Have I mentioned lately how glad I am that I'm not a Euro??

If I said or implied this you are right I failed to remember PM statements correctly. That said, the data from a PM sponsored study and other studies does suggest my basic contention--smoking costs society more money than it saves when society pays for treaments for smoking related diseases. The CDC-government study in the US also clearly supports this and there are two other underway studies in Europe (The Netherlands and somewhere else) that likely will support this. Now you can try to say the CDC is biased, but I'll say they do as fair as scienitifically possible on such complex questions and frequenlty publish results they were not hoping for (a sign of ethics and standards you would likely not see out of industry studies).

I think "inherently distorted" is way to strong a phrasing. These studies don't just see if someone smoked and associated all chronic illness with it if they did. They are based on the probabilities a smoker will have the problem versus a nonsmoker (controlling for all other factors to make them as equal as possible except for smoking) and then derive positive and negative costs associated with these probabilties at multiple levels (medical care, lost years of productivity, lost years of drawing on social security). I think if you looked at these studies you would be hard pressed to find a fairer and more balanced way to do them (at least from the government sponsored ones which go through peer review).

This was never my point because I was focusing on the fallacy of the general costs benifits to society for smoking. This point obviously was raised in the last article, and it is not too hard from a moral perspective that the rest of the argument (about money instead of quality of life and life itself) should be moot anyway. But again, that wasn't one of the lines of debate I was pursuing at the time, I was sticking to a narrower issue.

 

As I said before though lung cancer isn't even the #1 killer by smoking. It may be the worse death and the one that strikes the youngest—but it isn’t the most common one. The #1 death producing result of smoking is associated with increased CVD-related problems--which these authors seem to be aware of its high level long term costs.

This is only relevant if they have considered cohort effects. More people took up smoking in the 70s than probably had ever smoked before. Given this book is published in 92, we have to see how much health care burden these 70s smokers take one as they get 50-60-70-80 to have a complete answer to that question.

Again, same issue as before, most of this is due to cohort effects (smoking levels generally increased from like 60 to 80 and have been flat our down since).

The health care cost for lung cancer may be 50 fold higher than when they collected their data (say mid-late 80's at the latest for the book to come out in 92--could have been much earlier if they reviewed other studies rather than conducted their own research specifically for the book[less probable]). Lung cancer used to be a death sentence and probably pain meds and crude chemos were the main approach. Now we through all we can at it and have very modestly better success at enormously higher costs.

They are being very selective here. They state Alzheimer's effects 10% of the population. They say there is a protective effect of smoking ("a significant inverse correlation"). They say this (10%) is more than the smoking attributable deaths combined. But they don't say how strong the association is. They are comparing smoking attributable cancers and CVD deaths to total Alzheimers patients (not a fair comparison at all--I’ll get to this later). Further, "Significant" here means statistically significant, and with a large study--they used a meta-analysis so they combined all the data into one test so it is safe to assume the total sample is quite large-- the observed effect may very well be a "statistically-significant practically-insignificant" finding. But for now let us say for now smoking truly is protective on Alzheimers (I find this dubious because I did a medline search and found no recent work supporting this--further if there was a validated and strong protective effect of smoking I can assure you doctors would be proscribing Nicorete gum and patches at the 1st sign of Alzheimers)--and say you have 1% decreased risk for Alzheimers if you smoke. So then what you can say is smoking is associated .1% benefit towards Alzheimers (1/200 people would benefit)—“non-smoking attributable Alzheimers: if you will. Compare that to the smoking attributable cancer and CVD deaths and those figures are swamped. Just a further note, the fact Pharmacother is so selective in what he/she presents and that I didn't find any of his/her work published in the medical lit the last 20 years does not provide me a lot of confidence in his/her overall conclusions.

 

Actually I am thinking Pharmacother refers to the journal Biomed Pharmacother--but I didn't find any study related to smoking/tobacco/nicotene and Alzheimer's in 1994 or another year for that journal. I would be interested to see if someone in the media took a misquote or misunderstood an article in that journal, and that is what you came across. Or maybe I am just looking in the wrong place.

 

It is Biomed Pharmacother. I just got tired of typing all that stuff in.

Couple of things:

I agree that the positive effects on AD and Parkinsons are relatively small in comparison to the claimed CVD and SRC (smoking related cancers -just to save typing!) deaths. I just kinda threw that in at the end because presumption is so far against smoking that you WOULDN'T hear about a positive effect. Which is partly my answer to your absence of journal findings on the subject. The presumptive consensus against smoking prevents researchers from pursuing any avenue that could lead the public to a conclusion that smoking is not bad for you. There have been several studies in England and one Swedish researcher talked about how other researchers thought he was mad when he spoke about positive effects of nicotine on AD and Parkinsons.

Maybe, but lung cancer is the most reliably correlated to death from smoking. And remember that the CDC reported deaths associated with smoking, not caused by it. (Quoting Rosalind Marimont here): "Among risk factors for heart disease, for example, are hypertension, high serum cholesterol, obesity, sedentary lifestyle, smoking, and genetic factors. If we ran SAMMEC computations for each of these factors, we could estimate the number of heart disease deaths associated with each one. But suppose that John Smith, who died of heart disease, had all of these factors. He would have contributed 6 deaths to the total associated deaths. So that when we sum up these results to arrive at the total deaths, we find that our total is much larger than the number of people who actually died of heart disease."

Not sure about that. My understanding was that smoking peaked in the 50s. Even so, if you are right then we just don't know yet I guess. Sounds like a push.

Health care cost in general is also relatively higher, so the same effect would boost the economic cost of other procedures as well. And it would still depend on the success rate, which is still relatively low I believe, versus the cost of the illnesses associated with older retirees, like convalencence etc. The costs of which have DEFINITELY skyrocketed with no end in sight.

Overall very interesting DS. Are you a doctor or something?

 

much better soccer coverage in Europe.


I'm Jealous

 

Look Mango, all your info about Switzerland is great and all, but I didn't tell Houston(ians) to strive for anything in particular. All I said was that according to this large, well-publicised, multinational, annual survey on 39 general, trying-to-be-unbiased-to-the-best-of-their-ability quality-of-life criteria for expatriate execs, US cities come in behind European/Canadian/Australasian ones. Of course those criteria are averaged out to create rankings; clearly Auckland is going to do very well on 'natural environment/cleanliness' and not so well on cultural criteria like 'access to a gazillion amazing museums', right? Now, I'm able to accept that we lack some things or have some faults as a country without having some kind of nationalistic fit and listing all the bad stuff about, say, New York, which *does* have access to a gazillion amazing museums. And yes, I'm sure Houston has some things about it which are much more fabulous than Bern (Tex-Mex and the Art Car Parade, etcetera). But, you know, that's not my point. My point is, on average, with some cities scoring higher or lower on various criteria, the USA's best cities come out worse than Europe's best cities. And Houston isn't even on the list anyway.

Shrug.

 

........but that is on criteria that shows the European/Canadian/Australasian in the best light. When a different set of criteria is examined, the Europeans don't do nearly as well while the United States does much better.

From the first page of this thread:
<i>
Oh, I was talking about the British article - I'm no fan of skinheads, just socialists!</i>

When I gather info that should make a socialist cringe, it is dismissed as not relevant.......... Shrug?

The xenophobia that is associated with Le Pen extends to other European countries, including Switzerland with the tony cities of Bern, Geneva and Zurich.

<i>
....My point is, on average, with some cities scoring higher or lower on various criteria, the USA's best cities come out worse than Europe's best cities. And Houston isn't even on the list anyway......</i>

I can acknowledge room for improvement in the US and Houston, but it seems that the Euros are lacking in a key area, a <b>Soul</b>.

Houston has people from many parts of the world and struggles coping with the growth rate, diversity of languages and customs. The Europeans seem reluctant to embrace the diversity and acceptance of foreigners that is part of everyday living here. Stick to your position of European/Canadian/Australasian superiority because you seem to take relish in it. When you leave this country, do take the memories of:

Indian restaurants
Tex-Mex
Art Car Parade
Dollar stores ran by people from all parts of the globe
Cajuns
etc

because it is doubtful that they will be found elsewhere in your travels and surely not in Bern, Geneva and Zurich.


Mango

 

I'm still wading through this thread. Some excellent posts.

However, let me say that prior to it, I was about to give up on this board, just check in for some Rocket news.

It was so depressing to me for so many to say they would rather discuss pizza brands or video games than the middle east and political issues.

BTW I've always thought that interesting people discuss politics, religion and money at the dinner table and other locations.

 

Like you've never gotten embroiled in discussions over more worldly issues?

 

Uh, why?

Ever been to London?

 

Mango:

" ........but that is on criteria that shows the European/Canadian/Australasian in the best light. When a different set of criteria is examined, the Europeans don't do nearly as well while the United States does much better."

Look, man... that's *obvious*. If I rank the top ten cities in the world on, say, TV channels, then all the American cities are going to win. (French television is *horrible*! NZ only has 25 channels total including cable and satellite! Etcetera, etcetera...) Now, you can reject Mercer's criteria, as HayesStreet has, if it makes you feel better, but frankly this data is on fairly basic things that most human beings would see as important. You know, clean air and health services and housing and safety and all those wacky 'foreign-biased' priorities. If you want to change your judging criteria to Tex-Mex and TV, go right ahead. Cool with me.

"When I gather info that should make a socialist cringe, it is dismissed as not relevant.......... Shrug? The xenophobia that is associated with Le Pen extends to other European countries, including Switzerland with the tony cities of Bern, Geneva and Zurich. "

*Come on*. 40 years ago if I was here this place would be run under a system of *apartheid*. For all intents and purposes most housing is still segregated in this town. I encounter pretty appalling racism on a fairly constant basis here - and Houston is one of the most tolerant cities in the south, with one of the least dodgy histories. There's racism and xenophobia *everywhere*, including Europe. Including NZ. Including *here*. Now, I don't know how we can compare the 'internal' racism of the USA and the 'xenophobic' racism of Europe fruitfully, but my point is that I find *all of it* distasteful as a socialist, and I don't know which is worse. Again, shrug.

"I can acknowledge room for improvement in the US and Houston, but it seems that the Euros are lacking in a key area, a Soul."

Your argument is that Europe has 'no soul'? That's pretty weak. How do I counter that with anything but 'yes it does!'??

"Houston has people from many parts of the world and struggles coping with the growth rate, diversity of languages and customs. The Europeans seem reluctant to embrace the diversity and acceptance of foreigners that is part of everyday living here."

As someone else asked, have you ever been to London? *That's* a diverse place... and I *like* the way Houston is so filled with people from different places. That's really cool and I never denied it. But there are extremists everywhere including here, as someone else said upthread. How do we compare them and find out who's worse? It's really difficult.

"Stick to your position of European/Canadian/Australasian superiority because you seem to take relish in it. When you leave this country, do take the memories of:

Indian restaurants
Tex-Mex
Art Car Parade
Dollar stores ran by people from all parts of the globe
Cajuns
etc

because it is doubtful that they will be found elsewhere in your travels and surely not in Bern, Geneva and Zurich."

Look, I can find better Indian restaurants in Sydney, Auckland, and London than I've ever found here. There are also several (admittedly inferior) Tex-Mex restaurants in those places. Evil dollar stores full of crap are everywhere, and there's even a Cajun restaurant run by a real Cajun in Auckland too (hey, *I'm* half Cajun so I could probably count myself!). I'll give you the Art Car Parade, though. That's awesome and unique. And of *course* I'll miss some things about Houston.

Mango, I'm not trying to ruin your life in Houston or be a snotty b**** or anything. But I do have to hear 'we're the ******* greatest country in the world' go unchallenged *every single day* here in the US. I just want to shake up that assumption a bit. Again, shrug.

 

double post, sorry.

 

Strange, but in reading about Mercer, I found this:

"American cities all score highly on political stability, availability of consumer goods, and quality of medical services..."

Seems you were talking out of your, uh, arse, about US medical care, huh?

And really when comparing Europe and the States, even if you accept the Mercer survey as a valid place to start, there are plenty of low ranking European cities on the list. Lower ranked than many US cities, as a matter of fact.

You also ignore the jist of Mango's post, which is that while Bern and Zurich are high on the list (they have good facilities and are safe), they are also very expensive and allow almost no immigration. Now these two things are NOT of concern to expatriate executives, for why should they care? They expense the high cost of living, and they are ambivalent to immigration policy. However, when deciding whether you or I personally want to live in a city, living in a whitewashed practically 'gated' city is quite contrary to your most socialist perspective dimsie, or so one would infer from your constant harping on social inequity and your clamoring from the hills of how much of a liberal thinker you are.

So, the Mercer Survey is what it is and no more. It is a good index for rich corporate executives to decide how much they should pay their people to go to certain places. It is not, however, even an attempt to serve as an index for people comparing which cities are overall the best for permanent residence. Nor is it made for geopolitical or socio-economic evaluations.

It is should also be mentioned that the gap between the cities in the first world is not a large one. Major differentiations only show when you start to move down the list out of the first world. Also that crime is the major differentiator for US cities vis-a-vis Vancouver etc. Personally, I feel totally safe in NY, Chicago, San Fran, Houston etc, so I would have to disagree with Mercer on their evaluation. Especially when they use base crime statistics that do not reflect the areas expatriate executives are most likely to be staying, working, or spending leisure time in.

 

Hrm. Did I ever say that your medical *care* was bad? No, I said your *system* was f*cked up (overly expensive, not universal). Which it is. However, you're right that using the Mercer criteria probably wouldn't work as a backup for my pinko commie argument there, since it *doesn't* care about universal access. Didn't I already say that upthread? You changed your tune fairly rapidly on using Mercer as soon as you found out they didn't rank universal healthcare as a criteria. Come on, HayesStreet. Either you accept it as valid data or you don't. You can't just take some of the pro-US stuff and reject the rest.

Oh, totally. And actually the US has 20 percent of the top fifty cities, if I recall the rankings correctly. I never said you guys sucked, or anything. I did, however, say, that *the best European/Canadian/Australasian cities come out higher in the rankings than the best American cities*. Which is true.

Oh, is *that* what the gist of Mango's post was? I thought it was that Europe has no 'soul'. Yeah, I think it's legendary that Switzerland is very expensive. San Francisco is too, isn't it? Houston's fairly reasonable, cost of living wise. The gist of *my* post was that racism/xenophobia manifest themselves differently in different countries. The Swiss prefer to have restrictive immigration policies, while the US prefers to concentrate on treating the minorities it already has like crap. Swings and roundabouts, apples and oranges, don't know how to compare and see who's worse, blah blah blah...

I take issue with your assessment about permanent residence. I know the survey isn't made *for* that decision, but if those 39 criteria aren't important in deciding where to live, what actually are? Look, I only brought up the Mercer thing because it's a very widely-publicised annual survey done by a *huge* company and it's *much* more 'scientific' than posting two links about socialists and skinheads and b****ing about Europe's evils and how Americans 'don't like what they see' of other countries. Sure, it's not perfect. What survey is? Now, if you can give me some other data that you think analyses hundreds of cities *worldwide* more appropriately for 'permanent residence' and 'geopolitical/socio-economic evaluations' then please do so! Otherwise we're *all* talking out of our arses, including you.

By the way, if you feel 'totally safe' walking down the street in Houston, you're a brave soul! Give me the tube any day...

 

Hayes_Street, enjoyed the discussion as well. I would add though if there was a "strong" protective effect (practically significant if you will) of smoking on AD or Parkinsons it would be either 1) extensively studied right now to see if this is the case; 2) be used by practicing physicians to treat people with the first sign of disease. Those are terrible diseases and any edge the medical or scientific community could get on them they would. They would simply not recommend smoking as the delivery system, it would be through gum or the patch or what not. Many doctors do for instance proscribe an aspirin a day to reduce stroke risk and a few encourage patients with CVD who are light drinkers not to stop because of protective effects.

BTW-I am psychologist who interacts a lot with epidemiologists, biometricians and physicians. I also indulge in the occasional cigarette or even better a Cuban , but I am aware nicotine is one of the most addictive substances we know of once your body gets used to a certain sustained level in your bloodstream. Just a little story of mine, when I last had a fresh box of Cubans the third strait day home from a long work day I sort of went unconsciously to the box, I kind of caught myself and decided I better wait a few days to avoid this being a routine. It probably was a few weeks before I had the next one, not a bad thing.

 

For a number of years now, we have seen the highest inflation in pharmacy costs. What the US pays for the same Rx is often factors above what other countries pay for the same drug.

It would be interesting to see how much longer some of the 'unversal care' waiting lines would become if we didn't subsidize everyone else's drugs.

We also pay heavily for Health Care R&D, which many others will benefit from also.

Americans want health care when they want it, and they want extreme measures to save lives, even elderly who probably won't live a few more months (that is where a large % of our overall HC dollars go).

 

Actually I have consistently *rejected* the Mercer criteria. Feel free to point out where I've endorsed it. I merely clarified that despite your rants against our medical system even YOUR survey did not rank the US as lacking in that specific criteria. Nice try but you'll have to work harder than that to catch me in a contradiction.

And that does leave us with you trumpeting a criteria that is COMPLETELY inconsistent with your own philosophical leanings. Oops.

Only in its assessment of crime, which is the major differentiator between the US cities and the others at the top of the list. I *assumed* that you had *read* the survey, and that since you were harping on our healthcare that access or quality of healthcare was the difference, until I read the survey myself and found out you were just playing it by ear. As far as crime goes, cities like Bern and Zurich and Geneva are similar to the 'closed gate communities' you pinkos (your words) rant constantly about, which is why crime is lower. They are too expensive for poor people, and have no cultural clashes because they only allow one culture to live there. Again, neither is consistent with your own philosophy.

Indeed it is. And yet there seems to be a vibrant multicultural community there. More than can be said for Bern or Geneva or Zurich. All of which goes to my point that Mercer is NOT applicable to anything but its original purpose, which is deciding on compensation of expatriate executives. It is NOT made to evaluate the desirability of permanent residence.

True, racism/xenophobia does exist everywhere. Certainly we have our problems but we DON'T merely exclude other cultures from our borders as a solution to the problem ala Switzerland. Another reason Mercer is not applicable to our conversation.

Actually, you have convienently ignored my original answer to this, which is that Mercer's criteria is weighted toward an object other than 'desirability or quality of life' for permanent residence. Why? Because as I pointed out, it specifically VALUES the safety of a homogenized culture (ala Bern/Zurich/Geneva) and the safety of an expensive neighborhood, for example. When deciding where I want to live, and raise my kids, for example, I might want to value a multicultural community. That goal is at odds with the goal of the Mercer survey, which is to estimate the quality of life for an expatriate executive on temporary duty in different parts of the world.

Don't think you've been on the tube lately. Mind the gap ...

 

Maybe. Maybe not. There is at least the possibility of a chilling effect on research into the positive effects of nicotine. Certainly doctors would not be prescribing cigarettes, BUT the government would certainly be concerned about sending mixed signals to the populace. Joe Q Public could easily rationalize thier smoking by saying 'yeah i risk cancer but I reduce the risk of AD or Parkinsons because nicotine is good for me.' A government that has made a policy committment and a public relations committment in the opposite direction, and has consistently used 'science' as the backbone of its argument would not want contradictory research legitimized. AND we all know where the majority of research money comes from, right? It is the same dilemma the government is in with mar1juana etc. It is hard to say 'Just Say No' and "Just Say No unless...'

As a layman I won't try and match medical knowledge with you, but the jist of the studies seems to make sense. Nicotine stimulates the ol synaptic firing and AD/Parkinsons negatively affect those processes. Thus nicotine can help (at what level I have no idea) in those cases.

That's not something I'd brag about, Doc.

I am assuming that you are not in the US then, since we know Cubans are illegal there! (unlike being in London, where I can for the first time merely stroll out for a box whenever! )... Any recommendations? I have only recently begun to explore the Cubans...

 

--------------------------------------------------------------------------------
Originally posted by Mango
I can acknowledge room for improvement in the US and Houston, but it seems that the Euros are lacking in a key area, a Soul
--------------------------------------------------------------------------------


<i>
Uh, why?
</i>

Because when they have had chances to display a <b>soul</b>:

Bosnia
Immigration policies
Naturalisation policies
World leadership

they seem to have drawn back. The Swiss are supposed to be noted for being great humanitarians, yet there is evidence that disputes that image.

Maybe <b>soul</b> is the wrong word..................<b>backbone</b> is a better choice?

With the creation of the EU, it seems there would be more statesmanship/leadership from Europe than what the world is getting, yet the British seem to be the only European actor on the world's stage.

Again, the unanswered question:
Why do so many migrate to the US rather than countries in Europe?
<b>
Since the United Nations has quite a bit of administrative activity in Geneva, what have the Swiss been paying a year in membership dues? </b> Take the cash flow from the white collar UN staff out of the Geneva economy and see if it makes an impact on their <i>Mercer</i> ranking.

Cairo and many other poor cities could use the economic boost of the major UN administrative presence that is Geneva. Also, looking at the <i>Mercer</i> figures, many cities would be less expensive than Geneva.

The UN topics will have to be the subject of another thread because it is straying a bit too far from the title of this one.


quote:
--------------------------------------------------------------------------------
When you leave this country, do take the memories of:

Indian restaurants
(...)
because it is doubtful that they will be found elsewhere in your travels...
--------------------------------------------------------------------------------

<i>ever been to London? </i>

The list was meant as a set, not to be picked out and examined on a singular basis. I know that London has Indian restaurants, but how are the Tex-Mex and Cajun restaurants?


Mango