Preventive care - a marginal idea?

I've suspected this was true for about 18 years:

NYT Leonhardt - Free Lunch on Health Care ...

... Jay Bhattacharya, a doctor and economist at Stanford’s School of Medicine, estimates that to prevent one new case of diabetes, an antiobesity program must treat five people — “not cheaply,” he says. Along the same lines, Mr. Gruber found that when retirees in California began visiting their doctor less often and filling fewer prescriptions, overall medical spending fell. People did get sick more often, but treating their illnesses was still less costly than widespread basic care — in the form of doctors visits and drugs. Louise Russell, an economist at Rutgers, points out that programs that focus on at-risk patients cost the least, but even they are rarely free.

As Dr. Mark R. Chassin, a former New York state health commissioner, says, preventive care “reduces costs, yes, for the individual who didn’t get sick.”

“But that savings is overwhelmed by the cost of continuously treating everybody else.”

The actual savings are also not as large as might at first seem. Even if you don’t develop diabetes, your lifetime medical costs won’t drop to zero. You might live longer and better and yet still ultimately run up almost as big a lifetime medical bill, because you’ll eventually have other problems. That would be an undeniably better outcome, but it wouldn’t produce a financial windfall for society.

I don't know if it's an urban legend, but I read over a decade ago that Japan's finance ministry blocked anti-smoking programs because the led to high social security costs. The new addition is that preventive care is not economically efficient because it's not targeted. Presumably, if you could target preventive care more effectively (genomics, patient readiness to change) you'd get more value. Of course if a "pay for performance" program tracks preventive care metrics ...

It's often cheaper to cure than to prevent.

One caveat is that for the informed individual, preventive care makes LOTS of sense. It's only a marginal investment from a societal perspective. Another caveat is that this the research doesn't apply to immunization programs, it was looking at programs that advocate behavioral change.

How toy makers can save themselves

Toy makers are worried ....

Toy Makers Brace for a Chill in Sales - New York Times

...Meantime, toy makers are trying to prove to lawmakers that they can handle the matter themselves. Carter Keithley, the president of the Toy Industry Association, called tests at ports of entry “belt and suspenders checks,” arguing that such a measure would be overly cautious....

There's an easy way for toy makers to reassure the public. They can offer a $10 million prize to anyone who finds a problem that leads to a recall.

DeLong: China prior to WW I

DeLong has published a portion of what appears to be a textbook in process. He starts  by exploring the The Needham question, though he doesn't seem to know of Needham (I sent him a link). This paragraph is typical:

Grasping Reality with Both Hands: Brad DeLong's Semi-Daily Journal

...By the beginning of the twentieth century it looked like that Malthusian crisis had arrived. The more than 300 million people of late nineteenth-century China had no mechanized farm machinery and no industry-produced nitrogen fertilizers. They were crowded into the wet, arable eastern slice of what is "China" on today's maps, with the median family of 6 farming perhaps 4 acres at a time when the Radical Republicans were still hoping to somehow find 40 acres plus a mule for each family of American ex-slaves. Average adult height was, we think, significantly under five feet. There were enough landless and other desperate peasants that perhaps ten million joined the Taiping Rebellion of Hong Xiuquan--who declared himself the younger brother of Jesus Christ after repeatedly failing the shengyan exam--which burned through the Yangtze valley for nearly fifteen years. Perhaps ten million, 3% of China's population, died in that war alone....

It's a fascinating essay. I'm looking forward to the book.

Reality, perception, Hume, the red pill - and John Tierney

There's no way I have time to do this post justice, but I'll put something up anyway. Maybe I'll fill it in later.

What do these things have in common?

• Measurement in quantum mechanics and the "shut up and calculate" response to questions about reality and quantum mechanics
• Hume, Common Sense Philosophy and life in simulation (both of these are basically links to the end of a post, sorry, more below)
• How a digital picture taken of an analog photo can show more detail than is present in the analog original
• The output of the retina compared to the post-processed signals that become the fodder for perception
• The Red Pill and how to detect a VM

As a hint, here's a little bit more on the In Our Time programme on Common Sense Philosophy

• David Hume realized he couldn't "get out of his head". That is, he couldn't show that his "perceptions" were attached to an external truth, he had to simply assume there was an "out there". Thomas Reid responded with an 18th century version of "shut up and calculate", asserting that philosophy had to begin with the assumption of a physical reality and this could not be questioned. Reid was a deist, like Descartes he began with the assumption of a benign Principle Designer who wouldn't resort to trickery. Of course if one attributes more complex attributes to the PD then all bets are off ...
  

So, do we live in a simulation in a "real" world, or do we live in a simulation in a simulation?

Update 8/15/07: It must be something in the air. I just saw this: Tierney (NYT) interviews Nick Bostrum.

... The math and the logic are inexorable once you assume that lots of simulations are being run. But there are a couple of alternative hypotheses, as Dr. Bostrom points out. One is that civilization never attains the technology to run simulations (perhaps because it self-destructs before reaching that stage). The other hypothesis is that posthumans decide not to run the simulations...

Oh dear, it's getting harder to keep this blog on the fringes. I'll have to try harder. So, if we are (or I am) in a simulation run by ripples of space time in the infinite dying years of the endless universe, is this heaven, hell or are we (I) simply glitches in the software? Ok, now I'm back on the fringe ...

Or maybe not. Tierney, who was a miserable political columnist, is more imaginative than I could have imagined:

... My gut feeling is that the odds are better than 20 percent, maybe better than even. I think it’s highly likely that civilization could endure to produce those supercomputers. And if owners of the computers were anything like the millions of people immersed in virtual worlds like Second Life, SimCity and World of Warcraft, they’d be running simulations just to get a chance to control history — or maybe give themselves virtual roles as Cleopatra or Napoleon.

It’s unsettling to think of the world being run by a futuristic computer geek, although we might at last dispose of that of classic theological question: How could God allow so much evil in the world? For the same reason there are plagues and earthquakes and battles in games like World of Warcraft. Peace is boring, Dude...

Not bad really, though he's jumping to conclusions by assuming that whatever runs our purported simulation need have any similarity to us. This next bit I know Tierney got from a rather good science fiction story (I'll look it the story reference):

... There could be layer upon layer of simulations until you finally reached the architect of the first simulation — the Prime Designer, let’s call him or her (or it)...

and

...We’d start our simulation, expecting to observe a new virtual world, but instead our own world might end — not with a bang, not with a whimper, but with a message on the Prime Designer’s computer...

Darn, he took that one from me. I have to check if I ever seeded the meme that quantum computers would make us all dumber, since they'd suck the cycles that drive our simulations (hmm, is that testable? Probably not, the clock speed would simply drop.)

Next thing you know, Tierney will be onto the Fermi Paradox connection -- maybe after he recovers from the beating that he's about to receive from the general public.

I guess I can't stay on the fringe forever.

Update 8/15/07b: I remembered Reid's name and revised the post accordingly.

Update 1/18/08: See this later post on the same topic.

INTEL DUMP's insider comments on the Bush-era military

 Hoisted from INTEL DUMP - Tone Deaf comments:

... I, like many others have frustrations with GEN Casey. That said, he is about as good as we could have hoped for (other than making Petraeus CSA). He's got a hell of a challenge on his hand: 1) his VCSA is a cretin; 2) the Sergeant Major of the Army he inherited is useless; 3) he assumed control of an Army already bleeding out in the officer ranks and reserve components; 4) he oversees an ideologically culled general officer corps that saw 25-30 of its 2, 3 and 4 stars unceremoniously sacked by Schoomaker/Cody/Rumsfeld. Kern, Cavin, Byrnes, Taguba ... the list is Looong...

It's always interesting to get the insider perspective. Blogs let us do that.

See What Rove left us... is another comment about what you get when you select first and foremost for loyalty to one political party. You get the same thing every government that's ever done this gets -- and it's a long and unhappy list. You get incompetence.

Update on Peter Hausmann post - family fund

A few days ago I was moved by the story of Peter Hausman, a father of four who escaped the fall of the 35W bridge then drowned trying to help other victims. With a bit of trepidation, since not everyone knows that geek is a term of praise, I wrote:

... One might wish Peter, father of four, had been less heroic, but he was. MPR has a small article about him. I'd have titled this post "A geek dies heroically" but I can't know if Peter would have approved...

I never think my posts are widely read, so I was a bit surprised to hear from Peter's family. They told me Peter would have appreciated my sentiments. I've updated the post with information on a memorial fund to support his four young children.

Peter Hausmann Memorial Fund
c/o Anchor Bank
66 Thomas Ave E
West St. Paul, MN 55118

What Rove left us: a broken government

Rove went after the quiet professionals that used to keep America running. He eliminated many of them ...

The rise and fall of Turd Blossom (Sidney Blumenthal, The Guardian)

.... Rove's merger of politics and policy was an effort to forge a total one-party state. While he is acclaimed as a political strategist, his true innovation was in governing. He sought to subordinate the entire federal government to his goal of creating a permanent Republican majority. Every department and agency has been subject to an intense and thorough politicization. Indeed, Rove's ambitious plan was tantamount to a nascent Stalinism. Even science has been suppressed in the name of the party line, recalling the flawed biology propagated in the Soviet Union by Trofim Lysenko. Cheney and Rove acted as the pincers of the unitary executive. While Cheney sought to concentrate unaccountable power in the presidency, Rove brought down the anvil of politics on the professional career staff.

Rove's radicalization of government was early described by the first member of the administration to quit in disgust, John DiIulio, a University of Pennsylvania professor and the first director of the White House Office of Faith-Based and Community Initiatives. He discovered that "compassionate conservatism," Rove's slogan for Bush's 2000 campaign, was little more than a sham. "What you've got is everything - and I mean everything - being run by the political arm. It's the reign of the Mayberry Machiavellis," said DiIulio....

Rove would have been most content in a totalitarian state.

Update 8/15/07: Fallows points out that the occupation of Iraq was staffed with young republican Rove clones. Good point.

Google strikes a mighty blow against DRM

Actions always count more than mere words. No vendor's actions have been as "loud" as Google's.

Google recently abandoned a video retail scheme. This means their customers have lost access to the videos they "bought".

Does anyone really imagine that their Microsoft or Apple DRMd materials will still be playable in 2015?

No. Way.

DRM'd material is never purchased, it is always leased. The lease holder can terminate support at any time, sooner or later the material will become unavailable.

Eventually the market is going to get this.

Or will it? Macrovision is not digital. Still it's a partial counter-example to consider. Why did it last until the videotape died? It was extremely effective over its commercial lifespan.

Google does not understand the web: exhibit A

Google's Picasa Web Albums show a user friendly string in the album URL. I think this might be new, but I can't see any notification of the change. I thought Google used to show some occult identifier, but maybe that's because I'm used to private albums that are not shared.

Google encourages links to albums and photos that embed that URL.

The URL is formed by the name of the album.

You can edit album names.

When you edit them, you change the URL.

The links then break.

Google did the same thing with Blogger for years, a few months ago they changed the behavior so the URL no longer changes even when one edits a blog title. That was a bad mistake that took Google far too long to correct, but one could come up with some perverse rationalization for the original blunder.

I can't rationalize this one at all. Google needs help.

Gordon's Tech: Google Earth and Picasa strange loops and the need for four dimensional coordinates in Google's image map layer

Google really needs to add image acquisition metadata to its Picasa web albums; three dimensions are so 20th century:

Gordon's Tech: Google Earth and Picasa strange loops and the need for four dimensional coordinates in Google's image map layer:

...This would, of course, be even more interesting if Google Earth added a fourth dimension (time). Then one could view sites over time, and these images might show up only for certain time slices. Alas, if Google adds this feature in 2037 my heir's will need to update the image metadata, Google 2007 does not allow user specification of the image acquisition date....

Cheney predicted the entire course of the Iraq war

It only takes a few minutes to watch the 1994 video clip. I don't think we have the technology to forge something like this. Dick Cheney, in a few minutes of rapid and detailed explanation, predicts exactly what would happen were the US to invade Iraq. He got everything right, including the disintegration of Iraq and the cost in American lives.

Really, we all need to watch this.

So, what happened? I used to think Cheney had developed some kind of organic brain syndrome in the 90s, but a recent WaPo series suggested a Machiavellian brilliance that belies any significant cognitive impairment. So I'm left with a rather dark conclusion.

He knew exactly what was going to happen. He knew Iraq would collapse into civil war and then disintegrate. This was what he, and Rumsfeld, intended from the start. I wonder if he ever told Bush.

Update 8/14/07: I've been playing this in my head for about two years now. If Rumsfeld and Cheney knew what they were doing, then what was their intent (assuming they're not KGB plants or space alien saboteurs)? My best guesses:

1. To divide the arab world into a balanced pair of rival Sunni and Shiite fractions. Perhaps they'd decided that Pakistan and Saudi Arabia were the real enemies, and that the best way to balance them was to strengthen Iran and the Shiite world. Both these men would remember when Iran was the a core ally of US foreign policy.
2. To dismantle Iraq and place Iraqi oil into the hands of nations that would reliably maximize outputs and oppose Saudi Arabian control.

Really, the 2nd is just an derivative of the first. My best guess is that they wanted to weaken Sunni power, and they figured strengthening Iran and Shiite power was the best way to do that. Since the Bush family is closely identified with Saudi Arabia, maybe they didn't remember to brief GWB on the entire plan -- which would explain his clue-free state.

Alternatively, they could both have been merely incompetent. I'm not sure which explanation I prefer.

Join us. Don't be afraid, there's nothing left for you on Windows ...

Coding Horror, a preeminent Windows-tech geek writer, struggles to keep security despair at bay. It's a sad story of failed antiviral defenses and the inevitable doom of the average user's XP environment. This is the main reason I bought my mother a Mac Mini last year -- I needed something that would be safe for a non-expert user.

Please don't tell CH he could escape his fate by switching to OS X. First of all, he knows that. He mentions OS X's superiority in this regard at least three times; if anything he overstates how robust OS X has been. Secondly, he's a Windows programmer. He's talking about the downfall of his vocation.

CH advocates running as a non-admin user, but then admits that's futile under XP and frustrating in Vista. Beyond that he dodges and weaves, but he can't avoid his doom.

CH can't switch, but his essay is an flashing red sign for any home user looking for their next machine. It's time to bite the fruit.

No Google Earth infrastructure layer: thoughts on the community model

A week or two ago I speculated that Google could move the infrastructure discussion along ....

Gordon's Notes: Bridges: 77,000 deficient, 750 have I-35W design

8/3/07 Update: I thought a bit more about how Google could accelerate the infrastructure review. A 'route around risky bridge' option for Google Map directions would concentrate minds wonderfully. One can readily imagine icons for bridges with the I-35W design and risk designation....

In the meantime, I was pretty sure the Google Earth community would put an infrastructure layer up that would attach federal infrastructure ratings to bridges like this one (Strib, Aug 11, 2007)...

Corroded strands of rebar jut from the sides and pillars of the cracked Hwy. 36 bridge near Stillwater, while jagged pieces of fallen concrete litter the ground below.

Every day, nearly 10,000 vehicles travel eastbound over the crumbling structure. Most of the people in the huge trucks, cars and school buses on the bridge are unaware that it has been listed federally as "basically intolerable."...

I still can't find such a layer, though problems with the OS X version of GE may be limiting my search (Is Google losing interest in GE in favor of Maps only?). Today I posted a comment on a GE blog to try to move things along. In a sad sign of the times the blog I commented to does point to a Google Maps mash-up that claims to do just what I want -- but that map is festooned with ad words, shows no data, and seems to be a splog. Yech. I'll withhold that URL, thank you.

All of which leads to two questions. Why do some community products take off and others don't? Are we seeing a community fatigue where the small minority of compulsive contributors are tapped out?

I'm fairy sure the latter is true -- it would be very odd if we didn't see a drop in participation after the usual early adopter surge -- followed by a resurgence a few years from now. The relentless onslaught of the fraudulent and parasitic "contributor" (e.g. splogs) doesn't help, but of course game theorists and evolutionary biologists know how inevitable that is. [Hint: If you're going to do a genuine community project, you probably can't do advertising at all.]

As to the former, I think that question is going to be discussed for many a year to come. It's easy to guess that the mathematical model for community project success will resemble the models used to forecast disease epidemics. I think this would be a nice little project for a class in mathematical modeling ...

Gordon's Notes: check your feed

Gordon's Notes is going to move domains sometime in the next few weeks. When it does move, the old address (jfaughnan.blogspot.com) will redirect, so if you read this via a web browser your old links will work. You can update the bookmarks any time you want after the move.

Feeds, however, can be a problem.

If your feed looks like this:

http://jfaughnan.blogspot.com/feeds/posts/default

You'll be fine. This type of feed will redirect and most feed readers will automatically update to the new address.

If you have an older RSS style feed, however, your feed may break when the blog moves.

So, if you have a moment, please switch to the above feed address now.

We now return you to your regular show.

So that's what happened to my Chinese audience

Cosmic Variance writes about blog censorship from China:

...Any blog on Blogspot is definitely off-limits (so I can’t visit Preposterous Universe for old time’s sake). You can type in the address or click a link, and the browser will think for a minute, and then return a “Problem loading page: The connection has timed out” error. My impression is that that’s been true for a long time, although apparently it’s been on and off for a while now. Typepad blogs are also off-limits, so no Cocktail Party Physics for me, although that might be a recent development. Livejournal seems to be unavailable, and likewise Xanga, but blogs hosted on Wordpress.com seem to be available...

I used to have some PRC readers, but they seemed to have stopped a year or two ago. It didn't really occur to me that China had blocked all of blogspot. I wonder how moving this blog to a custom domain will change that.

I image China must block the major web based feed readers as well, otherwise a block on blogspot would be easy to avoid.