Hospitals are not like airports; patients are not like airplanes

In writing blog posts that are critical of other writing one of my goals is not to point to the specific flaws of any particular article. No one has time to discredit all of the specious and nonsensical things that get posted, even by reputable outlets, to the internet each day. One of the things I try, and you can let me know if I'm failing, is to point out some of the tricks used to manipulate and/or mislead readers.

Which brings me to the false dichotomies. For an excellent example there's this piece in the Washington Monthly. You don't even have to read past the subhead to find the comparison:

Last year there wasn’t a single fatal airline accident in the developed world. So why is the U.S. health care system still accidentally killing hundreds of thousands? The answer is a lack of transparency.

I've added emphasis on a particularly important part here, and I'll get back to it in a bit.

How problems in WTUs are like drug interaction deaths

Medical issues in the military seem to be getting a lot of press attention these days, so I feel it's important to take a look at the genesis of these problems, specifically the polypharmacy issue and the troubles with Warrior Transition Units (WTUs). The policies leading to these problems have been well intentioned, yet there seems to be little thought or care for how and why they've gone so far astray, although there is plenty that they have gone astray.

Before delving into the issues I mentioned above, let's use a more well known example of these "second order effects." During the toughening of drug sentences in the late 1980s the Anti-Drug Abuse Act made prison sentences proportional to the quantity of illicit substance that a dealer was holding when arrested. The thinking behind such laws is straightforward: stiffer sentences for bigger time drug dealers. At first blush this sounds like a solid enforcement strategy; however, both in theory and in practice these laws had the unintended consequence of incentivizing dealers to hold smaller quantities while still being able to meet demand. Dealers responded to this by placing a new premium on purity. If they could sell their customers half the weight for the same price, they faced a lighter sentence if/when they were arrested. In this way drug laws that were designed to curtail large scale drug dealing had the perverse effect of increasing drug purity, which itself has many second order consequences (higher overdose rates, increased addiction potential, etc).

Breaking down the Army's suicide data

Part I: What does the data say?

There's a lot of grist to Wednesday's news briefing with Gen. Chiarelli on the 2010 Army suicide statistics. As usual, everything I write is my own opinion, unvarnished.

Looking past the headlines telling you some suicides were up and some where down I want to point out an underemphasized point that Gen. Chiarelli made during his briefing:

So the numbers [...] have really only focused on this group, both the Army Reserve and the Army National Guard, to collect this data for about five years.