Sunday, November 04, 2007

Rudy Du Jour

First, let's recycle a couple of jokes:

What's the difference between a bucket of shit and Rudy?

Why, the bucket, of course!

How can you know for sure when Rudy's lying?

His mouth is open.

A rhetorical question: Rudy hasn't apologized for that sleazy, scummy riot he led in City Hall Park years ago, has he?

Prediction for the day: Rudy vs. Hillary; Rudy wins (maybe not through kosher means, but he wins).

Okay, down to business.

How Rudy lies with his bullshit prostate numbers:
First, the parameters must be the same. Rudy is using a set of figures from Britain that comes from their version of the CDC. The US numbers are from a right-wing think-tank paper that doesn't even claim to use actual numbers to justify the result. Apples to hand grenades anyone?

Secondly, before one can even begin to quantify the "quality of care" you must adjust for the natural variability in the studied population. The US is a melting pot - we have large percentages of all kinds of different racial and ethnic backgrounds. Most other countries in the world are not that way. They have a large group of their "founding" ethnicity, and a small minority of immigrants. This all has to do with basic genetics. (An example is that southeast Asian cultures have a much higher rate of lactose-intolerance than western Europeans.)

Third, one must adjust for attitudes. In the US, we have a societal abhorrence for the very natural part of life that is called death. We collectively feel that we must fight to the last inch before giving in to the inevitable. In other areas of the world, this is not the case. People choose to spend their last time with their families instead of in hospitals hooked up to machines. These attitudes do make a difference in outcomes.

Finally, we must all understand just what mortality figures really are - in Rudy's case, mortality rates for people with prostate cancer. A mortality rate is the number (not the percentage) of deaths per 1000 of the population that are diagnosed with the condition. That last bit can really change things.

In the US, the portion of the population covered by any kind of insurance is routinely screened using the PSA test. Lots of prostate cancer is found - however that in and of itself is misleading on the face of it. Prostate cancer comes in two forms, a virulent, fast-growing and quickly fatal variety that affects about 5% of the population, and a slow-growing type that almost 80% of autopsies reveal when the patient has died from other causes. The slow-growing type responds negatively to aggressive treatment, that is, it can respond like the more virulent form if you attack it with chemo or surgery, etc. Most experts now do a biopsy and then advise "watchful waiting" rather than any aggressive treatment.

Of course, the discovery, treatment and outcome of those without insurance is totally different. PSA tests are not administered in the emergency room. People with virulent prostate cancer wind up in the terminal stage of the disease, in the emergency room when it is too late to do anything except make them comfortable. Those with the slow type are never diagnosed at all.

In Europe, PSA tests are not routinely done. Doctors in many of these countries believe that the use of the "unreliable" PSA test results in too many false positives, and aggressive treatment protocols where it is not warranted. (There is also the issue of underfunded health care systems but that is an argument for another day.)

Here we have three groups of people - as you can see - they are not the same. Rudy is trying to convince us that they are. The first two groups here in the US are actually one group - and the one in Britain is the same as our one group. Nope.

It would take a large volume to explain why we may or may not be better or worse than Country B or Country C because of all the mitigating, aggravating and confounding factors that must be accounted for in order to make statistics like those quoted by Rudy meaningful in the least.

Far more useful for the health care discussion would be the mortality rates of the two different groups here in the US. It would answer the question - is some kind of universal healthcare coverage better than nothing? And that, my friends, is really the question. Not whether we are better or worse than Country B or Country C, but what is actually happening right here, right now.
And Ezra Klein describes the "scam" even better here.

How Rudy only wants in an aide a complete cocksucker, in this case, Bernie Kerik. Speaking of which: This Kerik legal defense: who's kicking in the money? I mean, Rudy's supporters must be.... (Josh Marshall is also curious... well, he was first....)

And here's Rudy, the Energizer Bunny of liars -- or: "Here he goes again!"; my next girlfriend should only have such stamina....

Finally: He's a fascist anyway who wanted to stay on as mayor beyond his term (bad enough) for absolutely no good reason other than, maybe, it was after 9/11 and his City so desperately needed his lies and bullshit because we know full well he didn't do fuck before or after or even during 9/11 except to bullshit about all he did.
QUESTION: Mr. Mayor, can you respond (OFF-MIKE) you would like to stay on?

GIULIANI: Well, I can tell is that what I'd like to do is to maintain the unity that exists in the city. And I've met -- I'm going to meet with the candidates and talk to them about something that we can agree on. Or I hope we can agree on a way in which to handle this tremendous crisis that we have.

And it's something that I would hope that the candidates would take very seriously. So I'm going to talk to them and try to come up with something that unifies the city because we have a very, very strong spirit of unity right now. And I think that it's my obligation to try to maintain it. So I can't tell what you that is until I tell them. And I've met with some of them, but not all of them yet.

QUESTION: Without being the candidate?

GIULIANI: I don't -- after I finish the conversations, I will tell you if we've succeeded in coming up with something that unifies. I hope we do.

QUESTION: Would it be fair to say that (OFF-MIKE) would basically allow you to continue being mayor for an extended period after your term expires?

GIULIANI: I'm not going to discuss it with you. I'm going to discuss it with the candidates first. And then there's time to discuss it. But I think we should try to come up with something that unifies and you're just going to have to, you know, labor under just a little less information than you would like to get.

QUESTION: (OFF-MIKE) are your hopes then?

GIULIANI: I hope that we're going to come up with a position that we agree on, so that it unifies the city. I could tried to find another way to say that.


GIULIANI: I don't know. Pardon me?


GIULIANI: The next couple days, hopefully. Maybe in a day or so.


GIULIANI: Pardon me? No, we should come up with an agreement now. The city is in a -- is coming out of a crisis and is having to get used to living a different way. And one of the great benefits of this terrible, awful tragedy is that the city is more you unified than it ever has been before. And I want to do something that unifies the city, because I love this place. I mean, I've invested before this 7.75 years into trying to make the best city in the world.

And it then got devastated by this horrible attack. It's still best city in the world, but it's going to need a lot of help. It's going to need a lot of assistance. It's going to need a lot of unity. And it's going to need politicians who think outside the box, who think outside the old way in which we used to practice politics. So that all came to me last night, that I should start thinking that way also.

QUESTION: (OFF-MIKE) I mean he came out on top. And he was the person (OFF-MIKE) sees two cities existing and this and that.

GIULIANI: Yes, I'm not going to -- that's -- here, once again, a terrible thing happened to us. And we can start think differently as a result of that. Which means we can everyone conduct our politics differently as a result of that. Or we can go back to the way we used to conduct our politics in the past.

And I think it's a lot better if we try to conduct our politics differently now. And things that people said before, you know, they have a right to rethink things now. They have a right to rethink things in light of a horrible, awful, unimaginable thing happening.

And frankly, I started thinking about that when I was with the two different groups of families, the fire families that went down to the World Trade Center today and the first group of civilian families that went down.

The pain and suffering that comes out of this is only beginning. There's more of it that's going to happen. And it is enormously important that we remain unified. And therefore, I'm going to see if we can all agree on an approach that allows us to handle this in the best interest of the city.

QUESTION: You said that you've come up with a position. Could that be a position other than mayor?

GIULIANI: No, I don't want a job, if that's what you mean. No, no, no. I meant an approach to how we handle this that we agree on, that makes -- there are now three candidates for mayor. We don't know which one of them is going to be the mayor.

So I'm going to present them with a proposal that as the current mayor, who has I think the best interest of the city at heart, that I think will help to unify this city. And I want to see if I can get their agreement. It has nothing to do with me. And it has to do the city.

UNIDENTIFIED FEMALE: Last question please?

QUESTION: Sheldon Silver has gone on record saying that you have approached him and other leaders involved saying that you're seeking to overturn term limits. Sheldon Silver said this on the record. Is he speaking accurately?

GIULIANI: That's a possibility. I mean, we might do that, but I'm much more hopeful that we can work out a unified approach to handling this.

QUESTION: (OFF-MIKE) you on after December 31?

GIULIANI: Let's see if we can come up with a unified approach first. And then I'll tell what you it is.

UNIDENTIFIED FEMALE: Very last question.

GIULIANI: I should present it to them first. I've had a chance to present to one or two of them, but not to all three at this point. Don't do that. Try -- you all try to get out of what you used to do, too. Try it.

QUESTION: (OFF-MIKE) legislation or would this be an agreement?

GIULIANI: Let's see what the agreement is. I need the opportunity to talk to them about it, but the objective is to come up with an approach that the candidates will agree with, I will agree with, and that will allow to us provide the best mechanism for getting ourselves through this, getting ourselves in a position where the city is secure, the city is safe and everything is handled seamlessly.

And I believe this will -- it is as having been mayor for the last 7.75 years, it's the best judgment that I can come up with as to the way to handle this. And also, to make the people of the city feel confident that their concerns are going to be put first and not anybody's particular desire to be in office. The three candidates or mine. Thank you.

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