Scientific American on compact fluorescent light bulbs - toxic waste or not?

We'd be using compact fluorescent bulbs -- except I'm kind of clumsy. I break a few bulbs every year. According to the EPA a broken bulb is a toxic waste spill. The incongruity of one part of government advocating fluorescents, and another department warning against them, made me dig in my heels ...

... A commenter pointed to this Energy Star Canada document. It's deeply "schizophrenic" in the non-medical sense of term. On the one hand it says:

• These are perfectly safe for your baby's bedroom. Don't worry about them. You could break one a day for the rest of your days and not have a problem.
• They must be disposed of as toxic waste. Vacuum up carefully and then drop your vacuum off at the toxic waste site ...

I'm joking about the vacuum. Sorry, this still doesn't make sense. Either the mercury content is harmless and they're not toxic waste, or they're toxic waste. (My bet is they're not really toxic waste, but I'm not buying 'em until we get the regulators to be internally consistent.)

Recently Scientific American covered this topic. Some highlights (emphases mine):

Are Compact Fluorescent Lightbulbs Dangerous?: Scientific American

... Compact fluorescents, like their tubular fluorescent precursors, contain a small amount of mercury—typically around five milligrams.

As effective as it is at enabling white light, however, mercury—sometimes called quicksilver—is also highly toxic. It is especially harmful to the brains of both fetuses and children. That's why officials have curtailed or banned its use in applications from thermometers to automotive and thermostat switches. (A single thermostat switch, still common in many homes, may contain 3,000 milligrams (0.1 ounce) of mercury, or as much as 600 compact fluorescents.)

Jim Berlow, director of the U.S. Environmental Protection Agency's (EPA) Hazardous Waste Minimization and Management Division, recommends starting by opening the windows and stepping outside. "Any problems at all frequently are handled for the most part by quickly ventilating the room," he says. "Get all the people and pets out of the room for 15 minutes and let the room air out. If you have a central heating system or an HVAC [heating, ventilating and air-conditioning] system, you don't want it sucking the fumes around, so shut that down."

... After airing out the room, the larger pieces of the bulb should be scooped off hard surfaces with stiff paper or cardboard or picked up off carpeted surfaces with gloves to avoid contact. Use sticky tape or duct tape to pick up smaller fragments; then, on hard surfaces, wipe down the area with a damp paper towel or a wet wipe. All materials should be placed in a sealable plastic bag or, even better, in a glass jar with a metal lid.

...Vacuums or brooms should generally be avoided, as they can spread mercury to other parts of the house.

Intact bulbs can be a headache to dispose of, too. In many locales it is illegal to throw fluorescents out with regular garbage, but the closest recycling or take-back facility may be miles away...

"Our first preference is not to see them go into landfills," Berlow says. "Recycling really closes the loop on this as best we can right now. But on the other hand, we also don't see huge risks from them going into landfills, either."

So the authorities aren't budging on the toxic waste cleanup routine, and legal disposal of even an intact bulb requires a significant trip (I have years of toxic waste dump material in the garage waiting for me to schedule that trip).

I'm waiting for the LEDs.

PS. I'm sure as heck not touching that thermostat switch ...

Condolezza Rice and Torture

Rice is said to be maneuvering to be McCain's VP.

Rice authorized torture. In detail. Repeatedly.

ABC has the story. Note that Ashcroft, who's reputation has been on the rise for a few years, was disturbed. Tenet wanted to be sure Cheney and Rice were implicated in the torture decisions, he didn't want his agents to take the fall alone. The torture proceedings are probably still continuing -- as indicated by the Goss transition.

Emphases mine.

Sources: 'Principals' OK'd Harsh Tactics

By JAN CRAWFORD GREENBURG, HOWARD L. ROSENBERG and ARIANE de VOGUE

April 9, 2008—

In dozens of top-secret talks and meetings in the White House, the most senior Bush administration officials discussed and approved specific details of how high-value al Qaeda suspects would be interrogated by the Central Intelligence Agency, sources tell ABC News.

The so-called Principals who participated in the meetings also approved the use of "combined" interrogation techniques -- using different techniques during interrogations, instead of using one method at a time -- on terrorist suspects who proved difficult to break, sources said.

Highly placed sources said a handful of top advisers signed off on how the CIA would interrogate top al Qaeda suspects -- whether they would be slapped, pushed, deprived of sleep or subjected to simulated drowning, called waterboarding.

The high-level discussions about these "enhanced interrogation techniques" were so detailed, these sources said, some of the interrogation sessions were almost choreographed -- down to the number of times CIA agents could use a specific tactic.

The advisers were members of the National Security Council's Principals Committee, a select group of senior officials who met frequently to advise President Bush on issues of national security policy.

At the time, the Principals Committee included Vice President Cheney, former National Security Advisor Condoleezza Rice, Defense Secretary Donald Rumsfeld and Secretary of State Colin Powell, as well as CIA Director George Tenet and Attorney General John Ashcroft...

... this is the first time sources have disclosed that a handful of the most senior advisers in the White House explicitly approved the details of the program. According to multiple sources, it was members of the Principals Committee that not only discussed specific plans and specific interrogation methods, but approved them.

... Tenet, seeking to protect his agents, regularly sought confirmation from the NSC principals that specific interrogation plans were legal.

According to a former CIA official involved in the process, CIA headquarters would receive cables from operatives in the field asking for authorization for specific techniques. Agents, worried about overstepping their boundaries, would await guidance in particularly complicated cases dealing with high-value detainees, two CIA sources said.

Highly placed sources said CIA directors Tenet and later Porter Goss along with agency lawyers briefed senior advisers, including Cheney, Rice, Rumsfeld and Powell, about detainees in CIA custody overseas. ..

... Then-Attorney General Ashcroft was troubled by the discussions. He agreed with the general policy decision to allow aggressive tactics and had repeatedly advised that they were legal. But he argued that senior White House advisers should not be involved in the grim details of interrogations, sources said.

According to a top official, Ashcroft asked aloud after one meeting: "Why are we talking about this in the White House? History will not judge this kindly."

The Principals also approved interrogations that combined different methods, pushing the limits of international law and even the Justice Department's own legal approval in the 2002 memo, sources told ABC News.

At one meeting in the summer of 2003 -- attended by Vice President Cheney, among others -- Tenet made an elaborate presentation for approval to combine several different techniques during interrogations, instead of using one method at a time, according to a highly placed administration source.

A year later, amidst the outcry over unrelated abuses of Iraqi prisoners at Abu Ghraib, the controversial 2002 legal memo, which gave formal legal authorization for the CIA interrogation program of the top al Qaeda suspects, leaked to the press. A new senior official in the Justice Department, Jack Goldsmith, withdrew the legal memo -- the Golden Shield -- that authorized the program.

But the CIA had captured a new al Qaeda suspect in Asia. Sources said CIA officials that summer returned to the Principals Committee for approval to continue using certain "enhanced interrogation techniques."

Then-National Security Advisor Rice, sources said, was decisive. Despite growing policy concerns -- shared by Powell -- that the program was harming the image of the United States abroad, sources say she did not back down, telling the CIA: "This is your baby. Go do it."

Rice, Cheney, Rumsfeld, Power, Tenet and even Ashcroft will need to be very careful about where they vacation for the rest of their lives. There are many nations which may be obliged to arrest them in the future.

If McCain accepts Rice as VP, he will be continuing a long repudiation of the values he once defended.

The Consumerist

A blog dedicated to consumer activisim: The Consumerist. It includes the Chinese poison train section. The world needs China to be enormously successful, in an ideal universe the Chinese government would be funding publication of "The Chinese poison train".

From the about stream:

7. Who is responsible for this?

The Consumerist is published by Gawker Media, the folks also responsible for Gizmodo, Fleshbot, Defamer, Idolator, Jalopnik, Gridskipper, Wonkette, Kotaku, Screenhead, Lifehacker, Valleywag and Gawker.

I can't get their feed to work with Bloglines at the moment.

Lester Brown, Julian Simon, the UNFPA, Malthus, and, again, the Food

I heard Lester Brown on NPR this morning.

That took me back 27 years. Bear with me, there's a reason to start then.

Once upon a time I was a covert intern at the UNFPA officers in what was then Bangkok.

In those days we thought of the "FP" in "UNFPA" as "family planning", though I think it stood for "Fund and Population". The UNFPA was all about changing fertility behaviors and accelerating the transition in family size from agrarian to industrial norms. Thailand, Taiwan, and Bangladesh were success stories. Rwanda was a worrisome failure. Afghanistan was on the map because of its ecological collapse.

In those days Lester Brown, the Worldwatch Institute, and Malthus were in the ascendancy. My UNFPA mentor and I leaned towards Malthus, and so I wrote essays for him attacking the optimistic economist Julian Simon, whose views were well summarized in his NYT obit:

... The essence of Mr. Simon's view of man and the future is contained in two predictions for the next century and any century thereafter that are in ''The State of Humanity,'' a book he edited for the Cato Institute.

''First,'' he wrote, ''humanity's condition will improve in just about every material way. Second, humans will continue to sit around complaining about everything getting worse.''

He argued that mankind would rise to any challenges and problems by devising new technologies to not only cope, but thrive. ''Whatever the rate of population growth is, historically it has been that the food supply increases at least as fast, if not faster,'' he said in a profile published in Wired magazine last year.

Mr. Simon's views were widely contested by a large coterie of the academic and scientific community, many of whose members believe that more people create more problems, straining the earth and its resources in the process.

''Most biologists and ecologists look at population growth in terms of the carrying capacity of natural systems,'' said Lester R. Brown, president of the Worldwatch Institute in Washington. ''Julian was not handicapped by being either. As an economist, he could see population growth in a much more optimistic light.''...

It's generally assumed now that Simon was right, but a pessimist would say it's too soon to tell. As DeLong and Krugman have pointed out, most of the human race was in a Malthusian trap from 6000 BCE until the time of Malthus himself. Rwanda, as feared in 1982, did experience a classic Malthusian collapse, though its subsequent recovery is much faster than the pre-industrial record. Afghanistan's fragile ecology collapsed in the 20th century, and we know how that story turned out.

Many things have happened since those days in Bangkok. Outside of Africa most of the world, especially China and India, followed the predictions of Simon rather than Malthus. On the other hand, world population growth has also followed the more optimistic projections of the 1982 UNFPA.

Given my historic roots, it's not surprising then that I would call the Simon vs. Brown battle a draw. On the one hand the Green Revolution worked, cheap energy meant cheap food, and worldwide trade combined with the kind of worldwide productivity growth Simon expected. On the other hand there were also near optimal changes in fertility behavior across many nations. The net effect was that a year or two ago we though that obesity might become a bigger public health problem problem than malnutrition in many once poor nations.

During this time the UNFPA, like all great bureaucracies, evolved to fill new niches. Now it's the "United Nations Population Fund - UNFPA" and all the links on the public page are about reproductive health and fighting HIV. The words "family planning" do appear, though they are a bit hidden.

Twenty-six years later, though, the wheel may have turned again. Simon died young at 65, but Lester Brown is still alive, and again on NPR. The reason, of course, is that classic collapse factors are again in play ...

Grains Gone Wild - Paul Krugman - New York Times

... Over the past few years the prices of wheat, corn, rice and other basic foodstuffs have doubled or tripled, with much of the increase taking place just in the last few months...

There have already been food riots around the world. Food-supplying countries, from Ukraine to Argentina, have been limiting exports in an attempt to protect domestic consumers, leading to angry protests from farmers — and making things even worse in countries that need to import food.

... First, there’s the march of the meat-eating Chinese — that is, the growing number of people in emerging economies who are, for the first time, rich enough to start eating like Westerners. Since it takes about 700 calories’ worth of animal feed to produce a 100-calorie piece of beef, this change in diet increases the overall demand for grains...

Second, there’s the price of oil. Modern farming is highly energy-intensive...

Third, there has been a run of bad weather in key growing areas. In particular, Australia, normally the world’s second-largest wheat exporter, has been suffering from an epic drought....

... Where the effects of bad policy are clearest, however, is in the rise of demon ethanol and other biofuels...

We need to dial way back on the biofuels experiment -- it's not working. Unless we figure out how to process cellulose it's an energy negative process. It should be a research project, not a production enterprise. Biofuel production happened prematurely because of US domestic politics (including, most shamefully, the actions of Minnesota's senators including the sainted Paul Wellstone).

The other problems are far less tractable, they'll persist even if we eliminate biofuels and lessen the direct competition between our mobility desires and food production.

So the EU, US, China and India could be simultaneously enlightened and decide to eat less meat, drive less, institute a carbon tax to fund research into alternative energy sources, and forswear biofuels. Or we could discover a something like "cold fusion", except it would have to work. Or we could ...

I'm out of ideas right now. Any suggestions?

It is worth remembering, in case anyone needs motivation for new ideas, that any local Malthusian collapse is likely to lead to the vengeful use of inexpensive weapons of mass havoc.

So we all have "skin in the game" -- beyond mere compassion.

Best explanation of the Monty Hall problem (Bayes)

John Tierney has been playing with explanations of the "Monty Hall" (Bayes theorem) problem for 17 years. That might be why he's provided the most succinct explanation I've come across ... (note: Monty knows where the car is, he can't open the door you picked, and he won't open the door for the car. That's important -- his actions provide new information. He's not picking randomly.)

Cognitive Dissonance in Monkeys - The Monty Hall Problem - New York Times

...Here’s how Monty’s deal works, in the math problem, anyway. (On the real show it was a bit messier.) He shows you three closed doors, with a car behind one and a goat behind each of the others. If you open the one with the car, you win it. You start by picking a door, but before it’s opened Monty will always open another door to reveal a goat. Then he’ll let you open either remaining door.

Suppose you start by picking Door 1, and Monty opens Door 3 to reveal a goat. Now what should you do? Stick with Door 1 or switch to Door 2?...

...You should switch doors.

... when you stick with Door 1, you’ll win only if your original choice was correct, which happens only 1 in 3 times on average. If you switch, you’ll win whenever your original choice was wrong, which happens 2 out of 3 times...

Probability problems are often asymmetric, they can be hard to solve in terms of the "correct choice", but easy to understand when considered when re-expressed in terms of the "wrong choice" (or vice-versa). That's what we see here.

Tierney's paragraph is a great example of expressing simple algebra in sentence form, but the key thing to recall is that Monty is adding new information because he doesn't choose randomly.

I'm fascinated by Bayesian probability. The mathematics is very simple, yet it can be very challenging to map correctly to the physical universe. On the other hand even a trivial understanding would greatly improve government and law enforcement. What a marvel!

The case of the curious silence: Counterfeit Heparin killed 62+

Counterfeit Heparin (alas, again fraud in China) killed 62 - Americans. I've not seen data on foreign deaths. The latest via ABC:

ABC News: FDA Puts Heparin Death Count at 62

... After reviewing adverse events back to January 2007, FDA said Tuesday it uncovered 103 reports of patients who died while taking heparin.

Of those deaths, 62 involved allergic reactions or hypotension, a type of dangerously low blood pressure. Those are the same side effects that caused Baxter's to pull all U.S. heparin injections from the market by February...

America's adverse event monitoring system is very unlikely to be complete. I would not be surprised if the true Heparin associated death rate were 2-3 times as high. Anaphylactic reactions are not universally fatal, so I suspect that for every death there might be ten people who were injured, some of who will not fully recover. Some will have been weakened at a critical point, and then died of other causes.

So let's make a wild guess, and estimate that 2,000 to 3,000 Americans were seriously injured or killed by a fraudulent version of an extensively used medication. Since up to 10% of our Heparin supply was affected by the fraud, that's not too shocking. In fact there's reason to suspect the practice started before January 2007, so the total could be higher.

But that's only one drug. And that's only the US. If we include all the wealthy nations of the earth (it's a cheap widely used drug but the most common uses are for expensive treatments) we can guess that 5,000 to 30,000 people have died or been badly injured as a result of fraudulent medications or fraudulent food practices over the past 2-3 years.

That's a fair total, so the curious thing in this affair is the public silence. There's a great deal of unmerited anxiety about immunizations, but very little about fraud and our food and medication supply.

So, why is America silent? Is this a variant of the social phenomena that leads to complacency about climate change?

I don't think so. Climate change complacency is relatively easy to understand -- for many Americans a warmer climate is seen as a net plus, and even some plausible experts feel our only hope is a technological breakthrough in either energy production or carbon sequestration.

This feels different. My best guess is a kind of learned helplessness, the result of 12 years of GOP destruction of government* and the obvious failure of Libertarian dreams of emergent market-driven auto-regulation.

If I'm right, matters will only improve if McCain loses the presidency and both the House and Senate stay Democrat. I don't see any other configuration that will allow the rebuilding of our government.

* 8 years of Bush, and during Clinton's last term the House and Senate were both GOP. It's much easier to destroy than to create or maintain, so control of either the presidency or the legislature is sufficient to destroy  government.

Aaronson's MIT lectures on theoretical computer science - open to all

Scott Aaronson teaches an MIT course on theoretical computer science (emphasis mine)

6.080 Great Ideas in Theoretical Computer Science

... a challenging introduction to some of the central ideas of theoretical computer science. It attempts to present a vision of "computer science beyond computers": that is, CS as a set of mathematical tools for understanding complex systems such as universes and minds. Beginning in antiquity -- with Euclid's algorithm and other ancient examples of computational thinking -- the course will progress rapidly through propositional logic, Turing m achines and computability, finite automata, Gödel's theorems, efficient algorithms and reducibility, NP-completeness, the P versus NP problem, decision trees and other concrete computational models, the power of randomness, cryptography and one-way functions, computational theories of learning, interactive proofs, and quantum computing and the physical limits of computation...

Prerequisites. This course is designed for undergraduates (both under- and upperclassmen) in computer science and related areas of science and engineering.... The only prerequisite is some facility with mathematical reasoning ... Programming experience is helpful but not essential; the course has no programming assignments.

Scott writes on his blog, Shtetl-optimized, where he's created blogthread for the course, including links to completed lectures:

• Lecture 1: Introduction
• Lecture 2: Logic
• Lecture 3: Circuits and Finite Automata
• Lecture 4: Turing Machines
• Lecture 5: Reducibility and Gödel
• Lecture 6: Minds and Machines
• Lecture 7: Complexity
• Lecture 8: Polynomial Time
• Lecture 9: P and NP
• Lecture 10: NP-completeness
• Lecture 11: NP-completeness in Practice
• Lecture 12: Space Complexity and More
• Lecture 13: Randomness
• Lecture 14: Probabilistic Complexity Classes
• Lecture 15: Derandomization / Crypto Double Feature
• Lecture 16: Private-Key Cryptography
• Lecture 17: Public-Key Cryptography
• Lecture 18: Cryptographic Protocols (including: how computer scientists date!)
• Lecture 19: Interactive Proofs / Machine Learning

A typical lecture handout is about 8 pages. I plan to print out each one and leave them by the spot where I keep all the material for five minutes of concentrated attention is practical.

Amidst the mixed news of everyday life in 2008, what a wonder it is that all of us can freely share in work like this. Thank you Scott, and thank you MIT.

Marx and Engels on the railway bubble of 1845

Brad DeLong has a great post for his econ class that includes, as an aside, a quote from Marx and Engels on a 19th century boom and bust ...

April 9 Lecture: Econ 101b: Arguments Against Lender-of-Last Resort Operations

... In the years of prosperity from 1843 to 1845, speculation was concentrated principally in railways, where it was based upon a real demand.... The extension of the English railway system... 1845... the number of bills presented for the formation of railway companies [i.e., IPOs] amounted to 1,035.... The heyday of this speculation was the summer and autumn of 1845. Stock prices rose continuously, and the speculators' profits soon sucked all social classes into the whirlpool. Dukes and earls competed with merchants and manufacturers for the lucrative honour of sitting on the boards of directors of the various companies; members of the House of Commons, the legal profession and the clergy were also represented in large numbers. Anyone who had saved a penny, anyone who had the least credit at his disposal, speculated in railway stocks...

I think something similar was going on in America, and the economic chaos is thought to have played an important role in the Civil War.

The entire quote is fascinating reading.

The railway bubble, though it burst, had very solid foundations. My Irish-Canadian grandparents and their extended family worked largely in the rail industry at the start of the 20th century -- fifty years after the great railway depression of 1848. So the historic analogy is not to the real estate bubble of 2002 - 2007, but to the Internet bubble of 1998 - 2000.

(Incidentally, DeLong is a solid neo-liberal capitalist, his reference to Marx belongs to the history of economic thought.)

Gordon's Notes move failed

My planned migration of Gordon's Notes is on hold -- Google's Blogger failed with a typically unhelpful Blogger error message.

I'm putting the migration on hold until I hear back from Google -- so posts should continue to appear at jfaughnan.blogspot.com.

Gordon's Notes to move to notes.kateva.org: In theory, no changes required

I've been writing Gordon's Notes at the Blogger address of jfaughnan.blogspot.com since July 2003. The 4050 posts to date have a very small (but much appreciated) regular readership, but they turn up in a gratifying number of Google searches.

The writing relieves my personal frustrations, and it helps me think and learn. I enjoy it, and I intend to continue. The address, however, is about to change to notes.kateva.org, where it will join Gordon's Tech which has been tech.kateva.org for about a year. It will still be published through Blogger, kateva.org is a Google "custom domain".

There's an explanation of the name change at www.kateva.org - Welcome to Kateva.org

... I originally published under my own name, but the common business practice of searching the names of new acquaintances meant I was making a bit too much of first impression. I've since taken a few steps to move the blogs one or two steps from my "real name", including publishing under a pseudonym (John Gordon) and moving the blogs to this domain. I am not, however, too hard to find...

In theory Google will do a "301 redirect" and old feeds will continue to work. In practice, problems can occur. In particular Google doesn't redirect for some legacy Blogger (working) feeds, only for the current feeds.

So if you find this post in your Feed, and then no "it worked" post after it, you should be able to find Gordon's Notes at notes.kateva.org. The Kateva.org main page will also have news of the move.

Most blog readers will reset your "unread" count to 10 posts.

Wish me luck, I'll make the move later tonight April 6th.

Update 4/6/2008: Well, I tried the move and I got:

We're sorry, but we were unable to complete your request.
When reporting this error to Blogger Support or on the Blogger Help Group, please:
* Describe what you were doing when you got this error.
* Provide the following error code and additional information.
bX-czudlu
Additional information
blogID: 5587346
host: draft.blogger.com
uri: /blog-publishing.do
This information will help us to track down your specific problem and fix it! We apologize for the inconvenience.

Sigh. There's no real support for blogger, so I guess I'll have to see how this works out. I wonder if this blog will continue to work ...

Primary care access problems in Massachusetts -- and the strange reporting thereof

The New York Times has a longish front page article on access problems in Massachusetts that could have been replaced by three bullet points:

1. Massachusetts' pseudo-universal coverage cut the uninsured in half, making another 340,000 eligible for non-emergent care.
2. The average radiologist in Massachusetts makes $380,000 dollars.
3. In the rural areas that are short of providers "...some physicians are earning as little as $70,000 after 20 years of practice...".

Gee, that's not so complicated is it?

Cut reimbursement to radiologists and other specialists by 30-40%, and increase reimbursement to rural family physicians by 60-80%, and I promise those access problems would melt away. I can even promise that overall quality of care would eventually improve across the board -- after an incredibly painful transition period.

This is roughly the income distribution that both Canada and the Mayo Clinic used to have, so it's known to work. Of course an income cut of that magnitude would put some specialists out of their homes, and a goodly number of senior people would simply retire. The transition would not be pretty, and perhaps not very fair. It would work though.

For me, the interesting thing about this story is not its unsurprising content, but its peculiar structure. The relevant information is oddly distributed, and few will read to to the meaningful paragraphs at the very end.

For example, here's the beginning:

In Massachusetts, Universal Coverage Strains Care - New York Times

...In pockets of the United States, rural and urban, a confluence of market and medical forces has been widening the gap between the supply of primary care physicians and the demand for their services. Modest pay, medical school debt, an aging population and the prevalence of chronic disease have each played a role.

Now in Massachusetts, in an unintended consequence of universal coverage, the imbalance is being exacerbated by the state’s new law requiring residents to have health insurance.

Since last year, when the landmark law took effect, about 340,000 of Massachusetts’ estimated 600,000 uninsured have gained coverage. Many are now searching for doctors and scheduling appointments for long-deferred care....

This is followed by filler, and then "page two":

... The situation may worsen as large numbers of general practitioners retire over the next decade. The incoming pool of doctors is predominantly female, and many are balancing child-rearing with part-time work. The supply is further stretched by the emergence of hospitalists — primary care physicians who practice solely in hospitals, where they can earn more and work regular hours. President Bush has proposed eliminating $48 million in federal support for primary care training programs.

Clinic administrators in western Massachusetts report extreme difficulty in recruiting primary care doctors. Dr. Timothy Soule-Regine, a co-owner of the North Quabbin practice, said it had taken at least two years and as long as five to recruit new physicians.

At the University of Massachusetts Medical School in Worcester, no more than 4 of the 28 internal medicine residents in each class are choosing primary care, down from half a decade ago, said Dr. Richard M. Forster, the program’s director. In Springfield, only one of 16 third-year residents at Baystate Medical Center, which trains physicians from Tufts University, plans to pursue primary care, said Jane Albert, a hospital spokeswoman.

The need to pay off medical school debt, which averages $120,000 at public schools and $160,000 at private schools, is cited as a major reason that graduates gravitate to higher-paying specialties and hospitalist jobs.

Then, at the very end, the two most important paragraphs ...

... Primary care doctors typically fall at the bottom of the medical income scale, with average salaries in the range of $160,000 to $175,000 (compared with $410,000 for orthopedic surgeons and $380,000 for radiologists). In rural Massachusetts, where reimbursement rates are relatively low, some physicians are earning as little as $70,000 after 20 years of practice...

Where do editors and journalists learn this obscure form of writing?

In any case, the problem is relative income of course -- it always is. Relative not only to medical specialists, but also to corporate executives, business owners, lawyers, accountants, etc.

Incidentally, I'm fine with Bush eliminating the $48 millions in subsidies for primary care programs. In 2007 42% of family practice residents came from US schools -- that's low enough to be a serious quality issue. We probably need to close half of the remaining primary care residencies, and losing the subsidy would ensure that. Of course the access problems would worsen, but subsidizing training is the wrong answer. Perhaps a sudden drop in a tight supply would concentrate minds a bit ...

Update 4/10/08: Coincidentally, today's NYT editorial also mentions the Mayo example, but fails to make the important connection to May's relatively small specialty/primary care income ratio.

AT&T vs. Sprint: one is better

I don't think there are any truly good cell phone companies [2], but three months after switching from Sprint to AT&T I can say that for us these two are not the same.

Sprint has better service and costs less.

Alas.

We switched because I wanted to buy an iPhone, which I still haven't bought [1]. I wasn't as wise as this writer:

ATPM 14.04 - Bloggable: Shallow Depth of Field

...Then, there’s writing about the iPhone. You see, I don’t have one, because I don’t have AT&T service. And until my friends who do aren’t constantly cursing dropped calls, I have no intention of switching carriers and buying an iPhone...

My friends weren't as forthcoming, but I can personally confirm that in the midwest AT&T drops calls routinely. My phone may show "four bars", but that's just a little AT&T joke. I go from four bars to no carrier in an eye-blink.

Cost? AT&T costs us about 70% more than Sprint for a similar set of services. I think this huge gap is partly an artifact of our usage patterns (two phones, moderate voice use, frequent calls to Canada, very little roaming on Sprint) but I suspect AT&T would cost most people about 20% more than Sprint.

Contracting trickery? Sprint has a nefarious history of covert contract extensions, but they've been getting better since being sued in Minnesota. AT&T has the rebate scam from Hell.

Sprint wins across the board on voice quality, cost, and contracting. I'm amazed.

The only thing AT&T has is the iPhone, but that's a very big thing. If you aren't going to buy an iPhone immediately, however, don't switch to AT&T.

As a current AT&T customer, I join the world's pleas for a great Google Android phone, and for a future iPhone free of AT&T.

--

[1] The timing of the switch was dictated by the impending death of my wife's beloved Samsung i500, I was waiting to see the shape of the SDK before committing to the iPhone. The SDK took so long to be revealed I ran into the pending iPhone 2.0 release!

[2] The contract lock-ins, switching costs, and the pricing costs all promote bad business practices.

Bush war crimes trial: exhibit A

Someday, many years from now, an aged George Bush may yet face a war crimes tribunal. If he does, the Yoo torture memo will be exhibit A:

There Were Orders to Follow - New York Times

...The March 14, 2003, memo was written by John C. Yoo, then a lawyer for the Justice Department. He earlier helped draft a memo that redefined torture to justify repugnant, clearly illegal acts against Al Qaeda and Taliban prisoners.

The purpose of the March 14 memo was equally insidious: to make sure that the policy makers who authorized those acts, or the subordinates who carried out the orders, were not convicted of any crime. The list of laws that Mr. Yoo’s memo sought to circumvent is long: federal laws against assault, maiming, interstate stalking, war crimes and torture; international laws against torture and cruel, inhuman or degrading treatment; and the Geneva Conventions.

Mr. Yoo, who, inexplicably, teaches law at the University of California, Berkeley, never directly argues that it is legal to chain prisoners to the ceiling for days, sexually abuse them or subject them to waterboarding — all things done by American jailers.

His primary argument, in which he reaches back to 19th-century legal opinions justifying the execution of Indians who rejected the reservation, is that the laws didn’t apply to Mr. Bush because he is commander in chief...

...When the abuses at Abu Ghraib became public, we were told these were the depraved actions of a few soldiers. The Yoo memo makes it chillingly apparent that senior officials authorized unspeakable acts and went to great lengths to shield themselves from prosecution.

The state of California needs to revoke John Yoo's right to practice law.

Those convicted of the Abu Grhaib war crimes should ask for a retrial, and submit the Yoo memo as evidence that they were following their leaders.

Over the hill

Older folk are slower at computer tasks:

Quoted : Good Morning Silicon Valley

...Does this mean that people in their 40s or 50s can’t do their jobs? Not at all. There are many other ways in which people get better with age...

We get more expensive, for one.

Oh wait, that's not a feature.

We need to move the retirement age to 40. Since many of us are in school and training to about age 30 that will give us ten years to work.

Today.

In ten years though, training will extend to age 33, and the age of incapacity will slip to 37.

I detect a problem.

How we perceive - a review of the art

Natalie Angier, while reporting on a science conference, provides a fascinating state of the art summary of visual perception.

We are again reminded that we live in our heads, and that the film that plays in there has only a loose connection to what's going on around us ...

Change Blindness - Natalie Angier - New York Times

.... Visual attentiveness is born of limited resources. “The basic problem is that far more information lands on your eyes than you can possibly analyze and still end up with a reasonable sized brain,” Dr. Wolfe said. Hence, the brain has evolved mechanisms for combating data overload, allowing large rivers of data to pass along optical and cortical corridors almost entirely unassimilated, and peeling off selected data for a close, careful view. In deciding what to focus on, the brain essentially shines a spotlight from place to place, a rapid, sweeping search that takes in maybe 30 or 40 objects per second, the survey accompanied by a multitude of body movements of which we are barely aware: the darting of the eyes, the constant tiny twists of the torso and neck. We scan and sweep and perfunctorily police, until something sticks out and brings our bouncing cones to a halt.

The mechanisms that succeed in seizing our sightline fall into two basic classes: bottom up and top down. Bottom-up attentiveness originates with the stimulus, with something in our visual field that is the optical equivalent of a shout: a wildly waving hand, a bright red object against a green field. Bottom-up stimuli seem to head straight for the brainstem and are almost impossible to ignore, said Nancy Kanwisher, a vision researcher at M.I.T., and thus they are popular in Internet ads.

Top-down attentiveness, by comparison, is a volitional act, the decision by the viewer that an item, even in the absence of flapping parts or strobe lights, is nonetheless a sight to behold. When you are looking for a specific object — say, your black suitcase on a moving baggage carousel occupied largely by black suitcases — you apply a top-down approach, the bouncing searchlights configured to specific parameters, like a smallish, scuffed black suitcase with one broken wheel. Volitional attentiveness is much trickier to study than is a simple response to a stimulus, yet scientists have made progress through improved brain-scanning technology and the ability to measure the firing patterns of specific neurons or the synchronized firing of clusters of brain cells.

Recent studies with both macaques and humans indicate that attentiveness crackles through the brain along vast, multifocal, transcortical loops, leaping to life in regions at the back of the brain, in the primary visual cortex that engages with the world, proceeding forward into frontal lobes where higher cognitive analysis occurs, and then doubling back to the primary visual centers. En route, the initial signal is amplified, italicized and annotated, and so persuasively that the boosted signal seems to emanate from the object itself. The enhancer effect explains why, if you’ve ever looked at a crowd photo and had somebody point out the face of, say, a young Franklin Roosevelt or George Clooney in the throng, the celebrity’s image will leap out at you thereafter as though lighted from behind.

Whether lured into attentiveness by a bottom-up or top-down mechanism, scientists said, the results of change blindness studies and other experiments strongly suggest that the visual system can focus on only one or very few objects at a time, and that anything lying outside a given moment’s cone of interest gets short shrift. The brain, it seems, is a master at filling gaps and making do, of compiling a cohesive portrait of reality based on a flickering view.

“Our spotlight of attention is grabbing objects at such a fast rate that introspectively it feels like you’re recognizing many things at once,” Dr. Wolfe said. “But the reality is that you are only accurately representing the state of one or a few objects at any given moment.” As for the rest of our visual experience, he said, it has been aptly called “a grand illusion.” Sit back, relax and enjoy the movie called You.

This evening my son was using a Flip Video camera to record the midst of a chaotic bout of present opening. I happened to play it back about an hour after the event, so I still had some memory of what I perceived. The video showed there was much more going on than I took in, including my oldest son reading a letter included in his brother's gift.

Truly, there are vast rivers of reality going by, we live on a few sips and a lot of extrapolation. It is a miracle, given the imaginary worlds in which we live, that we are able to communicate at all.