K Marx The Spot

Rx and T and A

It is bad enough that drug companies lure doctors with gifts, and hornswoggle them with advertising (if you think that drug advertising aimed at consumers is ubiquitous, check out advertising aimed at doctors). Now, drug companies are trying to ply them with a more old-fashioned approach. For now, at least, it is look and don't touch.

Anyone who has seen the parade of sales representatives through a doctor's waiting room has probably noticed that they are frequently female and invariably good looking. Less recognized is the fact that a good many are recruited from the cheerleading ranks.

Known for their athleticism, postage-stamp skirts and persuasive enthusiasm, cheerleaders have many qualities the drug industry looks for in its sales force...

Some industry critics view wholesomely sexy drug representatives as a variation on the seductive inducements like dinners, golf outings and speaking fees that pharmaceutical companies have dangled to sway doctors to their brands.

But now that federal crackdowns and the industry's self-policing have curtailed those gifts, simple one-on-one human rapport, with all its potentially uncomfortable consequences, has become more important. And in a crowded field of 90,000 drug representatives, where individual clients wield vast prescription-writing influence over patients' medication, who better than cheerleaders to sway the hearts of the nation's doctors, still mostly men.

Yes, the American health care system is clearly the most efficient one in the world. It is efficient, I mean, for maintaining the profits of big pharmaceutical companies.

Longtime readers might remember our longstanding support of the indefatigable folks at No Free Lunch. They have been trying to wean doctors from the more tangible lures of drug representatives for years now. A truly left-leaning media would at least have asked for their take on this industry practice.

Comic Opera Redux

News comes now that Bob Lobel and "Get Fuzzy" cartoonist Darby Conley have settled Lobel's libel suit against Conley, his syndicate, and a Massachusetts newspaper.

Bob Lobel filed the libel suit this spring after the May 13 "Get Fuzzy" strip—by Massachusetts-based cartoonist Darby Conley—showed Satchel the dog watching Lobel on TV and asking: "Is this sportcaster drunk?" Lobel said he never appeared on the air intoxicated during his career of more than three decades.

The Herald piece—by Gayle Fee and Laura Raposa—said the settlement might involve a "significant payment" to charity by Conley; his syndicate, United Media; and one of the clients that ran the strip, The Standard-Times of New Bedford, Mass.

(This is the spot where you can see the entire original strip, at least until Lobel's lawyers decide that we are somehow defaming him.)

In a stunning display of cowardice, by the way, the Standard-Times decided not only to disparage Conley, but to cancel the strip as well. At least the Standard-Times editor admitted that its supervision of the comics page has amounted to benign neglect:

I have my doubts that Mr. Lobel would win if the libel case went to trial because Mr. Lobel is a public figure and the statements occurred in a cartoon.

However, The Standard-Times tried to work out a settlement because I felt the strip was unfair and irresponsible. I got a call from a United Feature representative, who apologized for distributing the strip in the form in which we published it....

We didn't edit comic strips very carefully before (they come fully arranged on a page for us and all we have to do is add the advice strips that run alongside them and ship the page electronically to our Fairhaven printing plant), but I can tell you we pay closer attention to them now.

And while I agree that comic strip creators, along with political cartoonists, should have a good deal of freedom to criticize our elected officials and public figures in general, I believe that Mr. Conley overstepped the lines of what's considered acceptable comment by a longshot.

Only Mr. Conley knows whether or not the strip was intended as a personal attack or was simply a bad joke, but I believe it was sophomoric and mean-spirited, and United Feature shouldn't have let it get past its editors—and The Standard-Times shouldn't have published it.

Readers will notice that we stopped running "Get Fuzzy" two weeks ago. The cancellation, I hope, makes a big point in a small way: The Standard-Times is not in favor of needlessly causing any individual, famous or not, public embarrassment—in whatever form. [Emphasis in original text]

Let me get this straight. Picking the most ludicrous suggestion from this mess is well nigh impossible. Perhaps it was the idea that a comic strip (or a political cartoon) is offensive because it is "sophomoric." Perhaps it is the notion that a newspaper ought not needlessly cause "public embarrassment—in whatever form." (Where is the need for a police log? Or a retelling of a blunder in left field at Fenway Park? Or reminding the citizens of New Bedford what Dick Cheney has been letting slip from his lips? After all, there are plenty of things that a newspaper can print in their steads!) Or perhaps it is the idea that having a cartoon dog ask whether a notoriously slipshod public figure is drunk embarrasses to that person.

If embarrassment were the question, after all, it seems that Lobel has embarrassed himself lately, and not just in pursuing a lawsuit over what a cartoon dog asked about him. Take a gander at what even a sympathetic portrait in Boston magazine reveals:

Unfortunately for the 61-year-old Lobel, his affair with a fortysomething Nahant woman, detailed in the Herald, seemed to confirm the suspicions people have about him. He owns that one. "You know, I [fouled—inserted in order to avoid needlessly embarrassing a public figure] up," Lobel says of the affair....

"I guess I'm an easy target. If I was generic, if I just showed up and didn't fool around, wasn't sarcastic, maybe they wouldn't pick on me." But that will never happen. Lobel loves being off-the-cuff, loves speaking—and, yes, stammering—freely and unscripted on live TV. "The last thing I'd want to be is boring," he says.

Never boring, at his best he's personable and entertaining, with an insider's knowledge honed by years in the trenches; at his worst, he's distracted, his words a mumbled chop suey...

"I think it's because I talk faster than I think, or think faster than I talk. I'm just not synched up. I have ADD," he says, citing a diagnosis he received 15 to 20 years ago from a preeminent expert in the field. That's also the explanation he offers when asked why people think he drinks. "There are times I slur my words. There are times I make mistakes, but it's not because I'm drunk. I don't even drink. I used to. I used to go out between shows, but that was 15 years ago." Today, he might sip an occasional glass of wine, he says, but never when working. "If Bob drinks anything, it's a Diet Coke and a lime," says Peter Brown, his former news director....

Wornick backs up her former husband's claims of teetotaling, but she has a different take on why some people are skeptical. When she and Lobel were having marital problems, she, too, thought he acted drunk on television. "I knew that was when he was in the most pain," she says. "It was the only way he could deal with pain, was to be a goofball."

So, Lobel admits that he used to got out (for drinks) between the end of the 6:00 p.m. newscast and the start of the 11:00 p.m. newscast. And even his ex-wife, cited in the portrait as a "close friend" thought he was drunk on the air in the past. Where is the libel suit there? I think that Bob Lobel should consider himself lucky that Darby Conley decided not to play legal hardball.

As I wrote in May, "it seems to me that the best way to pursue a libel case involving claims of drunkenness is never to appear drunk even when you are not. That works great for most people, even when they are not television stars."

Registry of Bad Deeds

Randy "Duke" Cunningham decided this week not even to fight charges of fraud and corruption and admitted to taking millions of dollars in bribes from defense contractors eager for a pliant and reliable vote in the House.

For months, John Marshall of Talking Points Memo has bulldogged this story, particular the aspects, starting in June 2005, relating to his shady real estate dealings.

What is aggravating, if one lives any distance from San Diego, is how difficult it is to get to the documents that provide the base of the corruption case.

In states like Massachusetts, it is fairly easy (and free) to find out about what what the governor might be up to simply by searching at the proper Registry of Deeds. Most cities and towns have searchable tax databases, so, it is easy enough to see whether the lieutenant governor is, as she so wonderfully put it, overhoused.

In California, where the right wing has decried for decades the growth of "big government," many registries of deeds have scant information available to the public. In San Diego County, where Cunningham lives, it is indeed possible to see the November 2003 sales price of $1,675,000 and the subsequent October 2004 sales price of $975,000. But the deeds themselves will cost money (and one must order a paper copy: there is no online version). So, a journalist who wanted to know whether Cunningham had a House staffer notarize the deed selling his home for an inflated price to a company owned by Mitchell Wade would have to pay $3.00 and wait for the darned thing to be mailed out. (He did.)

In San Diego County, even the assessment map costs money and is not available online. What is puzzling is deciding whether a more transparent registry of deeds would have kept Cunningham's other bad deeds from coming to the fore. Did Cunningham try the real estate scam without regard to the registry's policies? Or did he try it because he thought that no one would bother to check the documents?

Labor Builds All Wealth

The Boston Globe on Sunday published a fascinating article that hints at what insiders in many industries already know—without lots of labor from illegal immigrants, the upper classes would have to find honest work. The article does not go that far, but what it relates is still worthy of attention.

On paper, it appears Hanani Medina is doing quite well.

The year-end tax documents filed by his employer say the Honduran immigrant was paid $103,770.55 last year...

But Medina did not really make all that money. Instead, he contends, he was a conduit for his employer, Olympic Painting & Roofing, which made payments through Medina, who was on the books, to a dozen other employees who were not...

Because Olympic classified Medina as a self-employed contractor, the men he supervised effectively became Medina's employees. This allowed Olympic to avoid large workers' compensation insurance bills and Social Security and other taxes.

This is the kind of arrangement upon which the construction industry in Massachusetts has become dependent, say workers, labor union officials, and immigration policy analysts.

This sort of arrangement is hardly restricted to Massachusetts. Throughout much of the country, contractors rely on subcontractors who hire workers too afraid to call for enforcement of all sorts of labor laws. And many owners are all too happy to ignore these practices, because any non-union job is a defeat for the unions.

Medina worked on several Olympic projects last year, including a luxury apartment development in Quincy, the Village at Quarry Hills. The owner of the development is The Finger Cos., based in Houston. The contractor on the project is Milford-based Plumb House Inc., owned by Richard K. Anderson. Plumb House subcontracted framing and painting work to Olympic. Representatives of The Finger Cos. and Plumb House did not return calls seeking comment on Olympic's alleged workplace practices.

If the attorney general's investigation finds that Olympic misclassified workers, neither the property developer nor the general contractor would be penalized, [Carpenters' Union general secretary-treasurer] Erlich said.

Plumb House is more than eager to advertise its anti-union stance by mentioned in its advertising and website that "merit shop works best."

What is Merit Shop? It is a business way of life for our company and its employees.

Since the beginning in 1973, Plumb House has promoted the Merit Shop philosophy in all of its dealings with everyone: employees, subcontractors and customers....

Merit Shop employees have unlimited opportunities to improve their careers through a bonus and promotion system that rewards individual and team achievements.

Somehow, Plumb House forgot to mention the opportunities that tax fraud and under-the-counter payments provide. Somehow, Hanani Medina found that "merit shop" was not the best way for him to earn his living.

Medina, the Globe article tells us, is worried that the IRS will come after him for back taxes. (He is probably in the clear on most of the money, because he could—at least as far as federal income taxes are concerned—write off the checks he wrote to his co-workers as legitimate business expenses.)

The only good news? Medina now gets an honest day's pay under honest conditions.

Medina is now a member of the carpenters' union. He makes $37 an hour, including benefits.

Bulletpoint Heads

It is hard to have much pity for the brain trust at Pajamas Media, formerly known as Open Source [sic] Media. On Tuesday, an announcement that the "Open Source [sic] moniker was out and the old Pajamas moniker was back in, appeared on the site. By late afternoon, it was gone (perhaps out of embarrassment). Fortunately, the Blogging of the President crew took notice and saved the piece for posterity.

So how did this happen in the first place? Back at the beginning, certain, shall we say, paternalistically minded parties (i.e., the guys in suits) decided that we should act like grownups, and being as yet somewhat immature—at least as businesspeople--we did as we were told.

Which is how, one day, we ended up sitting around a conference table listening to representatives from a "branding" company. What followed is still a bit of a nightmarish blur, but it involved a PowerPoint presentation on the history of names, and such probing questions as, "If you were an animal, what animal would you be?" (Which is how we almost ended up as Jellyfish Media.)

As Edward Tufte could tell you, the problem was probably with the PowerPoint presentation. It did in the space shuttle at least once, and it just did in a flotilla of reactionaries.

The standard PowerPoint presentation elevates format over content, betraying an attitude of commercialism that turns everything into a sales pitch.

Of course, data-driven meetings are nothing new. Years before today's slideware, presentations at companies such as IBM and in the military used bullet lists shown by overhead projectors. But the format has become ubiquitous under PowerPoint, which was created in 1984 and later acquired by Microsoft. PowerPoint's pushy style seeks to set up a speaker's dominance over the audience. The speaker, after all, is making power points with bullets to followers. Could any metaphor be worse....?

In a business setting, a PowerPoint slide typically shows 40 words, which is about eight seconds' worth of silent reading material. With so little information per slide, many, many slides are needed. Audiences consequently endure a relentless sequentiality, one damn slide after another. When information is stacked in time, it is difficult to understand context and evaluate relationships. Visual reasoning usually works more effectively when relevant information is shown side by side....

Presentations largely stand or fall on the quality, relevance, and integrity of the content...Audience boredom is usually a content failure, not a decoration failure.

At a minimum, a presentation format should do no harm. Yet the PowerPoint style routinely disrupts, dominates, and trivializes content. Thus PowerPoint presentations too often resemble a school play—very loud, very slow, and very simple.

Tufte's article, of course, gets to the point: its title is "PowerPoint is Evil."

The Pajamas contingent could have spared itself that "nightmarish blur"by just saying no to the suits with the Powerpoint. But that would require that the Pajamas brain trust be a trust that trusted its brains.

Intelligent Design

When President Bush and his political supporters confront a huge amount of evidence that shows that evolution is the process that created intelligent life, they remark that an Intelligent Designer was probably responsible.

Yet when low-level military personnel are caught brutalizing prisoners, not just at Abu Ghraib in Iraq, but also at Guantanamo Bay and in Afghanistan, these same proponents of Intelligent Design claim that there was no policy allowing such practices.

Indeed, by their logic, these brutal practices evolved out of nowhere, independently, at facilities around the world. No Intelligent Design behind those practices at all.

The Ghoulish Archipelago

It should hardly be news that the Bush administration has been secretly stashing undesirables in foreign prisons in the name of a "war on terror." Human Rights Watch has maintained a detailed and documented web site on the circumstances of the "ghost detainees." And yet it hardly comes as a surprise to read that the Washington Post, unlike most serious European newspapers, was too afraid of the Bush administration to publish the names of the countries involved.

Even merely in terms of scale, Stalin's system of gulags makes Bush's arrangements seem pitiful. Yet it seems that if one were trying to avoid such comparisons, one would at least avoid prisons with a Soviet provenance.

And at least the Bushites learned something from Stalin: when bad news gets told, punish the tellers.

As details emerged yesterday of CIA flights to remote military airfields in northeast Poland and southeast Romania, George W Bush's administration ordered an internal inquiry into how classified data was leaked to The Washington Post and Human Rights Watch, a New York-based group.

Senior intelligence sources blamed the leak on CIA officers unhappy at having to maintain what one former counter-terrorism official described as "secret gulags".

The prisons are believed to hold at least 30 Al-Qaeda leaders labelled "ghost detainees" by Human Rights Watch. Many no longer have any intelligence value, but the CIA has been ordered to shield them from international scrutiny or legal proceedings.

Place Your Bets

I hereby officially open the Dick Cheney Resignation Pool. It is more apparent than ever that Cheney is an embarrassment, even to those in his own party. History will remember his many failings, in particular his recent energetic lobbying for torture.

Just last week, Cheney showed up at a Republican senatorial luncheon to lobby lawmakers for a CIA exemption to an amendment by Sen. John McCain (R-Ariz.) that would ban torture and inhumane treatment of prisoners. The exemption would cover the CIA's covert "black sites" in several Eastern European democracies and other countries where key al Qaeda captives are being kept....

Increasingly, however, Cheney's positions are being opposed by other administration officials, including Cabinet members, political appointees and Republican lawmakers who once stood firmly behind the administration on all matters concerning terrorism.

Personnel changes in President Bush's second term have added to the isolation of Cheney, who previously had been able to prevail in part because other key parties to the debate—including Attorney General Alberto R. Gonzales and White House counsel Harriet Miers—continued to sit on the fence.

The first guess, from this correspondent, is for Friday, 7 January 2006, at 5:00 p.m. By 5:00 p.m. on Saturday, 8 January 2006, of course, Senators Lieberman and Biden will be throwing their wholehearted support behind Vice Presidential nominee Rick Santorum.

Healthy, Wealthy, and Unwise

A couple of months ago, Malcolm Gladwell examined the pitfalls of assuming that Health Savings Accounts were the magic bullet for the American health care system. (Workers set up tax-deferred health savings accounts in conjunction with insurance policies with very high deductibles.)

Americans have fewer doctors per capita than most Western countries. We go to the doctor less than people in other Western countries. We get admitted to the hospital less frequently than people in other Western countries. We are less satisfied with our health care than our counterparts in other countries. American life expectancy is lower than the Western average. Childhood-immunization rates in the United States are lower than average. Infant-mortality rates are in the nineteenth percentile of industrialized nations....The United States spends more than a thousand dollars per capita per year—or close to four hundred billion dollars—on health-care-related paperwork and administration, whereas Canada, for example, spends only about three hundred dollars per capita. And, of course, every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-five million people without any insurance. A country that displays an almost ruthless commitment to efficiency and performance in every aspect of its economy—a country that switched to Japanese cars the moment they were more reliable, and to Chinese T-shirts the moment they were five cents cheaper—lhas loyally stuck with a health-care system that leaves its citizenry pulling out their teeth with pliers.

Indeed, there is so much that is dramatically wrong with the American health care system: giant for-profit medical insurers, giant for-profit hospital chains, giant salaries for doctors in private practice, giant medical school loans for up and coming doctors, and giant numbers of the uninsured. In a perfect world, corporations would admit that universal health care would be a good thing because it would eliminate the need to compete with other companies on health care benefits. In a sane world, unions would be demanding some form of universal health care so companies would not be able to use health care costs as a wedge against the working class. In our world, companies are trotting out health savings accounts: and the business press considers them to be the best thing since Intel went public.

"Moral hazard" is the term economists use to describe the fact that insurance can change the behavior of the person being insured. If your office gives you and your co-workers all the free Pepsi you want—if your employer, in effect, offers universal Pepsi insurance—you'll drink more Pepsi than you would have otherwise.

Health savings accounts are supposed to counteract the moral hazards of health insurance. If every medical procedure is covered by insurance, then it costs me nothing, at least directly, to abuse the health-care system. If, instead, I have to pay out of pocket to a certain extent, then I will be a more responsible citizen. Gladwell points out the major flaw, of course.

The moral-hazard argument makes sense, however, only if we consume health care in the same way that we consume other consumer goods, and to economists like [University of Minnesota professor John] Nyman this assumption is plainly absurd. We go to the doctor grudgingly, only because we're sick.

Indeed, the attraction of health savings accounts is greatest for those who do not need the help—healthy, affluent, young workers. They can afford to gamble that they will not need their high-deductible policies. They can expect to contribute several thousand dollars each year to their tax-deferred accounts.

And when healthy, young workers opt out of conventional insurance plans, they shrink the pool of the insured, and opt out of the social contract that formerly bound the buyers of health insurance. At least I can understand when some of my colleagues this year decided to take the new HSA option offered by my company—for example, married couples without children could reasonably expect to save well over $1,000 per year.

But I could not understand why my company decided both to offer an HSA and to opt to be self-insured. Perhaps the solons in the board room are correct that the workers in my company are at least as healthy on average as the average person covered under our old health insurance plan. But I wonder why in the name of all that is economically rational did they decide to offer an incentive for the healthiest members of our 500-worker universe to opt out of the traditional insurance pool.

Yes, the company has bought reinsurance to protect against catastrophic claims. But reinsurance is based on perceived risk, and if any of the 500-minus-N members of our new semi-universal pool has a catastrophic claim, then that reinsurance is going to get more expensive, perhaps considerably so.

Memo to the Washington Press Corps

The question that should be asked of Scott McLellan at the next press gaggle is something like the following:

Scott, will the President guarantee that he will not pardon Scooter Libby, or any member of his administration?

Ultimately, Bush is the one man who can scuttle the criminal phase of this investigation.

Judicial Activism

If one listened to President Bush on Monday morning, one would think that Judge Samuel Alito was Marshall, Frankfurter, and Holmes, all rolled into one nice conservative package.

Judge Alito has served with distinction on that court for 15 years and now has more prior judicial experience than any Supreme Court nominee in more than 70 years.

Judge Alito's reputation has only grown over the span of his service. He has participated in thousands of appeals and authored hundreds of opinions. This record reveals a thoughtful judge who considers the legal matter—merits carefully and applies the law in a principled fashion. He has a deep understanding of the proper role of judges in our society. He understands that judges are to interpret the laws, not to impose their preferences or priorities on the people.

Yes, Democrats on Capitol Hill should remember one important thing&8212;if this fellow was so remarkably well qualified for the job, why did Bush fail to nominate him four weeks earlier?

[O]ne person stood out as exceptionally well suited to sit on the Highest Court of our nation.

This morning, I'm proud to announce that I am nominating Harriet Ellan Miers to serve as Associate Justice of the Supreme Court. For the past five years, Harriet Miers has served in critical roles in our nation's government, including one of the most important legal positions in the country, White House Counsel. She has devoted her life to the rule of law and the cause of justice. She will be an outstanding addition to the Supreme Court of the United States.

Is Bush an amazing relativist in his definition of "exceptionally well suited," and Alito meets that standard at the end of October but not the beginning? If Alito is really such a great jurist, why did Bush not nominate him to be Chief Justice? Is Bush wrong about both Miers and Alito being well-suited at all to the rigors of a Supreme Court Justice?

Certainly Democrats will view the Alito nomination as an attempt to rally the conservative base around the president. But what Democrats need to remember is that nothing that the Bush White House says about its nominees should be accepted as fact. Take, for example, the supposed vacancy on the court. There is none until a new nominee is chosen; until then, O'Connor stays behind the bench.

Even take Miers's qualifications for the job, which included both her opposition to so-called judicial activism and her evangelical Protestant faith. Many religious persons move from one congregation to another, for a host of reasons. But relatively few help to form a new congregation when they have doctrinal differences with an established church. Yet that is exactly what Harriet Miers, the supposed opponent of judicial activism, did in her religious life, which President Bush admitted helped to form her legal temperament. Democrats should examine with an eye to detail Alito's myriad rulings to see whether these rulings do make him out to be the judicial giant that Bush would have us believe him to be.