BBC's annotated version of Obama's speech to the Islamic world

BBC NEWS had the full Obama speech with clickable inline annotations.

We're luckier than we deserve to have this President.

Kristof was at Tiananmen square - his memories

I don't remember him writing this story before. It's very powerful. One day China will remember, and one day China may honor those who fell.

Op-Ed Columnist - Bullets Over Beijing - Nicholas Kristof

It was exactly 20 years ago that I stood on the northwest corner of Tiananmen Square and watched “People’s China” open fire on the people.

It was night; the gunfire roared in our ears; and the Avenue of Eternal Peace was streaked with blood. Uniformed army troops massed on the far end of the square, periodically raising their assault rifles and firing volleys directly at the crowd I was in, and we would all rush backward in terror until the firing stopped.

Then the volley would end, and in the deafening silence we would stop and look back. In the hundred yards between us and the soldiers would be kids who had been shot, lying dead or wounded on the ground.

Some protesters shouted insults at the troops or threw bricks or Molotov cocktails that landed ineffectually in the open area. But none of us dared to go forward to help the injured as they writhed. I was the Beijing bureau chief for this newspaper, and I was cowering behind a layer of other people whom I hoped would absorb bullets; the notebook in my hand was stained with perspiration from fear.

Troops had already opened fire on an ambulance that had tried to collect the injured, so other ambulances kept their distance. Finally, some unlikely saviors emerged — the rickshaw drivers.

These were peasants and workers who made a living pedaling bicycle rickshaws, carrying passengers or freight around Beijing. It was those rickshaw drivers who slowly pedaled out toward the troops to collect the bodies of the dead and injured. Then they raced back to us, legs straining furiously, rushing toward the nearest hospital.

One stocky rickshaw driver had tears streaming down his cheeks as he drove past me to display a badly wounded student so that I could photograph or recount the incident. That driver perhaps couldn’t have defined democracy, but he had risked his life to try to advance it.

That was happening all over Beijing. On the old airport road that same night, truckloads of troops were entering the city from the east. A middle-aged bus driver saw them and quickly blocked the road with his bus.

Move aside, the troops shouted.

I won’t let you attack the students, the bus driver retorted defiantly.

The troops pointed their guns at the bus driver and ordered him to move the bus aside. Instead, he plucked the keys from the ignition and hurled them into the bushes beside the road to ensure that no one could drive that bus away. The man was arrested; I don’t know what happened to him...

... When you educate citizens and create a middle class, you nurture aspirations for political participation. In that sense, China is following the same path as Taiwan and South Korea in the 1980s.

In Taiwan in 1986, an ambitious young official named Ma Ying-jeou used to tell me that robust Western-style democracy might not be fully suited for the people of Taiwan. He revised his view and now is the island’s democratically elected president.

Some of my friends are Communist Party officials, and they are biding their time. We outsiders also may as well be similarly pragmatic and patient, for there’s not much we can do to accelerate this process. And as we wait, we can be inspired by those rickshaw drivers of 20 years ago.

Fifteen years more. I hope to live to see the day.

China's perspective on North Korea

Via James Fallows, I came across a Washington Post columnist's summary of how China sees North Korea.

Superb. Seems some of today's best newspaper journalism never sees newsprint.

Fallows contrasts this piece to a dangerously stupid article that did appear in print.

I'll have to start reading Pomfret now. I stopped reading WaPo a while ago, they're a 3rd rate paper. Seems they do have some good journalists though.

Wisdom from the flames - a different OS X future

Gizmodo had fun recently comparing Windows 7 buzz to the disinterest in OS X 10.6 (Snow Leopard). The photo of a demonic Ballmer about to devour a sleeping Snow Leopard kitten should hang in his office.

It makes for lots of links and traffic, but I think there's a deeper lesson.

Windows 7, aka Vista 3.0 is very important. XP is decayed and too vulnerable to attack. Vista has gotten a bad rap and is not much used by businesses. Windows 7 will either be immensely successful or one of history's great corporations will go under. That deserves attention.

Snow Leopard? Ummm, tell me again why I need it?!

Sure, I love scalable UIs -- but I'm not sure that's in Snow Leopard and it should be an update to 10.5, not yet another big migration. Yes, 64 bit would be nice, but I can wait a few more years. We could do a lot with 4GB of memory if we were a wee bit less sloppy. I wouldn't mind putting those GPUs to use, but I suspect that need not require a big OS revision.

To be honest, I'm a bit tired. The 10.5 transition has not been a pleasant experience. There've been too many problems with OS bugs and hardware incompatibility. Too many parts of OS X 10.5, from iChat to accessibility to managed users to security usability (why can't one escalate privileges to modify a locked Dock?) need rework and finish.

I don't need 10.6. I don't want 10.6. I want Apple to pour a few millions in to making 10.5 better.

Ahh, but there's the rub. Apple needs to make money.

So here's my proposal to Apple.

Sure, keep working on 10.6. Maybe ship it this year if you need to, preferably ease off and wait until the summer of 2010. Meanwhile, find a way to make money off 10.5 updates. I don't know how Apple can fudge this and live within accounting rules, but there must be a way. Maybe Apple could bundle 10.5 enhanced with MobileMe, so that MobileMe subscribers get a steady stream of 10.5 fixes and improvements.

Please Apple, do something to make my life better. The current arrangement really ain't working that well for me.

Unheard stories of the 19th century - Irish evacuation to Montreal

Sometime in the 20th century, I was a medical student at St Anthony Hospital in the north of Newfoundland. The Hospital was a legacy of the Grenfell Medical Mission, so I read Grenfell's (sometimes fanciful) stories of the late 19th and early 20th century european hunter gatherers of those remote lands.

Those were, and are, tough lands. The native population was small even before the european plagues.

Foreign to those all but uninhabitable lands the europeans hunted fish and seal, lived as debt slaves in squalor and misery, and died in droves on the ice. I was not long from a stay in 1980s Bangladesh, then a synonym for misery, and I though that hot misery had its advantages over cold misery.

No-one in those days, incidentally, would have predicted Bangladesh would do as relatively well as it has. That's worth remembering.

The stories of Newfoundland's back country are fascinating, but they are all but forgotten to our time. Just like this glimpse of the Malthusian agony of Ireland's 19th century, seen from Montreal, Canada in the years before America's immigration-amplified civil war ...

Seeking hope, they found death Rene Bruemmer, The Gazette

The Irish came by the tens of thousands in 1847, packed like cordwood below deck in fetid ship holds meant for timber....

... There were so many corpses, trenches were dug to dispose of the dead in what is now Point St. Charles. Twelve years later, labourers building the Victoria Bridge would uncover the bones of their brethren and insist the remains be protected. To make sure of it, they planted a massive 30-tonne, 10-foot high boulder dredged from the St. Lawrence River over the burial site, and inscribed it, in part: "To preserve from desecration the remains of 6,000 immigrants who died of ship fever."  [Epidemic Typhus, a Rickettsial disease transmitted by human lice]...

... In 1845, potatoes were struck by a fungal infection that caused half the crop to rot in the earth. In 1846, the blight returned, wiping out almost the entire crop, followed by one of the harshest winters in living memory, and the people starved....

... Most would have preferred the well-established promised lands of New York and Boston, but America had set strict standards and fares for passage to the U.S. were too high for the impoverished. But British traders who shipped lumber from Quebec City and St. John's were happy to have emigrants paying a low fare to serve as ballast for their return trips to Canada. Many passage brokers told passengers food would be provided for the 45-day journey, which was untrue...

... Canadian immigration officials, who had no say in emigration policies determined by the British colonial authorities, were sorely unprepared and underfunded for the deluge of emaciated Irish. At the immigration depot on Grosse Île, an island in the middle of the St. Lawrence 50 kilometres east of Quebec City, the medical officer in charge of the quarantine station prepared beds for 200 invalids, thinking 10,000 emigrants had departed from Britain. That summer, more than 100,000 would flee to Quebec.

By the end of May, there were already 40 ships lined up for three kilometres, awaiting to discharge passengers. The ships kept coming till the river iced over in October....

... The ill overflowed the quarantine stations, lying outside on the grass and sand beaches. Healthy passengers were stuck waiting on the ships for 20 days, a death sentence for many. Bodies were pulled from the holds with hooks and stacked on shore. Between 3,000 and 5,000 died on Grosse Île...

... Overwhelmed health officials started waving many ships with "healthy" passengers on to Montreal.

They disembarked, malnourished and diseased, dying in the streets and on the wharves, begging for water on the steps of churches. Worried about an epidemic, authorities constructed three wooden "fever sheds" 150 feet long and 50 feet wide at Windmill Point, near where Victoria Bridge now stands in Point St. Charles. The sick and dying lay two or three to a bed, side by side with the dead, leaving hundreds of orphans behind. The number of sheds grew to 22. Military cordoned off the area so the sick couldn't escape.

Seeing the ill dying alone, the Grey Nuns went to help, attending to the sick and carrying women and children in their arms from the ships to the ambulances. Thirty of 40 nuns who went to help fell ill, and seven died, writes historian Edgar Andrew Collard. Other nuns took over, but once the surviving Grey Nuns had convalesced, they returned...

When a mob of frightened Montrealers threatened to toss the fever sheds into the river, Montreal mayor John Easton Mills quelled the riot, and later went himself to help in the evenings, giving them water and changing their straw bedding. The father of a large family, he died in November.

The Roman Catholic Bishop of Montreal urged French Quebecers, linked to the Irish by their Catholic faith, to help the orphans. Many came from the country to adopt one or two children, accepting them in to their families, in some cases passing their land on to them...

... Grosse Île, site of the largest Irish famine graveyard outside of Ireland, is now known as the Grosse Île and the Irish Memorial National Historic Site of Canada...

I grew up in Montreal, but this is the first I read this story. John Mills was born in deeply Protestant and English Massachusetts twenty years after the American revolution, but ended up in Canada. Were his family loyalists fleeing the rebels?  At 50 this presumably Protestant mayor of English descent died helping starving, diseased and exiled Catholic Irish. I wonder if any of his family survive to tell more of what must a remarkable life.

The movie almost writes itself, doesn't it? There would be worse ways to remember those people and those times.

There's a long way down from where most of the world is today. It would do us all well to look over the edge once in a while, the better to inspire our kindred ascents.

Videotron torments and choice in broadband markets (revised)

I wrote the original version of this post as a cautionary tale of miserable experiences with my mother's Quebec-based Videotron customer service. I related my personal story to broader concerns about lack of choice and competition in most broadband markets.

After I wrote it Videotron service did somewhat better. My original post was too one-sided. Things work differently in the old country.

Instead I wrote a technical summary of what I learned about managing a (Quebec) Videotron cable modem that's dropping connections.

There's one part of the original note I'll retain, and I expect to return this theme over the next few years. Most broadband markets in North America are increasingly served by only one or two providers. These at best oligopolies, and in many regions there's an effective monopoly.

This is a very bad thing for customers, and not such a good thing for employees who want to deliver good service. Oligopolies are corrosive. Always.

There's a role for government here. If we can't avoid oligopolies then we'll need regulation -- but that's a desperate solution. We need to encourage competition, even if that means breaking up companies that currently hold monopoly power.

Broadband is too important to become a part of a monopoly market.

The WHY of medical cost variation

The inescapable Dr Atul Gawande has drilled down on the why of medical cost variation: Annals of Medicine: The Cost Conundrum: Atul Gawande: The New Yorker. He drills down into the town with the world’s (universe’s?) highest health care costs -- McAllen, Texas – a mid-sized city with explosive population growth – and a significant amount of poverty …

… The median income for a household in the city was $33,641, and the median income for a family was $36,050. Males had a median income of $30,089 versus $22,480 for females. The per capita income for the city was $14,939. About 20.9% of families and 23.8% of the population were below the poverty line, including 30.5% of those under age 18 and 20.3% of those age 65 or over…

This isn’t another boring (boring) article on health care cost variation. Gawande, who is no amateur, knows the interesting question is “why?”. I loved his description of the body language of an anesthesiologist and hospital entrepreneur during one of his visits. I bet that CEO would prefer a root canal to a Gawande interview…

… I visited the top managers of Doctors Hospital at Renaissance. We sat in their boardroom around one end of a yacht-length table. The chairman of the board offered me a soda. The chief of staff smiled at me. The chief financial officer shook my hand as if I were an old friend. The C.E.O., however, was having a hard time pretending that he was happy to see me. Lawrence Gelman was a fifty-seven-year-old anesthesiologist with a Bill Clinton shock of white hair and a weekly local radio show tag-lined “Opinions from an Unrelenting Conservative Spirit.” He had helped found the hospital. He barely greeted me, and while the others were trying for a how-can-I-help-you-today attitude, his body language was more let’s-get-this-over-with.

So I asked him why McAllen’s health-care costs were so high. What he gave me was a disquisition on the theory and history of American health-care financing going back to Lyndon Johnson and the creation of Medicare, the upshot of which was: (1) Government is the problem in health care. “The people in charge of the purse strings don’t know what they’re doing.” (2) If anything, government insurance programs like Medicare don’t pay enough. “I, as an anesthesiologist, know that they pay me ten per cent of what a private insurer pays.” (3) Government programs are full of waste. “Every person in this room could easily go through the expenditures of Medicare and Medicaid and see all kinds of waste.” (4) But not in McAllen. The clinicians here, at least at Doctors Hospital at Renaissance, “are providing necessary, essential health care,” Gelman said. “We don’t invent patients.”…

Gawande, like me, is interested in the (too few) qualitative studies of health care spending decisions

… Brenda Sirovich, another Dartmouth researcher, published a study last year that provided an important clue. She and her team surveyed some eight hundred primary-care physicians from high-cost cities (such as Las Vegas and New York), low-cost cities (such as Sacramento and Boise), and others in between. The researchers asked the physicians specifically how they would handle a variety of patient cases. It turned out that differences in decision-making emerged in only some kinds of cases. In situations in which the right thing to do was well established—for example, whether to recommend a mammogram for a fifty-year-old woman (the answer is yes)—physicians in high- and low-cost cities made the same decisions. But, in cases in which the science was unclear, some physicians pursued the maximum possible amount of testing and procedures; some pursued the minimum. And which kind of doctor they were depended on where they came from…

But is it really where doctors trained, or is it something far more concrete?

.. I met with a hospital administrator who had extensive experience managing for-profit hospitals along the border. He offered a different possible explanation: the culture of money.

“In El Paso, if you took a random doctor and looked at his tax returns eighty-five per cent of his income would come from the usual practice of medicine,” he said. But in McAllen, the administrator thought, that percentage would be a lot less.

He knew of doctors who owned strip malls, orange groves, apartment complexes—or imaging centers, surgery centers, or another part of the hospital they directed patients to…

… many physicians are remarkably oblivious to the financial implications of their decisions...

.. Others think of the money as a means of improving what they do…

…Then there are the physicians who see their practice primarily as a revenue stream...

In every community, you’ll find a mixture of these views among physicians, but one or another tends to predominate. McAllen seems simply to be the community at one extreme….

When we talk about practice variation we don’t usually think anthropology. That’s probably a mistake …

Woody Powell is a Stanford sociologist who studies the economic culture of cities..

.. Powell suspects that anchor tenants play a similarly powerful community role in other areas of economics, too, and health care may be no exception. I spoke to a marketing rep for a McAllen home-health agency who told me of a process uncannily similar to what Powell found in biotech. Her job is to persuade doctors to use her agency rather than others. The competition is fierce. I opened the phone book and found seventeen pages of listings for home-health agencies—two hundred and sixty in all. A patient typically brings in between twelve hundred and fifteen hundred dollars, and double that amount for specialized care. She described how, a decade or so ago, a few early agencies began rewarding doctors who ordered home visits with more than trinkets: they provided tickets to professional sporting events, jewelry, and other gifts. That set the tone. Other agencies jumped in. Some began paying doctors a supplemental salary, as “medical directors,” for steering business in their direction. Doctors came to expect a share of the revenue stream…

…The real puzzle of American health care, I realized on the airplane home, is not why McAllen is different from El Paso. It’s why El Paso isn’t like McAllen. Every incentive in the system is an invitation to go the way McAllen has gone. Yet, across the country, large numbers of communities have managed to control their health costs rather than ratchet them up…

Culture really, really, matters. Damnit.

And now from my neighborhood (more or less) …

I talked to Denis Cortese, the C.E.O. of the Mayo Clinic, which is among the highest-quality, lowest-cost health-care systems in the country…

…The core tenet of the Mayo Clinic is “The needs of the patient come first”—not the convenience of the doctors, not their revenues. The doctors and nurses, and even the janitors, sat in meetings almost weekly, working on ideas to make the service and the care better, not to get more money out of patients. I asked Cortese how the Mayo Clinic made this possible.

“It’s not easy,” he said. But decades ago Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their income. Mayo promoted leaders who focused first on what was best for patients, and then on how to make this financially possible…

…Grand Junction’s medical community was not following anyone else’s recipe. But, like Mayo, it created what Elliott Fisher, of Dartmouth, calls an accountable-care organization. The leading doctors and the hospital system adopted measures to blunt harmful financial incentives, and they took collective responsibility for improving the sum total of patient care.

This approach has been adopted in other places, too: the Geisinger Health System, in Danville, Pennsylvania; the Marshfield Clinic, in Marshfield, Wisconsin; Intermountain Healthcare, in Salt Lake City; Kaiser Permanente, in Northern California. All of them function on similar principles. All are not-for-profit institutions. And all have produced enviably higher quality and lower costs than the average American town enjoys…

Gawande tries to come up with ways to replicate the lessons from Mayo et al. It’s not easy. One of lessons, which he quietly skates around, is that superb physicians will deliver superb medical care for much less than they’re paid in Texas. We don’t overpay our specialists as insanely as we overpay our CEOs – but we do pay far more than is needed to fill the jobs. CEOs are paid perhaps 5-20 times what they’d work for, but surgeons and many specialists are probably only paid 3-5 times too much.

Rationalizing reimbursement and incentives would more than pay for high quality universal health care – but it would be a devastating transition.

hat tip: Richard Neill, via Facebook

Mobile phone and automotive GPS collision avoidance for pedestrians, bicyclists, tricyclists, skaters and pets

Years ago I wondered about collision avoidance systems for bicycles and pedestrians.

Something like a vest that would reflect radar signals broadcast by cars.  The primary automobile use of the radar broadcasts would be to avoid auto collisions, but bicyclists would also benefit.

There would be lots of ways then to avoid bicycle fatalities. Maybe the bike is illuminated on an active windshield. Maybe there’s an audio alarm if vectors appear to intersect.

Now that we’ve got systems like Google Latitude (not available for iPhone – it needs background multitasking!) though, it’s obvious we can do the whole thing with next generation mobile phones.

We don’t even need to worry about this patent …

GPS collision avoidance system - Patent 5872526

… A collision avoidance system for a plurality of vehicles equipped with GPS receivers, each broadcasting current location information to other vehicles and receiving and displaying location information from other vehicles, enables a vehicle operator to be aware of the location of the other vehicles. For vehicles not equipped with GPS, and transceivers, information about location is taken from common ground control equipment such as an FAA control station and broadcast to all vehicles. In an aircraft environment, flight plans can be filed and closed out automatically…

The GPS source would be the mobile phones of the automobile passengers, and the mobile phone of the bicyclist. Not to mention the mobile-phone like device attached to dogs.

The phones can even manage the collision avoidance, though there are obvious advantages to having the car computer manage that.

It’s interesting to think how it could work with just phones, however.

If a phone knows it has a history of travel over 35 mph, it can assume it’s in a car. If Google Latitude 3.0 detects a car/mobile vector intersecting with a bicycle/skating/pet/pedestrian mobile vector it can send an audio message to the car stereo (“Pedestrian collision in 5 seconds … 4 seconds … 3 seconds … …. …. ambulance and police now enroute …”).

You can imagine lots of variants. Unfortunately, lots of opportunities for nasty abuse as well.

In a post-Peak Oil America of aging boomers, domesticating the wild and savage automobile will become increasingly important. These kinds of collision avoidance systems will mandated within 10 years.

How Apple could surprise

We know what to expect for our July iPhone. Sounds excellent. I'll buy one.

Sad not to have any surprises though.

Unless ... how about a combo display, keyboard, battery and iphone cradle for, say, $250?

Add iPhone, get netbook.

Excellent discussion of randomness in everyday life

Leonard Mlodinow shows more than a touch of wisdom in this interview about randomness in every day life: What Are The Odds?.

Once upon a time I thought I could predict my future. I gave up that idea a long time ago. There are too many wild cards, too many unexpected opportunities.

Sit back, relax, and enjoy the good parts of the show.

Another Cheney fan rediscovers waterboarding really is torture

Now if only we could persuade Limbaugh and Cheney to take the treatment (emphases mine)…

Mancow Waterboarded, Admits It's Torture | NBC Chicago

… WLS radio host Erich "Mancow" Muller decided to subject himself to … waterboarding live on his show.

… "I want to find out if it's torture," Mancow told his listeners Friday morning, adding that he hoped his on-air test would help prove that waterboarding did not, in fact, constitute torture.

.. With a Chicago Fire Department paramedic on hand,  Mancow was placed on a 7-foot long table, his legs were elevated, and his feet were tied up.  

Turns out the stunt wasn't so funny. Witnesses said Muller thrashed on the table, and even instantly threw the toy cow he was holding as his emergency tool to signify when he wanted the experiment to stop.  He only lasted 6 or 7 seconds.

"It is way worse than I thought it would be, and that's no joke,"Mancow said, likening it to a time when he nearly drowned as a child.  "It is such an odd feeling to have water poured down your nose with your head back...It was instantaneous...and I don't want to say this: absolutely torture."

"I wanted to prove it wasn't torture," Mancow said.  "They cut off our heads, we put water on their face...I got voted to do this but I really thought 'I'm going to laugh this off.' "

Last year, Vanity Fair writer Christopher Hitchens endured the same experiment -- and came to a similar conclusion. The conservative writer said he found the treatment terrifying, and was haunted by it for months afterward.

"Well, then, if waterboarding does not constitute torture, then there is no such thing as torture," Hitchens concluded in the article.

One the one hand, Mancow is a complete idiot*. How could he have failed to do even a trivial amount of research?

On the other hand, as a human being, he’s an improvement over Cheney, Limbaugh, Rumsfeld and the like. He at least has a sense of honor.

* In the modern sense of the word, as in someone who’s cognitively intact but voluntarily makes astoundingly bad choices.

Google needs to add permalinks to their social link generated feed page

Google generates a web view of the blog posts I share in Google reader.

That's great, but they're missing a killer feature.

I can link link to the page, but I can't create a link to a specific comment/reference pair on the page, such as this comment of mine

... (link) Fallows, who really knows better, slowly falls upon the nub of the matter.

There are a lot of good-enough amateur writers and thinkers in the world.

No, not usually as good as a professional journalist, but pretty darned good.

That's always been true, but over the past 17 years the cost of entry to the world of publishing has fallen by a factor of ... about 10,000.

Damned, that's disruptive.

Journalism needs to refocus on core strengths and value. The old equation doesn't work.

Oh, and newsprint is dead, dead, dead.

Google needs to add an inline permalink to the generated page, so we can reference a Google-generated feed-share with all associated notes and comments.

IBM should buy Bloglines and roll it into Lotus Connections

I was once a Bloglines customer, but Google Reader surpassed them years ago. Bloglines didn’t have the money to compete; their inability to produce a good mobile product in 2008 was the last straw for me.

Happily, they’re still around. I can’t see how they survive though.

There is a better future. In my corporate life I’ve been confounded by the lack of a decent, shareable, web-based feed reader for inside-the-firewall Sharepoint and other blogs. There aren’t even any decent Windows desktop feed readers left (though I’ve not tried the astoundingly horrible Outlook 2007 reader with SP2).

IBM wants to compete in this subscription/collaboration world with Lotus Connections, but their current web reader component is less than ideal.

Bingo.

IBM acquires or licenses Bloglines and funds Active Directory integration to support Sharepoint feed integration.

Win-win.

Dementia is normal - and what that means

In a post-industrial age of low birth rates the greatest economic challenge for wealthy nations is acquired cognitive disability -- better known as dementia.

So we ought to think clearly about dementia. It doesn't help that my generation of physicians were taught to think of dementia as an "abnormal" disease like the flu, rather than an all-but-inevitable consequence of aging.

A recent popular review, which was ironically intended to be inspiring, underscores how "normal" (typical) dementia is (emphases mine) ...

BRAIN POWER: At the Bridge Table, Clues to a Lucid Old Age

By BENEDICT CAREY

... In recent years scientists have become intensely interested in what could be called a super memory club — the fewer than one in 200 of us who ... have lived past 90 without a trace of dementia....

... Laguna Woods, a sprawling retirement community of 20,000 south of Los Angeles, is at the center of the world’s largest decades-long study of health and mental acuity in the elderly. Begun by University of Southern California researchers in 1981 and called the 90+ Study, it has included more than 14,000 people aged 65 and older, and more than 1,000 aged 90 or older.

... researchers have also demonstrated that the percentage of people with dementia after 90 does not plateau or taper off, as some experts had suspected. It continues to increase, so that for the one in 600 people who make it to 95, nearly 40 percent of the men and 60 percent of the women qualify for a diagnosis of dementia.

... it is precisely that ability to form new memories of the day, the present, that usually goes first in dementia cases, studies in Laguna Woods and elsewhere have found.

The very old who live among their peers know this intimately, and have developed their own expertise, their own laboratory. They diagnose each other, based on careful observation....

...Here at Laguna Woods, many residents make such delicate calculations in one place: the bridge table.

Contract bridge requires a strong memory. It involves four players, paired off, and each player must read his or her partner’s strategy by closely following what is played. Good players remember every card played and its significance for the team. Forget a card, or fall behind, and it can cost the team — and the social connection — dearly.

“When a partner starts to slip, you can’t trust them,” said Julie Davis, 89, a regular player living in Laguna Woods. “That’s what it comes down to. It’s terrible to say it that way, and worse to watch it happen. But other players get very annoyed. You can’t help yourself.”

... Later, the partner stares uncertainly at the cards on the table. “Is that ——”

“We played that trick already,” Ms. Cummins says. “You’re a trick behind.”

Most regular players at Laguna Woods know of at least one player who, embarrassed by lapses, bowed out of the regular game. “A friend of mine, a very good player, when she thought she couldn’t keep up, she automatically dropped out,” Ms. Cummins said. “That’s usually what happens.”

Yet it is part of the tragedy of dementia that, in many cases, the condition quickly robs people of self-awareness. They will not voluntarily abandon the one thing that, perhaps more than any other, defines their daily existence...

... In studies of the very old, researchers in California, New York, Boston and elsewhere have found clues to that good fortune. For instance, Dr. Kawas’s group has found that some people who are lucid until the end of a very long life have brains that appear riddled with Alzheimer’s disease. In a study released last month, the researchers report that many of them carry a gene variant called APOE2, which may help them maintain mental sharpness.

Dr. Nir Barzilai of the Albert Einstein College of Medicine has found that lucid Ashkenazi Jewish centenarians are three times more likely to carry a gene called CETP, which appears to increase the size and amount of so-called good cholesterol particles, than peers who succumbed to dementia...

Imagine how hellish that bridge table can be. Every game, a test. Show weakness, slip, and death is your fate. First social death, then the grave. It makes professional baseball look like ... child's play.

I'd bet a good amount that the "protective" "social" effect of playing bridge is bull poop. This is all about a survivor-effect correlation. Only the genetically gifted slow agers can play. On the other hand, I doubt that even the best of those bridge players could handle a modern knowledge worker job -- they are good for their age, but they are not immortal.

So if we (mostly) set aside wistful hopes of some kind of mental activity that protects against normal, all-but-inevitable, age related dementia, what do we have left to learn from these and similar studies?

We know it helps to be born clever, but that only gives your airplane more fuel -- it doesn't by itself slow the normal process of brain mush. Many brilliant thinkers with, at their peak, one in a million minds, are relatively disabled by their 70s - though still better off than most of us.

We can't do much with the brains we're born with, but we do have animal model evidence, and less definitive human evidence (because we don't randomly experiment then autopsy humans), that physical exercise is protective against normal dementia. Seems bizarre to me, but it holds up. On the other hand, head injury accelerates dementia, so don't make your exercise football, contact hockey, boxing, or horse jumping.

Exercise and head whacks aside, this is all about genes and medicines. It's about identifying those whose brains hold up longer, then figuring out the trick of it, then looking for a medicine that will help the average person. It's slow, hard work, but success is worth trillions in economic growth and a significant reduction in human suffering. By that metric, we're grossly underfunding this research. The potential payoff is enormous compared to say, cancer research. (I've been pointing this out, incidentally, for at least twenty years. It's not hard to do the math.)

Barring any breakthroughs, however, we boomers need to get real about our future. We expect we're going to have to keep working to 70 or beyond, but you can't cheat mother nature. Dementia is the end-point of a disabling process that starts, for most of us, when we're about 25. We'll be working, but we'll be doing more grocery bagging than particle physics.

Maybe we should think about how to make the less cognitive life more appealing. Maybe we ought to think about how society supports those with cognitive disabilities at all ages ...

The GOP's new message: we are a nation of cowards

Gail Collins said it well today.

The GOP's meme of the day is that we're a nation of cowards; we cannot tolerate evildoers living within massive prisons anywhere near our homes. Instead we should leave then near, say, Cuban homes. Or, better yet, kill 'em all without trial.

We are still a sick nation, but the GOP is sicker than the rest of us.

Get a freakin' grip America! Show some spine for a change.

It must be a sad thing to have to give allegiance to the modern GOP. If their idea of "reform" is Newt Gingrich then the party should be euthanized. America needs a new alternative to the Dems.