Andrew Sullivan's Blog, page 73

Carter In

Ashton Carter had a plan to fix the Pentagon—now he has the chance to implement it http://t.co/RU4O5zKl6G pic.twitter.com/M7VTS60Vzd

— Quartz (@qz) December 3, 2014

To replace Hagel, the White House has reportedly picked Ashton Carter, a theoretical physicist and former Harvard prof who served as deputy defense secretary under both Hagel and Panetta. Andrew Prokop provides more context:

Carter has a great deal of mainstream and bipartisan credibility, and he’s clearly well-equipped to manage the Pentagon bureaucracy. But he’s not particularly known for strategic thinking about the Middle East, so his selection would likely indicate that the White House will continue to center its foreign policy development process in the National Security Council rather than the Cabinet.

Carter is respected by many on the right: he was unanimously confirmed by the Senate to be Panetta’s deputy in 2011, Sen. John McCain has called him “a hard-working, honest, and committed public servant,” and conservative commentator Jennifer Rubin wrote in 2013 that Carter’s appointment could “add some muscle to an administration that has too rarely backed up its rhetoric with action.”

This could give him a good chance at winning approval from the GOP-controlled Senate, and McCain’s Armed Services Committee, quickly next year. However, he may face some criticism from liberals for his hawkish leanings on certain issues — for instance, in 2006, he co-wrote an op-ed calling on the Bush administration to strike and destroy the long-range missile North Korea was then constructing.

McCain and other Republicans say they could see Carter as an ally of sorts, but they doubt the administration will grant him any more independence than his predecessors enjoyed:

McCain said he expected to work closely with Carter on issues that aren’t micromanaged by the White House, such as reforming the process by which the Pentagon develops and purchases weapons and cutting the Pentagon’s bloated civilian bureaucracy. On issues where the White House has taken a policy lead, such as the negotiations with Iran or the war in Syria, McCain predicted that even if he did cooperate with Carter, it would not make much of a difference. “He’s not going to have a say in it,” McCain said. “I certainly could work with him — on Iran and Syria — but I guarantee that he would not have any influence on those decisions.”

That’s roughly Ed Morrissey’s take as well:

That makes sense on a political level, and perhaps an organizational level as well. It won’t help what really ails the Obama administration’s defense policy, though, which is that it’s being controlled by his inner circle rather than truly independent policymakers. Unlike George Bush’s decision to bring in Robert Gates in 2006, which helped change the strategy in Iraq and the approach to national-security policy, Carter’s appointment will mean the same incoherence that allowed the White House to float Johnson’s name last week as a trial balloon will continue. He won’t have the political clout to force an independent point of view within Obama’s inner circle, and Carter will just be another chess piece to sacrifice later when more failure results.

Loren Thompson calls Carter an inspired choice:

If cabinet members were picked purely on the basis of their resumes, Ash Carter would a compelling candidate for Secretary of Defense. The one facet of his credentials that does not come through in a resume or curriculum vitae, though, is that he is a smooth political operator — engaging, agreeable, and a good listener (which helps a lot on Capitol Hill). After decades of learning everything worth knowing about national defense, Carter usually finds himself the smartest person in the room and thus doesn’t have to strain to prove his expertise.

In other words, normal people tend to like Ash Carter — which is probably not something you could say about most defense wonks (or medieval history majors). That quality is very important in navigating Washington’s political culture, where relationships are crucial to success.

The Bloomberg View editors like Carter too:

He’s not on the right side of every procurement debate. He remains too fond of big-ticket items, such as the F-35 fighter, that need to be scaled back. He has been overly optimistic about the promise of saving money through smarter contracting. And in his stint as deputy secretary, he was timid about even minor, sensible changes in the biggest drain on military spending: the Tricare health plan and other benefits for veterans and their families.

On the plus side, Carter understands the importance of maintaining a robust nuclear arsenal, could play a strong role in shaping (and selling to Congress) a nuclear deal with Iran, and knows more about the reclusive and dangerous regime in North Korea than just about anyone outside the Hermit Kingdom.

Gopal Ratnam and colleagues look over what the new SecDef will have on his plate:

Carter will take charge of a Pentagon in the midst of an intensifying battle against the Islamic State. The administration has flatly ruled out the use of ground troops to fight the group in Syria and Iraq, but months of American and allied airstrikes have done little to weaken the militants or dislodge them from the vast areas of the two countries that they control. Carter will also have to figure out how to continue withdrawing U.S. troops from Afghanistan without allowing the Taliban to retake the country’s major cities amid a sharp spike of attacks inside Kabul. Russia’s continued aggression in Ukraine and Eastern Europe, as well as China’s assertive moves in its territorial waters, will also pose difficult and challenging questions for Carter and his staff.

The CDC vs Penises

The latest federal medical guidelines for circumcision are now out, and they emphatically want to return to the era in which infant boys are routinely subjected to the surgical removal of their foreskins – and even adolescent and adult men encouraged to cut their penises. A couple of things need to be emphasized, it seems to me. The core argument is about lowering the risk of HIV infection:

“The first thing it’s important to know is that male circumcision has been associated with a 50 to 60 percent reduction of H.I.V. transmission, as well as a reduction in sexually transmitted infections such as herpes, bacterial vaginosis and the human papilloma virus (H.P.V.), which causes penile and cervical cancer,” Dr. Jonathan Mermin, director of the CDC’s National Center for HIV/AIDS, told The New York Times.

The evidence for this is entirely with respect to heterosexual sex, and in sub-Saharan Africa, where, unlike in the US, heterosexual sex accounts for the vast majority of HIV infections. It refers, moreover, only to those cases where men are infected by HIV-positive women – a small fraction of the total HIV cases in the US. You wouldn’t know this from Mermin’s statement – which seems to me designed to scare parents with the HIV boogeyman, rather than present them with a clear sense of the tiny potential health benefits involved. (There’s no evidence that circumcision can reduce the chances of HIV infection in gay sex, which accounts for the big majority of US HIV infections.)

To flesh out its case, the CDC cites a statistic that estimates that 10 percent of HIV infections in men can be attributed to female-to-male transmission in the US. It’s worth reiterating that these statistics are estimates, not actual numbers. And the actual number of men estimated to be at risk from this kind of infection is a mere 4,000 a year. Around 2 million boys are born in the US every year. So the future risk of an infant boy getting infected with HIV by a woman, using the CDC’s own argument, is 0.2 percent, or two in a thousand baby boys. And remember, we cannot know that these men were infected by women – it’s an inference – and self-reporting on the matter is extremely unreliable.

We have some other circumstantial data with respect to HIV transmission and circumcision in the West. The AIDS epidemic was far worse in the US – with much higher rates of circumcision – than in Europe, where the infant mutilation was far less prevalent. We’ve also seen a major shift downward in circumcision rates in the US and no sudden upsurge in infection rates. Then there’s the simple fact that we now have a non-surgical preventative daily pill that prevents HIV infection, as well as condoms, providing a way for men to protect themselves from HIV without permanently scarring their dicks.

Somehow, none of this context is spelled out in the recommendations. Neither is any non-medical concern – such as not having your body permanently mutilated without your consent. The impact on sexual sensitivity is also unmentioned – because pleasure has no place in assessing mere medical costs and benefits. The reductions in the risk of getting herpes or HPV are also minimal. If I were to offer any recommendations for the final report on this, it would be for the real and minuscule potential medical benefits of circumcision to be spelled out more clearly, and the non-medical costs to be weighed at least in part. When the potential benefits of this are so marginal, the case for doing nothing – and doing no actual harm – seems to be a powerful one.

Correction Of The Day

A touching gesture by a loving family:

Kai was shocked by his mum’s openness. “I am so happy with what she has done. This last week has changed everything for me,” Kai said. “I am still me but I am more me than I was a few days ago and feel free.

Dressed To Diagnose

Anna Reisman explains why doctors’ clothing matters:

In days of yore, the doctor was clearly identifiable by the white lab coat over shirt and tie, his agreeable nurse counterpart unmistakable in white dress and cap (which, depending on one’s school, might be shaped like a coffee filter, sailor’s cap, or a hamantaschen). But in the 21st century, especially in primary-care medicine, much has changed; with more categories of clinicians (nurse practitioners, physician assistants) in every sphere of medicine, the traditional clinical clothing boundaries have blurred.

The definition of what counts as professional clothing is also in flux, thanks to increasing knowledge of infectious risks. Earlier this year, the Society for Healthcare Epidemiology Association (SHEA) published new guidelines for healthcare-personnel attire in hospital settings. Their goal was to balance the need for professional appearance with the obligation to minimize potential germ transmission via clothing and other doodads like ID badges and jewelry and neckties that might touch body parts or bodily fluids. The SHEA investigators’ take-home points regarding infection: White coats should be washed weekly, at the minimum; neckties should be clipped in place (70 percent of doctors in two studies admitted to having never had a tie cleaned); and institutions should strongly consider a “bare below the elbow” (BBE) policy, meaning short sleeves and no wristwatches or jewelry.

(Image via Wiki: “Paul Fürst, engraving, c. 1721, of a plague doctor of Marseilles. The plague doctor’s costume was the clothing worn by a plague doctor to protect him from airborne diseases. The costume consisted of an ankle length overcoat and a bird-like beak mask often filled with sweet or strong smelling substances (commonly lavender), along with gloves, boots, a brim hat, and an outer over-clothing garment.”)

The View From Your Window

South Dartmouth, Massachusetts, 9.35 am

A Marijuana Breathalyzer

It’s in development:

WSU chemistry professor Herbert Hill says that the team is using ion-mobility spectrometry – the same tech used by airport security and custom agents to detect drugs and explosives – and repurposing it for the new device. Unlike an alcohol breathalyzer, the WSU solution won’t determine how stoned a driver is, but instead just detect the presence of THC. After that, police would follow up with a blood test to be used as evidence in court, similar to an alcohol DUI.

David Knowles provides context:

While driving while stoned is against the law in all four states—Washington, Colorado, Alaska, and Oregon—where marijuana has been made legal for recreational use, as well in those where the drug has been given the green light for medical use, police have had to rely on blood tests and traditional standardized field sobriety tests such as walking a straight line. A 2012 studyfound that just 30 percent of those under the influence of THC failed the standard sobriety tests, and the results of blood tests can take up to twenty-four hours.

Samantha Murphy Kelly notes that this “isn’t the first time a product intended to keep marijuana-influenced drivers off the road has introduced”:

Earlier this month, a breathalyzer called Cannabix, which also detects THC in one’s system, was revealed at the National Marijuana Business Conference in Las Vegas. Cannabix is slated to roll out first to law enforcement and businesses, then to consumers; it is scheduled to hit the market next year.

Mental Health Break

Just let it play:

Putting Government Programs To The Test

Ron Haskins declares that “the last six years have seen the most impressive expansion of evidence-based policy in the history of federal social programs”:

The Obama administration has launched a series of evidence-based initiatives that have the potential to revolutionize the way the federal government funds social programs and what program sponsors at the state and local level must do to win and retain federal dollars. Specifically, grantees must show they are spending their federal dollars on programs that have evidence from rigorous evaluations of producing positive impacts on children’s development or achievement as measured by outcomes such as teen pregnancy, educational achievement or graduation rates, performance at community colleges, employment and earnings as young adults, or reducing rates of incarceration. Second, they must evaluate their programs using scientific designs to ensure that they are continuing to have impacts and to reform the programs if they are not.

This strategy requires a pipeline of social programs that have been tested and shown to be effective by rigorous evaluations. However, experience shows that most social programs, including some of the most celebrated such as DARE and Head Start, produce modest or no impacts that last when subjected to rigorous evaluations. An important virtue of focusing on evidence is not simply that the public will have reliable information about whether programs work, but that the evidence places pressure on programs to change and improve when they are not working.

He lists five examples of programs that work. One is a promising early-education initiative:

Success for All is a comprehensive school-wide reform program, primarily for high-poverty elementary schools, with a strong emphasis on early detection and prevention of reading problems before they become serious. Key program elements include daily 90-minute reading classes, each of which is formed by grouping together students of various ages who read at the same performance level; a K-1 reading curriculum that focuses on language development (e.g., reading stories to students and having them re-tell), teaching students the distinct sounds that make up words (i.e. phonemic awareness), blending sounds to form words, and developing reading fluency; daily one-on-one tutoring (in addition to regular classes) for students needing extra help with reading; and cooperative learning activities (in which students work together in teams or pairs) starting in the grade 2 reading classes.

The impact:

On average, 2nd-graders at Success for All schools score approximately 25-30% of a grade level higher in reading ability than their counterparts at the control schools.

Ebola, ISIS, Putin: Meep Meep Watch

Cast your mind back, if you can bear it, to the frenetic last days of the campaign in the mid-terms. The world, the GOP kept insisting, was coming undone – and everything was Obama’s fault. Somehow, Obama had fumbled the response to Ebola, letting infected people into the country, and risking a huge and fatal pandemic. At the same time, ISIS represented a grave threat to American security, was expanding with no limits in sight, proving that Obama had lost Iraq or thrown “victory” away in an act of reckless disengagement. And for good measure, Russia’s Putin was running rings around the president, creating a new world order in the Caucasus, while Obama fecklessly wrung his hands.

As a piece of political performance art, you have to hand it to the Republicans. They rolled up so many base-tingling themes into one hellish, end-times scenario: Obama as Carter, unable to stand up to the Soviets Russians; Obama as secret Muslim terrorist, standing by as Islamists terrorized Iraq and Syria; Obama as a dangerous import from Africa, which is why, we were told, the “O” in Ebola stood for Obama.

Funny, isn’t it, that almost all these themes evaporated after the election. And we now, moreover, have more time and evidence to judge how the president has responded to these different, emergent challenges. There have been no new Ebola cases in the US since the election; and the demon doctor who went bowling is now cured. Today, Obama touted some other measures of progress:

The administration announced Tuesday that it has set up a network of 35 hospitals across the country to deal with Ebola patients. It also said that the number of labs that can test for Ebola has increased from 13 in 13 states in August to 42 labs in 36 states. The White House said the administration has also increased the deployment of civilians and military personnel in West Africa, bumping the U.S. presence to about 200 civilians and 3,000 troops. It said the U.S. has opened three Ebola treatment units and a hospital in Liberia …

NIH researchers last week reported that the first safety study of an Ebola vaccine candidate found no serious side effects, and that it triggered signs of immune protection in 20 volunteers. U.S. health officials are planning much larger studies in West Africa – starting in Liberia in early January – to try to determine if the shots really work.

The downside? The GOP is unlikely to apportion enough money to keep the progress up. Concern about Ebola seems to be acutely timed to election campaigns. Afterwards? No longer that worried.

Then the campaign against ISIS. I’m still opposed to what the administration has done. But it behooves me to note today’s key measure of real progress – the new Iraqi prime minister’s deal with the Kurds on oil revenues:

In reaching a deal, Mr. Abadi, who has been prime minister for less than three months, has further distanced his government from a legacy of bitter sectarian and ethnic division under his predecessor, Nuri Kamal al-Maliki. As prime minister, Mr. Maliki deeply alienated the Kurds and enraged Iraq’s Sunni Arab minority with his confrontational personality and policies that were seen as both exclusive and abusive. “The new team, under Abadi, is a cooperative team, a positive team,” said Mr. Zebari, a Kurdish politician who was also Iraq’s foreign minister in the Maliki government.

This is the easy part, compared with an attempt to include the currently revolting Sunnis into a genuinely multi-sectarian government, and to roll back the territorial gains of the Islamic State. But it’s a start. My own skepticism about whether Abadi was truly a unifying figure deserves provisional retirement. And the IS has been rolled back in several key areas. And Kobani has not fallen. If you take Obama’s posture at face value – that he was trying to prevent much worse happening in Iraq and laying out a years-long strategy to nudge Iraq’s democracy along – I can’t see clear evidence that he has failed. Within the very limited goals he set, he has so far succeeded.

Then Putin.

The right was all aglow either with envy of the diminutive tantrum-thrower or with disgust that he had so easily rolled the West on Ukraine. Many found the slow, undramatic unfolding of sanctions as pathetically weak in the face of such unvarnished aggression. But, again, look where Putin is now. I’m with Kevin Drum:

Ukraine is more firmly allied to the West than ever. Finland is wondering if it might not be such a bad idea to join NATO after all. The Baltic states, along with just about every other Russian neighbor, are desperate to reinforce their borders – and their NATO commitments. Russia has been dumped from the G7 and Putin himself was brutally snubbed by practically every other world leader at the G20 meeting in Brisbane. Economic sanctions are wreaking havoc with the Russian economy. China took advantage of all this to drive a harder bargain in negotiations over the long-planned Siberian gas pipeline. Even Angela Merkel has finally turned on Putin.

Russia, meanwhile, is headed for an outright recession next year, hobbled by sanctions and the collapsing oil price (caused in part by America’s shale oil revolution in the Obama years). Now, as with Ebola and ISIS, there are obvious caveats. Obama’s successful cornering of Putin could mean the dictator could get even more reckless; Ukraine remains torn apart in the East. But from the perspective of now, does Putin seem the stronger strategist or does Obama?

I point this out because the conservative media-industrial complex is really about delivering news that can work as political messaging. When the news doesn’t fit that template, they move swiftly on to something else that does. But reality tells us something different: that you should judge a presidency not by short-term panics, but by long term progress in the face of contingent events. Six years after the worst recession since the 1930s, we have accelerating growth, a collapsing deficit, falling healthcare costs and universal health insurance; a decade after the Federal Marriage Amendment, we have over 30 states with marriage equality; six years since Obama took office, we have the toughest new carbon regulations yet on the books and an agreement with China.

I’ll say it again. Meep meep.

(Photo: Win McNamee/Getty)

Ruble Trouble, Ctd

With oil prices on the downslope, Russia’s currency has been losing value for weeks. But yesterday, it suffered its steepest one-day drop in value since the country’s 1998 financial crisis. In most countries, such a precipitous decline would set off alarm bells, but Jason Karaian doubts Putin will do anything about the falling ruble unless or until it starts to cut into his favorables:

Despite the steady economic deterioration—as reflected by the tumbling ruble—Putin’s popularity at home has soared. Granted, the president’s approval rating slipped from 88% in October to 85% last month, but that will hardly ring alarm bells around the Kremlin. Putin says he wants to stay in power for another 10 years, and the recent polls show the he will probably experience little resistance in doing so. A survey yesterday (link in Russian) suggested that he would win more than 80% of the vote if he faced re-election today.

Bershidsky argues that Putin is taking a bigger risk than he thinks:

Putin has explained the government’s strategy this way: The national budget is denominated in rubles, not dollars, and as Russia’s main export, oil, loses dollar value, the currency devaluation offsets the loss. This allows the government to keep its promises for social programs, in nominal terms. As imports drop, the theory goes, domestic producers will pick up the slack, and most Russians aren’t going to feel much of a pinch unless they travel outside the country or buy a lot of imported clothes, electronics and fancy foods. In any case, the people who do such things aren’t Putin’s biggest supporters. He relies on the poorer, older, more nostalgic and less educated electorate, which wouldn’t be hurt by the devaluation.

The problem with these expectations, of course, is that Russia imports a lot of the most basic products. … Even lower middle class Russians will notice when they can no longer afford shoes, cosmetics, medicine or cheap electronics.

Zachary Karabell, on the other hand, sees the falling ruble as giving Putin a chance to double down on his proto-fascist tendencies:

The not-so-veiled chortling in the United States and elsewhere that lower prices will force changes in Russia is, therefore, premature at best. If anything, lower prices could lead to more xenophobia and nationalism, and more Russian aggression over Ukraine and natural gas to Europe as Putin finds other ways to maintain power and prestige at home. It also is leading Russia to attempt to build stronger ties with China, as a way to inoculate itself from vulnerability to Western markets and finance. And Putin surely realizes that commodities are a risky foundation. No one country can control prices and being dependent on commodities means that you are never in control of your own destiny. This recent shock is one more spur for Russia to make more of what it needs itself, if it can.