August 30, 2016

Fragmented Health Care Causes Polypharmacy Harms



(p. D5) Dr. Caleb Alexander knows how easily older people can fall into so-called polypharmacy. Perhaps a patient, like most seniors, sees several specialists who write or renew prescriptions.

"A cardiologist puts someone on good, evidence-based medications for his heart," said Dr. Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. "An endocrinologist does the same for his bones."


. . .


"Pretty soon, you have an 82-year-old man who's on 14 medications," Dr. Alexander said, barely exaggerating.

Geriatricians and researchers have warned for years about the potential hazards of polypharmacy, usually defined as taking five or more drugs concurrently. Yet it continues to rise in all age groups, reaching disturbingly high levels among older adults.


. . .


Ultimately, the best way to reduce polypharmacy is to overhaul our fragmented approach to health care. "The system is not geared to look at a person as a whole, to see how the patterns fit together," Dr. Steinman said.



For the full commentary, see:

Span, Paula. "THE NEW OLD AGE; An Ever-Mounting Pile of Pills." The New York Times (Tues., APRIL 26, 2016): D5.

(Note: ellipses added.)

(Note: the online version of the commentary has the date APRIL 22, 2016, and has the title "THE NEW OLD AGE; The Dangers of 'Polypharmacy,' the Ever-Mounting Pile of Pills.")






August 29, 2016

"You Call It Procrastination, I Call It Thinking"



(p. 7) A few years ago, . . . , one of my most creative students, Jihae Shin, questioned my expeditious habits. She told me her most original ideas came to her after she procrastinated. I challenged her to prove it. She got access to a couple of companies, surveyed people on how often they procrastinated, and asked their supervisors to rate their creativity. Procrastinators earned significantly higher creativity scores than pre-crastinators like me.

I wasn't convinced. So Jihae, now a professor at the University of Wisconsin, designed some experiments. She asked people to come up with new business ideas. Some were randomly assigned to start right away. Others were given five minutes to first play Minesweeper or Solitaire. Everyone submitted their ideas, and independent raters rated how original they were. The procrastinators' ideas were 28 percent more creative.

Minesweeper is awesome, but it wasn't the driver of the effect. When people played games before being told about the task, there was no increase in creativity. It was only when they first learned about the task and then put it off that they considered more novel ideas. It turned out that procrastination encouraged divergent thinking.

Our first ideas, after all, are usually our most conventional. My senior thesis in college ended up replicating a bunch of existing ideas instead of introducing new ones. When you procrastinate, you're more likely to let your mind wander. That gives you a better chance of stumbling onto the unusual and spotting unexpected patterns. Nearly a century ago, the psychologist Bluma Zeigarnik found that people had a better memory for incomplete tasks than for complete ones. When we finish a project, we file it away. But when it's in limbo, it stays active in our minds.

Begrudgingly, I acknowledged that procrastination might help with everyday creativity. But monumental achievements are a different story, right?

Wrong. Steve Jobs procrastinated constantly, several of his collaborators have told me. Bill Clinton has been described as a "chronic procrastinator" who waits until the last minute to revise his speeches. Frank Lloyd Wright spent almost a year procrastinating on a commission, to the point that his patron drove out and insisted that he produce a drawing on the spot. It became Fallingwater, his masterpiece. Aaron Sorkin, the screenwriter behind "Steve Jobs" and "The West Wing," is known to put off writing until the last minute. When Katie Couric asked him about it, he replied, "You call it procrastination, I call it thinking."



For the full commentary, see:

Grant, Adam. "Step 1: Procrastinate." The New York Times, SundayReview Section (Sun., JAN. 17, 2016): 1 & 6-7.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date JAN. 16, 2016, and has the title "Why I Taught Myself to Procrastinate.")


Grant's commentary is related to his book:

Grant, Adam. Originals: How Non-Conformists Move the World. New York: Viking, 2016.






August 28, 2016

Cancer Is Not Due to Modernity



(p. 1A) Scientists' conventional opinion about cancer was that it's a relatively recent phenomenon caused by the stresses of modern life.

Dietary changes, behavioral changes and man-made changes to our environment have subjected humans to toxins that contribute to cancers, they say.

But new findings from researchers at South Africa's University of the Witwatersrand published in the South African Journal of Science challenge that assumption.

Paleontologists found a benign tumor in a 12 or 13-year-old boy specimen that dates back almost 2 million years.

More significantly, they also found a malignant tumor that's 1.7 million years old on the little toe bone of a left foot.

Previously the oldest discovered human cancer was between 780,000 and 120,000 years old.


. . .


(p. 2A) "The evidence is out there that these conditions have been with us a long time and we've been kind of hoodwinked that cancer is a modernity," said Patrick Randolph-Quinney, one of the study's authors. "These things are ancient."

The greatest predictor of cancer, the study argues, even in our ancestors, is longevity. The longer we live, the more chances something in our bodies goes wrong, the more chances that something is a tumor.



For the full story, see:

The Washington Post. "Ancient tumor upends notion of cancer as modern affliction; 1.7-million-year-old malignant growth is causing scientists to rethink diseases and human history." Omaha World-Herald (Sat., JUNE 20, 2016): 1A & 2A.

(Note: ellipsis added.)


The scientific article mentioned above, is:

Patrick, S. Randolph-Quinney, A. Williams Scott, Steyn Maryna, R. Meyer Marc, S. Smilg Jacqueline, E. Churchill Steven, J. Odes Edward, Augustine Tanya, Tafforeau Paul, and R. Berger Lee. "Osteogenic Tumour in Australopithecus Sediba: Earliest Hominin Evidence for Neoplastic Disease." South African Journal of Science (July/Aug. 2016), DOI: http://dx.doi.org/10.17159/sajs.2016/20150470.






August 27, 2016

"To Understand Zoning, You Have to Have a Law Degree"



(p. 27) Not all buildings are worth keeping. In Midtown East, many nonconforming structures have low ceilings and columns that make them unappealing to new businesses. Some developers have gone so far as to demolish all but the bottom quarter of their buildings, and then build up from there, allowing them to retain the old zoning for their plots so as not to sacrifice a single square foot. The city is currently reconsidering a proposal that would allow these buildings to be rebuilt to their original size and possibly even larger.

It does not have to be this complicated. In honor of the code's 100th anniversary, the Municipal Art Society of New York has called on City Hall to consider overhauling the code in a way that would make it intelligible to all.

"To understand zoning, you have to have a law degree, it's so convoluted and so dense," Mike Ernst, director of planning at the civic group, said. "The whole process of how buildings get built these days is so confusing and opaque to people. There really should be more transparency, so people can have an understanding of what the future holds for their city."



For the full story, see:

"Reviled, Revered, and Still Challenging Russia to Evolve." The New York Times, First Section (Sun., MAY 22, 2016): 27.

(Note: the online version of the story has the date MAY 20, 2016, and has the title "40 Percent of the Buildings in Manhattan Could Not Be Built Today." It is substantially longer than the print version and includes three authors, while no authors were listed for the print version. The authors listed for the online version were: QUOCTRUNG BUI, MATT A.V. CHABAN and JEREMY WHITE.)






August 26, 2016

VCRs Let "You Create Your Own Prime Time"



(p. B1) Many new technologies are born with a bang: Virtual reality headsets! Renewable rockets! And old ones often die with a whimper. So it is for the videocassette recorder, or VCR.

The last-known company still manufacturing the technology, the Funai Corporation of Japan, said in a statement Thursday [July 21, 2016] that it would stop making VCRs at the end of this month, mainly because of "difficulty acquiring parts."


. . .


In 1956, Ampex Electric and Manufacturing Company introduced what its website calls "the first practical videotape recorder." Fred Pfost, an Ampex engineer, described demonstrating the technology to CBS executives for the first time. Unbeknown to them, he had recorded a keynote speech delivered by a vice president at the network.

"After I rewound the tape and pushed the play button for this group of executives, they saw the instantaneous replay of the speech. There were about 10 seconds of total silence until they suddenly realized just what they were seeing on the 20 video monitors located around the room. Pandemonium broke out with wild clapping and cheering for five full minutes. This was the first time in history that a large group (outside of Ampex) had ever seen a high-quality, instantaneous replay of any event."

At the time, the machines cost $50,000 apiece. But that did not stop orders from being placed for 100 of them in the week they debuted, according to Mr. Pfost.


. . .


A consumer guide published in The Times in 1981 -- when the machines ranged in price from $600 to $1,200 -- explained the appeal:

"In effect, a VCR makes you independent of television schedules. It lets you create your own prime time. You set the timer and let the machine automatically record the programs you want to watch but can't. Later, you can play the tape at your convenience. Or you can tape one show while watching another, thus missing neither."



For the full story, see:

JONAH ENGEL BROMWICH. "Once $50,000. Now VCR, Collects Dust." The New York Times (Mon., JULY 21, 2016): B1 & B2.

(Note: ellipses added.)

(Note: the online version of the commentary has the date JUNE 19, 2016, and has the title "The Long, Final Goodbye of the VCR.")






August 25, 2016

"Doctors Often Do Not 'Know' What They Are Doing"



(p. A11) Into the "swift currents and roiling waters of modern medicine" plunges Dr. Steven Hatch, whose informative "Snowball in a Blizzard" adds an important perspective. Dr. Hatch believes that our health-care system can "champion patient autonomy" and facilitate "more humane treatment, less anxiety, and better care" by revealing to patients the "great unspoken secret of medicine." What's the secret? Simply stated, "doctors often do not 'know' what they are doing." In Dr. Hatch's view, despite spectacular advances in biomedical science, modern "doctors simply cannot provide the kind of confident predictions that are often expected of them."


. . .


He begins where Donald Rumsfeld ended: There will always be "known knowns, known unknowns, and unknown unknowns" in medicine. Dr. Hatch illustrates this spectrum of uncertainty with engaging exposés of popular screening tests like mammograms (attempting to detect breast cancer is like "finding a snowball in a blizzard"); common drug treatments, like those used to lower serum cholesterol or blood-pressure levels (about which expert national guidelines seem to change almost yearly); and health-care coverage in the lay media (whose "breaking news" too often ignores the uncertainty of the news being broken). Throughout his book, Dr. Hatch's message is "caveat emptor," warning his readers to beware not only the pseudoscientists, flim-flammers, anti-vacciners and celebrity doctors but also the all-too-certain pronouncements of the medical establishment.



For the full review, see:

BRENDAN REILLY. "BOOKSHELF; Give It To Me Straight, Doc; Doctors can't really be certain if any treatment will help a particular person. But patients are looking for prescriptions, not probabilities." The Wall Street Journal (Tues., March 15, 2016): A11.

(Note: the ellipsis between paragraphs, and the first two in the final quoted paragraph, are added; the third ellipsis in the final paragraph is in the original.)

(Note: ellipsis added.)

(Note: the online version of the review has the date March 14, 2016.)


The book under review, is:

Hatch, Steven. Snowball in a Blizzard: A Physician's Notes on Uncertainty in Medicine. New York: Basic Books, 2016.






August 24, 2016

Monopolist Ede & Ravenscroft Had 98% of Legal Wigs Market



(p. A1) British barristers and judges have worn wigs since Charles II Imported the idea from France in the 1670s. A London company, Ede & Ravenscroft Ltd., today claims 98% of the market for legal wigs in the United Kingdom. The wigs distinguish barristers from solicitors, lawyers who ordinarily don't appear In court.

Ede & Ravenscroft, 300 years old, pursues its monopoly from a narrow London shop whose carved mahogany paneling, brass rails and chest-high counters hark back to the Victorian era.


. . .


(p. A7) In a stuffy loft two floors above, six women fabricate about 1,000 wigs a year on pockmarked wooden blocks resembling shrunken skulls. The wigmakers attach rows
of tightly rolled curls and a pair of ponytails with painful hand stitching, using 12-yard lengths of bleached curls made from horses' tails and manes.

They strictly follow a pattern conceived by Humphrey Ravenscroft in 1822 when he invented the "modern" horsehair wig with fixed curls. It replaced ones made of goat hair, which had to be powdered and dressed with scented ointment every day to conceal the filth.



For the full story, see:

Lublin, Joann S. "Who Has Means and Motive to Steal in Halls of Justice?; British Barristers, It Seems, Can't Resist Purloining Each Other's Ratty Wigs." The Wall Street Journal (Weds., Oct. 4, 1989): A1 & A7.

(Note: ellipsis added.)






August 23, 2016

The Most Popular Kremlin Line



(p. A4) In an interview, Mr. Gorbachev shrugged off the fact that 25 years after the collapse of the Soviet Union, he remains among the most reviled men in Russia. "It is freedom of expression," he said.


. . .


Some adore him for introducing perestroika, or restructuring, combined with glasnost, or openness, which together helped to jettison the worst repressions of the Communist system. Mr. Gorbachev led the way, albeit haltingly, toward free speech, free enterprise and open borders.

"Some love him for bringing freedom, and others loathe him for bringing freedom," said Dmitri Muratov, the editor of Novaya Gazeta, one of the few remaining independent newspapers and one in which Mr. Gorbachev holds a 10 percent stake.


. . .


Mr. Muratov said they often recounted the same joke, based on Mr. Gorbachev's infamous campaign to lower alcohol consumption:

Two men are standing in a long, long vodka line prompted by the limited supply. One asks the other to keep his place in line, because he wants to go over the Kremlin to punch Gorbachev in the face for his anti-alcohol policy. He comes back many hours later and his friend asks him if he had indeed punched Gorbachev. "No," the man answered despondently. "The line at the Kremlin was even longer."



For the full story, see:

NEIL MacFARQUHAR. "Reviled, Revered, and Still Challenging Russia to Evolve." The New York Times (Thurs., JUNE 2, 2016): A4.

(Note: ellipses added.)

(Note: the online version of the story has the date JUNE 1, 2016, and has the title "Reviled by Many Russians, Mikhail Gorbachev Still Has Lots to Say.")






August 22, 2016

Economist Removed from Plane for Scribbling Math




The seatmate was wrong to think the scribbling was Arabic, but was right to be alarmed.


(p. A13) In May [2016], an Italian economist from the University of Pennsylvania was removed from an American Airlines flight in Philadelphia after his seatmate became alarmed, thinking that the math he was scribbling on a piece of paper was Arabic, The Washington Post reported.


For the full story, see:

CHRISTINE HAUSER. "American Airlines Orders 2 Muslim American Women Off a Long-Delayed Flight." The New York Times (Sat., AUG. 5, 2016): A13.

(Note: bracketed year added.)

(Note: the online version of the story has the date AUG. 5, 2016, and has the title "2 Muslim American Women Ordered Off American Airlines Flight.")






August 21, 2016

Brazilians See Government as a Father Who Should Hand Out Subsidies to His Favorites



(p. 9) . . . "Brazillionaires" offers more than a flat collection of billionaire tales. Cuadros shrewdly presents his collage of immense wealth against an underlying background of corruption. There are kickbacks for government contracts. There are gigantic taxpayer subsidies: In 2009 alone, the state-run development bank, BNDES, lent out $76 billion, "more than the World Bank lent out in the entire world." And of course there are lavish campaign contributions, attached to the inevitable quid pro quos. JBS, which leveraged government loans to become the largest meatpacking company in the world, spent $180 million on the 2014 elections alone. "If every politician who had received JBS money formed a party," Cuadros writes, "it would be the largest in Congress."

In his telling, Brazilians seem to embrace the cozy relationship between business and government as a source of pride rather than a risk for conflicts of interest. In one passage, Cuadros underscores the contrast between Adam Smith and the 19th-century Brazilian thinker José da Silva Lisboa, viscount of Cairu. Lisboa's "Principios de Economía Politica" was meant to be an adaptation of Smith's "Wealth of Nations." But rather than present a paean to the invisible hand of the market, the viscount offered a rather paternalistic view of economic progress.

"The sovereign of each nation must be considered the chief or head of a vast family," he wrote, "and thus care for all those therein like his children, cooperating for the greater good." Swap "government" for "sovereign" and the passage still serves as an accurate guide to the Brazilian development strategy. It's just that some children -- the Marinhos, the Camargos -- are cared for better than ­others.


. . .


It would be wrong, . . . , to understand Brazil's plutocracy as the product of some unique outcrop of corruption. The hold on political power by the rich is hardly an exclusive feature of Brazil. ­Latin America has suffered for generations from the collusion between government and business. Where I grew up, in Mexico, it is the norm.



For the full review, see:

EDUARDO PORTER. "Real Rich." The New York Times Book Review (Sun., JULY 24, 2016): 9.

(Note: ellipses added.)

(Note: the online version of the review has the date JULY 22, 2016, and has the title "Watching Brazil's Rich: A Full-Time Job.")


The book under review, is:

Cuadros, Alex. Brazillionaires: Wealth, Power, Decadence, and Hope in an American Country. New York: Spiegel & Grau, 2016.









Eight Most Recent Comments:



Ed Rector said:

There are more than 2000 colleges in the USA offering tens of thousands of degrees/majors. Oh yes, there are also a few thousand JC's, trade schools and apprentice programs that train welders. Who should decide what any individual student wants to study?? Senator Rubio, the Mercatus Center or the individual student?? And you call yourselves 'freedom-loving Libertarians' !!



Aaron said:

You need a "like" button. Here's to enjoying bacon and eggs on an unusually warm fall day and doing so guilt free.



Aaron said:

I'd also suggest that work is just part of who some people are and a reason they got rich. A friend's dad comes to mind; he's a millionaire and in his 60s and a couple years ago I saw him cleaning one of his rental houses and wondered why he didn't pay someone to do it, but he's just one of those guys who'd rather work than golf or relax.



Jim Rose said:

It is often forgotten that the Minister for International trade and industry in the late 1960s up until 1971 was Tanaka – the most corrupt man in postwar Japanese politics. He had previously been Minister for Public Works, but to generate the necessary bribe income to pay an entire generation of Japanese politicians to step aside to allow him to become Prime Minister in the early 1970s at a young age, he thought the Ministry of International trade and industry was a better position to garner influence and donations. My professors in Japan worked in the Ministry of International trade and industry and the Ministry of Finance in the 1970s and 1960s. None of them seemed to carry over their picking winners skills into their private portfolios when they retired. see http://utopiayouarestandinginit.com/2014/03/14/if-you-are-so-smart-why-arent-you-rich/



Aaron said:

Interested to see how not only did Hamilton gain a vote, but also how Jefferson lost one.



Dave Megan said:

Merging of companies is always better when they have a better goal. It will give better service for the public.



Ed Rector said:

The 'quickened pace of production' of the early Reagan years was directly attributable to RR's massive deficit spending. The national debt almost tripled under the watch of St. Ronnie. BO will have to work overtime to even approach this record of accomplishment.



Aaron said:

The last two paragraphs comport perfectly with what Paul Tough describes in a book you posted on a few months ago, "How Children Succeed." Tough advocates that a stable, loving relationship between kids and their parents, especially in the first few years of life, produces self-assured and less anxious adults due to brain formation or chemical reactions that take place in a baby's brain (simplified summary). As always, appreciate the posts, especially the Paul Tough book.





HP3D5006CropSmall.jpg






Archives















The StatCounter number above reports the number of "page loads" since the counter was installed late on 2/26/08. Page loads are defined on the site as "The number of times your page has been visited."


View My Stats