Obama and the dog (corrected)

FMH is right.

Most Disturbing Moment in Obama’s Leno Appearance - Follow Me Here…:

...[I]nevitably, he talked about the long-promised family dog, joking that he might not get one after all. “This is Washington,” he said with a sly smile. “That was a campaign promise."...

You can't fix the economy Mr. President. You probably can't deliver health care reform. You can get the damned dog.

Now.

Update 4/12/09: My apologies to President Obama. Now that the famed dog has been identified, the BBC gives us a bit more quote context:

"This is Washington. That was a campaign promise," Mr Obama said, as the audience roared with laughter. "No, I'm teasing. The dog will be there shortly."

That last bit was important. It turns the statement from nasty humor into just funny.

I wonder if FMH fell into the same trap I did -- an out of context quote.

Three whacks to me.

Health care reform – lessons from Quebec

Recently a woman hit her head while skiing and died.

That’s not news by itself. Downhill skiing is reasonably dangerous, and death from head injury is a yearly event at a major resort. In Colorado, for example, about 10 downhill skiers die every year, mostly from head injuries. So a major resort will have an average of 1-2 deaths a season.

The newsworthy part of this sad story is that the accident happened to a wealthy celebrity. The noteworthy part is that it took place in my birthplace – Quebec, at Mont Tremblant. I did my medical training in Quebec, and several family members, including my parents, still live there. So I have a reasonable sense of how well Quebec’s health care services work, and how well they don’t work.

In this case, the services didn’t work so well. Anyone with an epidural bleed, whether wealthy or poor, needs emergent neurosurgery. This patient was a long way from a neurosurgeon -- she needed a helicopter. Instead she got an long ambulance ride and she died. She might have died anyway, but the ambulance ride didn’t leave a lot of options.

The helicopter wasn’t available because Quebec’s government run health care system puts its limited money into other services.

Visiting nurses, good. Trauma care, not so good.

Which brings me to my old one slide summary of health care reform ..

(Or you can read the text version).

I’m certain Quebec could spend its health care dollars more wisely, but even a perfect government would make hard choices. Quebec provides universal health care coverage (more or less, meds not included) and it’s not a particularly rich region. Decades of stuttering separatism, political incompetence, and institutionalized corruption have taken their toll.

One choice Quebec has made is to spend less on costly air ambulance services. That means some people will die of trauma that, in the US or Ontario, might live.

And that’s the lesson for health care reform.

Health care costs money.

Sure, some people think computerized medical records will make everything affordable. Since I make things like that I must say that I agree completely and we’ll all soon drive our new Lexi to the Apple Store where our MacBook Pro will be ready for pick-up.

What?

Still here?

Ok, for the sake of argument, let’s assume that EHRs won’t turn out to be a miracle cure.

So what do we do then?

Well, we probably can’t do what Canada did when it introduced universal health care coverage. Most provinces banned private insurance, and then gave everyone top notch coverage. In other words, a Lexus for all. Then they ran out of money and, very painfully, started to make harder decisions.

We can’t do it because we’re massively in debt and more or less broke. We can’t pull that trick. Besides, it’s been done before, it might not work as well a second time.

So what can America do?

America can keep its luxurious waiting rooms and hospital Spas for people with money, and provide an effectively universal second tier health care delivery system that uses far fewer physicians, negotiates for cheap meds, and uses obsolete "netbook-grade" technology[1]. That system will be affordable.

Call it "Crummy Care". "Good Enough Care". It would be a huge benefit to our society.

People would hate it.

Or we can do nothing. We’re good at that.

Update: [1] On second thought, I think that analogy was obscure even by my standards. I'm pointing out that netbooks are cheap because they use obsolete technology. The best made netbooks perform like a 2004 stat-of-the-art laptop. I don't mean that netbooks have any impact on health care affordability. Sorry.

Skynet cometh

A dimly light cubicle, late in the night. Three large monitors display a bewildering array of controls and monitors, and Google Reader.

"Hitting the blogs Mike?" said Teresa as she sat on the table edge.

"Yeah, my brain is fried. We've tried everything, but all we're getting is basic AI. Sergey's gonna send me to tech support if we don't get something."

Teresa leaned forward. "Hey, what's that article?"

The human brain is on the edge of chaos - Follow Me Here…

“Cambridge-based researchers provide new evidence that the human brain lives “on the edge of chaos”, at a critical transition point between randomness and order. The study, published March 20 in the open-access journal PLoS Computational Biology, provides experimental data on an idea previously fraught with theoretical speculation...

... According to this study, conducted by a team from the University of Cambridge, the Medical Research Council Cognition & Brain Sciences Unit, and the GlaxoSmithKline Clinical Unit Cambridge, the dynamics of human brain networks have something important in common with some superficially very different systems in nature. ... critical systems are able to respond very rapidly and extensively to minor changes in their inputs.”

"Hmm", said Teresa. "You know, if we crossed the signal inputs with a chaotic amplifier we could get something like that ..."

"Damn, I'll give it a try. Not too hard ... there. It's done. Now we wait."

"I'm hungry. Pizza?"

"Sure. Oh wait. What's that?"

"Looks like a firewall down Mike. That's weird. Hey, there's another. Hell, they're all dow..."

The senescent web - lessons from eHow's cedar shake advice

In the middle age of the web there are an astounding number of garbage web sites. I fear the ratio of garbage to genuine sites is now approaching ten to one on Google search pages for some topics.

Consider home repair. As near as I can tell several businesses have created junk-bases full of stolen or ridiculously lousy advice. They then publish this under hundreds of domains, and sell ads across all of them. Many of these sites show up in Google searches, so today they're winning the algorithm wars.

I recently read a science fiction writer's description of a future "web" that was 99.99999% garbage, some of it insanely subtle garbage. None of this was apparent to users, because near-sentient AIs filtered 99.99999% of the garbage out.

A completely unrealistic scenario of course, since any such AI would be fully sentient and quite uninterested in such a menial task.

The web, inevitably, is going the way of usenet. It's being overwhelmed by fraudulent junk. It's barely twenty years old, and it's already senile.

There's hope, however. We carry a huge amount of noise and parasitic junk in our DNA but complex life forms exist. From chaos can arise a metastable system.

Maybe, on the way to Skynet, the web will do the same. In the meantime, on the web, as in the real world, reputation and brand identity matter more than ever.

When I was looking for advice on repairing dog-broken cedar siding shakes, eHow, a relatively old and established site, had the best advice. It has ads too, but there's a reasonable balance between ads and content.

There's a lesson here for Google, Yahoo, and especially for Microsoft. Google's algorithmic approach to search is quite vulnerable to fraud. In some domains it's failing. On the other hand a simple-minded Yahoo-1996 style approach is vulnerable to bias and other kinds of deception. If Microsoft can find a way to solve this particular problem, by joining algorithmic and human judgment, they may yet challenge Google.

On the other hand, if Google solves it ...

Google GrandCentral (Voice) has been saving me $80 a month

I started using GrandCentral last August, many months after I’d signed up for the service.

At that time, post acquisition, Google wasn’t marketing GrandCentral, so it took me an inordinately long time to catch on to the real value. I could call my aged parents in Montreal for free.

Now I’ve switched to Google Voice, and my calling cost has risen astronomically – to 1 cent a minute [1]. With the switch, and some minor glitches in the world economy that incent savings, I decided to look back at our cell phone record and see how much GrandCentral was saving us.

Eighty dollars a month.

Wow.

Ok, so I’m an extreme case. I call my mother on my commute home (it’s not very distracting, honest) so the time adds up.

Still, that’s a lot of money. It not only pays for my iPhone data plan, it’s now covered the cost of my iPhone. Not that Google Voice requires a smart phone (though I sure miss GrandDialer), I can make the calls from any phone for the same price.

Google Voice will be available to everyone in the US shortly [2]. Around the same time iPhone 3.0 will give me free instant messaging (background push notification).

I’m surprised AT&T’s share price hasn’t started falling.

[1] Precisely 1 cent a minute. None of the tricks those asinine international plans of old used to play. A 22 minute call costs 22 cents, a 1 minute call costs 1 cent.

[2] Looks like it may launch in Canada around the same time, other nations at varying times. It will make a big difference for some family members of ours.

Update 8/09: Google Voice calls to Canada are again free.

Fastest IE 8 bug find ever

I’m cursed.

I use Chrome 2.0 beta for 1 minute, and I find a significant bug.

I buy the iPhone and spend months raging a personal war against bugs and missing functionality while the world celebrates.

My Google Cloud torments me. At one time last week I was at war with Google Gmail Video Chat (unstable), Google Reader (team was at a conference, so they missed a significant function outage for 6 days) and Google Outlook Sync and Google iPhone sync (significant bug, I found a fix).

Let’s not talk about Windows, shall we. Or Apple iChat. Or the botched OS X model for file permissions. Or iCal. Or …

Cursed.

Even by my standards though, Internet Explorer 8 install was impressive. I found a significant bug before it installed!

The benighted installer copied the install files to my “D:” drive – which does exist.

Why the D: Drive?!?!

Well, I saw something like this before with Microsoft Office installers in 2006…

… Use Regedit to find "LocalCacheDrive" settings for Office. Notice that the drive letter is "D" when it should be "C"…

…In retrospect I think this all began when I installed Office with the 'remove install file option'. I use that option because I kept my install files on a hard drive. Alas, a separate hard drive in those days. Drive letter "D". Nowadays drive letter D: does not exist. The bug bites when Office looks for its install files using a drive letter that no longer exists. Office doesn't produce a dialog box or a reasonable error message, it just dies. The automated install process persists daily in the futile update. (Update: I've been told this was an ancient bug with Windows update too.)…

Yes, IE 8’s installer has the same I ran into in 2006, a bug that was very old even back then.

Update: Well, not quite the same bug. When I turned off drive D: there was a delay of a minute or so, then the installer continued using drive C: instead.

Of course on restart I had no network connectivity at all on my XP machine ...

Update: A restart cured the network hang -- looks like it was the result of having some Microsoft security updates waiting to be installed on restart. IE 8 is definitely snappier than IE 7 on my old XP box, but I have to run it in compatibility mode to get Blogger to render correctly.

How should we treat scientific fraud?

We know there's a lot of fraud on Wall Street. It doesn't end there though ...

Anesthesiologist Faked Data in 21 Studies: Scientific American

Over the past 12 years, anesthesiologist Scott Reuben revolutionized the way physicians provide pain relief to patients undergoing orthopedic surgery for everything from torn ligaments to worn-out hips. Now, the profession is in shambles after an investigation revealed that at least 21 of Reuben's papers were pure fiction...

... Reuben, 50, has been stripped of his research and educational duties and has been on medical leave since May...

... His lawyer, Ingrid Martin of Dwyer & Collora, LLP, in Boston, told ScientificAmerican.com that Reuben has cooperated with the investigation and that he "deeply regrets that all of this happened." She added that "with the [investigating] committee's guidance, he is taking steps to ensure this never happens again."

... Reuben's career would begin to unravel as Ekman began to suspect foul play. In addition to collaborating with Reuben on the now-retracted Celebrex study, Ekman agreed to review a Reuben manuscript on surgery on the anterior cruciate ligament (ACL) in the knee. But when he asked the anesthesiologist for the name of the orthopedic surgeon on the study, Reuben ceased communication with him...

... By then, Editor in Chief Shafer had already put several Reuben manuscripts on hold after learning that Baystate had initiated a probe into the validity of his research. The investigation later identified 21 articles based on patient data that had been partially or completely doctored...

This man caused great harm. He effectively stole large amounts of money. His fake results misled researchers, clinicians and patients and likely led to at least some suboptimal care.

He's done vastly more harm than the average crack addict, but in some states someone caught using crack cocaine can spend years in prison.

Why don't people who commit scientific fraud go to prison?

Another day, another 200 billion to pay

More taxes to pay one day for the trillion printed today ...

Fiscal aspects of quantitative easing (wonkish) - Paul Krugman Blog

... My back of the envelope calculation looks like this: if the Fed buys $1 trillion of 10-year bonds at 2.5%, and has to sell those bonds in an environment where the market demands a yield to maturity of more than 5%, it will take around a $200 billion loss.

It's comforting that we'll pay I guess. I assume the interest rate more or less works out to something near the Fed rate, and that Krugman has corrected for inflation with the loss amount.

Let's assume there are 100 million Americans who'll be paying back the $200 thousand million. That's $2,000 apiece, more for high earners so say $6,000 if you're doing ok.

That's a lot of money. On the other hand, if I'm unemployed for a few months I'm out far more money than that. Adjusted for risks and so on it seems like a reasonable bet even for those doing relatively well.

For folks not doing so well it's a bargain. Of course if the market were to recover it would be a real bargain for us.

Religion and recycling bin aversion

We all know we're heading for the recycling bin. (Yes, you too Mr. Kurzweil.)

Beyond that, many Americans say they expect better things. Yet they don't act on those stated beliefs ...

Religion, medicine and evading death | But not yet, Lord | The Economist

HOW do a person’s religious beliefs influence his attitude to terminal illness? The answer is surprising. You might expect the religious to accept death as God’s will and, while not hurrying towards it, not to seek to prolong their lives using heroic and often traumatic medical procedures. Atheists, by contrast, have nothing to look forward to after death, so they might be expected to cling to life.

In fact, it is the other way round...

So does religion promote fear of death, or does fear of death promote religion?

My money is on the latter.

Jurassic Lark? Nooooooooo

First Pluto. Now T Rex?

Did all dinosaurs have “feathers”? | Our feathered friends | The Economist

... Taxonomically, the very definition of a bird was until recently an animal that has feathers. Now, taxonomists argue that since birds are descended from dinosaurs they should be classified merely as a subgroup of the Dinosauria. But if feathers truly are the diagnostic criterion, then perhaps things should be the other way round, and Stegosaurus, Triceratops, Diplodocus, Tyrannosaurus and their kin should no longer be thought of as terrible lizards, but as overweight, flightless birds.

It must stop now.

Urban renewal - Habitat tears down houses

I think this is a good sign ...

Saginaw Journal - In Hard-Hit Areas, Habitat for Humanity Adds Demolition to Its Mission - NYTimes.com

... International leaders of Habitat for Humanity, an organization more than three decades old, say their focus is changing to meet the demands of a changing economy. In cities where so many homes sit empty, the group is leaning away from building new houses and instead fixing up old ones, said Ken Klein, the vice chairman of the group’s board.

In recent years, about 100 of the organization’s affiliates around the country have done the same, removing recyclable items, like cabinets, floorboards, plaster and light fixtures, from condemned houses and, in a few cities, even razing some structures...

When we drove across the northern-eastern border of the United States last year I was forcibly struck the immense stretch of desolation.

The region has been in decline for decades, but things felt much worse than even two years before. Since then we've been reading reports of vast stretches of Cleveland with many abandoned homes.

People still live where the lumber, water, and railways of the 19th century put them. In some cases new economies make those places viable. In most cases they, like the American automotive industry, need to downside by at least 50%.

It's possible to image a satisfactory end point in a world where telepresence and telecommuting are becoming commonplace. Cities with large parks and green spaces, better aligned along transportation corridors. Larger homes with expansive lawns. Bicycle paths and playgrounds.

To get there however a lot of homes have to go, and existing homes must be refurbished and expanded.

The classification and heritage of American torture

Everything has a history...

The history of CIA torture - By Darius Rejali - Slate Magazine

In the 20^th century, there were two main traditions of clean torture—the kind that doesn't leave marks, as modern torturers prefer. The first is French modern, a combination of water- and electro-torture. The second is Anglo-Saxon modern, a classic list of sleep deprivation, positional and restraint tortures, extremes of temperature, noise, and beatings.

All the techniques in the accounts of torture by the International Committee of the Red Cross, as reported Monday, collected from 14 detainees held in CIA custody, fit a long historical pattern of Anglo-Saxon modern. The ICRC report apparently includes details of CIA practices unknown until now, details that point to practices with names, histories, and political influences. In torture, hell is always in the details...

...For 30 years, I've studied a long and remorseless two centuries of torture around the world, and I can find only one instance of an account resembling the collars and plywood technique described in the ICRC report...

America needs a truth commission.

The other side of a bad kid dead

A troubled young man with a record commits suicide in jail.

Just another local story.

Except there were a few people who loved him.

There usually are.

Against creationism - the toenail

No rational creator would give humans toenails.

Ouch.

Get ready to refinance your mortgage?

The Fed just “printed” a trillion dollars.

One analyst expects mortgage rates to fall as a result …

Economists’ Reactions to the Fed’s Move - Economix Blog - NYTimes.com

David Greenlaw, Morgan Stanley: The Fed’s announcement signals a clear intent to continue to drive mortgage rates lower and we expect them to meet this objective. This could represent a powerful source of stimulus for the household sector of the economy. In 2008, the average mortgage rate on the outstanding stock of loans was about 6.50%. So, if the Fed brings 30-yr fixed rate mortgages down to 4.50% and all homeowners are able refi, the aggregate permanent cash flow savings would be on the order of $200 billion per year.

We’ll be watching.

Of course now we’ll all be watching for bubble #3. We had stocks, then we had real estate. What’s left? A bonds bubble?