Category Archives: Science

Football In the Future

Football Hall of Fame Re-opens

Newly remodeled Football Hall of Remembrance opens to celebrate Traumatic Brain Injury.

SATIRE AFFILIATED PRESS
CANTON, OHIO 11 September 2035

Although American style football has been banned, the Football Hall of Remembrance—formerly the Football Hall of Fame—is still a popular tourist attraction. It’s remodeling was recently completed and the familiar football roof is now surmounted by an artist’s conception of traumatic brain injury. Over the front door, the entryway features a bronze relief of a player being carted off the field after, as they used to say, “Having his bell rung.”

While the exhibits still include trophies, helmets, jerseys, and other game paraphernalia, it’s the preserved brain tissue and MRI scans that are today’s favorite. Visitors can view the pathology, then try to guess to which famous player the brain once belonged. Pressing a touch screen, the player’s name, teams, scores, and number of concussions is displayed. Original plans included videos of interviews with former players, but many could no longer communicate, being content to babble incoherently, or stop mid-sentence with, “What did you just ask me?”

Taking a page from big tobacco’s playbook, the industry insisted for years that football was not dangerous; eventually there were too many injuries at the high school, university, and professional levels to ignore. Professional teams found that medical insurance costs exceeded revenues—even if the revenue from sale of team products like hats and jerseys are included. With the profits gone, most owners took their investments elsewhere. Unfortunately, this left many cities with substantial debt for stadiums they built. Many are crumbling and have been condemned because of the degree of deterioration; there’s reason to repair them and no money to tear them down. Universities initially expected a huge financial crisis, but found that the sport had actually not been a money maker, in terms of real cash, but a huge annual loss. Without football many universities were able to improve facilities and pay teachers better.

Football, is gone, but not forgotten—except by those who played the game and had their bells rung too many times.

Only a Loan

Mother Nature loans us many things, but we need to remember that they’re only a loan.

Hurricane-Katrina-FloodingNorfolk, Virginia has much of its downtown built on filled in waterways and swamps. The area already tends to flood with nor’easters, and tropical storms, but with rising sea levels, flooding is expected to happen more often. Since there are people and businesses already established in the area, government officials are exploring possibilities such as levees, flood walls, and whatever the latest technology offers to prevent loss of life and property.

I understand. Where I live used to have a moderate risk of flooding, but as more of the area was developed the waterflow reversed. Low-lying wooded areas were clear-cut, raised five feet, and houses built so that instead of absorbing the rainwater, it now flows into my neighborhood. Bummer. Maybe if I replace my lawn with rice it will work better.

Mother Nature only loans us geography. I used to live in Louisiana. Mother Nature wants to move the Mississippi River west into the Atchafalaya basin. The United States Army, Corps of Engineers have been tasked with keeping the Mississippi River where it is. They’ve been mostly successful, except for the occasional world-class disaster like Katrina. History has shown that if weather doesn’t satisfy Mother Nature’s requirements, the occasional earthquake will. The New Madrid Fault in the early 19th century caused the Mississippi to flow backward for several days and reroute itself.

These issues are not unique to Norfolk and Louisiana. I grew up in Toledo, Ohio, which is built on what was the Black Swamp. Part of Downtown Chicago is built on the rubble from the great Chicago Fire, which was tossed onto the shore of Lake Michigan. Enough of Florida is built on drained swamps, or the equivalent, and so much groundwater is extracted that sinkholes routinely swallow cars or even houses.

Mother Nature loaned us these areas. I hope she doesn’t want them all back too soon.

Goodbye to an Old Friend

Long before my time, Theodore and Milton Deutschmann started a business to cater to the new field of wireless—specifically, amateur radio. They called their business Radio Shack.

rs

Why? Ships were among the first to adopt wireless communications, and since early transmitters created a signal by generating a huge spark, there was the risk of starting a fire. To minimize risk, the radio equipment was placed on the main deck, in a separate small building, which came to be called the radio shack.

Ham radio operators (no one knows for sure why they’re called “hams”) tended to call the place where their radio station was located as the radio shack, or ham shack. Amateur radio was shut down during both world wars, but hams returned to the air as soon as it was legal to do so. The end of the Second World War provided an added advantage with huge selection of inexpensively priced military surplus radio equipment.

When I was a youngster, there were a few radio stores around town where you could buy components or tools. However, periodically the mailman would deliver a catalog from Lafayette, Allied, or Olsen Electronics. The Sears Christmas toy catalog couldn’t compete with these for the pure lust they generated. I remember building a set of Knight Kit walkie talkies, purchased from Allied.

In the late 1960s, Allied began opening stores in malls, outcompeting most the other companies, which gradually faded away. Allied purchased Radio Shack, but the combined Allied-Radio Shack was determined to be too monopolistic, and the two companies were split up. Allied became the industrial supplier while Radio Shack stayed as the retailer in the malls. Radio Shack sold things that you couldn’t find elsewhere. The TRS-80 computer was one of the first personal computers. They introduced a pocket-sized computer and one of the first laptops. Radio Shack had a niche market—the nerds—but nerds were paying $2,500 for a radio shack computer before the general population knew personal computers existed.

You could find all the parts to build a stereo from tuner to speaker wire. How about a multimeter and a soldering iron? They sold CB radios, of course, but also some ham radio transceivers. Most everything was manufactured by someone else, but carried one of Radio Shack’s brand names.

If you were working on a project and need a 47 ohm resistor (usual price, 10 cents—Radio Shack price, two dollars) you could drive to the mall on a Sunday and finish your project before dinner, even on a Sunday afternoon. Yeah, their components were overpriced, but the convenience made it worth it.

Then, one fateful day, the brainless
pencilnecks management of Radio Shack decided to sell the same products (e.g., cell phones) that you could buy for less money at Best Buy, WalMart, RiteAid, etc.

I’ve been told by Radio Shack managers that the really profitable part of the store was the parts section with those overpriced resistors, capacitors, and semiconductors. You know, the ones you could buy whenever you needed them? The parts selection went from a large section of wall to a metal cabinet with multiple drawers. I think the cabinet got smaller, but in any case, there were fewer and fewer parts available. Cell phones—no problem. Parts? Sorry.

I hear that Radio Shack is still sort of, kind of, in business, but you couldn’t prove it by me. The last local store is now empty. Like Bigfoot or the Loch Ness Monster, you only hear about someone who knows someone whose brother-in-law saw one. It’s too bad—they could have coasted a few more years just on what I spent there.

Medical School Rationing

Fixing Healthcare – Part 2 — Doctors

I’ve known many intelligent, talented, committed young people who aspired to become doctors, but couldn’t get into medical school. Some were resigned to their fate and used their degree in biochemistry to become medical technologists; others made arrangements to attend medical school outside the United States—primarily in the Caribbean. In one case, in order to study at a school in the Caribbean, the aspiring medical student’s parents sold virtually everything to finance her education. She’s nearly complete with her rotations back here at US hospitals and plans on serving rural or tribal underserved areas.

While we don’t have enough graduates of United States medical schools, we grant 85,000 special visas to foreign medical graduates every year because it’s a “critical shortage.” Today, roughly one quarter of all practicing physicians are foreign medical graduates. I’ve worked with many, and while their initial desire is to return home, after about six months the sports car and the arm-candy significant other appears. When I ask if their plans have changed, I’ve been told, “If I return home, I will be paid in chickens and melons. If I stay here, I will be paid in dollars. I like dollars better than chickens and melons.”

So, we import thousands of non-American doctors every year even though we have many Americans who want to study medicine but are turned away.

A decade or so ago, when more students wanted to study law, the educational industry had no difficulty in adding seats—even if they had to build new schools. Why won’t (not can’t) we do the same for medical schools?

Some claim there wouldn’t be enough residency opportunities if we graduated more doctors from US schools, yet foreign medical graduates can and do get residency positions at US hospitals. In any other industry, this might be viewed as restraint of trade.

I suggest that the goal of US medical schools should be to increase their capacity so that by 2030 ALL US residency openings can be filled with US citizens who graduated from US medical schools.

Next, I would change the entry criteria to include the following:

  1. Accepting students with a commitment to actually practice medicine; better yet a commitment to practice whatever type of medicine is in short supply, wherever needed, for at least three years. After that, every accommodation should be made to place that individual in a residency or fellowship of their choosing for which they have the talent, without a decrease in salary.
  2. While academic achievement is important, the ability to work as a team is critical. History is full of brilliant people who didn’t succeed because they could not work with others, and medicine is now a team sport—whether the person with MD or DO after their name likes it or not, they are teammates with the nurses, technologists, therapists, etc. No one is a superstar.
  3. Children of doctors or other elites should have to prove themselves more—not less—than other medical school candidates. They’ve grown up exposed to the field, often in an environment of privilege, so they should demonstrate their desire to serve, not their pedigree.

In short, we need more doctors, but our current method of selecting them is less than optimal.

Fixing Healthcare in America

First in a series

To correct healthcare and get costs under control, we must first acknowledge, then change the healthcare industry’s unique and outrageously dysfunctional business model.

  1. Physicians and other practitioners who decide which resources will be used in a hospital are often neither the direct provider, the one who pays, nor the beneficiary of the service. Basic economic rules, therefore do not apply. Medical tests, which are intended to provide information that will in some way impact the patient’s course of treatment, don’t. Many test and other procedures are ordered even when the outcome of the test will in no way affect the treatment of the patient or its results.
  2. Medical products and services are priced without any rationale. Often, prices are set artificially high in order to allow large discounts to insurance companies. This means that patients without insurance can be charged list price; eighty dollars for an aspirin or $100 for a BandAid®. Hospitals, which were once a ministry, stewardship, or public service have changed their priority to the bottom line. Some hospitals now own and operate their own collection agencies augmented by a small army of lawyers to guarantee that they collect what they have billed. This is why it is not uncommon for a small-town hospital to have millions of dollars in the bank—and still retain their not-for-profit status.
  3. And the insurance companies that get those big discounts? The hospital needs a staff of trained bureaucrats to generate the paperwork that is sent to the insurance company in order to receive payment. Payments may not be received for several months (for the MBAs out there—remember the first rule of finance—a bird [dollar] in the hand is worth two in the bush [accounts receivable]). When payment does arrive, administrative staff must reconcile the payments and file additional paperwork as necessary. All this adds to the hospital’s costs without adding any value. The insurance companies, on the other hand, are usually quite profitable, even after spending a lot of money on lobbyists. But just like Don Corleone said, “It’s nothing personal, it’s strictly business.”

So, what do we do?

First, it would be valuable to have the physicians evaluate how tests really affect the outcome for their patients and develop appropriate protocols. Malcolm Gladwell relates an excellent example in his book, Blink. The cardiology staff at Cook County Hospital was able to reduce tests while simultaneously improving patient outcomes.

[Gladwell, Malcolm (2005). Blink: The Power of Thinking Without Thinking. New York: Little, Brown.  ISBN 0-316-17232-4 (Especially the chapter on Cook County Hospital Cardiologists)]

Second, revise medical pricing so that it reflects reality—and that must include adequate margin to offset costs for necessary but expensive services. Emergency rooms are expensive to operate while an intensive care unit for patients suffering from burns is actually cost prohibitive. However, hospitals have an obligation to the community to provide necessary services—either directly or by affiliation—to the community. The community, in turn, must ensure the hospital is resourced to provide a wide range of services. If hospital prices reflected cost plus a reasonable margin to offset other costs, and everyone paid the same price—patient or insurance company, it might lead to more rational decisions—outcomes first, but economics as a consideration. If Grandpa—God love him—is a 96-year-old heavy smoker with high cholesterol and other morbidity factors who was hospitalized because of a stroke, a battery of tests that will not affect his quality of life or his longevity are not appropriate, and the insurer should not be expected to provide carte blanche payments. However, if the prices are realistic, the family may decide that they would be willing to pay for those additional procedures on their own.

Third, emphasize cooperation over competition. Is there any other business, other than hospitals, that would allow someone to work in their facility AND directly compete with it? Radiologists have their competing imaging centers, surgeons may have their private surgery centers, etc. Should specialty practitioners be entitled to benefit from the hospital’s patients and compete with the hospital for those same patients? It should be the practitioners’ choice—one or the other, but not both.

Two excellent resources for these issues are:

Brill, Steven (2015), America’s Bitter Pill: Money, Politics, Back-Room Deals, and the Fight to Fix Our Broken Healthcare System. New York. Random House. ISBN 978-0812996951

Rosenthal, Dr. Elisabeth (2017). An American Sickness, New York: Penguin Press. ISBN 9781594206757

If you want to fix American healthcare, pass this along to your friends, neighbors, doctor, etc. I’ll get a lot of hate mail, but we need to have the discussion.

More to follow.

Everybody panic! It might snow!

Buffalo, NY 2014 (Courtesy PBS)

Southeast Virginia’s TV meteorologists are in a full-blown tizzy because (gasp!) it looks like it’s going to snow. This is not necessarily bad, because TV meteorologists love to be in a tizzy over any weather event—but if you lived as boring a life as they do, wouldn’t you? The only other excoitement they get is standing outside in a storm on a live broadcast telling everyone else not to go outside.

Our neighboring states average the following annual snowfall:

West Virginia 62″

Delaware and Maryland 20.2″

North Carolina (due south of us) 7.6″

Virginia as a state averages 10.3″ per year, but the southeast (Norfolk, Virginia Beach, Hampton, Chesapeake, etc.) averages a paltry 5.8 inches, although eighty years ago, in January 1936, there was a record snowfall of 20 inches. Wow!

So, wish your television weatherman a happy blizzard, but leave quickly or risk having it all explained in great detail to you.

Trying Something Different

 

linuxWe’re on a little trip, with a few changes from the norm. First, we’re using the train for transportation, which we’ve done several times, and after that, either walking or the Metro. Since it’s already a variation on my usual theme, I am not using my regular notebook computer, but instead a vintage 2008 hand-me-up netbook computer. Netbooks are generally about half the size (or less) of a standard laptop/notebook computer and have smaller memory and disk capability. While the modest hardware is designed to support a user who relies on the Internet instead of the computer itself, by using Linux as the operating system (OS) you can pack a lot of capability into a very small package.

Linux, in case you don’t know is an open-source operating system—meaning that developers can modify it to meet their needs, within certain parameters. More significantly, that also means that it is free. LINUX is a rewrite of UNIX, a very powerful—but very expensive commercial operating system. UNIX was written by computer nerds for computer nerds; LINUX, perhaps more so, since its development is shared among many developers. Many of the systems that you may connect with via the Internet probably operate using Linux, yet your Windows based computer is able to interact seamlessly.

This version of LINUX—Ubuntu—has a graphical user interface similar to Windows with similar functions; LibreOffice offers includes a word processor, spreadsheet, etc., all of which are also free. To utilize its most powerful features, however, you use the command line method—kind of like the old Microsoft DOS.

The reason I took this computer is to encourage me to learn more about the more powerful features of Linux by working with the command line. Linux seems to be popping up more often, especially among geek toys and systems. The Raspberry Pi microcomputer runs on Linux (although Microsoft made a Windows 10 version for it once it became so popular). However, Linux tends to be more robust, use less memory, and run faster in most cases.

In any case, so far, so good. Sunday’s blog was written on this machine, and so is today’s. We’ve been too busy having fun for me to devote myself to learning command line LINUX, but I’ve learned some. Having fun and learning all in the same day? Outstanding!