Wednesday, July 01, 2015

That evil diabetes

The prime whipping boy for the "war on obesity" is diabetes.  Being fat is supposed to give you diabetes, never mind that most fat people are not diabetic! So it is interesting to see what pops up in the research about diabetes.  And the latest study is an unusually strong one.  The researchers had data on both income and education, which makes it quite a rarity and worth mentioning for that alone. So the results can be accepted without the most usual caveat about the influence of social class.

Another usual caveat is however not excluded. By basing their conclusions on interquartile range they threw away half their data.  At least they did not use extreme quintiles, I suppose. So they are a bit up on a lot of other studies in that regard.  The bottom line, however, is that the effects they observed were weak.

So what did they find, albeit weakly?  The most interesting finding was a negative.  Neighborhood social environment was not associated with diabetes.  Bear in mind, however that race/ethnicity was controlled for.  Without that control, inner city environments would have been found to be bad for you.  So having congenial neighbors is nice but it doesn't protect you from diabetes. Not terribly surprising, I suppose, but with their tendency to blame everything on external factors, Leftists might not like it

The positive effects were that a neighborhood with good opportunities for exercise helped stave off diabetes and a neighborhood with more fresh food available helped a little too.  So having nearby parks to jog around was good for you and a less fat-intensive diet gave your pancreas a bit of a rest.

An amusing thing is that JAMA really liked that study and put up a laudatory commentary on it ("Risk for Type 2 Diabetes Mellitus:  Person, Place, and Precision Prevention").  And what the commentary said about it did not surprise me one bit. The commentary disregarded the weaknesses of the effects and even said that the authors found something which they did not.  Academics have a great tendency to draw conclusions they want to draw and damn the evidence.  So when dear little Nancy Adler and Aric Prather said in their commentary that: "physical and social contexts of neighborhood environments matter for disease onset", they were ignoring the fact that the study below found that social environment did NOT matter.  LOL.

We climate skeptics know well how little there is behind Warmist "science" but the same is true of science in other fields too, particularly health science.  And Leftism of course floats on a sea of lies.  The situation is so bad that, even at age 71, I feel I still have to keep going and keep pointing out the facts. I would rather spend my time watching operetta -- but fortunately I do get some time for that too.  Much more fun than politics and crooked science.

Longitudinal Associations Between Neighborhood Physical and Social Environments and Incident Type 2 Diabetes Mellitus: The Multi-Ethnic Study of Atherosclerosis (MESA)

By Paul J. Christine et al.


Objective:  To determine whether long-term exposures to neighborhood physical and social environments, including the availability of healthy food and physical activity resources and levels of social cohesion and safety, are associated with incident T2DM during a 10-year period.

Design, Setting, and Participants:  We used data from the Multi-Ethnic Study of Atherosclerosis, a population-based cohort study of adults aged 45 to 84 years at baseline (July 17, 2000, through August 29, 2002). A total of 5124 participants free of T2DM at baseline underwent 5 clinical follow-up examinations from July 17, 2000, through February 4, 2012. Time-varying measurements of neighborhood healthy food and physical activity resources and social environments were linked to individual participant addresses. Neighborhood environments were measured using geographic information system (GIS)– and survey-based methods and combined into a summary score. We estimated hazard ratios (HRs) of incident T2DM associated with cumulative exposure to neighborhood resources using Cox proportional hazards regression models adjusted for age, sex, income, educational level, race/ethnicity, alcohol use, and cigarette smoking. Data were analyzed from December 15, 2013, through September 22, 2014.

Main Outcomes and Measures:  Incident T2DM defined as a fasting glucose level of at least 126 mg/dL or use of insulin or oral antihyperglycemics.

Results:  During a median follow-up of 8.9 years (37 394 person-years), 616 of 5124 participants (12.0%) developed T2DM (crude incidence rate, 16.47 [95% CI, 15.22-17.83] per 1000 person-years). In adjusted models, a lower risk for developing T2DM was associated with greater cumulative exposure to indicators of neighborhood healthy food (12%; HR per interquartile range [IQR] increase in summary score, 0.88 [95% CI, 0.79-0.98]) and physical activity resources (21%; HR per IQR increase in summary score, 0.79 [95% CI, 0.71-0.88]), with associations driven primarily by the survey exposure measures. Neighborhood social environment was not associated with incident T2DM (HR per IQR increase in summary score, 0.96 [95% CI, 0.88-1.07]).

Conclusions and Relevance:  Long-term exposure to residential environments with greater resources to support physical activity and, to a lesser extent, healthy diets was associated with a lower incidence of T2DM, although results varied by measurement method. Modifying neighborhood environments may represent a complementary, population-based approach to prevention of T2DM, although further intervention studies are needed.

JAMA Intern Med. Published online June 29, 2015. doi:10.1001/jamainternmed.2015.2691


Libertarians Should Be Cautious in Celebrating homosexual marriage

To no one’s surprise, five justices of the U.S. Supreme Court held that “the right to marry is a fundamental right inherent in the liberty of the person, and under the Due Process and Equal Protection Clauses of the Fourteenth Amendment couples of the same sex may not be deprived of that right and that liberty.” The full opinion is here.

For example, Robby Soave over at Reason blasts the dissent from Justice Scalia and observes that he is no friend to libertarians. Also, Ilya Shapiro at the Cato Institute gives a thumbs up to the Court’s decision. Undoubtedly many readers of this blog share these sentiments and cheer today that homosexual couples can marry just like opposite-sex couples. However, before you get caught up in celebrating this “victory” for liberty, think about several things.

First, that the main liberty on which this country is founded is the right to self-government. For that reason we seceded from the British Empire so that each colony/state could govern its own affairs. Via the Articles and later the Constitution the states combined for certain external matters such as national defense and international commerce, but as to their internal affairs they remained separate and sovereign. This was supposed to allow the states to govern themselves based on peculiar local circumstances and culture; keep the governors close to the people; and allow for the states to serve as laboratories of democracy. Domestic relations were always seen as a matter of state and local regulation. There is no power delegated to the federal government over marriage, divorce, child custody, etc. When the federal government (legislative, executive, or judicial) acts outside the delegated powers and assumes prerogatives left to the states or the people, this cherished right of self-government is threatened.

Second, although the majority sets forth many good policy arguments on why same-sex marriage ought to be allowed, they are just that—policy arguments. Neither the Constitution of 1787 nor the 14th Amendment speak to same-sex marriage. Sure, there is a Due Process Clause in the 14th Amendment, but that should be understood as a guarantee that certain procedures must be followed in judicial proceedings before a person is deprived of life, liberty, or property. For example, a warrant should be submitted to a neutral magistrate to determine probable cause before a search is undertaken or a jury should be empaneled to decide felony cases between the government and the accused. Giving it a substantive meaning—i.e., giving the courts the power to determine if certain non-judicial policies or laws are “acceptable” in the opinion of the Court—sets the judicial branch above the other branches and the people. Policy is not the business of the Courts. We elect legislatures to debate policy and enact laws based on policy preferences. Actually, that was going on and going rather favorably for the gay community before the Court intervened with this decision.

Third, well what about Equal Protection? The 14th Amendment has an Equal Protection Clause, and states that did not allow homosexual marriage were denying homosexuals equal protection of the laws. Almost every law discriminates and creates classifications. For instance, a law that allows 16 year-olds to drive, but not 15 year-olds, creates a classification: those above 16 can drive, those below 16 cannot. This is not an equal protection violation because the intent behind the clause was to ensure that blacks enjoyed the same rights as whites and because the classification has a basis in reason. Sure, some teens 15 and 14 might drive better than adults who are 40 or 50, but courts have typically looked only to see that the classification has some basis in reason. It is reasonable to conclude that as a general matter a person should be 16 years or older to drive because as a general matter such an age brings enough maturity that the person can be expected to handle a car. Same thing for state laws on marriage. The traditional definition of marriage is based on the state’s desire to channel potential procreative activity into a stable social and legal relationship: marriage. This is per se reasonable, although there are policy arguments that can be made for expanding the definition. Bottom line: the view of marriage that has existed for thousands of years across a variety of different cultures (even cultures that were open to homosexuality, such as ancient Greece) is not bereft of a reasonable justification. And we don’t—or at least shouldn’t want—unelected judges looking beyond reasonable justification lest they be tempted to force their personal opinions—good or bad—on us.

Fourth, as my friend David Theroux pointed out to me, nationalization of states’ laws seldom results in greater freedom. For arguments pointing out the dangers of nationalization, see this Independent Institute op-ed. We should ask ourselves, based on this ruling, whether the federal government can nationalize any state law that increases government power, such as compulsory schooling, confiscatory taxes, bans on soft drinks and meat, higher drinking ages, etc. In other words, can the feds nationalize any state law that is intrusive and even tyrannical? Does this nationalization power bring greater freedom?

Fifth, think about what the gay rights movement has lost with this resort to the federal courts. Chief Justice Roberts puts this nicely in his dissent: “Indeed, however heartened the proponents of same-sex marriage might be on this day, it is worth acknowledging what they have lost, and lost forever: the opportunity to win the true acceptance that comes from persuading their fellow citizens of the justice of their cause. And they lose this just when the winds of change were freshening at their backs.” Opponents of gay marriage will ever believe that the debate and contest about the meaning of marriage was stolen from them. This will increase bitterness and likely close minds rather than open them to reasoned discussion and debate. What use is a democratic government with a First Amendment to promote debate, give and take, and respect when the judiciary decides all issues and questions that it deems important?

Finally, what does this bode for the future? With this decision, nine unelected federal officers firmly take on the power of legislating. The majority’s opinion reads like a collection of aphorisms from a far eastern philosopher and has little, if anything, to do with the application of established legal principles to an actual case or controversy. Many libertarians like the result in this case, but what will these cheerleaders say when the Court finds a state flat tax or state decision to reduce public assistance benefits to be unacceptable (that is, against the Court’s policy preferences) and declares these laws unconstitutional on due process or equal protection grounds? This is not idle speculation. Many progressive law professors urge, for example, that the poor should be considered a suspect class and thus the Court should strictly examine all state laws that impact various benefits. Here’s an article discussing this.

The Supreme Court has gone far from the judicial role outlined for it in the Constitution. Be careful when cheering for a result that you like; the power is there to reach issues and results that no friend of liberty will applaud. And you have no vote—none whatsoever—if you want to remove these Platonic Guardians from office.



The Court Only Delayed Obamacare's Collapse

With the Supreme Court deciding in favor of the Obama administration on the question of whether federal health insurance subsidies are legal, the rule of law – and the English language – took a real beating. As President Barack Obama takes a victory lap, he needs to realize that this is not the end of the fight.

It is true that the court's decision renders the federal Obamacare subsidies legal. But that does not mean an end to the conversation about health care in America, and it certainly does not make Obamacare a permanent institution. The simple reason for this is that there is no way the president's health care law can survive in the long run. It is structurally unsound, and the court's ruling will merely delay its inevitable collapse.

Across the country, the insurance exchanges established under the Affordable Care Act are falling apart. They are running deficits in the millions that are simply unsustainable. Even with the subsidies in place, the cost of premiums has been rising sharply, and deductibles are so high that many on the bottom rungs of the income ladder, the very people the law was meant to help, are actually being hurt by it.

Enrollment numbers are also far below expectations, meaning that only the people who need medical care the most are signing up for Obamacare, while many healthier Americans don't bother. The only way insurance can work is if healthy people sign up as well. If they don't start signing up en masse, premiums will keep rising in order to keep insurance companies solvent. We're rapidly heading for a situation in which people will have to choose between going bankrupt to buy mandated insurance, or going bankrupt to pay the penalty for not buying it.

What all this means is that the health insurance market is in deep trouble. In Chief Justice John Roberts' majority opinion in King v. Burwell, he wrote that "Congress passed the Affordable Care Act to improve insurance markets, not to destroy them." That may have been Congress' intention, but the fact is that markets are in deep, deep trouble, and this decision does nothing to change that.

The 2016 election will be crucial in determining what will happen when Obamacare meets its inevitable end. If Hillary Clinton becomes the next president and Republicans lose their majority in the Senate, the most likely response will be all out nationalization of health care markets, and America will follow the misguided path of social democracies in Western Europe. If Republicans carry the day, there will be an opportunity to enact free market health care solutions that empower patients and doctors, and make health care more affordable for all Americans. Let's hope they don't waste this chance to save our health care system.

The court's decision is a disappointment to those of us who believe that words mean what they mean and that the IRS shouldn't be allowed to rewrite laws to suit its agenda, but that's no reason why we should hasten to wave a white flag. Obamacare will stand for now, but sooner or later it will fall, and reformers had better be ready. What happens next will depend on which side has better prepared for the collapse. The battle going forward will be over laying the political and popular groundwork for repairing the health care system when Obamacare finally tears itself apart.



For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated) and Coral reef compendium. (Updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on A WESTERN HEART.

List of backup or "mirror" sites here or  here -- for when blogspot is "down" or failing to  update.  Email me  here (Hotmail address). My Home Pages are here (Academic) or  here (Pictorial) or  here  (Personal)


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