An Ounce of Prevention is Worth an Ounce of Cure

People have long believed – and by long I mean 4,000 years – that the right sort of lifestyle, accompanied by the right sort of medical care, will stave off illness. Thus we are constantly urged to get regular checkups, mammograms, colonoscopies, etc. But the evidence that these things actually extend life is weak, and since they cost money many medical economists think they are a waste. The latest study finds that people often respond to slightly alarming signals picked up during checkups by getting a lot of health care that doesn't help them:

Using unique individual-level panel data, we investigate whether preventive medical care triggered by health checkups is worth the cost. We exploit the fact that biomarkers just below and above a threshold may be viewed as random. We find that people respond to health signals and increase physician visits. However, we find no evidence that additional care is cost effective. For the “borderline type” (“pre-diabetes”) threshold for diabetes, medical care utilization increases but neither physical measures nor predicted risks of mortality or serious complications improve. For efficient use of medical resources, cost effectiveness of preventive care must be carefully examined.

So far as we can tell, there isn't much reason for healthy people to see a doctor.

On the other hand there is strong evidence that women who get pre-natal care have healthier babies, even when the checkups lead to no interventions at all. So this is a complicated business, and there may well be interventions that help. The ordinary sort of medical check-up just doesn't seem to be one of them.

This has some political importance when it comes to health care policy. Liberals have long hoped that universal health insurance would save a lot of money, because people would get to the doctor when their problems were small and easily treatable, rather than waiting until they are really sick and going to an emergency room. But the evidence that this saves any money at all is weak, and the cold truth seems to be that the more health insurance you give people the more they spend on health care.

A Time of Testing

We seek to be faithful in a time not of our choosing but of our testing. We resist the hubris of presuming that it is the definitive time and place of historical promise or tragedy, but it is our time and place. It is a time of many times: a time for dancing, even if to the songs of Zion in a foreign land; a time for walking together, unintimidated when we seem to be a small and beleaguered band; a time for rejoicing in momentary triumphs, and for defiance in momentary defeats; a time for persistence in reasoned argument, never tiring in proposing to the world a more excellent way.

–Richard Neuhaus

Khangchendzonga National Park

Today's place to daydream about is Kanchendzonga National Park in Sikkim, India, bordering Nepal in the Himalayan highlands.

The topography is extreme, rising from 6,000 feet to 28,050 feet (1,830 to 8,5550 m). In area it measures 328 square miles (850 km2).

The area is most famous for its extremely tall mountains, including the third highest in the world.

But I am more entranced by the high wooded valleys, a wonder of biodiversity that led to the park being named a UNESCO World Heritage Site.

Cloud forests.

Some of the amazing wildflowers.

Birds, including (top) the Satyr Tragopan.

Mammals include snow leopards and red pandas.

There are 18 glaciers and 73 glacial lakes, inhabited by a wide variety of folkloric creatures, from goddesses to goblins.

There is an old and famous monastery, Tholung, and many other sacred sites.

Stone marker on the border of India and Nepal.

What an extraordinary place.

What the Man Wants

Interesting bit from Tom Friedman's account of a tour of America's "heartland." He is interviewing Ron Woody, county executive for Roane County, Tennessee, home to half of the Oak Ridge laboratory:

It turns out that it’s not that hard to train someone, even with just a high school or community college degree, to operate an advanced machine tool or basic computer. “Factory managers would say, ‘I will train them and put them to work tomorrow in good jobs” requiring hard skills, said Woody. “The problem they have is finding people with the right soft skills.”

What are those soft skills? I asked. “Employers want someone who will get up, dress up, show up, shut up and never give up,” Woody responded without hesitation. And there are fewer workers with those soft skills than you might think, he added.

In a deep, long-term, philosophical sense, is it good or bad for a country that such people are in short supply? Do the virtues that make a good factory worker make a good citizen? Or do people need to compartmentalize, acting one way at work, another way at home, and some third way politically?

Meanwhile I will say this about Trump's victory: it has gotten a lot of elite globe-trotting types like Tom Friedman to take a serious interest in places like Austin, Indiana, Louisville, Kentucky, and Roane County, Tennessee. In that sense Trump's voters may have been onto something.

So Much for Infrastructure

Trump ran on a promise to invest a trillion dollars in American infrastructure. And if you look at the new budget's 10-year projections, you see a line item of $200 billion for the "Infrastructure Initiative." Not a trillion, but at least a substantial sum, right? Sadly no. Scanning the rest of the budget, you see the following cuts over ten years:

That adds up to more than $300 billion in cuts. If something resembling this budget is actually enacted, Trump will no doubt trumpet the Infrastructure Initiative as a big deal – no, a HUGE deal – and give speeches at some of the big project groundbreakings. But all the money and then some comes from cuts to infrastructure programs in other parts of the budget.

Honestly I don't think anything like this budget will emerge from Congress, because it makes big cuts in programs like the FBI and the State Department that have powerful Republican friends. But Trump's team is just caught in the scissors of budget math and Republican promises. If you want to 1) cut taxes, 2) preserve Defense spending, Social Security retirement programs, and Medicare, and 3) pretend to care about the deficit, you essentially have to eliminate the rest of the government.

Toshi Yoshida

Toshi Yoshida (1911-1995) was a Japanese painter and maker of woodblock prints. He learned print-making from his father, Hiroshi Yoshida, doing what was by the early twentieth century the most normal and traditional sort of Japanese prints. This was an old-fashioned Japanese family business in which the son was still a junior apprentice at 25, filling in details on compositions chosen by his father. The oldest works I can find in his name are from 1938, like this one: Tokyo at Night, Shinjuku.

Hie Shrine, Tokyo. Note the signature in Latin letters, which means this print was sold to a foreign buyer after World War II.

Yoshida managed to become independent during World War II, when he traveled as a journalist. But as you would expect the woodcuts from the war years are also strongly traditional. Idabashi, 1939.

Sacred Grove, 1941.

Shirasagi Castle, 1942.

In the poverty-stricken years after the war Yoshida seems to have kept on with the traditional Japanese material, I assume for sale to Americans and other foreigners; or perhaps his works were sold as cheap prints to decorate newly rebuilt homes. White Plum in a Farmyard, 1951.

According to online biographies, Toshi always wanted to experiment with abstract art, but never dared until after his father died. Once out from under the paternal shadow he began to experiment in many directions. The Beginning of Day, 1957. He actually produced quite a few abstract works, many of which were collected in the US and Europe.

Lost World, 1964. I sense in Yoshida a lifelong ambivalence about the traditional Japanese art in which his father trained him. He never abandoned it, but he kept trying to branch out.

Yoshida had always liked drawing and painting animals, and beginning in the 1950s he began to produce animal prints and picture books for children.

But he never stopped working with traditional Japanese subjects. Irozari Evening, 1961.

Morinji in Spring.

Autumn in Hakone.

Stone Garden, 1963.

Yoshida traveled to America and made prints of American scenes. Monument Valley, 1970.

In 1980 Yoshida opened a print-making school in Nagano Prefecture. He trained many future professionals there, including numerous Americans. Dance of Eternal Love, 1970.

Tokyo Bird Park, 1980s.

The Zimmerman Boulevard Submarine Sandwich Standoff

The perfect small town news story:

Veteran observers of town life and government said they're not surprised a man eating a sandwich caused such a stir.

This Week in Diplomacy

That's the esteemed leaders of the US, Saudi Arabia and Egypt showing solidarity. No, it isn't photoshopped, just weird.

Today's Sentence

Greece's anarchists are organizing like never before.

It seems that some of them divide their time between setting up squats for refugees and blowing up banks, or at least fantasizing about blowing up banks.

This reminds me of how amused I was to discover that in the 1930s there were anarchist ministers in the Spanish government.

Roses

Pictures from the height of rose season at my house this week.

Edoardo Tresoldi: Wire and Light

For a royal event in Abu Dhabi, Edoardo Tresoldi created this architecture made of wire and light. Photographs by Roberto Conte.

Reminds me of all those Renaissance artists who spent most of their time doing royal masks and the like. Via This is Colossal. More at the artist's web site.