August 20, 2012

Posted by orrinj at 5:35 AM

HEALTH CARE REFORM IS JUST ABOUT CUTTING SPENDING:

Testing What We Think We Know (H. GILBERT WELCH, August 19, 2012, NY Times)

The truth is that for a large part of medical practice, we don't know what works. But we pay for it anyway. Our annual per capita health care expenditure is now over $8,000. Many countries pay half that -- and enjoy similar, often better, outcomes. Isn't it time to learn which practices, in fact, improve our health, and which ones don't?

To find out, we need more medical research. But not just any kind of medical research. Medical research is dominated by research on the new: new tests, new treatments, new disorders and new fads. But above all, it's about new markets.

We don't need to find more things to spend money on; we need to figure out what's being done now that is not working. That's why we have to start directing more money toward evaluating standard practices -- all the tests and treatments that doctors are already providing.

There are many places to start. Mammograms are increasingly finding a microscopic abnormality called D.C.I.S., or ductal carcinoma in situ. Currently we treat it as if it were invasive breast cancer, with surgery, radiation and chemotherapy. Some doctors think this is necessary, others don't. The question is relevant to more than 60,000 women each year. Don't you think we should know the answer?

Or how about this one: How should we screen for colon cancer? The standard approach, fecal occult blood testing, is simple and cheap. But more and more Americans are opting for colonoscopy -- over four million per year in Medicare alone. It's neither simple nor cheap. In terms of the technology and personnel involved, it's more like going to the operating room. (I know, I've had one.) Which is better? We don't know.
.



Posted by orrinj at 5:18 AM

THE SMELL OF TROUBLE:

True Grit: Ross Macdonald Gets His Due : The beautifully charged language of Ross Macdonald's detective novels does more than adorn--it also helps swiftly clinch a character for the reader. (Malcolm Forbes. 8/07/12, Daily Beast)

Throughout his career, Ross Macdonald--the pen name of Kenneth Millar--was hailed as the true heir to Dashiell Hammett and Raymond Chandler as master of the hardboiled mystery. But accolades beyond the reach of a genre writer still eluded him--until towards the end of his career, when he was finally acknowledged as not "only" a crime writer but a highly regarded American novelist. Macdonald subverted the genre by delivering the riddles and intricacies demanded of the crime novel in language that could be stark but also subtly nuanced and beautifully cadenced, while never slowing the requisite pace or diluting the excitement. In doing so he silenced those naysayers who had previously scoffed at the idea that the humble detective novel could possess any intrinsic literary worth. Praise finally came from both sides of the literary divide, with James Ellroy acknowledging his debt to Macdonald's Lew Archer books and Eudora Welty lauding him as "a more serious and complex writer than Chandler and Hammett ever were." Five of the gripping Lew Archer novels have just become part of the U.K. Penguin modern classics series. For many, this anointment is long overdue.

The Archer series ran from 1949 to 1976, and it is one of the later ones, The Underground Man from 1971, that is arguably Macdonald's best. It opens calmly with Archer waking up, feeding peanuts to dive-bombing jays at his window and feeling a warm but ominous breeze. Such a slow set-up was typical: no crash-bang corpse-on-first-page histrionics. Gradually, though, Archer finds himself "descending into trouble" when he is employed by a beguiling blonde to track down her abducted son. To stoke the tension, forest fires are raging in the hills of Santa Teresa (Macdonald's Santa Barbara) "like the bivouacs of a besieging army." The case expands to include an AWOL father, a blackmailer, a couple of gruesome murders and a catalog of dark family secrets.

Those skeletons in closets were a tried-and-tested trope of Macdonald's. A great deal of the fun in reading him is in locating the plot's false bottom and sifting the many lies for nuggets of truth. Archer is adept at disinterring ghosts from the past to return and haunt his suspects in the present. Characters are never allowed to vanish completely. The Underground Man is full of overprotective mothers who will do anything to safeguard their errant sons. When Macdonald's plots show signs of repetition (a mother also wants her son found in The Galton Case; so too does The Goodbye Look explore dysfunctional family drama and a decades-old crime) it is still a pleasure to lose ourselves in the tight, labyrinthine twists and turns. "I've never seen a fishline with more tangles," remarks one character of the case in The Drowning Pool, and The Underground Man is just as knotty, to the extent that the denouement is as cathartic as it is surprising.


MORE:
REVIEW: of The Underground Man (BrothersJudd)

Posted by orrinj at 4:55 AM

WHAT WOULD THAT NUMBER GO DOWN TO...:

Paul Ryan targeted on women's issues (Maggie Haberman and Emily Schultheis and Lois Romano, August 19, 2012, Politico)

For all the attention on how his budget roadmap changes Medicare, Democrats see Ryan's record on issues related to women as an opportunity to yoke Romney, who has flip-flopped on abortion rights in the past decade, to positions the presumptive GOP nominee staked out during the Republican primaries.

The initial tweets from the @BarackObama account last weekend, after Ryan was selected, were 140-character frames on Ryan's record on women.

And the campaign's first purely negative ad about the new GOP running mate was not on Medicare, but on abortion rights and Planned Parenthood.

"These are really extreme positions that are far to the right of most Americans," said Eric Ferrero, vice president of communications at the Planned Parenthood Action Fund. "They're also quite consistent with, frankly, Mitt Romney's positions. This ticket is far to the right of most Americans.

"Pro-Choice" Americans at Record-Low 41% (Lydia Saad, May 23, 2012, Gallup)

The 41% of Americans who now identify themselves as "pro-choice" is down from 47% last July and is one percentage point below the previous record low in Gallup trends, recorded in May 2009. Fifty percent now call themselves "pro-life," one point shy of the record high, also from May 2009.

...if you removed those who view it as a way of reducing black births?



Posted by orrinj at 4:35 AM

IT'S DARNED PECULIAR TO IMAGINE IT A CRISIS...:

Skilled Work, Without the Worker (JOHN MARKOFF, 8/19/12, NY Times)

At the Philips Electronics factory on the coast of China, hundreds of workers use their hands and specialized tools to assemble electric shavers. That is the old way.

At a sister factory here in the Dutch countryside, 128 robot arms do the same work with yoga-like flexibility. Video cameras guide them through feats well beyond the capability of the most dexterous human.

One robot arm endlessly forms three perfect bends in two connector wires and slips them into holes almost too small for the eye to see. The arms work so fast that they must be enclosed in glass cages to prevent the people supervising them from being injured. And they do it all without a coffee break -- three shifts a day, 365 days a year.

All told, the factory here has several dozen workers per shift, about a tenth as many as the plant in the Chinese city of Zhuhai. [...]

The falling costs and growing sophistication of robots have touched off a renewed debate among economists and technologists over how quickly jobs will be lost. This year, Erik Brynjolfsson and Andrew McAfee, economists at the Massachusetts Institute of Technology, made the case for a rapid transformation. "The pace and scale of this encroachment into human skills is relatively recent and has profound economic implications," they wrote in their book, "Race Against the Machine."

In their minds, the advent of low-cost automation foretells changes on the scale of the revolution in agricultural technology over the last century, when farming employment in the United States fell from 40 percent of the work force to about 2 percent today. The analogy is not only to the industrialization of agriculture but also to the electrification of manufacturing in the past century, Mr. McAfee argues.

"At what point does the chain saw replace Paul Bunyan?" asked Mike Dennison, an executive at Flextronics, a manufacturer of consumer electronics products that is based in Silicon Valley and is increasingly automating assembly work. "There's always a price point, and we're very close to that point."


...when we develop machines to do the work we won't do ourselves.  That's right, we face a future where ever less effort provides ever greater wealth.  Commence fretting....