| Thursday,
July 30, 2009
Rationing
Charlie was flippant with his
statement, "So if we give everyone food, we have to starve some of
them?" and you answered that it depends on how much food we have.
You didn't go far enough. It also depends on how we
get our food, what we produce as food, and where it is produced. I submit
that health care is substantially similar.
By the way, I work for a Medicare Part B contractor
and have for 18+ years. The colloquialism about 'making sausage' is highly
appropriate.
David Couvillon
Colonel of Marines; Former Governor of Wasit Province, Iraq; Righter of
Wrongs; Wrong most of the time; Distinguished Expert, TV remote control;
Chef de Hot Dog Excellance; Collector of Hot Sauce; Avoider of Yard Work
Please reply to captcouv @cox.net
Indeed.
==
Health Care: Protocols
The fundamental problem with requiring conformance to
accepted medical protocols is that it requires accepting a certain number of
entirely preventable adverse outcomes (translation: deaths). The good
doctors know that there are cases where the accepted protocols are not
enough, and they know when to break the rules.
In my personal case, I am alive right now because a
very good primary care doctor in Dallas in mid-1993 chose to break protocol,
and hospitalize me when the accepted standard of care called for outpatient
treatment. He didn't have to answer to an HMO review committee, I was sick
enough that he could justify hospitalization if the insurance company tried
to argue with him, and he knew my brother's wedding was a few days off and I
was NOT going to make it to the wedding unless I was treated aggressively.
As a result of his decision, I was already in the
hospital, with IV access and on oxygen, when I crashed, instead of being 15
minutes by ambulance away, not including 911 response time, and they already
knew everything they needed to know. (There is also the question of whether
I would have figured out to call 911 in time...)
In all probability, the standard protocol would have
killed me. Unfortunate, but these things happen...
--John
==
Subj: Increasing the supply of
reasonable-quality medical care: Dr. Lawrence Weed's Problem-Knowledge
Couplers
This is far beyond the piddling record-keeping
automation Obama&Co. are pushing:
http://pkc.com/our_history.aspx
The basic tech has only been around since, oh, the
1980s.
When Weed first developed and demonstrated this, the
nurses loved it -- and a lot of docs hated it, because it threatened their
rice-bowls.
We can build computers much faster than we can train
people.
Nurses are much cheaper and faster to train than docs.
Nursing schools can ramp up production much faster
than med schools.
Rod Montgomery==monty@ starfief.com
One of my earliest BYTE columns was about Larry
Weed. This was the era of Ezekial, CP/M, and the Z-80 Chip. I'd been doing
the column for about a year when I was asked to be guest of honor at a
convention of Computer Using Physicians, I believe over at Harvard School;
somewhere near here. Dr. Weed was one of the speakers. We met the next day
to hike up my hill, which he insisted on doing backwards: hiking backwards
was better for the back.
At that time the Computer Using Physicians were a
small but active group. Weed had a number of points about check lists and
diagnostics. Some young physicians were afraid that the computer would
replace them. There was a lot of ferment and comment about a diagnostics
program called Tieresius, I believe (after the blind prophet in the
Odyssey).
I was enormously impressed by Larry Weed. We
corresponded for a few months after that meeting, but as often happens we
both had other interests and the correspondence faded away. I now wonder why
I haven't heard a lot more about this matter. It would seem to me that a
really good medical history program would be enormously useful in medicine,
and that we aren't doing anything like enough of what we can do now that
machines on each desk top are enormously more powerful than the Z-80's with
64k KILOBYTES of memory...
More on this another time; it ought to be an open
topic. Perhaps there's a whole world out there I have lost touch with?
===========
Continuing the health care debate:
Couple of points on the debate.
Can we find another term than "Insurance". How on
Earth can you insure yourself against something you have? It's complete
nonsense. If you have, for example, as my wife has, bad allergies that need
non-over the counter medication to control through the summer and leads to
asthma attacks - you can't insure against that. I have genetic tendency
towards hypertension - if father, mother, both grandfathers counts. The
medication isn't pricey, but I'm lucky. Charles Stross the SF writer needs a
bucket load of meds to control his hyper-tension.
So should "pre-existing" conditions be out of pocket?
Or do we accept that there needs to be a way of risk hedging across
populations to make treatment affordable?
I also keep reading about rationing of healthcare as
you see in Canada and the UK.
But I'm still struggling to see the difference between
the rationing of healthcare on grounds of medical need versus ability to
pay. Ignoring, for a moment, that in the UK at least you can purchase actual
insurance against the need for surgery or a medical emergency.
However, why on Earth do people keep reverting to the
UK as an example? The UK spends less that virtually any other industrial
nation on healthcare. How about some comparisons with the French, German,
Dutch, Swedish, Finnish, Norwegian or other similar countries with universal
care (mostly provided through a mixture of private and public money) who
offer apparently superlative care for less money that the US spends?
Dave
David O'Neill
Rationing by money vs. need: this is the
fundamental question of liberty vs. equality. Take two people who need
expensive health care, say a month of radiation therapy for an inoperable
brain cancer. You have facilities and staff to treat one. How do you choose?
If one of them can pay (at least part of the expense) and one cannot,
does this matter? Do we use a random number generator? Does it matter that
one is a street person with no criminal record and the other a semi-retired
professional with no criminal record? Do we choose the younger street person
over the older person still working part time? And so forth.
Your right to treatment is someone's obligation to
pay. Neglect where you got the right: where did the other part get the
obligation?
Liberty would say let it be paid for by the
consumer, who is welcome to apply to charitable institutions or beg in the
streets. Equality would say both must have treatment (extreme equality would
say neither if not both; we will not allow the rich to buy what the poor
cannot afford). How do we choose? Clearly the United States will choose
neither of those extremes; but the devil is in the details of compromise.
==
===========
Thorium Reactors
I see that no one has remarked on the Thorium reactor
idea brought up Monday. During my 25 years at Los Alamos, I worked on a
variety of projects and among them was a subcritical Molten Salt Reactor
concept based on Thorium and driven by spallation neutrons from an
accelerator (In the old days, Los Alamos was always looking for novel,
mostly crazy, ways to employ accelerators). I cannot find the old report
that we produced (it does not appear to be an LA-UR as the LANL library has
no mention of it) and I cannot find any of my supporting materials. As a
result, my comments are from memory:
1. Thorium for 50,000 years of nuclear power does not
sound unreasonable. We do have a great deal of it, and using it in a thermal
breeder is not difficult. You get U-233 as the fissile material. Of course
the lawyers and politicians that worry about proliferation do not like U-233
especially in a Thorium environment.
2. The molten salt reactor is attractive as you can
implement on-line reprocessing where you divert a portion of the 'liquid'
core stream and remove waste and excess fissile material. You may also add
other materials such as fissile material, fertile material, and waste to be
burned if you chose. Despite that, I don't much care for piping that nasty
stuff around; my favorite heat transfer fluids are water and Helium. Again
the lawyers and politicians won't like the on-line reprocessing aspect.
3. The idea of burning up our existing nuclear waste
is not realistic unless physics has changed. You can run ORNL's ORiGENx code
as I did or similar irradiation codes to look at what happens over a long
period of time. Many of the lighter radioactive isotopes do "burn up" faster
than they would if left alone, but the Actinides just don't go away.
Actinides just become other Actinides. You can recycle the Actinides into
other cores ad infinitum if you choose or you can dispose of them in a
repository such as Yucca Mountain. As a result, I cannot see the need for a
waste repository going away. You may recall some years ago there was intense
interest in Accelerator Transmutation of Waste (again spallation neutrons)
that rapidly faded away; the problem was again that the Actinides stick
around. Perhaps there is new technology that is better these days, but I
doubt that transmutation physics has changed.
Again the above is from memory, and I may be out of
date, but perhaps the above is a useful contribution to the discussion on
the Thorium reactors. In this context, it is also probably time to address
the proliferation aspects. Breeding new new nuclear fuel, which is easy to
do especially, I think, in a thermal breeder (without any need for an
accelerator!) is necessary for our future, our children's future, and our
children's children's future. We need to get over our irrational fear of
having new, undiluted fissile material available before our landscape is
littered with useless, decrepit windmills and crop-land consuming solar
panels.
Clay Booker
The point being that humanity does have resources;
given freedom we will make use of them.
Regarding nuclear wastes: at worst, they can be
made into glass and dumped into the Mindanao Trench, where they will be
subducted into the Earth's core. Of course they will be gone forever.
After 600 years the nuclear wastes are actinides
and are no more dangerous than the ores they came from. If we want them
again there are other ways to get rid of them including stacking glass
bricks in the Mojave at Fort Irwin. Surround them with three concentric
rings of fences with Deadly Force warnings and detectors and let the
military forces in training at Irwin do target practice on intruders.
============
BREAKING: Climate Revolt: World's Largst
Science Group 'Startled' By Outpouring of Scientists Rejecting Man-Made
Climate Fears!
http://www.climatedepot.com/a/
2213/Climate-Revolt-Worlds-Largest-
Science-Group-Startled-By-Outpouring-of-
Scientists-Rejecting-ManMade-Climate-Fears-
Clamor-for-Editor-to-Be-Removed
Climate Revolt: World’s Largest Science
Group 'Startled' By Outpouring of Scientists Rejecting Man-Made Climate
Fears! Clamor for Editor to Be Removed!
Scientists seek to remove climate fear
promoting editor and 'trade him to New York Times or Washington Post'
Wednesday, July 29, 2009 - By Marc Morano <http://www.climatedepot.com/contact.asp>
– Climate Depot <http://www.climatedepot.com>
Climate Depot Exclusive
An outpouring of skeptical scientists who
are members of the American Chemical Society (ACS) are revolting against
the group's editor-in-chief -- with some demanding he be removed --
after an editorial appeared claiming “the science of anthropogenic
climate change is becoming increasingly well established.”
The editorial claimed the "consensus" view
was growing "increasingly difficult to challenge, despite the efforts of
diehard climate-change deniers.” The editor now admits he is "startled"
by the negative reaction from the group's scientific members. The
American Chemical Society bills itself as the "world's largest
scientific society."
The June 22, 2009 editorial <http://pubs.acs.org/cen/editor/87/8725editor.html>
in Chemical and Engineering News by editor in chief <http://pubs.acs.org/cen/staff/biorb.html>
Rudy Baum, is facing widespread blowback and condemnation from American
Chemical Society member scientists. Baum concluded his editorial by
stating that “deniers” are attempting to “derail meaningful efforts to
respond to global climate change.”
Dozens of letters were published on July
27, 2009 castigating Baum <http://pubs.acs.org/cen/letters/87/8730letters.html>
, with some scientists calling for his replacement as editor-in-chief.
The editorial was met with a swift,
passionate and scientific rebuke from Baum's colleagues. Virtually all
of the letters published on July 27 in castigated Baum's climate science
views. Scientists rebuked Baum's use of the word “deniers” because of
the terms “association with Holocaust deniers.” In addition, the
scientists called Baum's editorial: “disgusting”; “a disgrace”; “filled
with misinformation”; “unworthy of a scientific periodical” and “pap.”
Marc Morano
ClimateDepot.com
CFACT
Apparently the consensus is breaking down. One
would think that those afraid of CO2 would welcome nuclear power, but I have
seen little movement in that direction and Yucca Mountain is closing...
==
Again, the global warming would still be a
racket since no one ever argues for a method to specify what the optimal
temperature of the planet is, not to say whether the cure is less than the
cost.
Richard S. Lindzen: Resisting climate hysteria
http://www.quadrant.org.au/blogs/
doomed-planet/2009/07/resisting-climate
-hysteria/page:printable
July 26, 2009
A Case Against Precipitous Climate Action
The notion of a static, unchanging climate is
foreign to the history of the earth or any other planet with a fluid
envelope. The fact that the developed world went into hysterics over changes
in global mean temperature anomaly of a few tenths of a degree will astound
future generations. Such hysteria simply represents the scientific
illiteracy of much of the public, the susceptibility of the public to the
substitution of repetition for truth, and the exploitation of these
weaknesses by politicians, environmental promoters, and, after 20 years of
media drum beating, many others as well. Climate is always changing. We have
had ice ages and warmer periods when alligators were found in Spitzbergen.
Ice ages have occurred in a hundred thousand year cycle for the last 700
thousand years, and there have been previous periods that appear to have
been warmer than the present despite CO2 levels being lower than they are
now. More recently, we have had the medieval warm period and the little ice
age. During the latter, alpine glaciers advanced to the chagrin of overrun
villages. Since the beginning of the 19th Century these glaciers have been
retreating. Frankly, we don't fully understand either the advance or the
retreat.
For small changes in climate associated with
tenths of a degree, there is no need for any external cause. The earth is
never exactly in equilibrium. The motions of the massive oceans where heat
is moved between deep layers and the surface provides variability on time
scales from years to centuries. Recent work (Tsonis et al, 2007), suggests
that this variability is enough to account for all climate change since the
19th Century. Supporting the notion that man has not been the cause of this
unexceptional change in temperature is the fact that there is a distinct
signature to greenhouse warming: surface warming should be accompanied by
warming in the tropics around an altitude of about 9km that is about 2.5
times greater than at the surface. Measurements show that warming at these
levels is only about 3/4 of what is seen at the surface, implying that only
about a third of the surface warming is associated with the greenhouse
effect, and, quite possibly, not all of even this really small warming is
due to man (Lindzen, 2007, Douglass et al, 2007). This further implies that
all models predicting significant warming are greatly overestimating
warming. This should not be surprising (though inevitably in climate
science, when data conflicts with models, a small coterie of scientists can
be counted upon to modify the data. Thus, Santer, et al (2008), argue that
stretching uncertainties in observations and models might marginally
eliminate the inconsistency. That the data should always need correcting to
agree with models is totally implausible and indicative of a certain
corruption within the climate science community). <snip>
The entire paper with footnotes is worth your time
if you are involved in this debate. And there is no debate at all on what
would be an ideal climate.
===========
Vindolanda.
<http://www.msnbc.msn.com/id/
32132580/ns/technology_and_science- science/>
Roland Dobbins
Fascinating. Thanks!
===========
JPL Asteroid Watch.
<http://www.jpl.nasa.gov/asteroidwatch/>
-- Roland Dobbins
===========
Lamarckian Machines vs.
Darwinian Humans--Not So
You said: "when computers become aware and are able to
evolve through Lamarckian rather than Darwinian means. Smart machines design
themselves to be smarter. What's the need for humans?"
If humans learn to modify our own DNA, then we could
also "evolve" rapidly. As with everything human, I cringe at the follies and
anticipate the triumphs that might ensue.
After doing that thought experiment, I suspect that
Lamarckian evolution has its pitfalls in addition to its advantages. In
competition (if it is to be competition between man and machine), it is easy
to imagine one's opponent as infallible--we see our own weaknesses, and
think our strengths to be easily countered. It is important to see our
competitor's strengths and weaknesses, in addition to our own. Machines are
not infallible, and men are not weak.
Neil Tice
That is indeed true. We are more likely to get to
the singularity through biochemistry than through physics/computer science.
There are many SF novels on this theme. There is also the meme of combining
biology and physical enhancement as in the Sauron cyborgs of my War World
series. Thank you for the reminder.
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