, it seems hardly surprising that he might have had a slightly cavalier attitude towards ethics in research and military tactics where it was directed against Iraqi tribesmen or Australian Aborigines. It seems like 70 years after the end of the war it might be possible to start talking about this stuff honestly outside of academia, and to publicly reevaluate the legacy of men like Churchill, and many of his senior scientists, in the light of everything we know now, rather than simply portraying all their efforts through only the lens of wartime heroism. Churchill was undoubtedly a great man and a powerful leader, and the world owes him a debt of gratitude. He was also a racist and a colonialist, and some of the decisions he made before, during and after the war may not have been either right or the best decisions for the time. It also appears that despite his greatness, the legacy of his interest in science and education was soon undone, and the reasons for this are important for us to consider now. What does it say about Britain that 70 years after the end of the war it is still not possible to honestly assess Churchill’s wartime efforts but only to extol his great contribution to science; yet 70 years later his contributions to science have been so far wound back that the government is considering abolishing the Census? Does such hagiography benefit Britain, or British science? I would suggest not.

This year is the 70th anniversary of the end of the war, and we are going to see a lot more public discussion of the actions and contributions of the great people of that time. I fear that this discussion is going to be very shallow, and sadly empty of any attempt to critically reassess the contributions of the people involved, and how they shaped our post-war culture. This exhibition is a good example of how the war will be presented this year: stripped of moral context, all uncomfortable truths banished from discussion, and all long-term ramifications for post-war politics and culture carefully sanitized to ensure that no difficult questions are asked, or answered. Perhaps we aren’t doomed to repeat history, but I think this year at the very least we are going to be bored stiff by it.

Only what you see man, only what you see

Only what you see man, only what you see

Today a friend took me, without explanation, to see Sophie Calle’s The Unsold (売り残し) at Koyanagi Gallery in Ginza. I don’t often attend art shows – let alone modern art installations – and I almost never visit Ginza, so this was a real novelty for me, but despite my initial misgivings it was definitely worth it. Here is my review.

When I entered the gallery my first glance revealed an installation of everyday objects, including two dresses, that to my jaundiced and cynical eye immediately resembled Tracey Emin’s execrable bed-type stuff, and I was immediately disappointed. However, right at the door there is an introductory explanation (in Japanese and English) of the premise of the work, which changed my mind. Basically, three artists set up a flea market in the grounds of Yasukuni Jinja. They laid out their wares on three squares of cloth, as shown in the picture. One (I don’t recall which) sold worthless every day items, to each of which was attached a story that actually happened (i.e. a real story) with some relationship to the item but in which the item itself was not directly involved (so e.g. the typewriter on sale is not necessarily the typewriter from the story). Another sold a mixture of semi-antiques (cutely mis-spelled as “semi-antics” in this exhibition) and ordinary items, to which were attached completely fake stories with apparent emotional content[1]. The third sold actual antiques, and one of his original photos. For example one person was selling a completely normal bra for about 25,000 yen, and another person was selling a picture of a psycho-analyst (freud?) for 38,000 yen. One of the antiques was an ancient ceramic hot water bottle, and the picture was a pretty cool sea/sky thing. Each artist catalogued what they sold and the amount of money they sold it for – which was surprisingly large. Apparently an American tour guide passed by as this sale was going on and told his charges “there is nothing here, ignore it.” (Cute). The explanation finishes with the simple, curt phrase “These are the unsold.” So the exhibition consists of the material that was not sold.

This exhibition consists of three pieces of cloth on which the remaining items are laid out, attached to each of which is a tag with the price and the story. Behind each installation, on the wall, is a photo of the original setup, so you can see what was sold. On the opposite wall are the tags for the sold items, with their corresponding story. These tags have no information about the item to which they correspond, so you have to wander across to the original picture and guess. The stories are really interesting and believable, though whether they are actually true or not I have no clue. Investigating on wikipedia I discovered that the Eiffel tower story is true, and just as unbelievable as it sounds – Sophie Calle certainly knows how to do crazy things (I can’t remember if the item attached to this story was sold or not).

I’m an uncultured barbarian, so I have no idea what this installation was trying to tell me about whatever, but I thought it was really cool. Trying to understand why people bought these ludicrously overpriced objects because of their vague stories, or didn’t buy some object even though its story was cool, was an exercise in intruding into someone else’s private life. The stories themselves were fascinating, disconnected monologues, none of which I believed (but some of which I have subsequently learnt are real!) I can’t speak for the Japanese but the English used in the broader narrative descriptions – what the exhibition is about, how the artists met – is clear, sparse and strong. The structure of the main introductory sign and its finishing statement, “These are the Unsold” is particularly powerful, and suits the style of the exhibition. It’s a simple idea done well, and it holds your attention. Why did the passersby leave the charred bedspring and buy the useless typewriter? This, I cannot fathom. I wouldn’t buy the red bucket some guy pissed in, but why would someone else buy the bottle. Also the story of the horn is acutely sad and the horn is quite cheap, but apparently un-sellable. What does that mean?

I didn’t know anything about Sophie Calle before this exhibition, but reading her Wikipedia page I get the impression that she is a powerful, prodigious and generally unethical talent. My friend has also seen the exhibit Take Care of Yourself, which as the quoted reviewer says seems to be both shallow and deeply engaging. Her attempt to get blind people to define beauty sounds like it has the potential to be very powerful (I don’t draw any conclusions!) and the work where she gets a guy to shadow her and then presents pictures of herself sounds really interesting. Invading others’ privacy, not so much. How come medical researchers have to get ethics approval, but French artistes can pursue some guy across the world, or hijack a stolen diary for money?

Don’t answer that.

Anyway, I’d never heard of Sophie Calle before today and I think her work is a genuinely interesting and challenging example of modern art at its finest. I don’t know what she’s trying to say with this exhibition and I can’t really say what I think of it, but it’s really cool. It would be better if she followed it up with some kind of article in a peer-reviewed journal giving her conclusion about what the purchases and non-purchases mean, instead of leaving it to an ignorant rube like me to try and understand, and if she had found a way to summarize what was bought and wasn’t (e.g. rankings with stories, or a website where you can see all the objects with what was bought and what wasn’t, and its story) then the exhibition would have been even cooler. But despite these missed opportunities this exhibition is very cool, and in general I have to say Sophie Calle’s work seems pretty interesting. I hope more of her stuff comes to Japan, and I recommend visiting it if you are in Japan, or keeping an eye out for her work if you are not.

 

 

 

fn1: I may be mis-remembering the exact nature of what these items were, but I hope you get the general gist.

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