Hopefully we'll see many presentations like this at Greensboro's TEDx in Spring, 2013:
Being a Superhero
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The Miracles and Limitations of Modern Health Care
My wife and I spent yesterday at Brenner Children's Hospital in Winston-Salem with our youngest son. Our son has been dealing with a condition called supraventricular tachycardia (SVT), which in layman's terms means his heart will sometimes beat really fast – like 200 beats-per-minute fast – for extended periods of time even if he's sitting still. He was in the hospital for a procedure called a cardiac ablation which, if successful, would prevent these episodes from happening in the future.
The way the ablation was explained to us is that the doctor would send catheters through major veins in the legs to our son's heart and, depending on where in the heart the problem was, either burn or freeze the part of the heart that was causing it to go into this abnormal rhythm. Our son would be put under general anesthesia for the procedure and it would likely take about four hours. They would provoke his heart into going "wonky" (that's our technical term for it), identify the problem area, treat it and then observe it for a period of time to make sure they got all of it. If they needed to they'd freeze or burn more spots until they had the problem area taken care of.
Here's the really amazing part: if all went as planned we'd have our son back home the same day and he'd be under orders to take it easy for four days, not lift anything heavy for about a week, and then he'd be back to normal. To us this was truly a miracle of modern medicine – our son would have a heart procedure as outpatient surgery!
Thankfully all went as planned and we had our son home last night. Truly amazing.
Unfortunately modern medicine also has its limitations. While we were in the waiting room during our son's surgery a doctor came out and met with a mother and grandmother waiting near us. It was very early in the morning and most of the folks in the waiting area were asleep, thus it was pretty quiet. We tried our best not to eavesdrop, but it was impossible not to hear pieces of what the doctor was telling the mother – that her child did indeed have some rare, malignant cancer. It was also impossible not to hear the mother's crying and her mother trying to console her. And quite frankly it was impossible not to break down ourselves once they left – I haven't cried in public since I was a child, and I'm not ashamed to say that I just couldn't hold it together. I can't imagine going through what that family is going through right now.
Right now our country is dealing with a lot of change in our health care system thanks in large part to the Affordable Care Act, aka Obamacare. There's (rightfully) a lot of discussion about how our health care system and the related health insurance industry work. The debate often focuses on cost and on whether or not we're moving towards a system of "socialized" medicine similar to Canada's or the UK's, and if we are, whether that will lead to a stall in medical advances that have led to every day "miracles" like what our family experienced.
Those are all worthy discussion points, but after yesterday all I could think was this: when it's your child in the operating room you really don't care how expensive the procedure is, you just want him to have whatever it takes to make him well. I would gladly live in a cardboard box in order not to have to hear what that poor mother next to us heard. Whatever we do I hope we continue to work towards making sure that fewer and fewer parents have to hear that their child doesn't have a miracle available to them at any price.
The (Unwinnable) War on Drugs
The "War on Drugs" has been waged in America for decades now, and it's becoming increasingly clear that the tactics used in the "war" haven't been real effective. One reason is that every time drug enforcement agents plug one smuggling hole another one opens up, and often in ingenius ways:
Just when you thought drug running couldn't get more extreme, U.S. border patrol officers find 33 cans of marijuana in the desert near the border that they believe were fired from a cannon in Mexico. Authorities caught wind of the new technique when they received reports of some strange canisters popping up near the Colorado River in southern Arizona recently. Agents arrived at the scene to find the cans which collectively held 85 pounds of marijuana. That's worth $42,500 on the street. By the looks of it, the smugglers had loaded the cans into a pneumatic-powered cannon (think: potato gun) and blasted them 500 yards over the border. Bummer none of their buddies came to pick it up before the police.
So maybe it's time to rethink our tactics like Portugal did ten years ago:
Now, the United States, which has waged a 40-year, $1 trillion war on drugs, is looking for answers in tiny Portugal, which is reaping the benefits of what once looked like a dangerous gamble. White House drug czar Gil Kerlikowske visited Portugal in September to learn about its drug reforms, and other countries — including Norway, Denmark, Australia and Peru — have taken interest, too.
“The disasters that were predicted by critics didn’t happen,” said University of Kent professor Alex Stevens, who has studied Portugal’s program. “The answer was simple: Provide treatment.”
Drugs in Portugal are still illegal. But here’s what Portugal did: It changed the law so that users are sent to counseling and sometimes treatment instead of criminal courts and prison. The switch from drugs as a criminal issue to a public health one was aimed at preventing users from going underground.
Other European countries treat drugs as a public health problem, too, but Portugal stands out as the only one that has written that approach into law. The result: More people tried drugs, but fewer ended up addicted.
Later in the story we learn that the US is spending $74 billion on criminal and court proceedings for drug offenders and just $3.6 billion for treatment. Maybe if more emphasis were put on treatment we would see the market for illegal drugs shrink, and demand would eventually fall far enough that smuggling would be less profitable, and the motivation to build cannons capable of blasting barrels filled with drugs hundreds of yards into America would disappear.
Crazy right?
“In Second Grade They Have a Dream. In Seventh Grade They Have a Plan.”
The title of Nicholas Kristof's column – Profiting From a Child's Illiteracy – gives you a clue about his take on the unintended consequences of America's anti-poverty programs:
THIS is what poverty sometimes looks like in America: parents here in Appalachian hill country pulling their children out of literacy classes. Moms and dads fear that if kids learn to read, they are less likely to qualify for a monthly check for having an intellectual disability…
This is painful for a liberal to admit, but conservatives have a point when they suggest that America’s safety net can sometimes entangle people in a soul-crushing dependency. Our poverty programs do rescue many people, but other times they backfire…
About four decades ago, most of the children S.S.I. covered had severe physical handicaps or mental retardation that made it difficult for parents to hold jobs — about 1 percent of all poor children. But now 55 percent of the disabilities it covers are fuzzier intellectual disabilities short of mental retardation, where the diagnosis is less clear-cut. More than 1.2 million children across America — a full 8 percent of all low-income children — are now enrolled in S.S.I. as disabled, at an annual cost of more than $9 billion…
THERE’S no doubt that some families with seriously disabled children receive a lifeline from S.S.I. But the bottom line is that we shouldn’t try to fight poverty with a program that sometimes perpetuates it.
A local school district official, Melanie Stevens, puts it this way: “The greatest challenge we face as educators is how to break that dependency on government. In second grade, they have a dream. In seventh grade, they have a plan.”
Complex problems beget complex solutions, or no solutions at all. As a society we long ago made a commitment to help those who needed a hand up, but we've struggled with how to do it without giving them a handout. If you read the full column you'll find that Kristof sees some programs – maybe not so coincidentally they are non-government programs – targeted at children that have shown promise. Unfortunately we don't seem to have the political leadership we need to make these programs a reality on a large scale – and it's appearing increasingly doubtful that we'll see that kind of leadership in this country any time in the near future.
US Student Loan Debt Up 814% Since 2001
Mary Meeker of Kleiner Perkins Caufield & Byers, does an annual "Internet Trends" presentation, and this year's slide deck can be found here. Included in her presentation is an amazing graphic (slide 79 of 88) that you can see above; it shows how the share of US consumer debt has changed from the 4th quarter of 2001 to the 2nd quarter of 2012.
It is absolutely stunning how much – and how quickly – student debt has grown in this country. From $100 billion in 2001 to $914 billion in 2012 is an 814% increase in just a decade. The next fastest growth category is "home equity" at 390% and it wouldn't be a stretch to say that at least some of that is attributable to parents taking out home equity to pay for the kids' college tuition, so it's conceivable that education is responsible for even more debt than is being reflected by this graph.
One has to wonder – has higher education delivered a return that can possibly justify such massive debt?
The Things They Taught
Stephen Dubner, one of the coauthors of Freakonomics, interviews three of his professors at Appalachian State to see if they remember some of the things they taught him – things that helped form the foundation for how he would build his post-graduate life:
I Don’t Remember
Those of us with children have had countless conversations with them that went something like this:
Parent: Why did you <insert some inexplicably stupid act>?
Child: I don't know.
Parent: What were you thinking?
Child: I don't remember.
Apparently the CEO of Bank of America is very much like a child:
In the case of Bank of America, MBIA has long wanted to depose Moynihan because it was precisely Moynihan who went public with comments about how B of A was going to make good on the errors made by its bad-seed acquisition, Countrywide. "At the end of the day, we'll pay for the things Countrywide did," was one such comment Moynihan made, in November of 2010.
As it turns out, Moynihan was deposed last May 2. But the deposition was only made public this week, when it was filed as an exhibit in a motion for summary judgment. In the deposition, attorney Peter Calamari of Quinn Emmanuel, representing MBIA, attempts to ask Moynihan a series of questions about what exactly Bank of America knew about Countrywide's operations at various points in time…
Early on, he asks Moynihan if he remembers the B of A audit committee discussing Countrywide. Moynihan says he "doesn't recall any specific discussion of it."
He's asked again: In the broadest conceivable sense, do you recall ever attending an audit committee meeting where the word Countrywide or any aspect of the Countrywide transaction was ever discussed? Moynihan: I don't recall.
Calamari counters: It's a multi-billion dollar acquisition, was it not?
Moynihan: Yes, it was. Well, isn't that the kind of thing you would talk about?
Moynihan: not necessarily . . .
The exasperated MBIA lawyer tries again: If it's true that Moynihan somehow managed to not know anything about the bank's most important and most problematic subsidiary when he became CEO, well, did he ever make an effort to correct that ignorance? "Do you ever come to learn what CFC was doing?" is how the question is posed.
"I'm not sure that I recall exactly what CFC was doing versus other parts," Moynihan sagely concludes.
The deposition rolls on like this for 223 agonizing pages. The entire time, the Bank of America CEO presents himself as a Being There-esque cipher who was placed in charge of a Too-Big-To-Fail global banking giant by some kind of historical accident beyond his control, and appears to know little to nothing at all about the business he is running.
In the end, Moynihan even doubles back on his "we'll pay for the things Countrywide did" quote. Asked if he said that to a Bloomberg reporter, Moynihan says he doesn't remember that either, though he guesses the reporter got it right.
Well, he's asked, assuming he did say it, does the quote accurately reflect Moynihan's opinion?
"It is what it is," Moynihan says philosophically.
(H/T to Lex for linking to this).
Making Things Interesting and Beautiful
This is a really nice piece on graphic design:
Why My Coffee Habit is a Very Good Thing
Those of you who know me well can probably appreciate how happy this article – The Case for Drinking as Much Coffee as You Like – made me:
"What I tell patients is, if you like coffee, go ahead and drink as much as you want and can," says Dr. Peter Martin, director of the Institute for Coffee Studies at Vanderbilt University. He's even developed a metric for monitoring your dosage: If you are having trouble sleeping, cut back on your last cup of the day. From there, he says, "If you drink that much, it's not going to do you any harm, and it might actually help you. A lot."
Officially, the American Medical Association recommends conservatively that "moderate tea or coffee drinking likely has no negative effect on health, as long as you live an otherwise healthy lifestyle." That is a lackluster endorsement in light of so much recent glowing research. Not only have most of coffee's purported ill effects been disproven – the most recent review fails to link it the development of hypertension — but we have so, so much information about its benefits. We believe they extend from preventing Alzheimer's disease to protecting the liver. What we know goes beyond small-scale studies or limited observations. The past couple of years have seen findings, that, taken together, suggest that we should embrace coffee for reasons beyond the benefits of caffeine, and that we might go so far as to consider it a nutrient.
Reading this was literally like having angels sing in my ear. Oh happy days!
Fox News Tries to Demote Christianity
Fox News' flagship personality, one Bill O'Reilly, has tried to demote Christianity from a religion to a philosophy – apparently in a battle fought in the War on Christmas. Jon Stewart, Comedy Central's flagship personality who happens to be Jewish, is there to set Fox and Bill straight:
Befuddled 