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Archive for February, 2012

Doctors for Dollars

Posted by heyrandy on February 27, 2012

On the Take: How Medicine’s Complicity with Big Business Can Endanger Your Health, Jerome Kassirer, 2005

Are you getting unbiased medical advice from your doctor? Probably not. The author, a medical doctor and former editor of the New England Journal of Medicine, should know. He was once part of the system. He spoke at various functions while being paid by a drug manufacture to do so. He said it did not influence his practice decisions, and he never mentioned any of the company’s products. When he refused a company request to do so, the speaking engagement stopped.

The big pharmaceutical companies spend millions on promotion. They seek to get knowledge of their products out to the ones who count: medical doctors. The doctors are the ones who write prescriptions. The influence is usually indirect. Free meals, symposia at nice resorts, lecture fees, research grants, cash. It is that bad. It is also petty. It is no secret that medical conferences have displays by drug and device companies. There is nothing wrong with this. What is really sad is how doctors mob the displays that give away the best trinkets. It is not unusual for the doctors to behave unseemly if the tee shirts are not dispensed fast enough. The Healers: a special caste.

Kassirer show that there is untoward influence in almost every area of medicine. The crushing debt of a medical education makes most young M.D.s easy prey. A free lunch while you listen to a sales pitch? “I have to eat lunch anyway,” is the usual excuse.

It is not just the drug companies that are a problem. Sometimes it is the doctors themselves. You need a x-ray? You may be referred  to a place partly owned by your doctor. What is the point of having all that expensive imaging equipment if it is not used? Often the doctors are willing to do what the patients want. Patients come in demanding this or that, so the doctors give it to them. It is too easy not to argue that it is unnecessary and a waste of resources, especially when you are getting paid to do the unnecessary.

Kassirer give some solutions. They are what you expect: transparency, honesty, integrity. He is naïve. There is too much at stake. There are too many dollars that will go to someone else. We have the system we have because we all benefit from it. At least we think we do. 

The system will not soon change. The costs of becoming a doctor, of developing drugs, and hospitalization are not about to go down. The book  was written before the passage of Obamacare, so there will be change: the doctors will all be subject to government review of all their actions. This does not bode well for a system is such a bad state. 

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Stealth Wealth

Posted by heyrandy on February 21, 2012

The Stealth of Nations, Robert Neuwirth, 2011

The free-market works. This is the author’s observation. I am not surprised. The author travels about the world to find the obvious. People when left alone will find a way to make a buck, even if that buck is a rial. I found the book predictable, but I am a free-market advocate.

All I found interesting in the book is the use of the phrase System D. It is a corruption of a French word use to describe an innovator. System D is everywhere. System D pays no taxes. System D is unregulated, unlicensed and uncontrolled. Indeed it is not capable of being regulated, licensed or controlled. If the governments were to try, they would find the task impossible. System D is the black-market, the grey-market, the informal-economy and the underground-economy. Bureaucrats have been at war with it since forever. The bureaucrats are using hammers to fight ants. Too many ants. Besides, the bureaucrats use System D. The prices are too good not to.

System D gets the job done. We all use it. The kids washing cars to raise money for the cause. The man who fixed the leak. The woman who traded you the cookies for the dress. The system is everywhere, does everything for everyone. System D satisfies customers.

System D is a bottom-up approach to the economy. Consumer demand drives System D. No government has been able to plan a successful economy. System D does not plan. It just does. When government plans bring disaster, budgets are increased because the next time the program will be successful since it will be adequately funded. When a System D vendor plans poorly, he goes broke.

You can read the book, but you will get a better understanding if you buy from some street-corner vendor. You will know more that the author if you become a street-corner vendor. Long live System D. Wait! It already has.

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Posted by heyrandy on February 17, 2012

Bobos in Paradise
, David Brooks, 2000

The world has changed from getting ahead by family connections to getting ahead by examination passing. The new group is the bobos, bourgeois Bohemians. We used to call them yuppies, but Brooks coined this term to better express the nature of this group.

Bobos drive for success. They strive, they excel, they  succeed. They are the ones who score perfect on the SAT exam, both sections. They are now filling the élite schools. Gone are the sons of the alumni, in are the test passers. All this is fodder for Brooks assessment of bobos.

Including himself in the group, the author looks at the major facets of bobo life: their education, their purchases, their business dealings, their intellectual life, pleasures, spiritual life, and politics.

Bobos don’t just exist, they be. They do things their way. As long as it’s acceptable to bobo mores, they will do anything. Bobos value the individual for his achievements as long as the achievements are the right kind. It is very good to be an honors graduate, but if it is at a third tier school, no good. It is good to make lots of money, but if that money is from real estate development, it is just evil. Software is so much more acceptable.

This kind of thinking drives bobos. They buy just the right stuff. It is acceptable to spend ridiculous amounts of money on everyday items, but you must do it the bobo way. A $25,000 stove? Sure, but not a $15,000 on a sound system with wide-screen TV. $400 mountain boots are acceptable, even requisite. You may never get near the Himalayas, but the boots will keep your feet safe in the “frozen food aisle at the Safeway.”  When he was at Microsoft’s campus, Brooks observed many employees dressed in climbing gear. Glacial sunglasses were especially popular. I guess Seattle is immune from the Algore.

Brooks best sums up bobo life by saying the bobos live life as if it were  graduate school. I think they live as if they were playing childhood games in their backyard.

Bobo come off as superficial, pretentious, and vain. They may be rich (Some are very rich, but it is  usually not the intellectual bobos. They are usually just academic hacks, even when at élite schools.) and smart, but they are pathetic. It is easy to disdain them, as they do us, but we all have our folkways to live by. Hauteur is not confined to the graduate school set. I view the book as a cautionary tale: This is me in other conditions.

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Boors Beware

Posted by heyrandy on February 14, 2012

I See Rude People, Amy Alkon, 2010

The subtitle of this book, One woman’s battle to beat manners into impolite society, is the core of the book. Ms. Alkon is a one woman army on the attack against boorishness. She has a lot of targets. She takes no prisoners.

From cell phone loudmouth to loudmouth children, Alkon assails the bad manners of inconsiderate people. She does not care a wit for what table setting you use, but she cares greatly about how you use it. To her, manners are about other people, she being one of them.

Can you imagine suing telemarketers because the called you up? She did–and won. Would you ever track down the lout who posted rude comments in you blog’s comments section? She called one man up at his job. He is a satellite controller for NASA. That he used government computers and time to make his comments just made her angrier–she rightly says, “I am a taxpayer. I am paying for this.”

Alkon tracked down the thief who stole her car, after the police gave a perfunctory try. Another time she found the man who hit her parked car. She won her suit against him. She once called the head of a chain store at home an railed at its telemarketing practices to the man’s wife. “How do you like being called at home?” She didn’t.

Ill-mannered children really get Alkon ire. Actually, it’s the parents at whom she is angry. She says, “I don’t tell people how to parent. I just tell them to parent.” Alkon realizes that no child is perfect all the time, so she give lots of latitude to parents who give lots of effort to teaching children how to behave.

One interesting bit of technotrivia I learned is that cell phone do not have a feedback mechanism in them to help the speaker know how loud he is talking. I had long ago noticed that the land line phones had this but though it was just me. If cell phones had this feature, Alkon might not have been able to call some woman and leave a message about the birthday party the woman was hosting at the woman’s home at 123 Main St. on July 15 at 2:30pm.

Alkon’s wit is sharp, her gall unmitigated. Cross her at her at your peril, read her for your own enjoyment. If you borrow the book, return it on time. Others are waiting.

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Missed by a Mile

Posted by heyrandy on February 6, 2012

The Mismeasure of Man, Stephen Jay Gould, 1981

Gould, a Harvard professor and evolutionary apologist, writes about the sorry story of evolution’s children. Social Darwinism gave the world some of the most racist pseudoscience ever invented. Gould does not realize it, but he indicts the evolutionary hoax. Presupposing evolution is true (he calls it a “fact”), he gives an account of the fruits of this poisonous tree in the area of intelligence measurement.

It is Gould’s thesis that there is no difference intelligence among the various human races nor can intelligence be measured. He never defines race, or intelligence, but disparages intelligence tests as bogus. He bases all this on the poor quality of the early intelligence test. He does excel in showing the gross errors in the design of the tests. He also shows that the administration of the tests was equally bad.

The early part of the book deals with the absurd belief that the size of one’s brain is indicator of one’s intelligence. Researchers measured the volume of prehistoric skulls in trying to prove early man’s intelligence was what ever the tester wanted it to be. The a priori assumptions drove the conclusions. Presuppositions were always vindicated by the data. Inconvenient data were ignored or altered. Fraud was common.

Binet developed the intelligence test as a method of finding out which school children needed more help to do well in their studies. The test was quickly seized upon as a method of determining the intelligence of anyone. This lead to immigration quotas. Southern and eastern European were not permitted as easy entry in to some countries as were the northern Europeans. Jews were not desirable regardless of where they were from. Africans were the least desirable of all. These quotas were the means to prevent the debasing of the country’s racial stock by the unchecked influx of lower intelligence immigrants.

But it gets worse. The eugenics movement evolved out of this nonsense. The eugenics movement lead to the anti-miscegenation and compulsory sterilization laws. Poison fruit indeed.

Gould spends some time dealing with factor analysis. All I got from this is that if two things change but keep the same ratio it does not necessarily mean anything. Gould thinks that a lot of factor analysis is number crunching for self-justification. It is a case of moving around the numbers until you get the answer you want. “Some studies show…” what the researchers want. Gould does not apply this to his evolutionary models. Truth is unimpeachable even when it is something else.

Read the book to help understand the feeble, early efforts to measure intelligence, the hubris of science, and Gould’s failure  to apply his criticism of intelligence tests to his evolutionary dogma. Presuppositions die slowly, even at Harvard.

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