NBC's "To Catch a Predator". Please tell me this is satire ...

Please tell me this is satire...

What’s on TV Tonight? Humiliation to the Point of Suicide - New York Times

In November 2006, a camera crew from “Dateline NBC” and a police SWAT team descended on the Texas home of Louis William Conradt Jr., a 56-year-old assistant district attorney. The series’ “To Catch a Predator” team had allegedly caught Mr. Conradt making online advances to a decoy who pretended to be a 13-year-old boy. When the police and TV crew stormed Mr. Conradt’s home, he took out a handgun and shot himself to death.

“That’ll make good TV,” one of the police officers on the scene reportedly told an NBC producer. Deeply cynical, perhaps, but prescient. “Dateline” aired a segment based on the grim encounter. After telling the ghoulish tale, it ended with Mr. Conradt’s sister decrying the “reckless actions of a self-appointed group acting as judge, jury and executioner, that was encouraged by an out-of-control reality show.”

Mr. Conradt’s sister sued NBC for more than $100 million. Last month, Judge Denny Chin of Federal District Court in New York ruled that her suit could go forward...

No, I suppose it's real. I honestly didn't realize that American television had fallen this far. I live in a different world.

I'm sure NBC is now begging to settle, but I hope Mr. Contradt's family nails them publicly. I've vote for  a $30 billion dollar fine myself ...

Whatever happened to medical progress?

By an odd bit of synchronicity I'm simultaneously engaged with leading edge research in "Translational Bioinformatics" and refreshing my very dusty knowledge of family medicine.

How dusty? It's been about ten years since I took care of a patient, though other work has kept me somewhat connected to clinical practice. My medical school ended in 1986, so we're talking antique knowledge with dust on it.

Problem is, my old knowledge is more topical than it should be.

In 1983 I wrote a friend an enthusiastic note boasting of how quickly medical knowledge was moving. I was sure that the future was bright for treating and preventing diabetes, the "Haitian disease" (later HTLV, then HIV), rheumatoid arthritis, ALS, autoimmune disease, osteoarthritis, lupus, hypertension, heart disease, migraine, asthma, schizophrenia, dementia, viral and bacterial infections, multiple sclerosis ...

Ok, so I was a tad naive -- but the twenty years from 1962 to 1982 had been amazing. Infectious disease, nutritional disorders, thyroid disorders, insulin, hypertension, angina, -- we were doing great. All we had to do was keep up the pace ...

Splat.

We hit a wall. Now we're relearning how to fear bacterial infections, and the antibiotic pipeline is dry. We can't even treat menopause any more -- estrogen is a bad word. Lipitor and Glucophage are great, but we thought Diabetes Mellitus would be cured by now. We can slow the progress of HIV, but we still don't have a vaccine. Our progress against everyday medical conditions has been lousy over the past twenty years. Mostly we've learned to stop doing silly things, like given people with heart oddities antibiotics prior to minor dental work.

Forget the propaganda about zillions of articles being published -- that's not translating to big changes in people's lives. Yes, we do make progress -- but automobile-style progress, not computer-storage type progress. No wonder we're expecting to spend 99% of our GDP on health care -- we're not getting any big productivity boosts from breakthrough treatments.

Which brings me back to the "translational bioinformatics" stuff. This is the dream that we can apply enormous progress in computational power, and basic science breakthroughs in genomics, to the intractable diseases that have been jeering at us for 20 years.

I'd really like to see us knock off just one of those suckers before I retire. Multiple sclerosis would be a good start. Make my 20 year old knowledge completely obsolete. Please!

Support Tom Harkin's Complete Streets legislation - write your senator

In a nation heading to $7/gallon gasoline and malignant obesity Tom Harkin's "Complete Streets" legislation is both good business and good public health:

Tom Harkin Introduces "Complete Streets" Legislation || Integrated Road Planning || Ride Boldly!

Senator Tom Harkin (D-IA) introduced a bill last week designed to promote proper road planning - designing facilities that are safe for all street users, including motorists, public transit, bicyclists, and pedestrians.

Tom’s office has put out a complete media release, including the list of organizational supporters, on his Senate site. Many organizations devoted to promoting livable communities have signed on to this bill.

Writing your own Senator to encourage passage of this bill is best done by e-mail in the post-anthrax Senate, per a friend who used to be a Harkin advisor. If you need info on contacting your Senators, check out the Senate web site.

Please shoot off a supportive email. I know I will.

Oil price speculation: is it rational investment or a bubble?

I've read recently that oil prices "now" are driven by "speculation" rather than "fundamentals". In other words, based on near term supply and demand curves, including our current recession, prices should be stable or dropping, not rising.

Yet rise they do.

In August of 2007 I'd thought that, absent any surprises, gas would hit $5/gallon in the midwest around 2011:

2011: The year American life changes (Aug 2007)

When will energy costs in general, and gasoline costs in particular, fundamentally change the way middle-class Americans live and work? We know gasoline prices will rise until something changes, even if the US never implements a carbon tax...

...I think a reasonable marker is the year that the baseline gasoline price hits $5 a gallon...

So when does it happen? I'll pull a number out of the air, extrapolating from my amateur chart and the Copernican Principle, and guess, even without a carbon tax or the complete collapse of Iraq, that it's 2011.

I'm in California today, and it's $4/gallon here in early 2008. My 2011 prediction for a change in American life is looking conservative.

So, is today's oil price rational speculation or bubbly speculation?

Well, I haven't read any good discussions of this lately, so I'll say something and hope Brad DeLong decides to clear things up

One way this speculation could be rational is of the people who are paid to know believe that peak oil is coming any time in the next 10-15 years -- especially given the current bleak options for alternative investments. For non-economist readers, here's why:

Gordon's Notes: Gasoline and the rule of 72 (May 2007)

... There's some smaller rate of return that would make retaining rather than selling petroleum products the right way to invest. This is what all the "peak oil" crowd get excited about; but the term is a bit misleading. It's not that oil production needs to peak, it's simply that demand has to persistently outstrip supply. Prices, of course, don't wait for demand to outstrip supply, they begin rising as soon as a demand/supply gap can be reasonably anticipated within the time frame of investment decisions (10 years roughly).

This, by the way, is a very good thing. It means that prices rise long before we run out of oil, giving everyone time to adapt and adjust.

I do wonder what the sober experts calculate. They can look at supply curves and demand curves and the available substitutions within the next decade. Do they see a significant supply/demand gap opening up? If the price of gas will be $7/gallon in six years (well within the lifespan of your next Ford F-250), is that enough of rate of return to justify holding products now?...

So here's my proposal for deciding if Peak Oil is on the way.

If the price of oil craters ($65) in the next 6 months then we're living in an energy bubble today and Peak Oil is more than 10-15 years away.

If the price of oil is above $105 a barrel in August of 2008 then Peak Oil is on the sooner rather than later, and the world I grew up in is shuffling away -- sooner than I'd expected.

So American Life may change in 2008 - not 2011.

Shocking news: incenting physicians towards one goal has negative impacts on other goals

I am so surprised by this shocking, impossible to predict, outcome:

AMNews: March 17, 2008. CMS metric may prompt excessive antibiotic use ... American Medical News

...A new study says physicians are 39% more likely to misdiagnose hospital patients as having community-acquired pneumonia due to the high-stakes environment fostered by mandatory public reporting of quality measures -- in this case, whether pneumonia patients got antibiotics within four hours of arriving at the hospital.

The results, published in the Feb. 25 Archives of Internal Medicine, are similar to those found in a Chest study published last year and echo many physicians' complaints about the measure of initial antibiotic timing, known as door-to-needle time. A February 2007 Infection Control and Hospital Epidemiology study tied excessive use of antibiotics encouraged by the performance metric to a severe outbreak of Clostridium difficile at a small rural hospital...

I trust my sarcasm is sufficiently dripping.

The CMS pay-for-performance programs will be eventually recognized as the most harmful health care innovation since Evaluation and Management coding killed primary care in the 1990s.

Alas, that recognition is still 18 months away -- and here I'm being atypically optimistic. E&M coding, for example, has now been a 13 year disaster.

There are many ways to improve health care quality that have been shown work and to be relatively free of perverse consequences. "Pay-for-performance", however, is an ideologically driven program that was reasonable to experiment with -- before the evidence of failure emerged. Now it needs to die -- but it won't until the Bush team leaves CMS.

How Homeland Security sets its priorities

Ever wonder how Homeland Security evaluates its security investments?

Maybe you imagine dozens of super-sharp analysts, veterans and geeks alike, weighing risk and assigning probabilities, preparing carefully reasoned analyses which their superiors review and confirm.

Oops. No, that a flash from the alternate reality where Gore became President, bin Laden and Zawahiri are dead, we're not in a recession, and we didn't commit ourselves to a 1.5 trillion dollar war in Iraq.

In the Bush administration it goes more like this ...

Airport passenger screenings to be reviewed - USATODAY.com

...Chertoff's department is about to issue requirements for crews and passengers of private jets to provide their names, birthdates and other information an hour before takeoff, so they can be checked against terrorist watch lists.

The next step could be requiring that private jets be scanned and passengers screened by U.S. Customs agents overseas, Chertoff said. The procedures might be "a little inconvenient," he said, but if a bomb got into the USA on a private jet, there would be calls to "shut all private aviation off."

Chertoff said he grew more concerned about the issue last year when a senior executive of a private-jet company told him, "I don't know who the heck gets on my planes, and it worries me."...

I'm imagining Chertoff is hitting up some GOP donor at one of those $2,000 a plate dinners, and somehow this comment lodges deep in his dormant brain. Maybe it was the fine Scotch. Who knows?

Fire.

Chertoff.

Now.

Please.

Then fire his boss.

iPhone developer response to Apple's 30% cut on iApp sales, and why I still won't order one.

iApp developers aren't too worried about Apple's 30% cute on all iPhone App sales -- "How about we make shitloads of money at 70% and ask questions later?"

Well said. The iPhones application distribution model is fantastic.

I almost ran out and bought an iPhone today. I had to tie myself to a chair and reread my August 2007 list of iPhone demands (rev Oct 2007). Of 9 non-negotiable demands, exactly 1 (a trivial one) was met in the past seven months.

Some of my demands will be met by iPhone developers - after June 2008. Some may be solved with the promised 2.0 firmware update. NONE of them have been met today. Gordon's third law of acquisition was written for this precise situation: "Don't buy on promises or potential. Acquire for real value now. Anything in the future is a plus (or, sometimes, a minus)."

So when the SDK is really available, and when I see the true state of the 2.0 firmware update, then I'll buy.

In the meantime, I've been abusing* the Aperture trial offer long enough. Instead of an iPhone I've ordered my copy of Aperture 2.01.

* If you delete the prefs you get another 30 days of trial. With 2.01 you have to swap a library in and out as well. It took me a long time to decide that Aperture's virtues outweigh its many flaws; I suspect Apple knows about the little quirk that extends the trial.

State of the universe: flat, 72% vacuum energy

CV provides the recipe for our universe from the most recent analysis of the echoes of the big bang:

WMAP 5-Year Results Released | Cosmic Variance:

...The WMAP folks have produced an elaborate cosmological parameters table that runs the numbers for different sets of assumptions (with and without spatial curvature, running spectral index, etc), and for different sets of data (not just WMAP but also supernovae, lensing, etc). Everything is basically consistent with a flat universe comprised of 72% vacuum energy, 23% dark matter, and 5% ordinary matter....

Of course the human brain is 70% water, so we shouldn't feel entirely bad that most of what we know is only 5% of the universe.

Here's what Wikipedia has on "vacuum energy":

... Two proposed forms for dark energy are the cosmological constant, a constant energy density filling space homogeneously,^[2] and scalar fields such as quintessence or moduli, dynamic quantities whose energy density can vary in time and space. In fact, contributions from scalar fields, which are constant in space, are usually also included in the cosmological constant. The cosmological constant is thought to arise from the vacuum energy...

and

...Vacuum energy is an underlying background energy that exists in space even when devoid of matter ...

So the recipe is basically definitional. Take away dark and ordinary matter and you get, by definition vacuum energy. Vacuum energy may arise largely from "smooth tension" (aka "dark energy"), but perhaps that's an interpretation of the results, not a statement of the results.

PS. Please note I'm not physicist in any form, I just like learning this stuff.

Update 3/8/2008: A little more detail on bad astronomy. Age - 13.73 billion years (middle aged in terms of a universe in which we can live). The average temperature of the universe is 2.725 degrees Kelvin -- just a smidgin above nothing.

Unintended consequences and accidental death from polypharmacy

Patients are empowered, but lack knowledge.

Health care providers have knowledge, but are stressed, disintegrated, and "disintermediated". Primary care, in particular, is near death (or dead).

The pharmaceutical industry is in a lesser known crisis. Chinese generics drive ferocious price competition, the discovery pipeline is dry, patents are expiring, and the last cash cow, the US, is running out of money. So the advertisement is getting desperate.

The GOP has stripped regulatory agencies of mission and funding.

Add it all up, and you have a storm of unintended consequences brewing. Larry Zaroff tells the story very well (emphases mine)...

Heath Ledger death |By Larry Zaroff, M.D., Ph.D. | Salon Life

...According to the Centers for Disease Control and Prevention, motor-vehicle crashes rank first among unintentional deaths in America. But poisoning is second, most commonly from the abuse of prescription and illegal drugs. Unintentional deaths from accidental drug ingestion rose significantly from 1999 to 2004. This trend is primarily due to increasing use of prescription opioid analgesics, and not heroin, methamphetamines or other illegal drugs...

...After leaving the drugstore, the patient realizes the wise doctor has given her only 30 pills, not enough, since one pill no longer gives her what she requires: deep, worry-free sleep or relief of pain or anxiety. If she has all three problems, she will need more pills or other kinds. She goes to another doctor and gets a second supply. She is set for the moment. But her work requires travel, sometimes out of the country. She can locate other doctors in other places who will prescribe. Now she has a fine stash both in her medicine cabinet and in her suitcase.

She is young, smart, well regarded by her associates. She is the opposite of careless. But she has no understanding of physiology, how the body works, what controls vital functions -- breathing, heartbeat, circulation -- and how drugs can affect these functions. How drugs work, their rate of absorption, their peak level of activity, is of no interest to her. She only wants relief of her insomnia, her pain, her worries. She has no idea that drugs have an optimum dose, that combinations of drugs might be like taking too much of a single drug, that often dissimilar medicines can affect the same organs and stop their activities. Unknown to her, she may even have a genetic abnormality that makes her more susceptible to the synergistic effects of the drugs.

The patient is not an addict and suicide is the last thing she would consider. But she has a tough day ahead of her. She needs her sleep. She decides to take two sleeping pills since one did not work well enough the previous night. Because she strained her back yesterday and feared the pain might keep her awake, she takes a narcotic, a single dose. She feels edgy despite the sleeping pills and the narcotic, and so she takes a tranquilizer. The witches' brew works. She dozes off but awakes in two hours, her mind jumbled. She must sleep. She slips into the bathroom and repeats the doses. She lies down, sleeps soon, too deeply. An hour later she stops breathing. She is alone, no one to aid her...

I don't agree with Dr. Zaroff's recommended solutions (read the article). I think we need to go back to the list I started this post with, and work each one independently. I think we also need a national education program. The modern patient is going to "play doctor" anyway, so they might as well start in on medical skill. "Drugs Kill" might be a good ad slogan, though it might be confused with anti-cocaine ads.

Brad DeLong: Principles for enlightenment 2.0

DeLong responds to a post about the age of Milton Friedman with a statement of his own principles for our age.

Friedman's and his acolytes ascribed, perhaps unwittingly, wisdom and justice to the market itself. The religious right mixed this strange meme with their own traditions, creating a new golden calf that was one part Yahwism, one part Rand, one part Market, one part Calvin, one odd part Darwin, and one small part Christ.

DeLong's perspective is quite different, but it's very important to begin by recognizing that DeLong understands why the Market isn't the worst possible deity: (emphases mine)

Grasping Reality with Both Hands: Economist Brad DeLong's Fair, Balanced, and Reality-Based Semi-Daily Journal

...My principles would start from the observation that market economies and free and democratic societies are built on a very old foundation of human sociability, communication and interdependence. That foundation had a hard enough time functioning when human societies had 60 members -- eight orders of magnitude less than today's 6 billion.

So my principles would then be developed from Karl Polanyi's old observation that the logic of market exchange puts considerable pressure on that underlying foundation. The market for labor compels people to move to where they earn the most, at the price of potentially creating strangers in strange lands. The market for consumer goods makes human status rankings the result of market forces rather than social norms and views about justice.

This critique of the market is, of course, one-sided. After all, other arrangements for allocating labor appear to involve more domination and alienation than the labor market, which offers opportunities, not constraints.

Similarly, "social norms" and "views about distributive justice" usually turn out to favor whomever has the biggest spear or can convince others that obedience to the powerful is obedience to God. Market arrangements have a larger meritocratic component than the alternatives, and they encourage positive-sum entrepreneurship, making it easier to do well by doing good.

Nevertheless, the distribution of economic welfare produced by the market economy does not fit anyone's conception of the just or the best. Rightly or wrongly, we have more confidence in the correctness and appropriateness of political decisions made by democratically elected representatives than of decisions implicitly made as the unanticipated consequences of market processes.

We also believe that government should play a powerful role in managing the market to avoid large depressions, redistributing income to produce higher social welfare, and preventing pointless industrial structuring produced by the fads and fashions that sweep the minds of financiers.

Indeed, there is a conservative argument for social-democratic principles. Post-World War II social democracy produced the wealthiest and most just societies the world has ever seen. You can complain that redistribution and industrial policy were economically inefficient, but not that they were unpopular. It seems a safe bet that the stable politics of the post-war era owe a great deal to the coexistence of rapidly growing, dynamic market economies and social-democratic policies.

Friedman would say that, given the the world in 1975, a move in the direction of his principles was a big improvement. When I think of former US president Jimmy Carter's energy policy, Arthur Scargill at the head of the British mineworkers' union and Mao's Cultural Revolution, I have a hard time disagreeing with Friedman about the world in the mid-1970s.

But there I would draw the line: While movement in Friedman's direction was by and large positive over the past generation, the gains to be had from further movement in that direction are far less certain.

This is also what I believe. The Market is the best possible system we know of for "finding local minima" -- but it is not a Deity. Democracy is likewise imperfect. We seek a balance, something closer to Denmark and Canada than to old Hong Kong. Something that recognizes the problem of the weak, while admitting the limitations of human culture in 2008. This we can achieve, and this we must achieve.

Stories forgotten: Putin and the 1999 apartment bombings

Sometimes, when searching my blogs, I find fragments of stories even I've forgotten. I came across this one today:  Did the KGB blow up those Russian apartment buildings?.

In 2005 journalists at the Economists took seriously the possibility that Putin's KGB was involved in the "terrorist strike" that launched the Chechen war, and led, eventually, to Putin's current popular tyranny over all of Russia.

I wonder what would happen if evidence were to emerge that Putin was, in fact, involved.

If I were running the CIA, I'd be looking for that evidence. If I found it, I'd keep it for a rainy day ...

A bad day for Gastroenterologists

The (very high) income of the Gastroenterologist just took a significant hit.

The cause? We've now learned that half of all colon cancers arise from hard-to-see "flat lesions" in the colon:

Easily Overlooked Lesions Tied to Colon Cancer - New York Times

Japanese researchers became concerned about these flat lesions in the 1980s and ’90s, but studies here had mixed results and American doctors tended to think that flat growths were less common and less dangerous in the United States.

The new study, to be published Wednesday in the Journal of the American Medical Association, suggests otherwise.

Some doctors in this country were already alert to flat lesions, but the findings will pose a challenge to others, because it takes a trained and vigilant eye to see the growths and special techniques to remove them...

...The study, of 1,819 military veterans, mostly men, found that 9.35 percent had flat lesions, and those lesions were five times as likely as polyps to contain cancerous or precancerous tissue. Depressed or indented lesions were the least common but the most risky. Together, the flat or depressed lesions accounted for only 15 percent of the potentially cancerous growths found in the study, but were involved in half of the cancers. Once the doctors spotted the flat lesions, they sprayed a bluish dye on them to see their outlines better and remove them completely...

These suckers are hard to see. Looking for them may double the duration of a colonoscopy.

Problem is, Gastroenterologists are paid by the procedure, not by the minute. If a colonoscopy takes twice as long, then colonoscopy earnings fall by 50%. That probably translates to at least a 10-15% overall income cut.

Or, they could do what studies have shown many already do -- believe they're so incredibly skilled they can go really fast and still do a good job. Not true of course, but wishful thinking is strong when the money is right.

Either way, not a good day.

iPhone announcement - Fake Steve Jobs says it all

Love the Iron Man graphic ...

The Secret Diary of Steve Jobs: Happy now, bitches?

...29 June 2007 might be the day the world changed, but today it just changed again. BlackBerry is dead. Microsoft is dead. Windows Mobile is dead. Amazon is dead. Kindle is dead. Nokia is dead. Motorola was already dead but now they are even more dead...

... Seriously, folks, it's game over.... In Canada they declared a national day of mourning for RIM. It's that huge. Today, frankly, is a day that will live in the history of our industry...

Read the whole thing. It's funny, but might be true. I'm still waiting for the catch, but this announcement is way on the high end of what I'd expected.

One caveat: the June (31st*) SDK release is likely to come with iPhone 2.0, and my past experience with Apple is that new software releases never quite fly on hold hardware. So those of us considering buying an iPhone today have to recognize that we might be selling it four months from now.

* see comments

iPhone surprise: Microsoft is on board. Why?

About one week ago Michael Mace declared the mobile application marketplace dead.

Today Apple's developer web site was knocked off the net, completely obliterated, by people downloading the beta version of the iPhone SDK.

Sorry Michael.

Of course my critique of Mace's thesis wasn't perfect. I wrote:

... So now we have the iPhone. The browser experience leads people like Mace to predict that the browser is the new platform.

Maybe.

On the other hand, there are a lot of very, very smart developers who want to create the best possible native experiences for millions of iPhone users. Experiences that work on airplanes, cars, trains and lots of other places where the wireless experience sucks. Sure, you'll be able to create disconnected apps using Google Gears 2009 and Adobe AIR 2009, but they won't have the smooth elegance of native apps.

If Apple can prosper while staying clear of Microsoft's Exchange turf (don't go there Apple, it's a death trap) Mace may discover that he's declared the mobile platform dead at exactly the wrong time ...

Well, Apple didn't exactly steer clear of Exchange. They've embraced it, even licensing Microsoft's ActiveSync technology (current version supports sync with Exchange AND Outlook, but I didn't see the latter mentioned.)

Microsoft is playing along, helping Apple far more than they've helped RIM. Not to mention Microsoft's past use of Exchange to eviscerate Palm almost a decade ago.

So why is Microsoft playing nice? Are they just luring Apple into a pit of doom? Is this a clever way to bury RIM/BlackBerry without getting into antitrust problems? How the heck does Microsoft intend to protect their crappy corporate Mobile platform if the iPhone can sync with Exchange?

Those billion dollar EU fines have to be a part of the reason. Microsoft's (mis)use of Exchange protocols is cost money even they notice.

Even so, ActiveSync licensing?

I really don't think Microsoft is going to drop Windows Mobile and embrace the iPhone, but this is weird.

Physicians to go iPhone crazy

This is only the beginning, though it was neat to see Epocrates get Steve (Jobs) Note attention:

Epocrates Search Portal

...it was recently announced that Epocrates is one of a limited number of developers who have been working directly with the Apple team to make our applications available on the iPhone/iTouch.  We look forward to making the product available in the near future...

The iPhone SDK isn't officially out until June, so I don't necessarily expect Epocrates before then. On the other hand, they did demo it.

So much for Emily's BlackBerry Pearl -- ePocrates barely works on it and there's some memory leak besides. Anyone want a cheap Pearl?

Physicians loved the Palm when it worked, and the Newton before that. There are a surprising number of physicians who are perfectly happen to program (some did it professionally in prior lives), they'll be cranking out free iPhone and commercial iPhone apps at an amazing rate.