Radiolab and Bolero

I stood in the middle off the G-Terminal at ORD the other day listening to podcasts.

Contrasting with the bustle of busy, annoyed, stressed, and sweaty travelers, RadioLab podcasts explore deep concepts and have some of the most creative uses of sound I hear in my day-to-day life.

Unraveling Bolero is a great example. While it is typical in most respect, certain elements came together and it struck me as one of the most beautiful and terrifying episodes I've heard.

You can listen to it here.

A visit to the Dentist

Last month was the first time in more than 10 years that I had been to the dentist.  Back then I began my series of visits after breaking a tooth on a tuna fish sandwich.  I subjected myself to the dental care system, had a root canal to fix the damage caused by that sandwich, and eventually stopped going.

Why?  Well, I wasn't entirely comfortable there.  The dental care was okay, but there was something off about the environment.  Sometimes I felt like they were selling me a used car.  Other times, I just got this weird vibe that screamed "Russian Mob."  I have no idea if they were connected, but eventually I trusted my instincts and stopped going, especially when they started pushing the idea of braces.

In the years since, I haven't needed dental care, though it may have been a good idea.  It always planned to look for a dentist "next month."  Months passed.  Then years.  And ultimately, a decade. Eventually, I ended up back in the chair.

Today was the second in a series of dental appointments in the current series.  It was for a deep cleaning.  Now, I don't recall ever getting this procedure done before, but then again, my last regular, every 6-month appointment dental care schedule was back during the thousand-points-of-light Bush administration so things may have changed.

So today I sat in the chair and got all novacained up for a deep cleaning.  If you're not familiar with this process, it involves scraping under the gum line to get gunk out.  Normally, they do only one half of the mouth at a time, but we decided to just do the whole thin today.

I spent an hour having some guy scrape my teeth with little metal tools. And though I felt like I was choking once or twice, it wasn't too bad.  Though it did give rise to this dialog:

Me: I'm starting the taste a little blood.

Dentist:  Just now?!

While the whole thing was going on, my mind tried to wander a bit.  I layed back in the chair and looked up at the spot light.  I wore orange sunglasses so it wasn't too bright.  The shop light reminded me of the sunset and I tried to transfer myself to the beach through that sun so I would't be terribly bored, but it wasn't that easy.

It seems you can't just ignore the guy poking around your mouth with metal implements, hoses, and a suction tool.  The scraping is loud as it echoes through the skull, bypassing the ears altogether.  And the the tools slip, which is always a little jarring.  I also had to frequently remind my self to relax my muscles, not drive my fingertips through the chair too hard, and breath through my nose.

My higher brain functions were perfectly okay with the whole process, but the lizard core deep in the evolutionary recesses of my brain, screamed, "AHHHHHH!!!!! Run AWAAAAAYYYYYY!" If I let down my guard, that part of my brain would start to gain more influence over the situation, and there is no way a Fight or Flight response could have ended well.

Now, I've got clean teeth, an aching jaw, and sore spots where the Novocaine needles had been plunged in and moved around like tiny liposuction hoses.

And for some reason, I'm willingly going back next week.

But those glasses sure made my phone easier to read.

Healthcare Reform 03: Follow up to the plan

Considering the depth of some of the comments I saw to my Monday post, I thought it would be good idea to respond to them in their own post.

As I respond to the comments below (and thank you very much for making them) I am not trying to dispute things. I am, however, using them as a jumping off point to further explore my thoughts on a topic and it's related ones.

When it comes to health care (and many other issues) I tend to be a radical moderate. Which means each time I think I have an answer to a question, it simply leads to 5 more questions.

I guess I'm trying to devise a system that is fair, compassionate, competitive, efficient, and effective.

The proposal I layed out a couple days ago is not intended to be the answer but it is intended to be an improvement. It won't solve all the problems for all people. But it may solve many of the problems for many people.

Sandy said...

Wow...I was with ya on the first half of your article. I think it's a terrible that the US, the most civilized country in the world does not provide for it's own. I do agree we currently have (though most would disagree) socialized medicine. The welfare system provides care for those who abuse the ER, which costs us all dearly and provides bad medical care management...but the working poor have zilch. They don't have care and thats wrong on so many levels.

Having worked in the medical field for 22 years, I can say Insurance Companies and the Medical field need to change. Doctors are paid far more than a decent wage, and so are Insurance companies. Drug companies have tremendous waste. Their employees are highly paid, and have lots of perks. Some of the fat from these 3 entities needs to happen. I have no problem with people who are working hard making a good living, I do have a problem with the rich getting richer, and the poor getting poorer.

We need Doctors, Insurance Companies, and Drug Companies to be more accountable. And employers who pay their Executives far more than they're worth, but cheat their regular employees ought to spend some time in their shoes. I do not think the burden they have of insurance is what you describe. I do know many companies who alter hours, and conditions of employment to get around the duty and responsibility of providing insurance for their employees. Firing employees, then hiring them as temps for example. Cutting their hours just a few hours a week to keep them under the radar on legally needed to pay for their insurance. This is wrong, and very unjust. These same companies provide private jet service to the management people for trips that are not business related, vacation homes, expensive cars etc. etc.

I say trim the fat, there's plenty of it, and then providing medical insurance would be a piece of cake.

I might also add, I have 2 family members who work in the insurance industry, and 1 for a drug company...this just isn't my opinion, but opinion based on personal information and experinces.

Sandy
Everytime we treat someone in the ER for the flu or a cold, or sore throat prices go through the roof. And everytime someone ends up having emergency surgery for soething that might have been caught had they been able to visit a family doctor...same thing. Current system is way too costly, both in lives and in $$

I appreciate the detail here. I'm not sure I would go so far as to say doctors are overpaid (though I may be reading too much into your comments). Theoretically, people are paid just enough to get them to keep doing the job. With doctor in private practice it gets more complicated because they are not necesarily salaried like many workers are.

And we want to draw the best people to the profession. That's one reason the system can produce such high-quality care. But obviously, salaries at all levels of the care system contribute the rising costs.

While I don't believe you are calling for salary caps for highly paid medical professionals, it is an idea that may merit some discussion. I think it makes more sense to discuss salary caps in a broader discussion of tort reform. Generally, I am not a supporter of legislative limits to pain and suffering award or punative damages for medical malpractice. While there have been some outlandish awards, I don't think they are representative of the broader malpractice issues.

However, if we were to impose limits on those awards through tort reform, then we also need to limit compensation for professionals shielded by those limits. It's about balancing the high-risk=high-reward equation.

Outside of that, when we talk about cutting pay and perks, do we risk driving professionals into other fields? Or discourage the next generation from pursuing those professions?

The broader picture of executive compensation merits a closer look. Although those highly paid executives are paid that way because that's what the company owners (the shareholders) want to pay them. The trick is to align highly paid executive pay more closely with both short and long term company performance.

It's interesting that you cite the cutting of employee hours as immoral while also citing profligate waste within the organization. I think most would agree that paying more for a product than it should cost is a form of waste. We see that in stories of aspirin and other things that cost pennies at retail and dollars in a hospital. Overpaying is typically regarded as a bad thing.

If a company is overpaying someone that means a couple things. First, they could get the same work done by someone else for less money. Second, the value that person brings the compnay does not exceed that person's cost to the company.

Reducing the number of overpaid people is cutting waste. When that standard applies to executives, people cheer. When that same standard applies to the lower ranks, people protest.

Cutting hours to reduce the number of full time employees and the need to pay for insurance is a way for a company to reduce waste. If they can get the same work product done at lower cost, that is a good thing for the owners.

While the ideal of living wage and full benefits is important to society overall, providing it, for many companies, is a form of waste.

I like the idea of trimming the fat, and I agree there is a lot of it, but defining the fat is where we get into trouble.

The costs and support structure in the industry need to come down somehow. It's not only a tremendous outlay of money, but the more people we have in the healthcare industry means there are fewer available to other industries.

One more note on the idea of wasted money: the money isn't being burned or destroyed. And getting even bigger than health care reform brings us to the broader issues facing the economy. Money wasted in healthcare isn't really wasted, as long as it gets spent elsewhere. The extra people employed there, or overpaid there, can spend their money in other aspects of the economy.

I certainly don't have all the answers, and my views are sometimes self-contradictory on this matter. That's one of the reasons I'm throwing these ideas out there.


Sharkbytes said...

It's all pretty broken, and those of us with just enough money to be poor but not destitute are left out in the cold.

That's the problem our modern welfare system faces, that need-based college financial aid faces, and that many programs that help the poor face. Programs that help the poor often do nothing to help those who are teetering on the edge. With a little help, perhaps fewer people would teeter off into serious problems and get past their current struggles. But when faced with limited resources, the general choice is to hlep the person that is starving today, and not the person who has been just a hair away from starving for the past few months.

And those who are struggling, and haven't given in to collapse, are the ones that we should be supporting more. The challege is to build social safety nets that don't encourage failure.



Mike Golch said...

the thing that worries me is will the plan become as bloated with ripoffs atrists like medicare has become.some of the reinbursements that are paid out of medicare are just gross.

My plan isn't the best solution out there. There are definite flaws; it's goal is to make the situation better, not to make it perfect.

There will always bee some ripoffs. The question is how much is too much? What is an "acceptable" percentage of fraud in a program? 2%? 5%? 10%?

In order to design a truly fraud proof plan, you will spend more money preventing fraud than you would have lost to fraud to begin with. And that makes no financial sense. The other option is to put such rigorous controls in place to prevent fraud that you end up making the program too difficult to be used by those it was orginally designed to benefit.

I'm not giving fraudsters a free pass. Inded, they should be vigorously prosecuted. But there comes a point where it's just not worth it. Right now, I'm thinking a 5% fraud rate is acceptable. But that's not set in stone.


grayspirit said...

I think the concept is a reasonable one, but my concern is that there is really nothing in place to manage the cost of healthcare. As long as the government provides reimbursements for healthcare, the industry tends to keep costs high because there really is no competitive pressure to bring prices down. Just my opinion. :)

And figuring out how to limit the costs without getting in the way of proper care is the challenge. HMOs are designed to do exacly that, and yet they are often considered one of the most evil aspects of the health care industry.

Time and again, we hear that bureaucrats should not be interfering in decisions between doctors and patients, and yet, that's exactly what limiting costs will require. Someone with the purse strings has to be able to say, "No." But that is not something most people want to see incorporated in the law.

I think the same problem faces colleges and universities today. Tuition and fee increases have exceeded the rate of inflation for well over a decade. One reason for this may be the proliferation of financial aide. If the government cut back the college financial aid programs by 75% or so, would we see a comparable drop in the number of students? Or would we see a much smaller drop in students and a larger drop in college costs?

College costs can rise as high as they have because the taxpayers are willing to give them more money through the financial aid system.


Pricilla said...

You forget in your plan people who are sick with chronic conditions or who have pre existing conditions. They (ie: ME) cannot get private insurance in the marketplace for any price. No insurer wants the risk. So my husband HAS to work. I am disabled and medicare does not begin to cover my medical costs.

Until there are viable options for sick people in the marketplace the system will not be viable. There are a lot of people with minor pre existing conditions that get them bumped from insurance plans. Major problems like what I have really cause issues.

The system is broken and needs serious fixing. I think you are right about corporate America though since they are paying for it now and basically paying for congress..

This is part of the problem with the idea of even offering health insurance. And here I am going to choose my words carefully. While there should be a way to cover those with preexisting conditions, it shouldn't be insurance.

Insurance exists on the basis of a gamble. People purchase insurance gambling that they will receive more in benefits than the pay in premiums. Insurance companies offer insurance gambling that they will collect more in premiums (and interest) than they pay out in benefits.

If I was guaranteed I would never need to file a claim, I would be an idiot to purchase insurance.

Likewise, if an insurance company sees a situation where they are guaranteed to pay out more than they are likely to collect in premiums than they would be idiots to offer that coverage.

Which make insurance a poor model for providing healthcare coverage to those with preexisitng conditions.

Once insurance is not a viable option, the question becomes who should pay? If the costs are outlandish, the person with the condition can't reasonably be expected to pay so someone else has to. Should that person be the tax payer? In many cases, the answer is likely,"yes," due to lack of alternatives.

This raises another issue then. (Note: I am not saying this has anything to do with your conditions.) The issue is one of lifestyle choices.

As a taxpayer, maybe it makes sense for me to pay for the medical care of someone who can't pay if they are sticken with cancer. But what if that person is a smoker? Should I now have to pay for the care of someone who has lung cancer when that person caused the disease themselves?

What about someone who is obese and suffers from diabetes or heart disease? Should I have to pay for that person's care when the reason they require care is because of poor life style choices?

If I get injured in a car accident that's not my fault, can I expect the tax payers to cover that cost? Maybe. But what it 90% of the costs are because I wasn't wearing as seatbelt? It is still fair?

What about child birth? Should I as a tax payer have to pay for pre-natal care and the birth process someone choose to undergo in what, again, is a lifestyle decision?

These are questions we will need to struggle with in any program that ultimatley gets implemented. Do we cover everything regardless of cause?


Kerrilee said...

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Kerrilee

Thanks, Kerrilee. It's always nice to be recognized.

Healthcare Reform 02: Electronic Medical Records

This week seems to have turned into Healthcare Reform week at Cromely's World. Or more specifically, Unresearched Healthcare Reform week. I'm not sure how that happened.

I'll be responding to the comments on yesterday's post tomorrow. But as I think more about some of the issues we encounter, Medical Records is a big one.

The volume of paper work generated by the health care and insurance industries is mind-boggling. We spend hundreds of millions of dollars each year in administration. I don't want to call that waste because without it, so many things simply wouldn't get done, but there has to be a better way.

Besides the cost, there is the hassle for the patients. When you move to another doctor, you either need to get your records transferred or start from scratch. And if a new doctor uses a different system than an old doctor, there is the transition to deal with.

If a patient needs medical care away from home and is unable to speak, ER physicians may also need to start from scratch.

We hear about deaths every year related to mistakes with prescription drugs. A pharmacy may misunderstand a doctors instructions, or a doctor may prescribe a drug that has deadly interactions with something else that patient is already taking and is prescribed by another doctor.

Friends in the medical industry have told me about different electronic medical records system. In my own job, I tangentially have dealt with the issue as well. Thousands of people are involved in various, diverse ways of attacking the paper problem.

Moving all the records off paper and into bits is part of the solution. But it's the next step that I get concerned about.

From a practical standpoint, it makes sense to me to have all medical providers creating patient records in one electronic format that is readable instantly by any other medical professions. I believe Google and other companies are already pursuing this.

The records should be comprehensive. Everything should be in one place, so every healthcare provider knows what the other is doing. And it should be easily accessible for the patient, and easy for an authorized medical provider to access should a patient arrive incapactitated. Information should be easily exportable to the appropriate health insuarnce providers to effectively manage coverage and payments.

Theoretically, such a system could save hundreds of millions of dollars, thousands of lives, and hours of incovenience for patients.

And it scares the heck out of me.

The privacy implications of such a system are staggering. Collecting that much information in one place could put people at risk with employers. It could expose embarrasing information to firends and family. And if it fell into the wrong hands, it is ripe for abuse by conartists.

And if incorrect information makes its way into such a file, it could be painfully difficult to remove and could compromise care for years to come.

In other words, if humans were not involved in the process, I would feel much better about it. But once you factor in human error and greed, the system becomes potentially dangerous.

So I'm torn on whether I want to see such a system in place. There are trememndous cost- and life- saving benefits to such a system. But is it worth the risk to freedom and privacy?

And is such a system inevitable despite such concerns?

Healthcare Reform 01: Government sponsored health care

A key initiative of the Obama administration is to bring health insurance to the uninsured in one form or another. Whether this is the US finally coming out of the dark ages or the beginning of an apocalyptic slide into communism is a more complicated discussion than I have the energy to get into tonight.

But that won't stop me from opining on the topic.

Here are some assumptions I am starting with, and I think many people are likely to agree.

We already have socialized medicine.

Between Medicare, Medicaid, CHIP, workers compensation, the VA, Federal employment benefits, and assorted other programs, the Federal, State, and local governments already provide millions of people with health care.

A person in need of immediate medical attention won't be denied care at an emergency room. Millions of people already use hospital emergency rooms for primary health care because they can't/won't pay to see a regular physician.

Socialized medicine is here today -- it's just delivered with terrible inefficiency.

We have some of the best medical technology in the world.

The medical schools and technology we have in the US create some of the best procedures, medical instruments, and medication. We have fantastic physicians and they are typically well compensated after years in their profession. Many other health care providers (RN's for example) are not as well compensated as we would like, but are still extremely talented.

The US pharmaceutical industry is a technological leader.

The US drug companies come under fire for their prices and for their defense of patents around the world. But the reason they are so often attacked for not sharing their products with the poor of the world is because they make such fantastic and innovative products.

Employers in the US have an extra burden they don't share with the rest of the world.

The primary provider of health care coverage in the US is the employer. Large companies provide coverage for employees. This cost, which is measured in the thousands of dollars, either depresses cash wages, or it reduces profits. Companies in other countries do not have to pay for health care for their employees.

Any health care plan we implement in the US must meet the following standards:

1. Preserve the health care technology leadership the US has
2. Keep and fairly compensate the skilled people in the industry
3. Make the system more efficient and less wasteful than the current system
4. Make health care affordable for those who currently can't afford it
5. Reduce the burden on employers

We don't have to get there in one step. And I've always doubted that health care reform will come from the Democrats. Not because I question their commitment, but because there are too many industries opposing it, and too many varied constituencies within the party to reach consensus on one plan.

The true impetus for health care reform in the US will not come from the left. It will come from the corporate interests on the right. Health care reform in the US will come when big and medium business decides it is time to shift the burden of paying f0r health insurance to someone else.

In the meantime, the tragic stories of individuals will provide headlines, but are not likely to result in a significant changes to the system.

A small proposal

In the interim, here's a way to tweak the system that may help lower individual costs and increase coverage. I am making up the numbers out of thin air, so bear that in mind.

Everyone should have a government provided health insurance program that features a $50,000 annual deductible. Above that amount, the Feds (taxpayers) would cover the costs.

This will mean the private health insurance providers can lower their rates to make health insurance more affordable since their losses will be capped.

This will also lower the costs for employers.

Most people don't spend more than $50K per year on health care, so there is still an incentive for individuals to look for ways to minimize their costs.

The pharmaceutical and hospital industry can continue to operate as they currently do. Doctors and pharmacists don't suddenly become government employees, so the local hospitals don't become the local DMV.

This plan addresses some of the concerns above, but it's not comprehensive. It's a simple plan that provides a step forward. And maybe it will break the current political log jam.

Aporkalypse!

"Aporkalypse" is my new favorite world, and I'm grateful to @xenijardin for introducing it into my vocabulary.

Here are some random thoughts about the outbreak.

I recently read Scott Sigler's, "Contagious," a story about an outbreak of alien spores, which seems appropriate given the current news about the potential for an H1N1 influenza outbreak. (Of course I was also reading it on an Airbus A319 when I encountered a passage about an unfortunate incident impacting an Airbus A319.)

My employer recently banned travel to Mexico. Seems reasonable. I wasn't planning to go, but now I guess I don't have to. Which is good, because I haven't gotten my yearly vat of SPF 96 yet.

They also recomend that employees who are sick take, you know, a sick day. It's seems silly, but apparently at many organization a lot of people still go into work when they are sick. The company wants to discourage that. And with modern technology, telecommuting is a great option for those who have to get stuff done but don't want to go into the office.

And by the way, why are there still so many office workers? We have broad band. We have secrure VPNs. We have cheap phone service and mobile phones. We have web cams. We have instant messaging. We have powerful computers. Why are the streets still flooded with people going to an office every day to type on the computer and talk on the phone? It makes no sense.

In the last few years, we have seen huge problems with traffic -- which telecommuting addresses.

We have seen a huge spike in the cost to get to work through fuel prices -- which telecommuting addresses.

We saw a huge run up in commercial real estate -- which telecommuting addresses.

And now since issues have been mitigated by the slumping economy, how about using telecommuting to reduce costs?

Maybe a pandemic and "social distancing" will finally push telecommuting the mainstream.

Even if telecommuting is just a few days a week, it helps.

"Social Distancing" is another phrase I learned today. In this article on the Capitol Hill Blog, they discuss the measures King County is taking to deal with the potential for a pandemic. Apparently the county updated its plans this past fall. We are currently in Phase 4 of a pandemic. It makes for interesting reading.

And finally, I learned that my brother's alma mater is the epicenter of the NYC swine flu outbreak.

Dr. Richard Besser, acting director of the Centers for Disease Control and Prevention, said of the 40 U.S. cases, only one has been hospitalized, and all have recovered.

New York Mayor Michael Bloomberg said Monday 28 cases have been confirmed at St. Francis Preparatory School in Queens. More than 100 students at the school were out with flu-like symptoms last week.

Bloomberg and New York City Health Commissioner Tom Frieden said all of the students who were ill had mild symptoms and none had been hospitalized.

The school is remaining closed through Tuesday.

...More

Ents in Indonesia

In recent months, there has been a great deal of controversy surrounding the HPV vaccine. Many medical organizations and states/local governments recommend that young girls (I believe 12 and up) get the vaccine to protect against this STD regardless of whether they are sexually active or not.

Don't click the link yet.

Here is a good reason for the vaccine. An Indonesian fisherman injured himself as a teenager and picked up an HPV infection. Sure, this is apparently a different strain that was transited when the victim cut his knee, but it is still HPV. The HPV infection interacted with his unique genetic flaws and is turning him into a tree.

Bizarre warts that look like roots and branches are growing from his skin.

The video and pictures at the site may be disturbing if you are sensitive to that sort of thing. Consider your self warned.

The good news is this may be treatable.

I originally found the link on fazed.net, and I really hope it's a fake. Unfortunately, it seems all too real.

Regardless of how HPV is transmitted, if the vaccine will stop this sort of thing from happening, it's probably worth it

Resistance is Futile 02: Out of Memory Error

In the current issue of Wired (15.10), columnist Clive Thompson talks about the recent decline human memory. He suggests that reason people remember less now is because they don't need to.

That reflexive gesture — reaching into your pocket for the answer — tells the story in a nutshell. Mobile phones can store 500 numbers in their memory, so why would you bother trying to cram the same info into your own memory? Younger Americans today are the first generation to grow up with go-everywhere gadgets and services that exist specifically to remember things so that we don't have to: BlackBerrys, phones, thumb drives, Gmail.

But is this a problem?

In The Matrix, when people needed to learn a new skill, they could just have it downloaded into their mind. I'd like to be able to do that. Imagine the possibiliities of having a memory card slot in your head that allowed you to download new information or skills.

I've talked before about adding senses, VR goggles, Modafinil, and other ways the improve on biology. Biology and technology continue to converge.

But in reality, are we alread there? Sure we can't download the information immediately into the brain, but we can get it all on the internet.

It may seem obvious, but the problem is nothing more than an interface one. The Keyboard-Mouse-Ears-Eyes interface between the Internet and the brain is simply too slow and clumsy.

And that's the realm where improvements will come in the next few decades. Either the interface will be improved, or it will be replaced.

To expand the idea even further, at what point does the body itself superflous?

Top Ten Causes of Cancer

From the USA Today -- March 27, 2012.





Source: Journal of the American Medical Association. Data first published Februay 23, 2012.

Resistance is Futile 01: Treating Parkinson's

I wake up as they wheel me into recovery, which at Stanford is a kind of fun house sideshow. People in various states of undress — many of us having just had parts removed or new parts installed — loll or roll about in pain and confusion, all under the watchful eyes of a room full of nurses, orderlies, and aides. The occasional doctor breezes through to provide expert advice or — because this is a teaching hospital — comic relief. The nurses, rolling their eyes, patiently guide the young doctors like sergeants working with newly minted lieutenants.

That's my favorite paragraph from a great article about Parkinson's Disease that appear in the March 2007 (15.03) issue of Wired.

Author Steven Gulie talks about how he developed Parkinson's and how doctors treated the symptoms successfully by implanting electrodes directly in his brain and then installing essentially a brain pacemaker in his chest.

It's a long article but a great read.