Links to Consider, 11/27/2024

Alice Evans and Augustina Paglayan on schooling like a state; Frances Woolley on colon cancer screening; how the police interrogated Daniel Penny; David Brooks on elitism

In a podcast with Alice Evans, Augustina Paglayan says,

as I started investigating the ways in which politicians make decisions about education, naturally I kept going further and further back in time to the foundational period, the period when education systems were created and set, it's the period when many of the education institutions we have to this day were created. And looking at the debates that politicians had around that foundational period, what I discovered was that their goal was not to promote skills, their primary goal was to use primary education as a means to instill obedience to the state and to its laws in order to promote social order, promote political stability, and ensure the sustainability of the status quo.

It seems that she arrived at her analysis through research, not because she is a libertarian crank.

Frances Woolley writes,

no one wants to talk about life expectancy; to tell patients that it's not worth screening them because they're likely to die within the next 10 years. So the American Cancer Society recommends simply avoiding these conversations: "patients may be receptive to a discussion with a clinician of screening cessation based on age and health status, but not emphasizing limited life expectancy" (source).  In this spirit, the Ontario government's colorectal cancer screening guidelines say "You can do an easy-to-use at-home test if you’re at average risk for colon cancer. You are at average risk if you are ages 50 to 74." That makes it sound like your risk goes down after age 74. It doesn't. It's just that historically many 74 year olds couldn't expect to live 10 years or more, so it wasn't worth screening them. 

But no one wants to tell you that. And people may die because of this systematic refusal to have difficult conversations.

So should you still be getting a colonoscopy at 75?

That is a trick question. Because the cancer screening test that Woolley is talking about is called a fecal immunochemical test. It costs only $75, and you can do it at home.

Colonoscopy for cancer screening is one of my pet peeves. I think that the cost per life saved is astronomical. And this is particularly outrageous given that there are much cheaper alternatives.

Medical procedures with high costs and low benefits are one of the chief reasons that the U.S. spends more on health care than other countries, with little to show for it in terms of outcomes. That is a major theme in my book Crisis of Abundance.

The Free Press reports,

Penny, then 24 years old and a former Marine, even waives his rights to an attorney and to remain silent, ostensibly because he thinks he has nothing to hide. But then the questions begin—and they’re not about Neely, a schizophrenic with a long arrest record. They’re about him.

I sat on a jury on a case like this. The police were talking to a 17-year-old black kid who had participated in a murder by supplying the murder weapon—a bat. But he was under the impression that he was a witness, and he signed away his Miranda rights.

The jury deadlocked at 6-6. He was obviously guilty, but the prosecutors over-charged him.

I voted to acquit, because I was offended by the police conduct. If you don’t clearly inform someone that they are a suspect, and they are under the impression that you are talking to them as a witness, then you are de facto denying them their right to remain silent and to have an attorney present. If I were on the Penny jury, my guess is that I would vote to acquit for the same reason.

David Brooks has a long piece (paywalled) called How the Ivy League Broke America. The thesis is that once elite colleges started admitting on the basis of cognitive ability, they created a new sort of class-based society, supplanting the old WASP class society of the 1950s.

This is pretty much just a repeat of what he wrote 25 years ago in Bobos in Paradise. And as with that book, he bathes the college-educated elite in flattery while offering some mild criticism of minor flaws, ignoring their major deficiencies. I was bothered by Brooks back then, and I am bothered now. (My old essay holds up quite well. Its praise for the ACLU is no longer valid, but it was reasonably on the mark at that time.)

Basically, he fails to see that the college-educated elite has an unwarranted moral arrogance. They are often wrong but never in doubt.

Brooks makes a further error in describing elite college admissions as based exclusively on cognitive ability. That is no longer true, if it ever was. Just ask the Asians who have been turned down in favor of people who could put “BIPOC” or “social justice activist” on their application.

If elite colleges really selected for intelligence, we would not see the sort of pro-Hamas demonstrations that take place at Harvard and Columbia.

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