Tag: Austin Frakt

On Shutting Off Blog Comment Sections

A few months ago, the editors of Popular Science’s blog announced the following change in policy:

Comments can be bad for science. That’s why, here at PopularScience.com, we’re shutting them off.

It wasn’t a decision we made lightly…we are as committed to fostering lively, intellectual debate as we are to spreading the word of science far and wide. The problem is when trolls and spambots overwhelm the former, diminishing our ability to do the latter.

More recently, the bloggers at The Incidental Economist (TIE) largely followed suit:

All TIE admins are in agreement that we need a break from comment moderation. It’s a lot of work and the benefits relative to costs have dwindled. We’d rather use our time in other ways.

Andrew Sullivan makes his own case against comment sections here. Although I failed to find it when I googled just now, I am pretty sure that some of the bloggers at Outside The Beltway have publicly questioned the value of comment sections, though their site still has one.

I have been ambivalent about this issue for some time. At RBC, we have some absolutely terrific commenters (I saluted some of them here) who add tremendous value to the site for commenters and bloggers alike. At the same time, we also have accrued, it pains me to say, a bad reputation for our comments section being vitriolic and fact-challenged on some topics, most particularly drug policy but also some others (anything about guns usually gets ugly fast).

Can’t bloggers just closely monitor comment sections and separate wheat from chaff? Given unlimited time, yes. But even for the few people who make their living by blogging, time to do this is not unlimited. And for those of us who have demanding day jobs, it’s an awful lot to ask.

Last week, I had a twitter exchange with Austin Frakt about what TIE had done, in which he defined destructive comments as a collective action problem that he was tired of trying to solve. This resonated with me. I was also struck that when I emailed a group of our very best commenters and asked whether we should close off comments on drug policy posts, the modal response was that they didn’t care because they had been driven away from reading those comment sections.

I was sad to hear that and recognized that a negative feedback loop had developed: As a few commenters were abusive or intellectually dishonest or both, those initially more numerous commenters who were civil and substantive began dropping out of the conversation. These two trends reinforced each other until being abusive and non-substantive became more the norm (though some heroes and heroines soldier on, God bless you all).

I do not speak for RBC as a whole on this, but I have come to the conclusion personally that the TIE approach of making a lack of comment sections my default on future posts is the best one for me. There are significant costs to this decision because some excellent comments that would have been made will no longer grace our site. I hope those of you who have for so long contributed reasoned, respectful and data-based reactions, critiques and counter-arguments to my posts will continue to do so on those that remain open for comment.

The Siren Song of New Medical Technology

We have a hard time saying no to medical technology that doesn’t work

Don Taylor recently noted the likely resistance to Blue Cross Blue Shield’s refusal to cover the ineffective, costly procedure known as proton beam therapy. Austin Frakt has a terrific post up at JAMA Forum that presents more reasons why the decision will probably not stick:

The historical record provides some clues. In general, there is a strong bias in the United States in favor of covering new technology. This is among the reasons why technology is one of the leading drivers of health care spending growth. We pay for it — a lot.

Austin mentions autologous bone marrow transplantation for breast cancer as another example of an ineffective medical technology that became political impossible not to fund. As related in the must read book False Hope, scientific evidence that a technology doesn’t work has little chance of being influential once compelling advocates with emotional stories capture the limelight. No Members of Congress want to preside over a panel of grieving families blaming them for denying care to a deceased love one (yes, even ineffective care) and in a media battle with a “plucky patient who is taking on the insurance industry fat cats” on one side and a bespectacled nerd with randomized clinical trial results on the other, the patient will carry the day almost all the time.

In the case of autologous bone marrow transplantation for breast cancer, that meant that a number of breast cancer patients “won” access to a needless, ineffective and absolutely excruciating medical procedure. Proton beam therapy advocates will probably “win” a similar victory, sustaining another center of high-cost, ineffective medical technology in the U.S. health care system

What Do You Hope to Accomplish, Policy Bloggers?

Public policy blogging has purposes other than moving mass opinion

Bill Gardner cites research showing that even people with big megaphones (e.g., U.S. Senators) have not apparently influenced public opinions regarding the Affordable Care Act. He reasons therefore that health policy bloggers, with their smaller audiences, haven’t a prayer of shifting public debate:

If you view yourself as a writer in service to a political movement, a soldier in the skirmishes over the daily meme, then give up. You are throwing pebbles, hoping to breach a castle wall.

Gardner’s comments were focused on health policy bloggers (e.g., Austin Frakt), but could be made more general. Why should Mark Kleiman bother to blog about drug policy? What does Harold Pollack think he is accomplishing by writing about criminal justice policy? Or to take it to a more personal level, who am I to delude myself that the hours I spend blogging about public policy affect public opinion one whit?

I will let my friends Austin, Mark and Harold answer Gardner’s challenge for themselves if they wish, but for me at least the response is simple: I have no expectations that my blog posts will sway mass opinion so it doesn’t bother me that they don’t. The main places at which I blog about public policy have a far larger audience than most…but since most blogs are read by hardly anyone, that’s just a nice way of saying that from the viewpoint of the mass public, I labor in obscurity.

A memory of a Roger Mudd story during his time on Macneil/Lehrer News Hour makes this okay in my mind. His segment examining who watched their show revealed that it had an extremely small audience, indeed laughably so by national network standards. But it was an unusually policy-connected, policy-saavy audience, and that’s what made the show important.

Years ago I got a telephone call from a journalist at the Economist who wanted to talk about drug policy. I asked how he found me, i.e., was it through some newspaper that quoted me or the medical school press office or what? To my surprise and delight, he said that he and his colleagues had long followed Mark Kleiman’s and my blog posts on drug policy.

I discovered over time that our readers also include other journalists, elected officials, Congressional and White House staffers, police officers, health care system managers, teachers, judges, economists, social workers, physicians, university administrators, business leaders, civil servants, policy analysts and many other people who regularly face up to the challenge of designing, analyzing and implementing public policy. We also have many readers — and this is reflected in the quality of our comments section — who are not public policy professionals but are public policy buffs: They have studied up on water conservation or solar power or Middle East politics and they take the trouble to share what they have learned with the rest of us.

Add up all the people who implement public policy, study it, or just know a lot about it, and you get a sadly small number, way too small to ever kid myself that my blogging could move mass opinion in a country of over 300 million people. But what it clearly can do is put good information and ideas into the hands of people who matter in and care about the public policy world. It can also provide me with an opportunity to learn from my readers and thereby come to a better understanding of the policy issues I care about. The public at large will likely never know (or care) about this ongoing exchange of wonky material within a small community. But I do, and that’s enough to keep me going.