Confusion about medical errors, sigh

A Health Care Cost Shift (washingtonpost.com)

'So we're spending a third more than any advanced industrial country, but half of that money is wasted and people are hurting,' Darling said. 'The employer has to pay more just to undo the damage done' by medical mistakes.

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There's no evidence that the US has a higher medical error rate than other wealthy nations. In fact, based on my experience in Canada, our error rates are probably about the same or a bit lower than elsewhere. (It's not that US physicians are more virtuous or better trained, it's that US consumers are more aggressive and have more lawyers.)

This is not a chance bit of confusion. It's a deliberate smokescreen by the insurance companies and payors. Of course journalists at the Washington Post are readily bamboozled by this kind of thing.

We know from studies in the 80s and 90s why our costs are higher than other nations. We use more subspecialists, we pay far more in overhead to payors and insurance companies, we're more aggressive in neonatal and end-of-life care, we pay our physicians and nurses more than other nations. (Note we pay our CEOs far, far more than other nations). It's no great mystery.

Reducing medical errors might reduce costs -- it depends how you define "error". In the popular sense of a "mistake that causes harm" reducing those might increase costs! Most the mortality from medical errors comes near the end of life, to vulnerable people who can't survive commonplace mistakes. Since most of those people would die even with perfect care, medical errors are reducing costs. (This is a common mistake about medical errors btw. The years-of-life-lost to medical error are far less than years-of-life-lost to other causes.)

If by "error" one means duplicate testing, "unnecessary care" (MRI for sore shoulder -- one man's luxury is another's necessity), etc. then indeed reducing these "medical errors" would reduce costs. That's in part what "managed care" is about. It's not what Leape et al were writing about in the 80s and 90s when they made their mark.

Of course there's no way any journalist will get this straight. They have been betrayed by their publishers/editors and are massively outgunned by the insurance/payor industry.

Yahoo squashes Google -- again

Yahoo! Search Results for "fermi paradox" "intelligent design"

I'd just posted on the results of a Google search on "fermi paradox" and "intelligent design". That search didn't come up with much, hence my post.

Then it occurred to me to try Yahoo Search. I already know that Yahoo does a far better job of indexing Blogspot (Blogger) than Google does (Google owns Blogger/Blogspot).

Sure enough, the same search in Yahoo finds many more posts. These aren't just "noise" results, the Yahoo search is simply much better than the Google search.

So it does look like the intelligent design folks are starting to tenderly inch their way towards the Fermi Paradox. Tenderly, because the ones doing this are smart enough to see the perils of this line of inquiry. My old Fermi Paradox page is still the top result, but not for long I'd guess. This should become interesting in a year or two.

In the meantime, Yahoo is a better search engine than Google! It's not really much of a contest. It will take me a while to switch over -- Google is so embedded in my workflow. Fortunately Firefox can be readily reconfigured, though Safari is stuck on Google.

I like Google as a company and an innovator, but they're clearly struggling in their core domain. If Yahoo can beat them, then so can Microsoft.

I wonder why Yahoo doesn't get more credit for their new search excellence? Yahoo is still dumb in a lot of things (their map/address book/directions integration has been broken for years) and often fails to deliver (of course my needs & criteria are not typical) -- but they are showing flickers of excellence. Maybe they'll join Amazon and Google in the top ranks of the innovators this year ...

Update 1/16: It occurs to me that Yahoo has a significant advantage over Google. It's the same advantage OS/X has over XP. Google is the dominant player, so the bad guys target their hacks against Google's search algorithms. It's a constant war, and it often means Google has to use suboptimal algorithms to thwart easy attacks. Yahoo isn't a dominant player, so they can use the algorithms Google has passed over or has abandoned (once Google abandons them, so do the bad guys, they need to track Google).

Of course if Yahoo's current search excellence gets noted, they'll be targeted too. The costs of targeting both Yahoo and Google are high however, indeed techniques that work for one may fail for another.

If this sounds familiar to you, then perhaps you're a life sciences person. This is the same kind of struggle one sees in ecosystems, and in antimicrobial therapy. HIV multidrug therapy works because HIV can readily adapt to one drug, but that adaptation makes it more vulnerable to another.

Again I wonder, how do the anti-evolution folks make any sense of the universe around them?

Why don't the creationists chase after the Fermi Paradox?

Google Search: "fermi paradox" "intelligent design"

I mentioned in a previous post that I think the creationists/intelligent design folks are barking up the wrong tree. They attack natural selection, a very robust model with wide applicability. Natural selection offends them because it makes man a happenstance -- rather than a deliberate creation of a God who has made Man "in his own image". (Of course any decent theologian could find a vast number of workarounds to this problem, but the anti-Darwinists are weak theologians.)

They ought instead to be chasing physics. In particular, the Fermi Paradox is a uniquely interesting argument for intelligent design. Since I'm not a creationist by inclination it took me a few months of puzzling about the Fermi Paradox to come to the (duh) obvious realization that one of the explanations is that we exist in a created environment -- an environment designed for rare or singular sentience.

My favored explanation for our solitude is still the 'Singularity' thesis -- that all sentiences experience Singularities and none go traveling afterwards. To be fair, however, I have to admit that "intelligent design" feels like it's in the same range of implausibility. So why don't the creationists go after the Fermi Paradox?

I did a google search to see if this theme was emerging in creationist discussions. My search returned only a handful of pages, of which my old SETI Fail/Fermi Paradox page was at the top (a peculiar and fleeting glory -- for a year or two my old skijoring page led that search).

I do hope they'll chase this one down. It's much more interesting than a bizarre ideological attack on Darwin.

Preventing child abduction

Schneier on Security: Fingerprinting Students

...Child kidnapping is a serious problem in the U.S.; the odds of a child being abducted by a family member are one in 340 and by a non-family member are 1 in 1200 (per year)...

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Schneier, a security guru, points out that fingerprinting children, or attaching RFID tags to them, is a waste of energy and, by creating an illusion of action, is actually harmful.

I was surprised by the 1/1200 risk for non-family abduction. This is about 10 times higher than I'd have guessed. I'm skeptical. If it were so high, I should have a personal acquaintance who's suffered a child abduction. It's not the kind of thing that people stay quiet about. Still, I don't want my wife to hear this number ...

Darkness in America. Who cares?

The New York Times > Books > Sunday Book Review > Book Review: Atrocities in Plain Sight

...Whatever happened was exposed in a free society; the military itself began the first inquiries. You can now read, in these pages, previously secret memorandums from sources as high as the attorney general all the way down to prisoner testimony to the International Committee of the Red Cross. I confess to finding this transparency both comforting and chilling, like the photographs that kick-started the public's awareness of the affair. Comforting because only a country that is still free would allow such airing of blood-soaked laundry. Chilling because the crimes committed strike so deeply at the core of what a free country is supposed to mean. The scandal of Abu Ghraib is therefore a sign of both freedom's endurance in America and also, in certain dark corners, its demise.

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Blah, blah blah. Torture. Deception. Betrayal. Stupidity. Cruelty. Who cares? Freedom was a heavy burden, we're better off without it.

Venezuala is the future

Salon.com Arts & Entertainment | Thong warfare and a kidnapped beauty queen

Is Venezuala our future? It reads like the majority of modern dystopian science fiction. A bright, spoiled and corrupt elite, a dull, corrupt and spoiled dictatorship, and the faceless masses below. Actually, it's mostly Terry Gilliam's 'Brazil'. Come to think of it, isn't Brazil nearby? (joke)

Read it.

This is one of our possible futures.

A contrarian view of dog training

Train in Vain - Why dog training fails. By Jon Katz

...Training also requires that we understand the animal nature of dogs, their love of rules, ritual, food, and reinforcement. Let dogs be dogs—it's an honorable thing to be. Because many owners prefer to view their pets as soul mates, therapists, ethereal beings, even mind-readers, we give them too much credit, make them too complex, muddying our communications.

Seeing dogs as piteous, abused, and pathetic creatures doesn't help either. Many dogs are mistreated, including my elder border collie. But I never refer to Orson as an abused dog. I don't want to see him that way, and when it comes to training, it doesn't really matter. I treat him well, love him wildly, train him carefully, and have high expectations. We will work until we get there; he deserves no less. If one more well-meaning owner tries to explain that his dog is biting my ankle or attacking my dog because 'he was terribly abused,' I might go buy some mace. And not for the dog....

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Jon Katz loves dogs. Not just his dogs, but dogs as a people (species is not quite the right word.)

This is a good essay on training. It reminds me of the many years I spent with Molly at Marly's Canine College (which was of the "old school", she regarded me somewhat affectionately as a soft-hearted wimp). At Marly's I saw what Katz writes. Every dog needs his or her own approach to training. Ever trainer needs his or her own approach. The two compromise. Mostly it takes a long long time for most dogs and trainers.

Molly was a bit high strung, and jealous of our attention. She did very well with our kids even in her middle-age, but that was a result of a lot of work from us and her. There are resemblances between the lessons Katz outlines and those I've learned from our children.

Who will save American journalism?

The New York Times > Arts > Frank Rich: All the President's Newsmen

ONE day after the co-host Tucker Carlson made his farewell appearance and two days after the new president of CNN made the admirable announcement that he would soon kill the program altogether, a television news miracle occurred: even as it staggered through its last nine yards to the network guillotine, 'Crossfire' came up with the worst show in its fabled 23-year history....

I do not mean to minimize the CBS News debacle and other recent journalistic outrages at The New York Times and elsewhere. But the Jan. 7 edition of CNN's signature show can stand as an exceptionally ripe paradigm of what is happening to the free flow of information in a country in which a timid news media, the fierce (and often covert) Bush administration propaganda machine, lax and sometimes corrupt journalistic practices, and a celebrity culture all combine to keep the public at many more than six degrees of separation from anything that might resemble the truth...

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DeLong returns often to this theme. The current ethos of American journalism is a mirror of NPR's talk shows. Present the words of one side, then present the words of another side. Pay no attention to who contradicts reality -- reality is constructed, hence it cannot be objectively defined and it cannot be defended.

We are suffering terribly for the sins of the deconstructionists.

Who will resurrect journalism in America? Not the New York Times! Not the Washington Post. Who?

The National Intelligence Council predicts the future

NIC - Mapping the Global Future: Executive Summary

The site is unreachable at the moment, but it should slow down in a day or two.

Huygens has landed

BBC NEWS | Science/Nature | Titan data from Huygens arrives

We disturbed the gods today.

Apple revenues: the missed story

SiliconValley.com | 01/13/2005 | Apple unveils iProfit Maxi

Silicon Valley's newspaper notes what most miss on the Apple story: "More astonishing were Apple's overall computer sales, which surged to $1.6 billion, a 26 percent improvement from a year ago."

Conventional wisdom in some quarters has been that Apple may succeed with music, but that their computer business is doomed. The real story of this year's annual report is that their computer sales are surging -- even while everyone else is hurting.

Social Security assault: It's ideology, not demography and not economics

Shrillblog: WaPo Goes WaCkoFrom the WaPo:

... In short, Social Security is not facing a financial crisis at all. It is facing a need for some distinctly sub-cataclysmic adjustments over the next few decades that would increase its revenue and diminish its benefits.

Politically, however, Social Security is facing the gravest crisis it has ever known. For the first time in its history, it is confronted by a president, and just possibly by a working congressional majority, who are opposed to the program on ideological grounds, who view the New Deal as a repealable aberration in U.S. history, who would have voted against establishing the program had they been in Congress in 1935.

It's the same story with the funding of education in Minnesota. Pawlenty's attack is not about economics, or even about outcomes, it's about ideology. It's all about the foundations of the Republican/Libertarian agenda:

1. Eliminate progressivity in taxation and services.
2. Let the wolves take the weak.

We can have good and important discussions about both of these principals. We can't, however, start those discussion until American journalists find their way out of the deep, dark, black hole they're wandering in. Without journalists cutting through the fog of clever nonsense, Pawlenty and Bush, each in their sphere, will win their covert war.

I don't mind losing a war of ideology that's openly fought. If those two principals are the new core of our society, I can handle that (mostly by looking for refuge and moving!). It really annoys me to never have a chance to fight at all.

Be the Best You can Be: Pawlenty vs the american dream

Be the Best You can Be: Pawlenty's educational plan -- killing the american dream

He shows his colors.

Friedman's seven rules of mideast politics

The New York Times > Opinion > Friedman: Ballots and Boycotts

Rule 1 Never lead your story out of Lebanon, Gaza or Iraq with a cease-fire; it will always be over by the time the next morning's paper is out.

Rule 2 Never take a concession, except out of the mouth of the person who is supposed to be doing the conceding. If I had a dime for every time someone agreed to recognize Israel on behalf of Yasir Arafat, I would be a wealthy man today.

Rule 3 The Israelis will always win, and the Palestinians will always make sure that they never enjoy it. Everything else is just commentary.

Rule 4 In the Middle East, if you can't explain something with a conspiracy theory, then don't try to explain it at all - people there won't believe it.

Rule 5 In the Middle East, the extremists go all the way, and the moderates tend to just go away - unless the coast is completely clear.

Rule 6 The most oft-used phrase of Mideast moderates is: 'We were just about to stand up to the bad guys when you stupid Americans did that stupid thing. Had you stupid Americans not done that stupid thing, we would have stood up, but now it's too late. It's all your fault for being so stupid.'

Rule 7 In Middle East politics there is rarely a happy medium. When one side is weak, it will tell you, 'How can I compromise?' And the minute it becomes strong, it will tell you, 'Why should I compromise?'

Rule 8 What people tell you in private in the Middle East is irrelevant. All that matters is what they will defend in public in Arabic, in Hebrew or in any other local language. Anything said in English doesn't count.

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I think these are quite interesting. Best he's done in a while. For what it's worth, I agree that it's not worth postponing the Iraq elections unless the Shia's ask for a delay.

Titanic Friday

The New York Times > Opinion > Op-Ed Contributor: Under the Moon

Our lander flies into Titan tomorrow.

Keep your toes and fingers crossed.

Never have we reached so far.