HHS Plans To Delete 20 Years of Critical Medical Guidelines Next Week (thedailybeast.com)

An anonymous reader quotes a report from The Daily Beast: The Trump Administration is planning to eliminate a vast trove of medical guidelines that for nearly 20 years has been a critical resource for doctors, researchers and others in the medical community. Maintained by the Agency for Healthcare Research and Quality [AHRQ], part of the Department of Health and Human Services, the database is known as the National Guideline Clearinghouse [NGC], and it's scheduled to "go dark," in the words of an official there, on July 16. "Guideline.gov was our go-to source, and there is nothing else like it in the world," King said, referring to the URL at which the database is hosted, which the agency says receives about 200,000 visitors per month. "It is a singular resource," Valerie King, a professor in the Department of Family Medicine and Director of Research at the Center for Evidence-based Policy at Oregon Health & Science University, added. [She] said the NGC is perhaps the most important repository of evidence-based research available.

Medical guidelines are best thought of as cheatsheets for the medical field, compiling the latest research in an easy-to use format. When doctors want to know when they should start insulin treatments, or how best to manage an HIV patient in unstable housing -- even something as mundane as when to start an older patient on a vitamin D supplement -- they look for the relevant guidelines. The documents are published by a myriad of professional and other organizations, and NGC has long been considered among the most comprehensive and reliable repositories in the world. AHRQ said it's looking for a partner that can carry on the work of NGC, but that effort hasn't panned out yet. Not even an archived version of the site will remain, according to an official at AHRQ.

Comments

The Administration that Keeps On Taking

[NEDHead]

They just can't stop themselves. Sad.

Re:The Administration that Keeps On Taking

[SuricouRaven]

Even if it were copied - I would not be surprised if some people are desperately writing bulk-download scripts right now - it's a medical guideline database. It would quickly become outdated unless maintained by medical experts able to take the incoming stream of new guidelines from professional bodies, sanity-check them and incorporate them into the database.

Re: The Administration that Keeps On Taking

[Hognoxious]

They had a meeting about it, but afterwards nobody could read the notes they took.

Re: The Administration that Keeps On Taking

[datavirtue]

They would end up farming it out to the drug companies through a third party like they do with drug information pamplets--any educational materials in a doctor's office is written by the drug companies with the copyright being held by a third party stooge to mask the fact.

So actually no value then

[SuperKendall]

Nix has been helping coordinate an effort to get some outside stakeholder to take over the site's operations. She said she's still hopeful, and even days before the siteâ(TM)s scheduled demise, AHRQ spokesperson Hunt told the Daily Beast that the search continued.

So if it were truly a valuable resource where are the charities or groups of large insurance firms or hospitals willing to pay for this to be kept up?

The article mentioned how the database had been heavily politicized in the past, is it possible the value of this database is less than we are being told by the article writer?

Re:So actually no value then

[fyzikapan]

Actually the article makes clear that this source is particularly good because it makes a serious effort to vet articles and weed out the ones that are just pushing a company's agenda.

The administration really has no good argument for getting rid of it. The budget problem is entirely self-inflicted. Claims that it is politicized aren't particularly convincing considering that people who wound up in the Trump administration are the ones who tried to politicize it in the first place.

Re: So actually no value then

[fyzikapan]

Far better to be ignorant and have people die needlessly than to suffer the horror of a government-provided collection of medical best practices.

The private sector isn't magic. Hand this to the private sector and you'll wind up with something that's just drug pimping.

Re: So actually no value then

[Anne Thwacks]

You might want to look at how that has worked in other countries.

Basically, being ruled by warlords is even worse than Trump, and allowing the rich to rule the roost generally ends with something resembling the French revolution.

Re:So actually no value then

[Cinnamon Beige]

From the article:

--- “Many guidelines are actually written mainly for commercial purposes or public relations purposes,” said Poses, and can be subtly shaped to promote a given course of treatment. A guideline written for the treatment of depression, for example, may emphasize pharmaceuticals over talk therapy.

“The organizations writing the guidelines may be getting millions of dollars from big drug companies that want to promote a product. The people writing them may have similar conflicts of interest,” Poses said. NGC’s process provided a resource comparatively free of that kind of influence. ----

Arguably this is just swamp draining. The summary sucks this advertising platform's cock pretty hard, but this is not some thing where "trump destroys science" like all the fucking comments are running with.

That sounds like it's not even actually evidence-based, given that the point with depression at which pharmaceuticals actually start being significantly better than non-pharmaceutical treatments is when you hit severe depression--especially given that good large swath of antidepressants cause dependency...and, in general, doctors don't know this so they don't know to warn their patients.

If it's as widely used as claimed, and it doesn't include that sort of info--which we've known for most of a decade at least, as well as the simple fact that you need to go off them if pregnant (meaning, effectively, that pregnancies will have to be planned)--then it may not be worth mourning too much.

Content is king

[bugs2squash]

This sounds like just the kind of content a private company would love to host. Lots of influential, wealthy eyeballs on it each day. Hell, they could probably sell a backup of the site to someone to get them a quick start.

America elected an anti-government

[rsilvergun]

and anti-science administration. I'm not saying this to troll. We (or the 45% who voter for him) knew exactly what they were getting. Americans have been kicked around non stop for 40 years and unfortunately instead of blaming the billionaires that outsourced their jobs and brought in cheap labor to replace what they couldn't outsource they blamed "elites"; e.g. scientists and college professors. You know, nerds. And, well, this is the result.

Re: America elected an anti-government

[TheMiddleRoad]

The article is about deleting a valuable health database. Your response is to blame the unions. You're a moron. An abject shithead. For goodness sake, don't have children.

Re:America elected an anti-government

[Anonymous Coward]

Point of fact: ~20% voted for him, not 45%. ~21% voted Clinton, another ~1% wasted their votes on throwaway protest "message" which effectively let Trump eke out an electoral victory. The others, nearly 60% of the US population, did not vote at all.

Re:America elected an anti-government

[GerryGilmore]

I've got mod points, but I'm gonna burn them here to support you more fully.
Specifically, we collectively - as Americans - have allowed ourselves to become incredibly stupid and brain-washed to the point that we prioritize who kneels at a sports game over who will guarantee a civilized level of medical coverage for all citizens.
As an old-school American patriot, it greatly saddens me to say that we deserve our declining fate.
When the President and Vice-President regularly appear on idiot shows (Fox and Friends, Hannity and Limbaugh, the epitome of "irritable mental gestures which seek to resemble ideas") to get their political blowjiobs and the broad electorate elects them...again, we deserve our fate of decline. Jesus wept.

Re: America elected an anti-government

[GerryGilmore]

And, sadly, a voter is TMR, hence our predicament.'

Re: America elected an anti-government

[Anonymous Coward]

Anytime someone blames unions you can bet they consider themselves "fiscally conservative" and they vote R almost exclusively. But in this case I'm guessing they probably call themselves "libertarian" which means they want to do away with all taxes and regulations. They claim that they really believe that the general public will step forward and take care of everything the government currently does through private donations and private businesses will get the money and not government employees and red tape. The problem is that nobody who suddenly has an extra 25% or more income is going to immediately turn around and give that money out to people to do what the government did with our taxes.

My older brother is a good example of a modern American libertarian. He doesn't want to pay property taxes because he doesn't have kids and is 50. He doesn't think he should be paying taxes for public schools on his property. I asked him who should and he said people with children. When I pointed out to him that not very many parent could afford to send their children to what would basically become private schools he said that wasn't his problem they shouldn't have kids. I asked him if he would set aside the same % of his income he pays in taxes to support the programs and infrastructure that money currently goes to. He said he would take a look at what he wanted to support and put some of his income into that. He wouldn't say that he would give what he currently pays in taxes.

He is just another person who wants to keep more for themselves. He would not give a penny to anything because he thinks his income is his and poor people should just stop being poor. He thinks the roads and bridges will just build and maintain themselves and people will volunteer to serve in the military for free and that business will build all the weapons they need at no cost out of the goodness of their hearts. Conservative and Libertarian voters are basically one in the same. They simply don't care about what happens to everyone else as long as they get a bigger piece of the pie.

Both parties blame everything on the government and unions because it's an easy target and gives voters something to focus their anger on. I generally just ignore them because they never have any evidence to back up their claims. They can never post any peer reviewed studies to back their claims or any statistics from any official sources. It's all from websites that cater to that voter base and the only links those articles will have go to another similar website with what is basically the same article worded a little differently. They are full of solutions but every solution they offer always benefits them at the expense of others. They are not willing to make any sacrifices for the good of the country or the good of humanity as a whole. The only thing they care about is adding to what they already have. In most cases they already have more than most people but they want to get a new $250,000 RV to park at the lake where they have their $90,000 boat docked. So they blame unions and the government and vote for people who make bad laws that hurt the most vulnerable citizens of the nation and who embarrass the country in front of the rest of the world. Just so they can keep an extra few % of their income so they can add another toy to their collection.

Re: America elected an anti-government

[Anonymous Coward]

Not voting is effectively endorsing the winner. You don't care who wins.
When people quote these figures they are implying that the non-voters oppose the winner, but that is not the case.
If you don't vote, you are equally responsible for the result as those who vote for the winner.

Re: America elected an anti-government

[Anonymous Coward]

Good public education helps everyone, even people without kids. So everyone should pay for it. Better educated labor force creates a greater GDP.

Re: America elected an anti-government

[Joce640k]

Not voting is effectively endorsing the winner. You don't care who wins.
When people quote these figures they are implying that the non-voters oppose the winner, but that is not the case.
If you don't vote, you are equally responsible for the result as those who vote for the winner.

Either that or you didn't want to vote for any of them.

What "democracy" really needs is a meaningful "none of the above" box on the voting papers.

How should it work? If the number of people who vote "none of the above" is greater than the difference between the top two candidates then it should force a new election with new candidates.

Re: America elected an anti-government

[Anonymous Coward]

"I've never met anyone who cares more about kneeling than healthcare; only a blowhard would claim that "Americans collectively" do."

This statement is so demonstrably false as to be downright silly. There are a *lot* of people that care more about football players kneeling than about healthcare policy. Further, the general American focus is undeniably more on kneeling athletes than healthcare.

How can you tell? Because the people upset about the athletes learn their names. They know exactly who has betrayed their concept of "patriotism" in their favorite hobby. Meanwhile, the people who are "more or less fine with the way things are" don't even bother learning *anything* about healthcare policy. These people say "The government needs to keep its hands off my medicare" while opposing medicare. They believe outright ludicrous lies like "government death panels that decide to kill grandma" without putting forth the slightest effort to learn why that's so patently fictional.

Sounds more like you're either out of touch with what Americans actually care about, or you're just absorbed in your own bullshit cognitive biases that cause you to reactively defend your "team" regardless of the available facts. Probably both.

Re: America elected an anti-government

[Ol Olsoc]

There are libertarians, and then there are Libertarians. Some people just take it too damn seriously. Increased social liberties at the same time as increased economic liberties, that sounds good. But then they start adding in lots of litmus tests, and welcome goofy theories like the gold standard with open arms. This is what political parties do, the want to attract those with the extreme views and purist ideologies, leaving moderates who think about things behind.

Libertarianism is like all other isms some ideas are good, but the ideology always destroys the idea. Its always the core assumption

Capitalism assumes that the people who are driven by greed to accumulate, are also very generous.

Socialism (real, not the socialism that crypto conservatives bandy about) assumes the government is always benevolent and honest.

Communism assumes altruism on the part of the governed.

And Libertarianism assumes everyone is smart and honest.

Modern crypto-conservatives have also damaged it by usurping the anti-tax aspects

And this is why ideologues need kept in check.

We really do need Barry Goldwater about now!

Re: America elected an anti-government

[spire3661]

Both of those men gave away money to buy a better legacy. Bill Gates would be excoriated if he didnt start giving away his money. Its literally his only redeeming quality.

Re:America elected an anti-government

[drinkypoo]

As an old-school American patriot, it greatly saddens me to say that we deserve our declining fate.

1) This was done to us deliberately by politicians who desire low-information voters. Like, all of them.
2) Not all of us are like that, and the people who are don't listen to us. We're victims, and you're blaming us. That's abusive.

Re: America elected an anti-government

[zmooc]

There's nothing wrong with wanting to keep more for themselves, nor is there with being a libertarian. The real problem is that people fail to understand that the vast majority of their propery, income and quality of life simply would not exist without a joint effort to create a properly organized safe and efficient country. Among western countries, the US already takes quite an extreme position in this w.r.t. health care, crime prevention, homelessness, unemployment and fossil fuels (where the ignorance even affects the rest of the world).

Your brother just wants to add education to that list. And perhaps infrastructure. He fails to understand that his income, like just about all incomes, fully depends on other people spending money. This simply works best if these people are healthy, safe, educated and able to move from A to B.

Most somewhat smart animals (e.g. ravens, dolphins or rhesus monkeys) understand this concept naturally because in the long run, altruism benefits groups as a whole. Humans show altruistic behavior out of the box as well. Unfortunately, our society has become so complex and impersonal that our natural tendency and ability to show altruism fails miserably. Our brain simply does not recognize it if it hides behind taxes and people you've never seen. Likely, your brother would naturally understand the value of contributing to society as a whole if it were about real tangible people. But it isn't.

Re: America elected an anti-government

[bestweasel]

Weird that you should have more faith in a single random doctor than the collected and curated wisdom and experience of thousands. A good doctor would of course use her own judgement and knowledge of the patient combined with the best practice of the rest of the medical community.

The NGC has a screening process designed to keep weakly supported research out.

The real reason the database is being deleted is that it's costing medical institutions money.

That gatekeeping role has sometimes made AHRQ a target. The agency was nearly eliminated shortly after its establishment, in the mid-90s, when it endorsed non-surgical interventions for back pain, a position that angered the North American Spine Society, a trade group representing spine surgeons. A subsequent campaign led to significant funding losses for AHRQ, and since then, the agency as a whole has been a perennial target for Republicans who have argued that its work is duplicated at other federal agencies.

The vetting role played by the NGC is a critical one, says Roy Poses, with the Patient-Centered Outcomes Research Institute.

"Many guidelines are actually written mainly for commercial purposes or public relations purposes," said Poses, and can be subtly shaped to promote a given course of treatment. A guideline written for the treatment of depression, for example, may emphasize pharmaceuticals over talk therapy.

"The organizations writing the guidelines may be getting millions of dollars from big drug companies that want to promote a product. The people writing them may have similar conflicts of interest," Poses said. NGCâ(TM)s process provided a resource comparatively free of that kind of influence.

Underscoring how medical research like that maintained by the NGC can be politicized, AHRQ drew the ire of then-congressmember Tom Price in 2016 when it published a study critical of a drug manufactured by one of his campaign donors. According to ProPublica, one of Priceâ(TM)s aides emailed "at least half a dozen times" asking the agency to pull the critical research down. Price was the first director of HHS, AHRQâ(TM)s parent agency, under the Trump Administration, before resigning under pressure last year over his spending on chartered flights.

Re: America elected an anti-government

[apoc.famine]

Absolutely correct.

The GP has tried to work around the problem rather than finding a solution for it. The solution is preferential or ranked voting.

As an example of how this works, see what Maine just did for their primaries. And that's what will happen there in November too.

Yes, it's more complicated, but it's far less complicated than the "solution" that the GP describes. Imagine that happening twice in a row!

Re: America elected an anti-government

[sjames]

Not voting is just a way to say the election is between "turd sandwich" and "giant douche".

To top it off, the current president didn't even turn out to be the least unpopular choice in the election, but won anyway.

Only an egomanic fool would consider that an endorsement.

Re: America elected an anti-government

[cas2000]

> Who could I have voted for?

You didn't have to vote for anyone.

You vote against the greater evil - Trump.

Clinton would have been "more of the same" but that's nowhere near as bad as the current accelerated radical path to fascist theocracy.

That's what you should have done - not vote for HC but vote against the nazi clown.

Voting against the greater evil isn't even a novel or unusual voting strategy - given that you'll probably never get a great candidate that you can support without reservation, it makes sense to vote so that you minimise the harm that can be done by any politician. i.e. this should be the default strategy of every citizen.

And then you work to get rid of the electoral colleges and implement a preferential voting system so that third-party votes aren't wasted - if your 1st preference doesn't win, your vote is transferred to your 2nd preference, and then to your 3rd and so on until it eventually ends up with a candidate who has a majority of votes.

You'll probably still end up with something close to a two-party system but the two major parties have to be careful not to alienate too many other voters - which discourages extremist policies and actions. It also leaves open enough space for new parties to arise and gain enough support to eventually displace one of the current major parties (or at least shift their policies in the same direction).

Re: America elected an anti-government

[Agripa]

How should it work? If the number of people who vote "none of the above" is greater than the difference between the top two candidates then it should force a new election with new candidates.

How should it work? Puree the candidates and feed them to Congress.

Re: America elected an anti-government

[Jason Levine]

I really wish we'd move towards ranked voting. Not only would it give a better idea of voter preference over "pick column A or B:, but it would also allow third party candidates to run.

Imagine a Ranked Voting situation in 2016. Hillary and Trump win their primaries. For the moment, we'll ignore the third party candidates who did run and suppose that Bernie Sanders decided to run third party. Perhaps someone from the GOP (let's say Jeb Bush just to pick one at semi-random) would have ran third party also.

Someone who votes Democrat but didn't like Hillary could vote: 1) Bernie 2) Hillary 3) Jeb. Someone who votes Republican but didn't like Trump could vote 1) Jeb 2) Trump 3) Bernie. This way they say "I'll still vote for my party's candidate, but I prefer this other candidate more." The 2016 election might have turned out with Bernie or Jeb winning instead of Hillary or Trump.

Of course, it's precisely this reason why it won't be done. The Democrats and GOP don't want a strong third party.

Re: America elected an anti-government

[apoc.famine]

I agree completely.

I just hope that the two main parties adopt this thinking it's going to benefit them and hurt the other to the extent that the third parties/candidates can actually make a real difference. For the 2016 election, I don't think we disagree that it would have been better for the country to have had this voting method. We had two of the most disliked candidates ever, and to not have to vote for either one of them would have made most of both parties happier.

If Maine can do it, that shows it's possible. We just need enough other motivated people in other states to push it forward.

It has lots of value

[Anonymous Coward]

It may have no commercial value, so no-one can make a profit from it.
But it can still have huge social value as general knowledge for medicine.

This is just the kind of thing the government should do.

So what? not really needed and this was well known

[will_die]

This was announced officially back in April.

Back in February the HHS, which runs the office which runs this, released its budget request for the upcoming year. In it, they identified this as being duplicated in other governmental agencies and requested money to transfer the duties and money to different offices or agencies.
The office than in April decided to kill this database even before any of that request to kill it off was approved by Congress and divert the money they were spending on it to something else.
The article being linked to is yet another worthless opinion piece being passed off as actual journalism. The truth is no one really cares about this database and given four months for someone to come forward take it over no one has. The only reason it is being posted here is as a political hit piece.

I don't think we deserve our fate

[rsilvergun]

for one thing less than 50% of us choose that fate. It's only because of a messed up political system designed specifically to favor wealthy land owners (seriously, look it up, the electoral college, senate and even the SCOTUS were all checks not on the president but on the voters).

There's a lot out of folks hands. Hell, I'm stuck in a red state with a ton of problems I wouldn't have healthcare wise if I lived back east or even California. Why am I stuck here? Mom moved me here when I was 6 and by the time I was old enough to know better I couldn't afford to move. This country crushes people, and when it does you can't just go where life doesn't suck. You've got to make due with what you got.

Re:I don't think we deserve our fate

[Solandri]

2016 was different from 2000. In 2000, Gore won a plurality of the popular vote (but not a majority), and liberal parties (Gore + Nader) won a majority of the popular vote. The Electoral college did not reflect a majority of the popular vote in 2000.

In 2016, Clinton won a plurality (but not a majority) of the popular vote. However, Conservative parties combined won more popular votes than liberal parties combined (49.88% vs 49.13%, with the rest being cast for candidates without a party affiliation). So in 2016, the Electoral College awarded the election to the candidate whose ideology came closest to winning a majority of votes, rather than the individual who came closest to winning a majority. I didn't vote for Trump, but he was probably the correct winner in 2016.

People like to criticize the Electoral College. But IMHO the plurality-wins system they propose be used instead is nearly as bad (consider the California primaries where some candidates won one of two slots in the general election with barely 20% of the vote). We really need to switch to instant run-off voting, which is designed so that a candidate always gets a majority of votes before being declared the winner.

Re:I don't think we deserve our fate

[CanadianMacFan]

Probably the best thing to do would be to stop the gerrymandering of the districts. In Canada there is an independent third-party organization that sets the ridings (districts) according to a strict set of rules.

Re:I don't think we deserve our fate

[currently_awake]

Or Proportional Representation where you add up the votes nation wide and you get a percent of the seats equal to your percent of the votes.

Re:I don't think we deserve our fate

[fafalone]

Sorry, conservative parties? Libertarians might have supported Trump slightly more than Clinton as I just posted about above; but it's hardly unanimous, and it's absurd to call them a conservative party and chalk their votes up to the right. If you break it down point-by-point by ideology, Trumps didn't even come close to winning, because Libertarians diverge in majority percentages in just about every area outside domestic economics and regulatory issues (some; for instance NN has majority support among (L)). Trumps social conservatism, criminal justice policies, international trade policies, foreign intervention policies, and more, are all deeply offensive to most libertarians.
I've heard some ridiculous spin before to try to get past the fact you lost the popular, but claiming libertarians are conservatives and count towards conservative ideology is one of the great manipulations that sounds intelligent to people who have no idea what libertarians actually stand for. And the bottom line, the electoral college is a system that says "you live in a rural area, so your vote counts for more".

Bernie Sanders

[rsilvergun]

or hell, even Hilary Clinton. Yeah, she's a right wing corporatists bitch, but at least she isn't openly anti-science. As terrible as she was/is it's always better to pick the lesser of two evils.

Re: Bernie Sanders

[giggleloop]

At least some of those were policy/opinion changes she made over the course of several decades. If she held the same views in 2016 as she held in 1986, she'd be an idiot. Trump's lucky if his policy opinions are the same at the end of a sentence as they were when he started it.

Re:Bernie Sanders

[apoc.famine]

Good idea! Lets pick minority candidates who can't win, making it a toss-up between whether we get the greater or lesser evil. That's much better than picking the lesser evil, right?

In a first-past-the-post system, the majority party candidates are the only choices. If you don't like that, you're SOL. The only option is to change the system. You can't fix anything by choosing a third party candidate.

Re:Compared to what?

[GerryGilmore]

I wrote-in Bernie. Living in North Georgia, I knew that Trump would win Georgia anyway so I voted for the guy who would have wiped the floor with Trump.
I say that knowing that 90%+ of Trump's vote was actually ABC (Anybody But Clinton).

Um... there utterly and completely overwhelmed

[rsilvergun]

you do know we just spent the last 40 years systematically dismantling the social safety net so we could make way for tax cuts for billionaires, right?

In the entire history of humankind charity has never once solved any problem long term. It's always been civilization in the form of government that did. A few nice people at the middle can't make up for the bad done by folks up at the top. Complex, widespread problems (like public health) need comprehensive solutions done an a society wide scale. You and me dropping change into a plastic bucket twice a year is not a viable solution to the world's problems.

Archive.org to the rescue?

[Narcocide]

Is there any chance they will let the public sector copy this database before they just burn it along with all the books?

Re:So what? not really needed and this was well kn

[lastman71]

Not really needed by some pharmaceuticals lobby, maybe?

https://www.propublica.org/art...

Also you should remember:

"Price was the first director of HHS, AHRQ's parent agency, under the Trump Administration, before resigning under pressure last year over his spending on chartered flights."

And of course people appointed by Trump Administration think it's a duplicate. How convenient... Less money spent in research, more budget available for chartered flights!

Re:Perhaps you should read the entire article

[Cinnamon Beige]

What I see on Slashdot is an awful lot of non-doctors (myself included) pontificating on this move. Is it really widely used? I don't know. All *I* (and the rest of you) have to go on is the demonstrated value which currently is zero as there are no takers to carry on this data.

Not a doctor yet, but I am a biomedical nerd and aware of how useful those in the research area tend to consider best practices guidelines--and my first question about this actually was "Why is this not at NIH?"

The general rule of thumb is that the lag time is too long between where the research says are the medical best practices and what any published list anywhere will say--part of this is because, to put it bluntly, most doctors aren't particularly into research and don't keep up with it. Those best practices databases aren't going to be getting kept up-to-date and current, and I honestly don't think there's a solution for this short of starting from scratch--if nothing else, because each and every entry should have a date on it saying when it was last checked on and it should be routinely gone into to add data. There is no such thing as too much data if you're trying to figure out what works in which populations; the more you have, the more certain you can be...and the more likely you are to be able to pin down which populations that have strange responses, which is pretty much a basic requirement if you want to do anything more than shrug and move on...and it's also a requirement for improving and fine-tuning the evidence.

Re:Compared to what?

[serviscope_minor]

I say that knowing that 90%+ of Trump's vote was actually ABC (Anybody But Clinton).

I really don't get the attitude of "we hate clinton so much we'll vote for someone far worse!".

I also don't get the hate for Clinton (actually I do). I mean she's basically another poltician and has the same sort of patina that people grudgingly accept on most other politicians. And yet she gets far, far more hate for it. I wonder why...

Re:Compared to what?

[phantomfive]

I really don't get the attitude of "we hate clinton so much we'll vote for [anyone else]!".

I'm not sure very many people have that attitude. The Trump supporters I know actively like him (that's why they're supporters). Everyone I've talked to who voted for him can articulate some reason why they think he is better than Hillary. It's not always a fact-based reason, but they feel like they voted for the best candidate.

It's the fault of your dumbarse electoral system

[Anonymous Coward]

Your current system guarantees nutball vs shithead elections.

You need a preferential voting system. Only your main parties can field candidates with any chance of winning and thus every vote for an alternative is a lost vote. You need a system where voting for a minority party is not equivalent to putting your vote in the bin.

Also you need compulsory voting. Your main parties no longer target the middle. They target the extremes. And the extremes DO NOT want to vote for anyone who would compromise with the OTHER guys. Until you force the middle to vote, nobody will want to attract their votes (by being centrist).

You are destined for the toilet unless you can get some centrists voted in. The only way to do that is to fix your voting system.

Or just give in and have that series of secessions and/or civil war that seems inevitable at this point.

Re:Compared to what?

[Ichijo]

Some might say you threw your vote away, but I like how you gave it meaning when it had no chance to affect the outcome of the election. I wish people would vote their conscience more often.

Re:Compared to what?

[Hognoxious]

I don't think it's because she's a woman, if that's what you mean. Remember Sarah Palin? And Obama was, well, you know...

There were a few iffy things in her past - nothing proven, but mud sticks. She has the charisma of a tepid lettuce. And the whole dynasty thing, though I suspect we ain't seen nothin' yet on that front.

The survivors in 2050 or so might speak of 1776 as being the First American Revolution.

Re:Thank god!

[meglon]

Clinton had to fix what Reagan and Bush sr did driving up the debt; Obama had to fix what Bush Jr did basically fucking up everything, crashing the economy and driving up the debt.... he just didn't have enough time; for Trump, it's going to probably take 16-20 years of democrats to fix his fuckups so far, let alone all the shit he's going to fuck up tomorrow.

This country works much better under Democrats...except for the neo-nazi's and other fascist and bigots, but they all need to go fuck themselves.

Re:Compared to what?

[serviscope_minor]

Everyone I've talked to who voted for him can articulate some reason why they think he is better than Hillary. It's not always a fact-based reason,

Well, that's part of the problem. Lots of people here seem to be willing to believe outright lies in order to justify the thought that Trump was less bad than Hillary. The thing is they have an irrational hatred for Hillary and won't vote for her no matter what.

Re:Compared to what?

[Hognoxious]

What you say is true. The way they go on about Benghazi you'd think she was on sentry duty. But she somehow failed to win people over on those issues. A lawyer who can't defend herself, FFS! Maybe she was just too old, by about 8 years.

The way the primary (I almost wrote primatary - Freudian slip?) was biased against Bernie probably turned some natural Dems against her too.

300 million people and those two were the least bad they could find? Then again, Boris ...

Re:Won't need "hundreds of thousands" for a static

[Antique Geekmeister]

One hundred thousand dollars a year is enough to fund roughly one full-time senior engineer with the the broad skills to automate heavily and keep a bulky site with critical data alive. Anohter hundred thousand for one broadly skilled developer to keep the front end working and compatible with new browsers and new standards is also conservative. If we assume servers in AWS, at roughly $1/hour to support the necessary storage, backups, and web traffic for such a bulky system, hat is roughly $17,500/server per year. If we assume roughly 4 servers to allow one host to be down while others are supporting the load, that is also almost $100,000/year.

This is not a service that can run from someone's laptop. The fact that a physician is looking up specific information about a specific disorder at a specific moment is sensitive, so it has to be encrypted, which adds computational requirements which translate to fiscal requirements. Hardening it with a commercially supported load balancer, say an AWS load balancer, is another expense.

Re:Compared to what?

[serviscope_minor]

Very true:

Hillary told lies so I voted for an much bigger liar. My point exactly.

What I find especially funny

[rsilvergun]

about "fiscal conservatives" is while claiming people will take that extra 25% and solve the world's problems they simultaneously believe that raising wages (especially the minimum) is pointless because prices will just go up.

Gerrymandering has almost ZERO impact

[mpercy]

Gerrymandering has almost ZERO impact on US Presidential elections.

Unless one considers state borders to be gerrymandered. Because 48 states use a winner-takes-all method for allocating electoral college votes. That is, the person receiving the most presidential votes within a state gets all the EC votes from the state. Maine and Nebraska have different rules that are impacted somewhat by district lines, but they have so few districts that its hard to figured gerrymandering has much impact. Maine has all of two districts, with Augusta and Portland and the section of the state between them comprising one district, and the rest of Maine the other, and Nebraska has 3 and their map is hardly what I'd consider gerrymandered, with the tow countries comprising Omaha in one, the suburbs of Omaha in another, and the rest of the state comprising the 3rd.

Further, gerrymandering does not impact Senate seats either. Senate seats are at-large within each state (no districts, only state borders).

Gerrymandering does impact the House of Representatives. It also impacts State legislature seats.

But please stop throwing gerrymandering around as a problem for Presidential elections...

Re:Gerrymandering has almost ZERO impact

[apoc.famine]

You are absolutely incorrect. I can understand why it doesn't seem like it could impact national elections, but it absolutely does.

Gerrymandering has allowed mostly republicans to hold onto state legislative majorities while receiving far less than half the vote. In 2012 in Wisconsin, Democrats won 52% of the aggregate vote but only 39% of the seats in the Assembly.

That majority in state legislature has allowed republicans to install laws designed to prevent voting, which disproportionately impacts democratic voters. If likely democratic voters aren't allowed to vote at all, national elections are absolutely impacted by gerrymandering.

As a great example, look at Wisconsin. While I know Mother Jones isn't necessarily a great source, feel free to click through and listen to the interview where Wisconsin Attorney General Brad Schimel says:

How many of your listeners really honestly are sure that Sen. Johnson was going to win reelection or President Trump was going to win Wisconsin if we didn’t have voter ID to keep Wisconsin’s elections clean and honest and have integrity?

It should be noted that you can count the voter fraud convictions in WI over the last decade on one hand. "if we didn’t have voter ID to keep Wisconsin’s elections clean and honest" is absolutely saying, "if we didn't have Voter ID to keep democrats, especially blacks, from voting".

23k-45k voters are estimated to have not been able to vote due to the voter ID law. Trump won the state by 22k votes.

If the state wasn't gerrymandered, that law wouldn't have passed, and those people would have voted. The supreme court has decided to pass on this lawsuit, because apparently the democrats didn't have standing? Apparently it will take someone losing a gerrymandered district to sue, and then proving that it was the gerrymandering that caused it. I.E., gerrymandering by political parties is fine according to the supreme court. That's fucked up, and pretty undemocratic.

But we got a supreme court that thinks this way in part due to gerrymandering. How's that for full circle?

False dichotomy

[rsilvergun]

You're suggesting a strong social safety net with guarantees of healthcare, food and shelter would result in miserable and isolated people. As if people can only make friends if they're in a constant state of desperation. No matter what you saw in a jug band once poverty does not bring people together. Money is the #1 cause of divorce you know? People can be economically secure and happy.

San Fransicso's problem is that it's stuffed with people who don't want to live there but do so because that's where the work is. They're unhappy because the city is a bad fit for them, but when you've got no social safety you can't take risks like moving to a smaller city with less job opportunities and worse schools for your kids. So you suck it down. For the people who _want_ to live in San Fransisco it's a paradise and they'd never leave.

Basic income's a great way to solve this. People could live where they want to instead of where they have to to find work. Also, it would be a nice way to distribute the productivity gains from the last 40 years (which have doubled).

Or we could do your way and keep giving all the gains to the rich plus a huge chunk of what the working class already has. That's what we've been doing for 40 years. How's that turning out for you, Mr takes time out of their day to post a bitter rant on /.?

Re:False dichotomy

[iMadeGhostzilla]

Just because I consider far left views harmful it doesn't mean I am on the opposite side. I am against big corporations as much as I am against big government. What I consider harmful in the far left is not the humanity of it, on the contrary any decent social system has an obligation to protect the weak. What I'm arguing against is the left's worldview of what I see as a blind faith in pseudo science and "experts" and mental models -- something I've grappled with in myself for much of my life. Applied beyond its usefulness I believe such worldview leads to misery inside.

All that said, I wrote the post as I felt for your situation and know that anyone can find themselves in it. I reasoned that by pointing out that there may be some good sides of living in the redneck country which may be taken for granted, it might serve to lessen the suffering. Of course that never works.

if it's that important, scrape it

[reanjr]

Is there anything stopping somebody from just downloading everything and hosting a mirror?

Re:Voting by the numbers

[cas2000]

> First, require all eligible voters to vote as they do in Australia.
> There is a financial penalty for not voting.

Yes, there's a fine for not voting here. It's only ever paid by those too stupid to tick the "I was too sick to vote" box on the "Why didn't you vote?" form you get sent - i.e. almost nobody.

This might seem pointless, but it has the effect of making not-voting almost as much work as voting. Actually, an equivalent amount of work since it's trivially easy to ask for a postal ballot so you can vote by mail. It also reminds you that it's your duty as a citizen of a democracy to get off your fucking arse and vote - it's less than an hour once every few years.

Every electorate here has polling booths in local schools and town halls and other places anyway, so even voting in person rarely takes more than half an hour or so. On a Saturday (not a fucking Tuesday - which disenfranchises many workers). Voting is open all day up to 6pm. Or you can vote early at your local town hall or by post.

Both early voting and postal votes are still anonymous, your vote is inside a sealed envelope which is inside another sealed envelope with your name on it (matching your electoral enrolment). When the votes are tallied, the external envelope is checked to make sure it's a valid enrolment and to prevent multiple-voting, and the internal envelope is added - unopened - to the pile of votes to be counted.

and if you don't like any of the candidates you can always invalidate your ballot (i.e. vote "informal") by writing some "fuck you all" or some shit on it.

The ballot papers are randomised so that nobody gets the advantage of being the first on the ballot paper - some fuckwits just vote 1 2 3 4 5 ... in order down the page. AKA donkey voting

BTW, our last federal election was an anomaly with much lower voter turnout than usual (about 9% didn't vote), but Australia routinely gets 95+% voter turnout in every election.

Re:Compared to what?

[Hognoxious]

Though Trump is a couple of years older.

Not what I meant and you know it. Compare her to when she ran against Obama. Can't you see the difference? She's clearly past her prime.

Same with McCain. I think he'd have been better than Shrub, but when he ran with Palin he just looked kind of frail. Then again maybe it was being around her...

Re:Compared to what?

[Jason Levine]

The Republicans have been building a hatred for Hillary Clinton since 1993 when he took office. The 2016 elections were over two decades of hatred erupting. You can see it how they still go on about Hillary even after she hasn't been in or running for public office for 20 months. They will STILL go on about her supposed crimes and how horrible she is. They turned her into a boogeyman (boogeywoman?) representing all evil in the world. Now that she's gone from public life, they need someone else to focus their hate on. Yes, they can direct hatred at Nancy Pelosi, Chuck Schumer, or Elizabeth Warren, but it's not the same as the hatred they've had for over 20 years.

Re:Compared to what?

[Jason Levine]

Hillary and Trump really represented two opposite types of people. Hillary loved getting into the details on policy and learning everything about it. Her problem here, though, was that she wasn't really good at boiling that policy knowledge down to catchy statements and energizing speeches. "Read my twenty page policy proposal on Immigration on my website" doesn't exactly draw crowds to the voting booth.

Trump, on the other hand, has zero knowledge of policy and no desire to learn. He seems to go based on whatever pops into his head at that moment or whatever someone told him last. However, much as I hate him I've got to admit that he seems to know how to fire up a crowd. He might not know how to deal with the complex immigration issues, but he can shout "Build that wall" and get people cheering for him.

This election was between no flash/all substance and no substance/all flash. Flash won and substance lost. Yes, this is a huge simplification, but I think this was a big part of it. Trump actually won by about 77,000 votes in Pennsylvania, Wisconsin, and Michigan. Had just over half of those votes gone to Hillary instead of Trump, she would be President now. Had Hillary been able to resonate more with those people, she might have won the election. Sadly, this isn't the only instance. All too often, Americans seem to go for a flashy option even if the "more boring" option is better in other ways.