Health care reform – the road ahead

Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.
Winston Churchill, 1942.

One way or another I'm gonna find ya
I'm gonna getcha getcha getcha getcha.
Blondie.

In the original Senate version of the Health Care reform bill we find this clause …

Subtitle D: Improvements to Medicaid Services - (Sec. 2301) Requires Medicaid coverage of: (1) freestanding birth center services …

Yes, there are a lot of funny bits in this sausage. We don’t know the half of ‘em, but I do know my family will pay for them. Now that the bill done (for now) I can say that the wingnuts were right about some things; my team’s “$250,000 and above” slogan was nonsense. “One way or another” upper 30th percentile “tax-equivalents” [1] will go up.

I’m good with paying for this; I expected to pay for it when I campaigned for Barack Obama. Altruism aside, there are tangible personal benefits for my family:

• We’re no longer lashed to my employer. Since I expect to be an involuntary entrepreneur within 8 years this is rather good.
• Not all of our children are equally suited to life in the post-modern world. This bill increases the probability that they will, at least, receive health care after my warrantee expires.
• Now my insurance provider doesn’t have to be demonic to survive
• America is less likely to turn into Haiti of the North. I really don’t like broken glass topped walls.

What’s next? We’ve been stuck in the headlights for a generation, but now we’re moving. We might be charging towards the oncoming truck, but even that may be an improvement on standing still. At least with motion comes opportunity.

The question isn’t where we need to go. We’ve known that for at least thirty years. We’re going to the same place as everyone else on earth – good enough care for everyone and luxurious care for those with money. The question is how we get there.

Until now the American people have been completely unwilling to think about health care cost. It would have been nice if we could have cut costs before increasing access, it would have been nice if we’d come up with a reform plan that made it easier to cut costs, it would be nice if we weren’t charging towards the right fender of that oncoming truck. Nice – but not going to happen in a world where the GOP has gone mad.

Now, however, we’ll all be, at last, considering costs and value. It won’t be pretty, but if it were pretty it wouldn’t be real.

That’s progress.

See also:

Post-passage commentary

• Summarizing the Patient Protection and Affordable Care Act – in two pages and 10 titles (worth a scan, really)
• Best health care reform commentary (all the things I don’t need to say)
• Health insurance companies only the demonic survive (Just before passage, but fits here. Now insurance companies can explore non-demonic options.)
• How the Health Care Overhaul Could Affect You - Graphic - NYTimes.com (try it – it’s great)

Older general discussions that are still relevant

• Discovering medical prices and the problem with paying cash
• Health insurance we're defeated by a complexity attack
• The hidden insurance problem they can play the game better than we can
• Gawande and NEJM cost of care roundtable

The future: “pretty good care”, aka “good enough care” – where we’re going

• Health care reform – lessons from Quebec (pretty good care)
• Healthcare Reform The One Slide Presentation
• Staggering towards health care access

[1] Federal “Taxes” rarely include anything so obvious as a rate increase. Tax equivalents include

• actions that shift services burdens to the states – which either reduce state services or increase state or local taxes
• unfunded federal state or local mandates of all varieties including regulatory or reporting burdens
• means testing that remove tax breaks (the AMT is the mother of means testing)
• elimination of tax dodging programs such as the Flex plan we enroll in (I’ll be glad to see that evil scam die)
• user fees
• service taxes (such as the 10% tanning tax – which, amusingly, is aimed squarely at the Tea Party demographic of less educated paleskins).

Rwandan genocide and the Zani score

I made up the "Zani score" as "... a measure of how concerned one should be about nascent entities or organizations. It tries to measure social structures that, 999/1000 times go nowhere, but 1/1000 times lead, given chance and circumstance, to very bad things..."

I imagined it in the context of an industrial society, but I asked a friend who's an expert on the Rwandan genocide to try to apply the metric to that setting:

1. A belief that the ends justify the means, or, in other words, "extremism in the defense of liberty is no vice". NOT SURE.
2. A sense of grievance and injustice. YES.
3. A charismatic leader. NOT REALLY. NO ONE WAS CHARISMATIC, BUT AUTHORITY WAS TOTAL.
4. Celebration and admiration of violence. WELL, SINCE 1990. IT WAS SPECTACLE FOR SOME.
5. Tribal or ethnic boundaries; a division into the "chosen" and the "other". YES.
6. Anti-intellectual, in particular anti-geek. YES, INTELLECTUALS WERE AMONG THE FIRST KILLED.
7. Denial of skepticism. Skeptics are outcast, dissent is forbidden. NOT SURE.
8. Welcoming and affirmation of the convert. NONCONFORMITY WAS NEVER ENCOURAGED GENERALLY.
9. Membership alone is proof of virtue. IN TERMS OF ETHNICITY.
10. Scorn for the weak; denial of pity or sympathy for the other. NOT SURE.

The only real conflict to the model was that the leader of the genocide was not particularly charismatic -- but since he had total authority that wasn't much of an obstacle. There are a number of unknowns, but not bad for something that was designed with a very different society in mind.

My Google Reader Shared items (feed)

Three NYT OpEds on the latest American extremism

Shortly after writing my post on the Zani score, the NYT has published 3 OpEds over 3 days on the latest Zani-score bumps in American culture:

• Krugman - Going to Extreme - March 25 NYTimes.com
• Charles Blow - Whose Country Is It? - March 26 NYTimes.com
• tFrank Rich - The Rage Is Not About Health Care - NYTimes.com

The GOP's Zani score is probably about five. We should really worry if it hits 8.

Incidentally, Palin's Facebook page still uses gun sight cross hairs to mark our her enemies.
--
My Google Reader Shared items (feed)

Miep Gies and the Zani score

At age 50, at a local theater, I attended a performance of The Diary of Ann Frank.

I knew the story of course, but, until now I'd missed the book, the movie and the play. Seeing it at this point in my life I am awed by the endurance and compassion of Otto and Edith Franck, sympathetic to the less favorably portrayed refugees, and curious about the heroes Victor Kugler, Johannes Kleiman, Jan and Miep Gies, and Johannes and Bep Voskuijl. Curious too about what kind of man Otto Franck was to create such love and loyalty in his employees.

Of the heroes we know the most about Miep Gies, in part because of her astounding longevity. She passed for an ordinary person before and after World War II. She claimed, somewhat convincingly, that she was motivated not by courage but by a fear of unbearable guilt should she fail to perform her duty. It may be relevant that she was, by necessity, given up for adoption by her birth mother.

I wondered then, and wonder now, how extraordinary Gies was. In coverage of her death this past January I recall that of 81 people asked by the Dutch resistance to shelter Jews, 7 accepted. Clearly they did not ask just anyone; if we guess that only 1/10 were considered candidates, and 7/81 of those accepted, then Gies-class heroes were, and are, perhaps 1/100. Unusual certainly, but more common than world class athletes.

That feels right. I can believe that somewhere between 1/30 and 1/100 of humans are heroes born, and another 1/10 to 1/20 heroically inclined. Likewise it feels like 1/5 of us are Nazi-capable and 1/50 Nazi born.  The rest of us, in most circumstances, favor the good. Which is why civilization is possible.

I expect the epidemiology of heroism has been studied by scholars of later genocides in Cambodia and Rwanda. I know one such, so maybe I'll update my post with some real data.

Do the demographics of hero and villain vary by society? Obviously some societies are far more evil than others; Germany of 2010 is not Germany of 1940. I would not be surprised to learn, however, that the frequency of fundamental human heroism and villainy is fairly constant. It might instead be chance and circumstance that leads to the rare, but cataclysmic, ascendance of the villainous.

Could villains win in modern America? Obviously yes. Even if there had been any past doubts, the recent widespread public support for governmental torture has put them to rest. We, like most nations, are quite capable of industrial evil.

Given that we Americans, like most nations, have a low but real risk of repeating the worst of modern human history, shouldn't we put some measure in place so we can estimate and track our risk?

We can't call this the "Nazi score" because the word Nazi has too much baggage. It cannot, for example, be applied to readily applied to Israel and it is historically bound to a peculiar form of industrial organization. In any event  a Nazimeter score would be a Godwin's Law violation.

Still, the lessons of Nazism are so powerful, and so often studied, that it would be insane to ignore them. So I'll permute some characters and name this metric the Zani score.

It only remains then, to assemble the metric. Tradition dictates a 10 point scale, so we need to come up with 10 distinct indicators of roughly equal weight. As a rough guide we can assume that the National Socialists get 9-10 points and the American Tea Party movement must score less than 5.

Given that rough outline here's my start on the 10 indicators that sum to a Zani score for any social movement or organization. Suggestions are most welcome and I hope to refine the scale over time.

1. A belief that the ends justify the means, or, in other words, "extremism in the defense of liberty is no vice".
2. A sense of grievance and injustice.
3. A charismatic leader.
4. Celebration and admiration of violence.
5. Tribal or ethnic boundaries; a division into the "chosen" and the "other".
6. Anti-intellectual, in particular anti-geek.
7. Denial of skepticism. Skeptics are outcast, dissent is forbidden.
8. Welcoming and affirmation of the convert.
9. Membership alone is proof of virtue.
10. Scorn for the weak; denial of pity or sympathy for the other.

Any suggestions on additions or deletions? Does anyone know of a genuine, empirically tested, Zani metric?

Dinosaurs born of CO2

The new bit is the Triassic transition, but an Economist article is a handy summary of current thoughts on the Permian and later extinctions (emphases mine):

Economist: Rise of the dinosaurs

… This cycle has happened five times in the history of modern life. The most famous occasion was 65m years ago, when the dinosaurs were wiped out and the mammals emerged victorious from the wreckage. A bigger mass extinction, at the end of the Permian period 251m years ago, killed 70% of the world’s land vertebrates (and 96% of all marine animals) and paved the way for the age of reptiles.

Exactly which sort of reptile would come out on top, however, was not something that was decided until later—201.4m years ago, to be precise. This was towards the end of the Triassic period. Then, the ranks of aetosaurs, phytosaurs, shuvosaurs and many other uncrocodile-like relatives of the crocodiles were suddenly thinned, and a previously obscure group came to the fore. The result, once natural selection had done its work over the course of millions of years, was the now familiar cast of Allosaurus, Diplodocus,Triceratops and Tyrannosaurus rex…

… The dinosaurs were done for, as everybody knows, by a collision with an asteroid. The Permian was curtailed by massive volcanism. But what exactly happened towards the end of the Triassic has been much debated. A study just published in the Proceedings of the National Academy of Sciences, by Jessica Whiteside of Brown University in Rhode Island and her colleagues, pretty well nails it down. It was the geological chaos that created the North Atlantic Ocean.

… The initial volcanism as North America split from Europe released carbon dioxide from deep inside the Earth. That produced a greenhouse effect which, in turn, melted seabed structures known as methane clathrates, which trap that gas in ice. This caused a massive release of ¹²C-rich methane into the atmosphere, explaining the initial drop in ¹³C concentrations. The methane, being a much more potent greenhouse gas than carbon dioxide, exacerbated things, while the carbon dioxide acidified the oceans, killing most of the animal shellmakers and fertilising the photosynthesis of planktonic plants. The subsequent plankton bloom sucked up the¹²C and the isotope ratio veered off in the opposite direction.

The greenhouse warming and the acid rain also did for the forests and many of the reptiles. Only once things had settled down could the survivors regroup. New species of trees took over. The forests grew back. And a bunch of hitherto not-so-terrible lizards began their long march.

So a spike in CO2 from deep sources led to a methane spike. Together the two baked and acid burned the planet. A plankton bloom sucked down the CO2 and things settled down again.

We, of course, are on track to repeat history.

CO2 or not, we are in the midst of a mass “holocene” extinction anyway. What comes from that remains to be seen, but if humans last a bit longer it might be retrospectively labeled the transition to the age of the machines.

Summarizing the Patient Protection and Affordable Care Act – in two pages and 10 titles

You may have heard that the Senate passed a health care bill. It is likely that it will be further amended by the House, and of course there will be challenges, but it is probable that the directives in the bill will be turned into law.

It is conceivable that this bill will have some implications for the future of health care, so it is useful to learn what is in it. It is quite a large bill.

Uwe Reinhardt, a well known health economist, recommended a summary prepared by the Congressional Research Service [1]. Even the summary takes a while to read. One can, however, get a sense of it simply by looking at the headings. I’ve excerpted them below. There are quite a few odd bits in there, but the scope of this bill is occasionally breathtaking.

Patient Protection and Affordable Care Act – Summary of Senate Bill – Library of Congress March 2010

Title I: Quality, Affordable Health Care for All Americans
Subtitle A: Immediate Improvements in Health Care Coverage for All Americans
Subtitle B: Immediate Actions to Preserve and Expand Coverage
Subtitle C: Quality Health Insurance Coverage for All Americans
Part I: Health Insurance Market
Part II: Other Provisions
Subtitle D: Available Coverage Choices for All Americans
Part I: Establishment of Qualified Health Plans
Part II: Consumer Choices and Insurance Competition Through Health Benefit Exchanges
Part III: State Flexibility Relating to Exchanges
Part IV: State Flexibility to Establish Alternative Programs
Part V: Reinsurance and Risk Adjustment
Subtitle E: Affordable Coverage Choices for All Americans
Part I: Premium Tax Credits and Cost-sharing Reductions
Subpart A: Premium Tax Credits and Cost-sharing Reductions
Subpart B: Eligibility Determinations
Part II: Small Business Tax Credit - (Sec. 1421, as modified by section 10105)
Subtitle F: Shared Responsibility for Health Care
Part I: Individual Responsibility
Part II: Employer Responsibilities
Subtitle G: Miscellaneous Provisions

Title II: Role of Public Programs
Subtitle A: Improved Access to Medicaid
Subtitle B: Enhanced Support for the Children's Health Insurance Program
Subtitle C: Medicaid and CHIP Enrollment Simplification
Subtitle D: Improvements to Medicaid Services - (Sec. 2301)
Subtitle E: New Options for States to Provide Long-Term Services and Supports
Subtitle F: Medicaid Prescription Drug Coverage
Subtitle G: Medicaid Disproportionate Share Hospital (DSH) Payments
Subtitle H: Improved Coordination for Dual Eligible Beneficiaries
Subtitle I: Improving the Quality of Medicaid for Patients and Providers
Subtitle J: Improvements to the Medicaid and CHIP Payment and Access Commission (MACPAC)
Subtitle K: Protections for American Indians and Alaska Natives
Subtitle L: Maternal and Child Health Services

Title III: Improving the Quality and Efficiency of Health Care
Subtitle A: Transforming the Health Care Delivery System
Part I: Linking Payment to Quality Outcomes under the Medicare Program
Part II: National Strategy to Improve Health Care Quality
Part III: Encouraging Development of New Patient Care Models
Subtitle B: Improving Medicare for Patients and Providers
Part 1: Ensuring Beneficiary Access to Physician Care and Other Services
Part II: Rural Protections
Part III: Improving Payment Accuracy
Subtitle C: Provisions Relating to Part C
Subtitle D: Medicare Part D Improvements for Prescription Drug Plans and MA-PD Plans
Subtitle E: Ensuring Medicare Sustainability
Subtitle F: Health Care Quality
Subtitle G: Protecting and Improving Guaranteed Medicare Benefits

Title IV: Prevention of Chronic Disease and Improving Public Health
Subtitle A: Modernizing Disease Prevention and Public Health Systems
Subtitle B: Increasing Access to Clinical Preventive Services
Subtitle C: Creating Healthier Communities - (Sec. 4201, as modified by Sec. 10403)
Subtitle D: Support for Prevention and Public Health Innovation - (Sec. 4301)
Subtitle E: Miscellaneous Provisions - (Sec. 4402)

Title V: Health Care Workforce
Subtitle A: Purpose and Definitions - (Sec. 5001)
Subtitle B: Innovations in the Health Care Workforce - (Sec. 5101, as modified by Sec. 10501)
Subtitle C: Increasing the Supply of the Health Care Workforce
Subtitle D: Enhancing Health Care Workforce Education and Training - (Sec. 5301)
Subtitle E: Supporting the Existing Health Care Workforce - (Sec. 5401)
Subtitle F: Strengthening Primary Care and Other Workforce Improvements- (Sec. 5501, as modified by Sec. 10501)
Subtitle G: Improving Access to Health Care Services - (Sec. 5601)
Subtitle H: General Provisions - (Sec. 5701)

Title VI: Transparency and Program Integrity
Subtitle A: Physician Ownership and Other Transparency - (Sec. 6001, as modified by Sec. 10601)
Subtitle B: Nursing Home Transparency and Improvement
Part I: Improving Transparency of Information - (Sec. 6101)
Part II: Targeting Enforcement - (Sec. 6111)
Part III: Improving Staff Training - (Sec. 6121)
Subtitle C: Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long Term Care Facilities and Providers - (Sec. 6201)
Subtitle D: Patient-Centered Outcomes Research - (Sec. 6301, as modified by Sec. 10602)
Subtitle E: Medicare, Medicaid, and CHIP Program Integrity Provisions - (Sec. 6401, as modified by Sec. 10603)
Subtitle F: Additional Medicaid Program Integrity Provisions - (Sec. 6501)
Subtitle G: Additional Program Integrity Provisions - (Sec. 6601)
Subtitle H: Elder Justice Act - Elder Justice Act of 2009 - (Sec. 6702)
Subtitle I: Sense of the Senate Regarding Medical Malpractice - (Sec. 6801)

Title VII: Improving Access to Innovative Medical Therapies -
Subtitle A: Biologics Price Competition and Innovation
Subtitle B: More Affordable Medicine for Children and Underserved Communities - (Sec. 7101)

Title VIII: Class Act - Community Living Assistance Services and Supports Act or the CLASS Act - (Sec. 8002, as modified by Sec. 10801)

Title IX: Revenue Provisions -
Subtitle A: Revenue Offset Provisions - (Sec. 9001, as modified by section 10901)
Subtitle B: Other Provisions - (Sec. 9021)

Title X: Strengthening Quality, Affordable Health Care for All Americans -
Subtitle A: Provisions Relating to Title I - (Sec. 10101) Revises provisions of or related to Subtitles A, B, and C of Title I of this Act
Subtitle B: Provisions Relating to Title II
Part I: Medicaid and CHIP - (Sec. 10201)
Part II: Support for Pregnant and Parenting Teens and Women - (Sec. 10212)
Part III: Indian Health Care Improvement - (Sec. 10221)

[1] These summaries are written in a programming language for the creation of regulations. The bulk of the omitted material begins with command verbs that tell regulators what to do. I created this summary by regex operations on paragraphs beginning with the command operators which include:

Allows
Amends
Applies
Appropriates
Authorizes
Declares
Directs
Establishes
Excludes
Expands
Expresses the sense
Provides
Reauthorizes
Redesignates
Requires
Revises
Sets forth

It’s a very structured document that resembles generated software code and could indeed be created from a regulatory meta-language.

If you laid every virus head to toe ...

You would get a very slender string of significant length ...

Welcome to Your Viral World | The Loom | Carl Zimmer for Discover Magazine

...Line up all the viruses on Earth end to end (go ahead, I’ll wait), and they’ll stretch over 10 million light years....

Is this conceivable? I know our planet is a seething ball of virii, but even a single light year is a very great length.

See also:

• The most marvelous world of the virus
• Why would a virus fatten an animal? (2006)
• Dark matter DNA
• Reflections on my personal bacterial companions
• Computers, viruses, intelligent design, natural selection, memes, mitochondria and, of course, the Fermi Paradox

Best health care reform commentary

I'm waiting for week's end to write mine, but I'll be working from these early commentaries:

• Economist Brad DeLong: The Curious Triumph of RomneyCare
• Physicist Sean Caroll: Obamacare | Cosmic Variance
• Science fiction author John Scalzi: Health Care Passage Thoughts
• NYT Infographic: How the Health Care Overhaul Could Affect You

I think it's pretty damned awesome that the three* most intelligent commentaries I've read were written by amateur blog-only journalists. (Ok, so Sean is probably paid for his science blog).

Incidentally, I expect my "taxes" will rise to pay for this. More on why, how and where the quotes come from in a later post. We're good with that.

PS. DeLong: RomneyCare Passage Aftermath - support Betsy Markey (for her courage)

* I wrote "four" originally but I moved one to the PS and didn't decrement!

Update: The Christian Science Monitor has a detailed breakdown. Well done.

Update 3/24/2010: Leonhardt focuses on the distributive nature. This is why the GOP is enraged.

Update 3/24/2010b: Uwe Reinhardt points to the readable references. He discretely but clearly points out the cost will be higher than the CBO score -- but much less than the Bush Part D boondoggle.

Update 3/28/2010: HCR and labor motility

Farewell Palm

I work in an IT shop. I can almost always find a home for my old gear. Tomorrow will be a real test though, I'm bringing in my Palm stuff to give away ...

The five PalmOS devices shown above are probably 1/2 to 1/3 of the total Emily and I bought between 1998 and 2006. I underwent the exquisitely painful Palm to iPhone transition in Aug 2008 (in some ways it's still continuing).

I don't think anyone will want the devices, but the chargers and accessories might be of interest. I have zillions of styli.[1]

One SONY made device uses AA batteries. It's the only one that would still work; I might keep it around for grandchild show and tell (I bet there's still an AA equivalent in 30 years. If there's civilization.) The others had LiOn batteries that are pretty dead by now.

Ahh, Palm. They were great in their time, but they peaked in the 90s with the Graffiti One Vx. Even after they lost their way, the company was sustained by some terrific developers like Pimlico Software (DateBk).

I'm not tossing everything. I added the Vx manual and Pogue's PalmPilot book to my shelf of computer book honor:

Even though Palm Inc's WebOS seems to have no relationship to PalmClassic, I'd hoped it would provide some inspiring competition for Apple. Judging by their share price, however, that seems unlikely ...

They fell of a cliff in the past week or so. I assume the price was being sustained by hope of a Nokia or Microsoft acquisition, but that news of Windows Mobile 7 made that unlikely. Instead the key people are likely to go to Microsoft or Google and someone will buy up any useful patents.

Farewell Palm.

See also:

• AvantGo RIP - memories of the roaring 90s
• The descent of the PDA: Newton, Palm, Blackberry and iPhone
• What the iPhone needs is Gorilla Haven’s DateBk6

Update: Details on the sad future from Gasee (via Gruber).

Update 3/23/2010: The best pre-iPhone smartphone was the PalmOS Classic Samsung i500. Also, the Palm Vx pioneered the non-removable LiOn battery.

[1] Update 3/24/2010: My coworkers took almost every accessory, but nobody wanted a device. I love Minnesota -- the home of geeks who hate throwing things away.

Ancient wisdom: Their experts are like your experts

This one is the converse of "No man is a prophet in his own country".

On average, their experts are a lot like your experts.

No, it's not that your experts are right and their experts are wrong. It's rather that experts you don't know are as vain, clever, mistaken, thoughtful, rushed, insightful, venal and proud as the experts you know.

Just because you're reading them in a newspaper, or hearing them on TV, doesn't mean they're a different species of expert. Be as trusting of them, and as suspicious of them, as you are of the very human experts you know personally.

Try it the next time you read a recommendation about estrogen use, or a political opinion, or a CEO's strategic insights, or a blog post. Think of it as coming from an expert you know. Chances are you'll give the words respect and consideration, but not the unthinking acceptance of prophecy.

Top 50 children's film

I like this "top 50" list because I'd totally forgotten about #1. Our children would probably like it. Added to netflix queue ...

E.T. voted greatest ever children's film

1. E.T: The Extra-Terrestrial
2. Toy Story
3. Mary Poppins
4. Lion King
5. Wizard of Oz
6. Bambi
7. Back to the Future
8. Shrek
9. Finding Nemo
10. Labyrinth
11. 101 Dalmatians
12. Aladdin
13. Beauty and the Beast
14. The Goonies
15. The Jungle Book
16. Chitty Chitty Bang Bang
17. Alice in Wonderland
18. Home Alone
19. Ice Age
20. Harry Potter and the Sorcerer's Stone
21. Snow White and the Seven Dwarfs
22. Annie
23. Cinderella
24. Monsters Inc
25. Madagascar
26. Sound of Music
27. Wallace and Gromit – The Wrong Trousers
28. Mrs Doubtfire
29. Babe
30. Beethoven
31. Beetlejuice
32. Black Beauty
33. The Little Mermaid
34. The Railway Children
35. A Bug's Life
36. Dumbo
37. Wall-E
38. The Lion, the Witch and the Wardrobe
39. A Little Princess
40. Bill and Ted's Excellent Adventure
41. Jurassic Park
42. Kung-Fu Panda
43. Who Framed Roger Rabbit
44. Billy Elliot
45. Lady and the Tramp
46. Neverending Story
47. Short Circuit
48. Sleeping Beauty
49. An American Tail
50. Chicken Run

Things I suspect: generic meds

Things I suspect without much evidence ...

... That our quality problems with generic medications are much bigger than we imagine.

Update 4/5/2010: see comments for more on this. A recent WSJ Health blog mentioned increased safety recalls for generics. I had not heard of the examples they cited.

Investing today

Burton Malkiel wrote “A Random Walk down Wall Street” in 1973. He believed the prices of publicly traded assets reflected all publicly available information. John Bogle, influenced by Malkiel, created index funds to reduce the risks of random market fluctuations and to profit from this rational pricing.

Peter Lynch wrote “One up on wall street” in 1989. He didn’t agree with Malkiel; he felt that “local knowledge” and personal experience could detect under and overpriced shares.

I suspect each was more or less right for his era. That is, I suspect share prices in the mid to late 1960s were more or less rationally priced. I suspect share prices in the late 1970s and early 1980s were not rationally priced, and that the anomalies were potentially discoverable by a rational investor with limited resources.

Of course by the time each person wrote their book, their era had passed.

Which brings me to our current era.

Since Lynch’s book we have experienced 20 years of economic turbulence fundamentally driven, I suspect, by the commercialization of the microprocessor and the industrialization of what we once knew as the third world. As a side-effect of these fundamental changes, including the collapse of the fourth estate, we have shifted towards the upper end of the historic scale of corporate and governmental corruption.

So what is the rational small investor strategy of today?

Of course I don’t know. My only personal insight is that I don’t yet see much short term correlation between share prices and the value of most of the goods and services I buy. Companies that deliver lousy value seem to track with their industry. The exceptions are a few companies that are intensely monitored (Apple, Google, Microsoft, etc); I think they are rationally priced but they are, of course, very volatile.

This would suggest we’re still in a Lynch era, where one should be able to use local knowledge to detect anomalies and profit from them. Over the past 10 years though you couldn’t detect the anomalies using the “local knowledge” he described – you had to be an insider who was able to sniff out fraud and corruption. In the past decade some have done very well detecting evidence of corruption and de facto fraud, and shorting companies like Lehman.

Of course by the time people like me decide shorting corrupt corporations is a good strategy, its time has passed.

I where are we today? I’m guessing that we’re in transition back to a Malkiel era. So for a few years shorting corruption might still work, but increasingly share prices will be a random walk. Even if index funds were a crummy investment over the past decade (everything was, except shorting fraud), this might be their time again. I wouldn’t mind some 1960s style dull dividend paying companies though.

Of course by the time anyone writes the “Random walk” or “One up” book of our era, that strategy will have passed into history.

Oh, and if you take investment advice from me, you totally deserve your impending financial ruin.

Why we need to retire at sixty

Ten years ago there was talk of the boomers working into their seventies. The "me generation" was said to be "young at heart".

Then reality set in. Contrary to popular belief, brain decay is not a late life disorder. It starts in our twenties ....

This Is Your Faulty Brain, On a Microchip - Memory forever - Gizmodo

... Starting in your 20s—not old age—behavioral evidence suggests that you enter a linear cascade of general cognitive decline....

This decline is notably seen in tasks that are highly mentally demanding, like speed of processing (how quickly you handle incoming information), attention, working memory (how well you manipulate and keep information active in your mind), and, of course, long term memory.

In real life, these effects are seen in everything from how long it takes to learn a new skill to how quickly you can recall a factoid....

The Gizmodo article, clearly written by a young chap, imagines we'll outsource our recall and declining cognition to an onboard chip (vs., say Google). Sure.

While we're waiting to be chipped, however, knowledge work is becoming ever more demanding - and non-knowledge work doesn't pay too well (unless you're CEO, then non-knowledge work can pay very well).

In the post-modern world, unless we can bend that decay curve (hello? dementia meds?) many of us will have a hard time doing competitive knowledge work into our 60s - much less our 70s. Bagging groceries yes - genomic engineering not so much.

That could be a bit of an economics problem.

We really should be spending more money on trying to bend that curve. We need my generation to earn money until we take our dirt bath.

Why geek genes win

How is that that many of my fellow homely geeks are happily married to women so much more attractive than we are?

Geek genes (yes, we are "effeminate" no matter how many mountains we might climb)turn out to become desirable in high tech civilizations. Since geeks make tech, geek genes thereby support and create the environments that make more geek genes. Talk about the selfish gene ...

The battle of the sexes: Face off | The Economist

... Mating preferences, too, vary with a society’s level of economic development. That, at least, is the conclusion of a study by Ben Jones and Lisa DeBruine of Aberdeen University, in Scotland, published this week in the Proceedings of the Royal Society.

Dr Jones and Dr DeBruine, themselves a married couple, examined what might be called the Deianira paradox. Hercules, demigod and paragon of masculinity in the ancient world, was indirectly done for by his own sexual prowess—his jealous wife, Deianira, accidentally poisoned him with a potion she thought would render him eternally faithful. Deianira’s predicament is a woman’s ultimate dilemma. In a man, the craggy physical characteristics associated with masculinity often indicate a strong immune system and thus a likelihood of his producing healthier offspring than his softer-featured confrères will. But such men are also more promiscuous and do not care as much about long-term relationships, leaving women to raise their kids alone.

Nowadays, sound parenting is often more important to the viability of a man’s offspring than Herculean strength. That, some researchers suspect, may be changing the physical traits that women look for in a mate, at least in some societies. A study carried out in 2004, for example, discovered that women in rural Jamaica found manly types more desirable than did women in Britain, which led to questions about whether those preferences were arbitrary or whether women in different parts of the world might be adapting to circumstances that place different emphasis on manliness in the competitive calculus.

Dr Jones and Dr DeBruine therefore looked to see if there is an inverse relationship between women’s preference for masculine features and national health. Sure enough, they found one. In environments where disease is rampant and the child-mortality rate is high, women prefer masculine men. In places like America and Britain, where knowing how to analyse health-care plans is more important than fighting off infection, effeminate men are just as competitive...

... Neither wealth nor mating pattern had much impact on women’s preferences for manly men. Disease rates, by contrast, seemed to be directly related to how they went about choosing a mate—the healthier the society, the less women valued masculinity. Hygiene and wimps, it seems, go hand in hand....

So non-geeks really do need to destroy civilization. This explains the GOP.