CBD Maybe not a Miracle Cure for Childhood Seizure Disorders

One of the stories that got a lot of media time during the fight to make recreational marijuana a legal reality was the one of Haleigh–a young girl who, prior to adopting a CBD regimen to treat her seizures, was having 200 episodes a day and now is closer to 10. That is a huge success. We read a lot out here about all the families that are moving to Colorado to obtain marijuana for their children’s seizure treatment. I would say that, aside from treating chronic pain…especially chronic pain in association with chemotherapy…marijuana’s miraculous power in treating seizures in children is the driving narrative of why marijuana should be reschedule, why every state without a medical marijuana law should get one, and why recreational marijuana should be far more widespread.

I have no doubts that Haleigh’s story is a true. In fact, a recent study (abstract here) found that 33% parents of children taking CBD reported their  children’s seizures drop by half. That’s huge.

However, that same study found that 44% of children taking CBD were suffering negative health outcomes from the treatment including (and this is important) increased seizures.

In a more objective measure of seizure-related brain health, only 3 of the children in the study showed any actual improvement (which indicates that some portion of those 33% of children who saw their seizure decrease by half, may have have been over-reporting the benefit, or may be operating under some placebo effect).

In any case, those last two points are crucial and they will no doubt be completely, and tragically, overlooked.

Medicine is weird; it works for whom it works. The way we determine if a medicine works is to get two groups. Individuals are randomly selected into one of the two groups. One group receives the treatment, the other receives a placebo. If possible, even the administrators don’t know which individuals are receiving which medication and which the placebo. Then we look for improvements in both groups. For various reasons, some people in both groups will get worse and some people will get better and some people may see no change in their condition at all. Ideally we will see more people get better in the medication group and less people getting worse. In either case, the differences observed within each group will be compared to the differences observed in the other group to determine if those change are “statistically significant.” That’s a real rough description of the “double blind, randomized, placebo-controlled, trial.”  Basically if the improvements in the medication group are better than the natural improvements seen in the control group, researchers conclude that the medicine “worked.”

But something peculiar happened up there. Something that researchers know about but doesn’t always get translated out. The medicine didn’t seem to have any effect at all on some people. And worse, some got worse.

Some of those differences might be chalked up to an inability to precisely measure changes in the condition. We tend to think of illness as a thing you either have or you don’t, rather than thinking of it in terms of how much of it you have. So it might be that very minor improvements in condition were beneath a threshold where those improvements were observed and reported to researchers. It’s also possible that declining condition in the medicine group would have been more pronounced had the medicine not been present.

But it’s also entirely possible that the medicine helped some people in the medicine group and harmed other people in the medicine group. Humans are all different. Diseases manifest differently in different people, medicines react differently to different people. So when we claim that a medicine “worked” it’s not always entirely clear what is meant. So the medicine works for whom it works and not on anyone else. Ideally, we would give medicine that works only to people that it works on…and maybe even prescribe medicine that “doesn’t work” to the people it works on as well even if it doesn’t “work” any better than chance at the group level.

I’m not saying that the story linked here proves that marijuana is a crappy medicine for children with seizures. It’s entirely possible that marijuana is very good for some children, and maybe not quite as good and possibly harmful for others. The problem is that the rhetoric of these “miraculous” cures is problematic. Parents desperate to find any cure for their children may overlook problems with marijuana in their child, they may see signs of improvements that don’t exist. And worse, they may forego other, effective, treatments while hoping that the marijuana miracle works out.

I think this is an area where we definitely need more research. And marijuana is cheap and, compared to many traditional treatments, safe. So I’m glad that it’s available for parents to try. But I also wish that the conversation we were having didn’t involve the word “miracle” quite so often. And that the potential for no- or bad outcomes was more appreciated.

Where’s the Rest of The Rest of the Story?

Generally I am a fan of Dr. Siegel, but I do not always agree with him. Here is one example. I am not a fan of the kind of analysis offered in yesterday’s post.

Siegel has picked an enemy…The Campaign for Tobacco-Free Kids, and he grabs a hold of a recent press release of theirs where they are encouraging states to raise the minimum age to buy tobacco products to 21. The central component of his rant is that the Campaign supports this law even though it was the Campaign itself that helped prevent the FDA from gaining that power. He calls them disingenuous. That’s it. A charge of hypocrisy and nothing more substantive.

  1. There are two things to point out here:
    Either raising the minimum age to buy tobacco products is a good policy or a bad one. There are good arguments on both sides, but Siegel presents none of them. He seems to support it, so he should ally himself with organizations that also support it, regardless of how they felt about it last week, last year, or ten or twenty years ago. When organizations or individuals come around to your way of thinking, that should be applauded, not used as another opportunity to vilify them. This raises the specter of ulterior motives on Siegel’s part, which makes his stance appear to be the disingenuous one. I’m not making any accusations here. I wouldn’t know what accusations to make. I normally consider Siegel an authentic and committed voice in tobacco control. This doesn’t feel like what’s happening here.
  2. If it is a good policy, that does not imply that it is equally good if implemented by either the states or the federal government. In a federalized system like the US has, one could easily advocate for all 50 states adopting a policy but combat the federal government adopting that same policy or overseeing its administration. There’s no hypocrisy there. I don’t know if the Campaign’s stance was that this would be better as a state decision or not–it doesn’t really make any sense in this particular instance to support state-level decision making over federal action–but it’s possible and without exploring that possibility, Siegel performs a disservice.

Siegel always calls the second half of his posts “The Rest of the Story,” but I think this is an instance where The Rest of the Story needs its own The Rest of the Story.

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Is Red Wine the Miracle Fat-Burning Miracle Cure You’ve Been Waiting For?

r0eThere is a debate among scientists, researchers, and journalists that goes something like this:

  • Scientific community: We need better science reporters.
  • Science journalists: Don’t blame us, science is pretty freaking tough and we rely on good press release writers to give us the skinny.

I think there’s some truth to both of these statements, but they are almost certainly incomplete. A recent flurry of new stories on the benefits of wine drinking is a good example of where it falls short.

In a recent press release from Oregon State University they claim: “The findings suggest that consuming dark-colored grapes, whether eating them or drinking juice or wine, might help people better manage obesity and related metabolic disorders such as fatty liver.” Which, of course, earned OSU and the scientists in question many accolades and clogged up my Twitter and Facebook feeds for days with people claiming they can finally start skipping the gym.

But is that what they said? While the headline writers seemed to concentrate on the “fat burning” sentence above, the reporters were pretty keen on adding this line from later in the press release. “‘These plant chemicals are not a weight-loss miracle,’ cautions [study team member Neil] Shay. ‘We didn’t find, and we didn’t expect to, that these compounds would improve body weight,’” he said.”

I have a tendency myself to take science reporters to task, but here’s a good example of science reporters more or less getting it right. Of course, if the story was truly understood from the get-go, it’s hard to see it getting much coverage. So it’s clear that something went wrong, but what? And what has been people’s takeaway? Most of my friends took to Facebook and Twitter in jest, but it was a jest that relied on a misunderstanding of the truth of that first sentence. Can we say that the reporter’s were “at fault” for this misunderstanding?

A part of me says, sure. If a failure to communicate is large and consistent, then it must be the communicator’s fault to some degree. On the other hand, the reporting seems accurate enough that the misreading seems willful, and no reporter should be held accountable for willful misreading.  And in this case, even the press release was not explicitly overblown. The bolded sentence above, the cautionary corrective to the italicized sentence above that, was drawn directly from the press release.

In this case, there was potentially an effort on the part of the press release writer to deliberately persuade reporters to lead with the “fat burning” bit–and to use that in the headlines as well. And this is what seems to have occurred, deliberate or not. (It was deliberate.) In this case then, maybe there’s some room for criticizing the reporters for falling prey to their incentive to make a splash with the headline–an incentive played to by the press release author.

To say “we need better science journalists” in an instance like this, is to say, “we need people who work for newspapers to not care about the incentives of the newspaper business.” It’s true, but it’s also extremely infantile a wish. Most of science isn’t truly headline worthy, in the sense that newspapers look for headlines. To cover science at all we must expect errors like this. It’s up to non-reporters to carry the weight of explaining what is going on and spread the word. Speaking of which…

Thomas Lumley’s post on Stats Chat can help shed some light on what was actually found in this study.

How Many is That? Pot Smokers in Colorado

These two sentences appear back to back in a WaPo article on a report on marijuana usage in Colorado. Both are inaccurate out of context.

Adult residents either smoke pot (relatively) few times a month or nearly every day—there are few in the middle.

More than half of all adult resident users consume the drug in some form fewer than six times a month.

The author, Niraj Chokshi, knows, but does not say in these sentences, that only 9% of Coloradans had used marijuana, in any form, 12 times in the last year. He cites this statistic in the paragraph just above the first sentence. But as sentences are supposed to capture a complete idea, leaving out the statistic that places the idea in context is almost certain to confuse some folks.

I don’t think Chokshi means to do this. But taken out of context these sentences imply:

  1. All adult residents consume the drug a little everyday at least.
  2. More than half of all adult residents consume marijuana fewer than 1-6 times a month, the rest use more often.

In reality the relevant universe here are the set of individuals who are

  1. adult
  2. residents of Colorado
  3. and who use marijuana at least 12 times per year

So not “more than half” of our more than 5 million residents, but “more than half” of 9% of that number. Using just Choksi’s out of context sentences you might think there are millions of pot smokers in Colorado. There are, in fact, (according to the cited report’s very good methodology, btw) just under 500,000 smokers. So, the “more than half” here is talking about a couple hundred thousand smokers. That’s not nothing, but it ain’t millions either.

It’s an unforced error and it makes this issue harder to understand given the limited amount of cognitive power people can be expected to expend on any one article.

The important part of this report, btw, is that few who use smoke everyday or most days (which includes nearly all of the *medical marijuana* folks) account for nearly 70% of all the pot consumed in Colorado. Choksi doesn’t miss this point, but he does bury it a little.

America’s Democracy: A Rant in Favor That this is a Thing (still)

Perhaps you’ve heard. America, it has been proven, is “no longer a democracy.” Or perhaps you heard that “it’s an oligarchy.”

No one agrees on what a democracy is, but Princeton has determined that America is definitely not that...at least according to the news reports. America has been demonstrably less of a democracy than it is today and yet, somehow, we are “no longer” one as “proven” by science. This is of course all poppycock. And if you let me explain, I will. First, go familiarize yourself with the news stories linked above…or better, go read the actual paper [PDF]. Then, let’s start with my libertarian friend.

I have a friend, let’s call him “Brian.” He’s more-or-less a libertarian and as such often find himself in agreement with the policy pronouncements of groups like the Cato Institute. The Cato Institute is financed and operated primarily by the now infamously rich Koch brothers—millionaires with a lot of political power. Now, I’m not saying that everything that is in the Koch brothers’ interests is also in the best interest of my friend Brian, but when they are, they are. And when they are not, they sometimes are. Let me explain.

Brian is a single voter in a country of millions of voters. He is also a busy person with a job and family. He isn’t interested in running for office and he does not have the time to campaign constantly for those things that are in his best interest. Nor does have the skills, necessarily, to lobby distant and hard-to-reach representatives in his state capitol or in DC. Moreover, he lacks access to those people. Sure, we could say that Brian’s lack of access is related to his limited wealth. But it’s just as accurate to say that Brian’s lack of access is related to his inability to try to gain access on a full-time basis. It is also related to the fact that Brian would only be speaking for himself (and perhaps accidentally for a few unknown others with whom Brian shares an ideology and perhaps a financial and geographic salience). So Brian relies on a groups like Cato to speak for him. So Brian needs groups like Cato to be around. And groups like Cato stay around when they are successful at what they do. So even when Cato is not representing Brian, Brian benefits from their victories, because those victories ensure that Cato remains profitable and relevant in a very competitive industry and they will be there to speak for him tomorrow. Provided that Cato is victorious more often in ways that benefit Brian than in neutral or disadvantageous ways, then Brian gains from having his views represented by this strategically-minded, successful organization run by two economically elite brothers.

My views are often fought for and represented by the Brookings Institution. More locally I find myself in agreement with the Colorado Trust and the Colorado Health Institute. Sometimes very wealthy professors at Harvard who happen to run organizations that I am a member of express my views. Sometimes my views are expressed by the millionaire functionaries at the top of certain for-profit engines, like Google. They do not do this for me or because of me. Many times they do this through their support of a political party that I ally myself with in the same manner that Brian allies himself with Cato. I am frequently at odds with both the policies and politics of my chosen political party. But overall they represent my views more often than the alternatives. It behooves me to vote for members of that party even when I know that individual has different values than I do, because on net, the party more often than not passes laws that I am more or less in agreement with. The party and our polity’s structure constrain the actions of individuals so much that one rarely votes for an individual. An individual in Washington has nearly as little say over what goes on as an individual outside it. [PDF]

My freedom to have my own views is unconstrained in this environment. My freedom to ally with this or the other side of any policy fight is unconstrained by law and, for the most part, by society (except in certain marginalized areas). My freedom to give my own money directly to politicians that support my views is virtually unconstrained. My ability to support millionaires by purchasing products their companies manufacture is limited only by my income and my willingness to do so. I am fully capable of extending my politics into my capitalist activities by boycotting stores I know support politicians I don’t, and I can even publicly rally my friends to do so as well without fear of imprisonment. My power to do this has grown exponentially over the past decade and a half. Through Facebook, Twitter, Yelp, and Amazon I am more capable than ever of communicating my ideas of how the world should run and advocate for the success of agents, both public and private, that agree with me. Pro-equal rights groups just caused the CEO of a major tech firm to willingly step down from his top post.

This relationship, the one I describe above, between different sects of voters and different sets of economic elites is not a new thing. It is the very thing—the thing at the heart of American democracy. I don’t want to get all wonky, but to paraphrase Louis CK, America has only been a democracy since the 1920s when women got the right to vote. Actually, I’ll expand that to the 1960s when certain laws, primarily but not exclusively in the American South, de facto prevented African-Americans from voting. Even today our franchise is arbitrarily limited—by law. Felons cannot vote and in many states ex-felons cannot vote. This is a tragedy, and it is deeply undemocratic. You can only vote once you’re 18 with no rhyme or reason. Most of the +18-year-olds I know (and practically all of the freshly 18-year-olds) lack the intelligence, the education, and the wisdom to vote with anything but their emotions. I also know (or knew) a not insignificant quantity of more than capable 14-, 15-, and 16-year-olds who would have made fantastic additions to our dwindling pool of participating voters. Some reasonable people advocate opening the franchise to any child with the interest in voting and the ability to push the buttons on their own. And why shouldn’t they? But that’s beside the point a little. My point is that, free, frequent, and fair elections open to the people (the “demos,” in Greek) is a fundamental attribute to “democracy.” At various stages our so-called “democracy” has fallen dramatically short of this of this very simple measure for most of its existence. Is “democracy” relative to a point in time? It might be. If there were a polity out there right now that denied women—half the population—the right to vote, it would scarcely be called “a democracy” by most today.

Certainly elections are not the beginning and end of what constitutes a democracy, but what other factors are important? A president is not required. Most of the world’s democracies lack this position and instead embed their executive functions inside the legislative branch—a far more “democratic” structure by any measure. But separate branches and a checking and balancing of powers seems to be important. But in what way is it important? Is it fundamentally necessary or is it contingent? There doesn’t seem to be anything inside the definition of “democracy” that requires competing branches of power. Rather, it’s something inside human nature, or something inherent in the nature of power itself that requires institutional constraints to prevent power from accumulating totally in one agency—or worse—one person. Our democracy, and I do qualify “democracy” with “our” because our type—however we decide to define it, is not the only type. That is, even without a specific definition we can see that any two places that most people would consider a democracy have differences between them. And we can say that some of these differences make those democracies more or less democratic to those other democratic nations to which we decide to compare them. But this is just to emphasize what we already knew—that “democracy” is not only dynamically altering its nature in one nation over time, but differs statically from one nation to the next.

“Democracy” is not like “this apple;” it cannot be held up to the light, or sliced and placed under a microscope. It’s existence and nature cannot be objectively verified by independent coders with 100% accuracy. This is true, of course, even of the classes of supposedly simple things, “apples,” for example. Some are green, some are yellow, some are red. Some have mushy meat, other crisp. Some are sweet, others tart, some sour. If apples can be this complex, would it even be possible for “democracy” to be less so, subject as it is to the competing demands of millions—billions—of people to shape its structures and edges on the one hand and to attempt to define it on the other? Of course not. What we do know is that there was never a doubt in the minds of the world’s elite observers that America in 1887 was a democracy, also in 1913 and in 1958—and this despite failing to have an open franchise—an absolutely crucial feature of a democracy.

And it is no less a democracy today.

It is certainly far from a perfect democracy—whatever that is, however we decide to define it. Democracies are not discovered, they are invented. We should have discussed that earlier. They are art, they are not the unalterable, provable law of the universe. They are subject to the fall and folly of human beings. We can’t even draw a perfect circle and I’m supposed to be shocked that two political scientists at elite universities have decided that the United States fails some basic test of their definition of “democracy” even as they admit that theirs is only one of several such definitions and is by no means agreed upon.

And I haven’t even started talking about their methodology.

And please bear in mind, I think this study is a good one. It seems to me the authors themselves showed all the requisite lack of certainty around their choice and definition of terms and showed appropriate doubt as to the reliability of their proxy measures. It is not them or their work that I find concerning here. It is the coverage their article is getting—and from where. It is primarily liberals, anti-capitalists, and conspiracy theorists that have glommed on to this study as final truth supporting their long-held belief that we are a capitalist oligarchy, that our system is entirely corrupted by cash and the wishes of the top 1%.

These beliefs, however, are deeply problematic to start with because they assume two untrue things—demonstrably untrue. They assume 0% social mobility. Social mobility in the US is small—and certainly smaller than the myth of the American Dream says, but it is not zero. And it assumes 100% homogeneity in the ideologies of the 1%. This is not true either. They fight each other over ideologies, over access to markets, over politics, and over personal matters. This is not how true, that is to say “ideal,” oligarchies are run. The constraints on power, the separation of power into distinct branches and into federalized levels, discourages the formation of elite cartels.

Again, it is not perfect.  Our laws are neither perfect nor perfectly enforced. Government transparency is certainly not 100% transparent. Our government spies on us and uses the language of jurisprudence to validate the inhumane slaughter of untried “terrorists” residing in other countries. This is undemocratic by any measure. Our laws do not substantively recreate the natural rights on which most of them are based, which allows our legal system to unfairly imprison free men and let guilty men walk. I would never want to be in a position to say that “America, in its current condition, is the best democracy the world has known and the best that it can know.” That is clearly wrong. It is just as wrong as saying it is not a democracy at all.

But let’s look at the study, briefly. The authors do not provide a review of the democracy literature. To do so at this point is difficult. They acknowledge that this literature is “rich and variegated” and then claim it can be “loosely be divided into four categories of theories” (3) This may or may not be true. It is a claim and not one that is particularly testable–and if nothing else, the authors do not provide us that ability, nor do they appeal to other scholars who have defended this four-class typology of theories (which are not, descriptions of democracies themselves). I’m not critiquing this move, mind you, but merely pointing out where in the world of theory we are. The authors have proposed a theoretical way of classifying theories of polities–not a way of classifying democracies. These classes of theories include: “majoritarian electoral democracy, economic elite domination and two types of interest group pluralism.”

What may not be immediately clear is if this typology is supposed to be exhaustive. Where are the totalitarian regimes: (monarchies, sultanships, dictatorships etc), where, other than in “economic elite domination” are the other types of group leadership (tribunals, councils, etc)? What seems to be happening here is a typology of Who can Influence Democratic Regimes. So this study cannot prove that the US is not a democracy, because it relies on an assumption that it is one. That is not to say that it attempts to and then fails. That is to say it is logically impossible for it to do so. In the authors own words:

Each of these perspectives makes different predictions about the independent influence upon U.S. policy making of four sets of actors: the Average Citizen or “median voter,” Economic Elites, and Mass-based or Business-oriented Interest Groups or industries.

The authors set up a situation where the only thing they can test is who influences US policy. There is an assumption here, based on a simplified version of the median voter theory, that the US policy should reflect the wishes of “the average voter.” So their test is this: look at what “the average voter” wishes would happen on a certain policy question and then look at what “economic elites” wanted to happen on the same question. When those two parties differed, who “won”? This test does present a certain kind of problem though: time. What if, as with S-CHIP, Bill Clinton (a Democrat) wants something passed and all the Republicans think it’s a horrible idea, BUT THEN George Bush gets in the White House and he wants it passed and then all the Republicans think it’s a grand idea but the Democrats (suddenly) think it stinks? (This all happened with NAFTA, but in reverse.) Well, the authors propose a window: What did “the People” think of the policy in Year 0? And what laws were passed within four years of the poll being conducted? Obviously the examples above would confound this particular test, but in most cases the test probably works to determine whether the voting preferences of the mythical “median voter” were thwarted or not.

It’s a pretty simple test really, but it is fraught with problems in addition to the one mentioned above. Not “problems” because the researchers are stupid, ignorant, or biased, but problems because social science is hard and studies like this, warts and all, are the best we can do (a lot of the time). In the authors’ own words, same page “Our measures are far from perfect.” So what are these imperfections?

Think about a policy…like Obamacare. Who “won” that fight? Obviously, if you read the newspapers it was the “liberals” or the “Democrats.” “Conservatives” and/or “Republicans” lost. But is that what really happened? Almost everyone understood that healthcare finance reform needed to happen. It’s been on every presidential agenda since Truman. Many of the reforms in Obamacare look similar to reforms initially submitted to the public from the extremely right-wing think tank, The Heritage Foundation. I’m not saying, as some have, that “Obamacare was a product of the Heritage Foundation.” I know better than that. But it is worth considering that this law was not a purely Democratic creation. The notion behind Obamacare was non-partisan. And the ultimate bill that passed was a watered down version of the bill that was proposed. It was a compromise between the two parties (even if the Republicans disowned it come time to vote). Most people did not like the bill by the time it came to vote. Many insurance companies aligned against it, but the AMA and some important insurance companies backed it. 

The authors describe their methodology beginning on page 10. The policies in question are 1,779 instances between 1981 and 2002 where a national poll was administered asking respondents a Yes/No choice on specific federal policy decisions and also provided some economic information about the respondents. Policy preferences were measured at the 50th income percentile (the median income response) and at the 90th percentile (representing the affluent response). The authors claim that the 50th percentile income response is identical or nearly so with the median voter preference. The authors also claim, but do not argue or prove, that the 90th percentile vote can be used as “proxies for the opinions of wealthy or very-high-income Americans” even though “people at the 90th income percentile are neither very rich nor very elite“! [Words theirs, emphasis mine.] I’m not sure how it is that non-rich, non-elite voters can be used to proxy the voting preference of rich, elite voters. The authors unfortunately leave that explanation up to my very limited imagination. They do show a correlation between the the top 2% and the top 10% income earners in a study of 13 policy preferences. It’s strong, but leaves me wondering why they didn’t just measure the top 2% of earners (the “truly wealthy”) instead of relying on a proxy of a proxy. To be sure, the top 10% of earners’ preferences are correlated with the top 2% r=.91, but they are also correlated with the 50th percentile r=.69. The difference is significant, but not absolute.

The authors argue that their use of a proxy will produce underestimates of the impact of economic elites but I think they are dead wrong. If both the 50th and 90th percentiles agree on an issue, (and they do about 35% of the time, statistically speaking) that isn’t diluting the differences, it’s masking them. We don’t know what’s under the mask. It could be the case that the 98th percentile are more often in agreement with the 50th than they are with the 90th. This is unlikely, but it is possible. We see exactly this sort of intra-strata economic competition at lower financial levels all the time (e.g., poor whites often vote with elite whites on issues related to race). With this particular test, the voting preferences of the truly elite is hidden. It may be diluted, it may not be. We simply don’t know.

To test the power of business/economic elites the authors rely of Forbes Power 25. This in turn is a proxy for a large dataset of business groups previously compiled by another researcher, which in turn is a proxy for “the opinions of the average rich person.”  By now I shouldn’t have to point out the problem here. Introducing a proxy measure produces a lot of uncertainty, introducing a proxy of a proxy introduces another layer of uncertainty. Uncertainty isn’t additive, it’s multiplicative. And now we’re using a proxy of a proxy to measure voter preference and we’re using a proxy of a proxy to measure business elite preference. And of course we’re also using polls (and self-reported income) to measure “voter preference.” Polls use a sample to predict the parameters of the population. In other words…a proxy there too…and one that relies on self-reports and all the problems that introduces.That is not to say that such proxies are not useful or accurate. It is to say that the amount of uncertainty in this study are substantial. To repeat the authors’ own caveat “Our measures are far from perfect.” The only thing that is certain in this study is “Bill X did or did not become a law within four years of conducting a poll asking people their preference for or against passage.” But, as I tried to make clear in my examples above, it is often unclear if voters really know their policy preferences. If they vote YES for a bill introduced by George Bush and NO for the same bill introduced by Bill Clinton how do we know what they want policy wise?

Similarly related to the above and points mentioned earlier, the authors offer this disclaimer:

Before we proceed further, it is important to note that even if one of our predictor variables is found (when controlling for the others) to have no independent impact on policy at all, it does not follow that the actors whose preferences are reflected by that variable – average citizens, economic elites, or organized interest groups of one sort or another – always “lose” in policy decisions. Policy making is not necessarily a zero-sum game among these actors. When one set of actors wins, others may win as well, if their preferences are positively correlated with each other.

Well then! With the full acknowledgment from the authors that a situation like Brian’s described at the beginning of this rant probably happens all the time, let’s proceed to our analysis! So what do the authors find?

It turns out, in fact, that the preferences of average citizens are positively and fairly highly correlated, across issues, with the preferences of economic elites (see Table 2.) Rather often, average citizens and affluent citizens (our proxy for economic elites) want the same things from government.

Um. So when economic elites win, the average citizen wins. There you have it folks. Your proof that our democracy is an entirely corrupt oligarchy dominated by the policy preferences of the average citizen..er….the 1%, or both, or something. Maybe. But certainly business-related interest groups take similar policy stances as the 1%…the 1% are all up in our business, LITERALLY!!!

Nor do we find an association between the preferences of economic elites and the alignments of either mass-based or business oriented groups. The latter finding, which surprised us, may reflect profit-making motives among businesses as contrasted with broader ideological views among elite individuals. For example, economic elites tend to prefer lower levels of government spending on practically everything, while business groups and specific industries frequently lobby for spending in areas from which they stand to gain.

Well, … shit.

Honestly, the authors are able to find a significant correlation for elite interests against so long as those interests are shared with business interests but not with the average citizen. In other words, when two of three measured groups align against the average Joe, Average Joe loses out. This is not nothing. Basically, they find that independent of their alignment with economic or business elites, the “average citizen” has no political power. But that’s nothing new. Madison wrote about this. The role of the citizen is to create just such groups and organize them to fight. The single citizen is powerless. That’s what we want. We want the individual to be representative of a class. We don’t pass laws that support ONE PERSON. That would be weird. Here are some more caveats from the authors about their findings:

This does not mean that theories of Economic Elite Domination are wholly upheld, since our results indicate that individual elites must share their policy influence with organized interest groups.


Again, the predictions of pure theories of interest group pluralism are not wholly upheld, since organized interest groups must share influence with economically elite individuals.


These results suggest that reality is best captured by mixed theories in which both individual economic elites and organized interest groups (including corporations, largely owned and controlled by wealthy elites) play a substantial part in affecting public policy, but the general public has little or no independent influence.

Well, you know, except that part where the average citizen is mostly in support with elite opinions. But whatevs.


The rather low explanatory power of all three independent variables taken together (with an R-squared of just .074 in Model 4) may partly result from the limitations of our proxy measures, particularly with respect to economic elites (since our “affluent” proxy is admittedly imperfect) and perhaps with respect to interest groups (since only a small fraction of politically active groups are included in our measure).


Policies with strong support (as defined above) among both groups are only adopted about 56 percent of the time. (17)

That last point is worth noting. They note a “a strong status quo bias.” Indeed, this is a feature, not a bug, of our specific form of…wait for it…democracy!!!! Don’t believe me? Here’s the authors, emphasis added.

Because of the impediments to majority rule that were deliberately built into the U.S. political system – federalism, separation of powers, bicameralism – together with further impediments due to anti-majoritarian congressional rules and procedures, the system has a substantial status quo bias.(18)

From this statement alone you can still argue that our original “political system” was not democratic, but you certainly cannot claim “it is no longer” a democracy. Whatever it was, it still is. The little guy is protected from 44% of business and elite interests that run contrary to his own because of institutional constraints that make it hard for those groups to get their way all the time. And how often does the “average citizen” get what he wants? When he has an 80% majority preference, he gets his way about 43% of the time. About half. I’m not blind to the difference of 56% (plus a margin of error) and 43% plus a margin of error. Neither should you or anybody else be blind to their amazing proximity.

James Madison, tiny genius that he was, just clogged our legislative process full of veto points. It’s just full of them. That makes it very hard to get bills passed in our system. Seriously. Even though when business policy preferences combines with the power of America’s incredibly wealthy upper-upper crust, they get their bills passed just over half the time. Not much better than flipping a coin. What kind of “oligarchy” is that?

No kind. That’s what.

Has the Worldwide Trend toward Freedom/Democracy Slipped?

Dartthrowingchimp has built a simple but informative graphic charting the growth of civil and political rights over the past four decades as indexed and reported by the Freedom House index. You can click through to see it and read how it works; and if charting democracy around the globe is your bag, I highly recommend it–it’s way better than looking at country counts and line graphs.

DTC says that he thinks he “can see the slippage that Freedom House emphasizes in its recent reports, too.” I’m not sure that’s what I’m seeing.

What I think I see is the explosion of Democracy optimism that swept over the world in the wake of the Soviet collapse. When the Soviet Union collapsed several states regained independence and several states were newly formed. Some states both regained independence and then fractured and collapsed into new states which roughly coincided with old world dutchies and clan-based borders.

In most of these instances the newly (re-)formed states claimed a nominal dedication to democratic principals. Many of them wrote constitutions affirming this direction. Several states that underwent civil wars and came out as newly formed democracies were never formal satellites of the USSR. In Africa several states spent the Cold War with their internal conflicts stifled by either the US or the USSR–typically by funding dictatorships that, once left alone, were unable to maintain order.

In any case, these states used democratic rhetoric, passed democratic laws, and sometimes, maybe, possibly, actually had a passion to move in a democratic direction. Unfortunately, these commitments—whether sincerely held or not—were beset by the obstacles we knew in advance exist between power of the one and power of the many. These democratic gains were never consolidated, democratic institutions never gained the legitimacy or capacity to repel its assailants,  and ultimately both proved illusory.

In other words, whether these states were ever truly democracies remains an open question.

Freedom House (and Polity) both set for themselves a difficult task. Attempting to understand the political context of a state, from a distance, and in (more or less) real time is virtually impossible. Once ranked, that’s the rank. It is not subject to historical revision (historical revision comes with its own problems).

But my assumption is that these states were not democracies in any meaningful sense. Democracies are only democracies when, as Linz and Stepan said “democracy is the only game in town.” Before that, the true policy is somewhere in anocratic region…leaning toward democracy, maybe, but not a “a democracy” yet.

FHI is not measuring “democracy” directly, but in offering an indexed score of civil and political rights, it is, I think subject to the same criticism. A law and nominal protection to certain ideals is fine but how robust are they? How quickly can they decay? What level of trust in those institutions is there? The FHI has a great methodology, utilizing several types of experts with a variety of interests and knowledge about the countries they report on. But that does not free them from being victims of the zeitgeist. The Democracy optimism of the mid-90s wasn’t isolated to the US–it couldn’t have been. Democratic movements in the Eastern bloc and elsewhere were also, often, popular movements. Victories are perceived as victories, probably most of all by those that fought. So I don’t think FHI was “wrong” to record them as democracies (free). I just think that real time measures, although important, especially for prognosticators like DTC, are also deeply flawed. I think the freedom recession of the last decade or so is more a reflection of this methodological flaw.

That’s not to say there weren’t real gains made at this time, nor is it to deny there have been real losses since then. I just don’t think that in reality global freedom reached as high as it is reported by FHI, thus the recession we are in now would look less startling if that peak were modified.

The Tragedy of Philip Seymour Hoffman

Richard Grenell should study literature. A classic tragedy is one where a very rich, famous, smart, or talented person is brought low by inherent flaws—flaws which are known in advance to the spectators. The very essence of the tragedy is that the audience knows in advance that the hero is doomed while the hero himself is either unaware of this fact or (worse) thinks he can escape this preconstructed fate. Thus all actions are tinged with the foreknowledge of …well…tragedy. This literary mechanism is even called “tragic irony.”

Now, it’s kind of cynical to view Hoffman’s death as a tragedy in this way. If you thought Hoffman’s overdose was inevitable, that his cause was hopeless, then you would probably feel that way about all addicts. But the truth is, people escape addiction everyday. Most of us think of tragedy differently today. Today we think of tragedies as bad endings that didn’t have to be that way. The idea they could be avoided but weren’t is the tragedy.

What Grenell is saying is the former idea. And, I think it’s worth pointing out that Grenell’s interpretation of Hoffman’s death is the original notion of tragedy to a very fine degree. Sophocles could  not have crafted a better contemporary tragedy. Grenell may be heartless enough he isn’t saddened by Hoffman’s death. But “being sad” is a child’s response to tragedy. A real tragedy should cause anger on one level and force submission to the sublime awesomeness of an unfeeling and somewhat mechanical universe on another.

The Gold Standard in Research Design

A few days ago a piece ran in the New York Times criticizing the methodological approach the Center for Medicare and Medicaid Innovation Center uses to assess the effectiveness of different health care delivery options.

I recently moved from the social sciences (“International Relations” but with a focus on the socio-economic causes of conflict…technically a “comparativist” field or, because my research focused on Mexico, Venezuela, Peru, and Colombia…an “area studies” field). Now I work in behavioral health care and public health. In truth, I have always worked in policy. In studying policy from an academic point of view, we hear tell of these fancy methods known as Randomized Controlled Trials, but we rarely get a chance to read of one in our field. Dani Rodrick, a developmental economist preaches their use and is developing ways to utilize them in the field, but apart from him and, given our respective limitations as finite creatures in a world of scarcity, most of us never get a chance to actually conduct one.

Although I have always worked in policy, this is my first experience with health care policy. Most of my hallway mates are doctors. Some of them are medicals doctors, most of them are PhDs in psychology or PsyDs (Doctors of [Clinical] Psychology). Many of my current coworkers are from the world of randomized controlled trials, which they refer to as “clinical trials.” As a professional research assistant, I have two main functions: translating the findings from clinical trials for policy-focused folks, and translating policy stuff for clinical trial-focused folks. So when Austin Frakt and Adrianna McIntyre write “And just because health policy is closer in proximity to medicine (and its many RCTs) doesn’t actually make health policy more amenable to this kind of study than any other policy domain,” I feel them.

When I tell people my background, they look at me like I’m crazy. But this really is policy work. This really is outside the lab. Randomized controlled trials are great but they have limitations, extreme limitations.

Prior to this, in social sciences research, the biggest methodological conflict was always the quantitative folks versus the qualitative folks, the large-n folks versus the case study folks. My own thesis attempts to straddle that line, using a case study to fine tune certain macroeconomic models. It’s an uncomfortable world in-between these two approaches. So, trying to act as mediator between policy and RCTs now is uncomfortable–but familiar–territory.

So what am I trying to say in this long-winded comment? Basically this: In the world of lab coats, pills, placebos etc. the RCT is the “gold standard” of research designs. But outside that world, they are flawed and limited. And…for that matter, not all RCTs are equal. Many of them are flawed in their own ways, in their design, in their implementation.

But it’s this idea, specific to the hard sciences, that RCTs are “the gold standard” that I think is to blame for that NY Times “hit piece.” No one else outside the laboratory world thinks that RCTs are “the gold standard.” RCTs, like any method, are good at what they’re good at, and bad at what they’re bad at. They are a method, not the gold standard. If we dropped this idea, then it never would have occurred to anybody to critique the Innovation Center for not using RCTs when RCTs are either impossible or the wrong method entirely.

Legal Pot Means More Violence in Mexico–Not Less

There’s a lot going on here, both in Humphrey’s quick take and in the Alejandro Hope piece that he links to. I’ll start by saying that, at the top, broadest level, I agree with the Hope-Humphrey’s analysis that were pot fully legalized in the United States this would not collapse the cartels or bring peace to Mexico. I do however, disagree (a little?) on why that’s true.

Drug trafficking organizations (DTOs—or International Criminal Organizations ICOs, the nomenclature I prefer) are involved in several different markets—the vast majority of which are more accurately described as “grey markets,” that is, the illegal manufacturing, trade, or transport of legal goods. This would refer to the Knights Templars’ recent takeover of the otherwise legal avocado market, the infiltration of the ICOs into tomato farming, and even the diversion of oil from legitimate channels into illegitimate ones.

There are of course, as Hope mentions, several other drugs the ICOs trade in as well-heroin, cocaine, and methamphetamine. But there are also a group of non-narcotic but yet still illegal products as well: exotic animals, lumber and worst of all humans.

It’s hard to estimate the amount of money the ICOs make in just the marijuana sector. Hope cites between 1.5 and 2 billion dollars and that seems right to me based on my research. Hope says this will be “a blow” to the ICO revenues but “wouldn’t put them out of business.” I agree with this as well. As a matter of fact, I’m more pessimistic than Hope on this score. Mexico will maintain a comparative advantage in the cultivation and hybridization (and transport and retailing) of marijuana for several years even if (against all odds) the US went all-legal, everywhere, all at once. And the preeminent possessors of that institutional knowledge are the current ICOs and the farmers, soldiers, transporters, retailers (and their US-side distributors). In other words, a legal US marijuana market will be the endpoint for ICO-sourced marijuana. In other other words, while profits in marijuana will decrease, to the extent that any money accrues south of the border, most of it will still be going into ICO bank accounts.

I also agree with Hope, that “Mexico does not have a marijuana problem: it has a state capacity problem.” But that is where Hope and I split (a little).

Right now, 100% of marijuana profits end up in ICO bank accounts. They can use this money to offset future losses due to interdiction, crop burns, etc.; to bribe public officials; to hire new soldiers; and to buy formidable weaponry and other battlefield technologies. The government gets none of it (except those accepting bribes).

However, a legal marijuana market will decrease the cartel’s take while at the same time also increase the government’s take. These are funds the government can use to hire more police officers and soldiers and train them and to raise salaries—making bribery harder. They are funds the government can use to—simply increase their capacity to rein in lawlessness.
The ICOs have done their best to hollow out the Mexican state. Their main weapon in doing this is not their absolute wealth, it’s the difference between the money they can spend to do it vis-à-vis the money the state has to combat it. Addressing this gap is important in increasing state capacity.

So I think legalizing marijuana can actually have a greater-than-the-sum-of-its-parts effect on Mexican state capacity. Why I eventually come to the same conclusion as Hope is because of the nature of the violence in Mexico. Most of the violence in Mexico is not between state actors and the ICOs; it’s between ICOs.

If it’s hard to determine how much money is made in the marijuana biz, it’s even harder to determine which ICOs are profiting the most from this sector (relative to the other sectors they are in). And that’s an important point. Whichever cartels are most affected by the loss of the additional revenues are going to become weaker relative to those cartels which aren’t as affected.

These relative power shifts are the primary driver of inter-ICO violence. In other words, legalized marijuana—at least for a while—should increase violence in Mexico. The plazas that abut the US border will be important geographical areas to control so long as there remain any black or grey market goods to smuggle across them. Disrupting the ICOs relative positions as they battle for equilibrium is exactly the kind of thing that will make violence worse.

Turning Beer into Water

It’s cliche, I know, but it must be said, that as the world prepares for (and hopes to forestall and mitigate) The Coming Water Wars™ turning water into alcohol is the lesser of two miracles; the greater is its obverse, which is why I love stories like this one from Drink Up Columbus.