The hardback edition of The Substance of Style costs $15.72 and takes a long time to ship (currently listed as "ships within 1 to 2 months"). The paperback edition costs $10.46 and ships in 24 hours. (The paperback also includes some additional material, though you can't tell that from the Amazon page.) Yet the hardback is consistently ranked much lower on Amazon than the paperback, though they generally move up and down together. Why? The best I can guess is that you can go to the bookstore and buy the paperback, while the hardback is harder to find.
Posted by Virginia Postrel on January 10, 2005 • Comments
It never rains in Southern California. It pours. Slide show of scary photos here.
Posted by Virginia Postrel on January 10, 2005 • Comments
For as long as I can remember, Tom McClintock has been the one true budget hawk in California state government. He's a politico, but he's first and foremost a policy wonk, which means that implementing policy is more important than personally holding office. The SacBee's Dan Weintraub says Governator's State of the State speech is channeling McClintock, Arnold's erstwhile (rather friendly) opponent:
For the next year, McClintock watched from the Senate as Schwarzenegger learned the ropes in the Capitol, compromised with Democrats, avoided confrontation and, in the end, made little progress on the fundamental problems that bedeviled the state. The senator offered muted criticism when appropriate, support where he could.
Then, Wednesday night, suddenly everything changed. It was if the flashy governor were channeling his straight-laced colleague. Schwarzenegger's speech sounded almost as if McClintock had written it.
"Maybe I should have copyrighted some of my ideas," McClintock said with a laugh when I asked him later about the resemblance.
McClintock, some might remember, was one of only a handful of lawmakers to vote against a pension bill in 1999 that boosted state retirement benefits and paved the way for a wave of local pension increases that have threatened the financial solvency of some cities and counties. Three years later, McClintock was the only legislator to vote against a lavish new contract for the state's correctional officers, or prison guards. And all along he warned that the state's spending growth could not be sustained.
Now Schwarzenegger was saying that pension bloat, the guards union and other ills McClintock has spotlighted over the years were the heart of the state's problems. And with no apparent bitterness, McClintock endorsed the Schwarzenegger agenda.
Read the whole column here. The Weintraub column archive is here.
Posted by Virginia Postrel on January 10, 2005 • Comments
Grant McCracken posts some thoughts.
Posted by Virginia Postrel on January 10, 2005 • Comments
The porn industry, long a high-tech pioneer, may decide which of two competing DVD technologies becomes the standard. The article linked above prompted a long, intermittently amusing Slashdot threat.
Posted by Virginia Postrel on January 10, 2005 • Comments
USA Today notes a trend toward more family time and less work among Gens X and Y, terming them the "family first generation." As with all things familial, the trend is attributed to a morally positive change in attitude. (Work=bad, Family=good.)
The article isn't about waitress moms, of course. It focuses on what we used to call yuppies, before they moved to the suburbs. Among the professionals profiled, I suspect that economics, not some sort of moral conversion, explains most of the trend. If you're a highly skilled, highly educated professional, you can make quite a good living these days without working terribly long hours or putting your work first. (You can, of course, make more if you work obsessively. But even the most rationalistic economist believes people maximize utility, not income.) And, contrary to widespread belief in places like LA, Washington, and New York, in most of the United States, a family can live a comfortable middle-class life on middle-class pay, in many cases on a single salary. You won't have every luxury, but you'll have more than your parents.
Back in the pre-Slate days, Mickey Kaus took another angle on the same general trend--baby boomers who don't really have to work that hard to live.
Posted by Virginia Postrel on January 05, 2005 • Comments
After reading all the reports, Andrew Sullivan addresses the torture issue with bracing specificity.. I fear, however, that it's too kind to condemn Bush as merely "indifferent" to torture. Alas, I suspect he supports it. Torture in a righteous cause is the slipperiest of slippery slopes--all the more reason to make a categorical rule.
Remember, torture (notably but not exclusively rape) goes on every day in our domestic civilian prisons, with far less justification than interrogation, and we make jokes about it on TV shows. That most of this abuse is by prisoners of prisoners doesn't excuse the justice system, which is not merely indifferent but complicit, using the threat of prison abuse to coerce pleas.
Posted by Virginia Postrel on January 05, 2005 • Comments
For those who can't get enough of the Gawande debate, biologist Jim Hu has several interesting blog posts. (Jim's lab also has a blog that illustrates how you can use blogging for organizational coordination.) And Oren Grad, with whom I've corresponded about medical outcomes research for years, writes:
Thanks for posting the link to Atul Gawande's interesting article in the New Yorker. I do think Gawande, who in general is quite good at writing about medical topics for general audiences, went astray this time in hanging the article on the implications of the bell curve.
Another way of looking at the objective of Berwick and his followers is to think of it as pushing the entire performance curve up and reducing its spread so that even performers who are, in a mathematical sense, below average nonetheless deliver a level of quality that is entirely satisfactory in a substantive sense. If they succeed, then why should anybody care who is below average?
Of course, there will be some lumps and bumps along the way from here to there, as low performers have their consciousness raised by being publicly "named and shamed". But the response Gawande describes in Cincinnati is consistent with much else in the literature in supporting an optimistic view of the impact on patients' attitides of the candor and good faith effort that Berwick preaches.
There may be a very few domains of medical practice, perhaps especially in certain areas of high-risk surgery that require truly virtuosic manual dexterity, where there just can't be enough high-quality practice to go around. But it's not obvious that this is true, or if it is that it can't be solved in time with computer-guided mechanical assistance - and it's anyway doubtful that this is the rule more broadly. In the meantime, there's so much low-hanging fruit still to be picked in health care quality improvement that it doesn't make sense to waste too much of one's energy worrying about theoretical extreme cases.
The really hard, really interesting issues, and many, many fascinating stories, lie elsewhere. How do we know what constitutes best practice, anyway? Berwick drew his own inspiration from the pioneering quality improvement work of Deming and his colleagues. But the application of these methods to health care is not without controversy. There's a very nice point-counterpoint on this in JAMA in 2002 (full references below, in case you're interested). The competing position in the JAMA debate, the reigning dogma that true knowledge is derived from controlled clinical studies, also has its problems when you dig deeply enough into its conceptual foundations.
Despite the vogue for "report cards" and the genuine benefits that can be achieved through their careful use, assessment of health care outcomes, or more particularly reliable attribution of cause and effect, remains a huge problem. Our ability to adjust outcome measures for pre-existing risk, and thus draw attributions from purely observational data, is still fairly primitive on the whole. This is something that Gawande does acknowledge in a nice passage, but dismisses a little too easily in his rush to lay on the psychological dilemmas of being graded on a curve.
How physicians manage to grope their way forward through this epistemological fog and make real, tangible improvements in health outcomes, and how to arrange things so that they can see more clearly and make more rapid progress against the inertia of existing institutions and practices and vested interests, is one of the great, ongoing stories of our time, for much more interesting reasons than this article allows.
We can certainly use more writers who can figure out how to explain this stuff with sufficient clarity to the general public so that they understand what the issues really are, and how to demand better in an intelligent way. In fairness, Gawande's writings as a whole are a valuable contribution to public understanding - it's just a pity he stumbled a bit this time.
Sources:
"What Practices Will Most Improve Safety? Evidence-Based Medicine Meets Patient Safety, Leape LL, Berwick DM, Bates DW, JAMA 2002 July 24;288:501-7
"Safe But Sound: Patient Safety Meets Evidence-Based Medicine," Shojania KG, Duncan BW, McDonald KM, Wachter RM, JAMA 2002 July 24;288:508-13
On Oren's point, one of the reasons CF is a good candidate for spreading best practices is that there are established, measurable indicators, such as lung-function, that can be tracked.
Posted by Virginia Postrel on January 05, 2005 • Comments
For his year-end wrapup, Steve Portigal (a smart consumer-behavior consultant whose name will be familiar to readers of the comments on Grant McCracken's blog) "went to several online sources - BoingBoing, MetaFilter and Core77 - and skimmed their archives of two random 2004 months, February and April. I used these sites as triggers for stories that seemed cool when they broke but eluded my memory by the time December rolled around." The results are interesting, as are Steve's thoughts on why cultural stories don't stick in our memories for long. And what did he remember? "My own design-y experiences from this past year - experiences that affected me emotionally and intellectually (either positively or negatively."
And for crosscultural fun, check out his Museum of Foreign Groceries.
Posted by Virginia Postrel on January 05, 2005 • Comments
I'm ambivalent about the move to turn Alberto Gonzales's confirmation hearings into an inquiry into the Bush administration's sanctioning of torture. On the one hand, the administration has far too easily dodged the issue, and the public has been too ready to pretend that serious human rights violations aren't taking place. On the other, I fear that partisan confirmation hearings are the worst possible forum. By turning torture into just another partisan weapon, the Democrats will almost certainly demean what should be a grave inquiry.
One hopeful sign: This column by the WaPost's Anne Applebaum, who's the furthest thing from a partisan hack--an intellectual with real ethos on human rights. Maybe, just maybe, we'll get a serious discussion, at least outside the halls of Congress.
Posted by Virginia Postrel on January 05, 2005 • Comments