Street Rat Crazy Saloon

The Assumption With Gold

2011-09-22T09:51:00.000-07:00

The underlying assumption when people say gold is the ultimate store of wealth is that there will always be a market infrastructure in which we can exchange the gold for other things (nutrients, potable water, cell phone chargers, etc.).

Perhaps this assumption is always why I've found discussing the issue with goldbugs so exasperating. A miscommunications about scenario parameters. The term "economic collapse" to them means fiat currency lowering in value so other people eat generic-label cereal while they get to buy Ferraris by trading for a few bracelets. Whereas to me the term "economic collapse" means that there is no food to buy at any price (or medium of exchange), and no gas for Ferraris at any price (or medium of exchange).

In a way, goldbugs are more optimistic about social stability in the future. It just seems to me that in past crises, the planet had a low human population and abundant resources. The peasant farmers may have been poor in terms of cool stuff (silks and toys), but the basics (food and water) were still obtainable. So a stable, tolerable poverty. The planet is at a point now where if the infrastructure fails due to an economic collapse, the basics aren't going to be obtainable. So social instability on a scale never before imagined.

In summary, I now feel a sense of peace with my gold-loving brothers. A miscommunication in perception. They believe in a market after dollar death whereas I am an eternal skeptic. Like with my religious friends who believe in life after death, I disagree but am open to pleasant surprise and will be very happy to be wrong.

Italian and Spanish Debt Yields are Spiking

2011-08-02T18:41:00.000-07:00

And that's bad news for Europe.

I've taken to watching the 10-year yields on Italian and Spanish soverign debt as a recent hobby. Apparently, Europe is experiencing a slow motion soverign debt train wreck.

With respect to Italy, it has the third largest bond issuance in the world. I think they normally would simply revalue their currency. But they no longer have their own currency.

I don't quite know how the EU is going to bail out Italy (and Spain). They're going to try something.

And given that the rates are on a rocket ship to the sky (over 6% as of this post), they are going to need to do something immediately.

Oh, and the U.S. may be entering a recession. And the U.S. stock market is tanking.

It's going to be a fun August.

Fair play -- a question of self-image? Researchers explain conditions under which people are prepared to behave fairly

2011-07-30T11:13:00.000-07:00

Fair play -- a question of self-image? Researchers explain conditions under which people are prepared to behave fairly

Funny Cartoon

2011-07-20T15:16:00.000-07:00

I used to could

"I used to could" is one of Jeff Foxworthy's made-up southern words. As in "Dink, do you remember how to embed images into a blog post?". Well, I used to could. I managed to add the link, anyway.

Strange Days in the World of Educational Finance

2011-07-04T16:37:00.000-07:00

It appears, as Jeremy Grantham notes in his most recent missive (1Q 2010), that the Days of Abundant Resources and Falling Prices Are Over Forever.

He is talking, mostly, about the recent apparent paradigm shift in commodity prices. The days of cheap everything is over.

Our obsession with economic growth at all costs is running up against a slight problem in the real world, known to the general public as math. Specifically the feature in math known as compound growth.

Hellasious touches on this with repsect to his various discussions on permagrowth.

The problem is as follows: No compound growth is sustainable.

In terms of debt, this means that no real (non-inflationary) compound growth in debt is sustainable over the long term.

Resources are no longer abundant. Good-bye real compound growth.

What does this have to do with the financing of education? Everything.

The educational finance model permits real compound growth with respect to student loan debt. This is then passed on to colleges and universities in the form of real compound growth in tuition with students taking on the risk of paying this money back.

Put simply, colleges and universities increase tuition faster than inflation. We all know this. Everyone complains about it. But nothing ever happens.

Colleges and Universities use the compound tuition growth model to ratchet up costs, year after placid academic year, with no discernable improvement in anything except massive resort-type facilities for students. However, this idiotic system has never come face to face with a major economic paradigm shift before.

The fuse for the coming major discontinuity in the world of educational finance has been lit.

Let's just wait and see what happens when the now permanent feature of price pressure and shortages of resources hit student loan debt system and the ivory tower.

Hazy Recollections....Awkward Synthesis....

2011-06-30T11:23:00.000-07:00

Austerity riots. I'm annoyed by them. First the rioters seem like spoiled children demanding the grown-ups figure out a way to make life a permanent Disneyland when any reasonable person realizes that their wish is logistically impossible. Then I feel annoyed about being annoyed by the rioters because I feel like a reactive pawn of some collective banking industry that has brainwashed me with carefully crafted lies. There is no winning. But the riots have acted as a muse of sorts:

Hazy recollections:

In the late Eighties a friend gave me "Atlas Shrugged" to read right after we graduated high school. It was intriguing. Hazy recollections of feeling that personal responsibility and rugged individualism were the only moral way of life. Absolute fairness! Had to watch out for bad people who wanted to manipulate their way into things they didn't earn.

Was it the mid-Nineties that Bono of U2 argued to some G7 summit that all debts accumulated by third world countries should be forgiven? After all, the debts were created by corrupt leaders of those countries who didn't use the money to help the citizens. On top of that, the payments on these corrupt loans were taking cash needed to finance projects that actually would help the citizens. Clean water and such. Its a very hazy recollection, but I recall thinking "Well that makes sense and seems ethicially to be the right thing to do". Sure, some nameless investors would lose money in the default, but they were bastards who shouldn't have been lending to other bastards who were clearly lying about using the funds for civic endeavors.

About a decade later I came across some mind-bending books on evolutionary biology. Soon, the CDS situation was spiralling out of control. I was curious and learned all sorts of horrendous things about the Federal Reserve system and the US financial system in general. I couldn't believe that educated people in suits created such sloppy work. And that the rest of us weren't even paying attention even though the sloppy work permutated nearly ever aspect of our physical existance. Sobering, no? This research led me to the Sudden Debt blogsite where an insider named Hell explained much of multifaceted horror along with a devotion to alternative energy since (well, one reason was saving the environment which seems like a good idea in general) the thermodynamic accounting wasn't balancing out any more with hydrocarbons. The blogsite also carried a mad genius commenter named Thai. He worked at light speed with complex ideas shooting off in all directions. Fairness perception in game theory experiments. Scaling benefits of cooperation. Zero sum, breaking symmetry, and fractals. It was a blur of mind-bending (mind-breaking at times) idea candy.

Awkward synthesis

So take all these puzzle pieces of knowledge and/or beliefs and fit them into a coherent, flowing picture. Well, not today obviously ;)

On Dreaming

2011-03-06T09:38:00.000-08:00

This is from Dr. Robert Godwin's post of December 16, 2010. I copied it from his One Cosmos Blog where he generally posts daily.

"What distinguishes daytime consciousness from night time consciousness is that in the former mode we are separate from the creations of our consciousness -- or at least we weave in and out of them, merging and observing, producing and critiquing, spewing and cleaning up.

At night things are different. Although there is a Dreamer and a dream, we only know this after the fact, upon awakening. We generally cannot experience the distinction when the dream is occurring. This is a fascinating principle of consciousness, because it means that in the most profound sense, we are both the subject (creator) and object (created) of our dreams, even though we identify only with the object pole.

But once you appreciate the protean genius of the Dreamer, you cannot possibly believe that your little ego is anything more than a tiny satellite in the orbit of a higher conscious power. But who is the Dreamer if not you?

However, this You is like the dark side of the moon. I Syd you not. It is always there, even if we cannot see it. Indeed, we cannot see it because it is in a permanent dialectical relationship with the visible side; even if you bring a portion of darkness into the light of consciousness, it is now in the latter world, just as there is a distinction between dreaming vs. recalling and interpreting a dream. Note that the latter activities can never exhaust the Dreamer. Truly, to interpret a dream is like bringing a sponge to the ocean.

Grotstein writes of the unconscious as a sort of alter-ego or background presence with (or in) whom we go through life -- the “stranger within” that shadows our existence in a most intimate, creative, and mysterious way. We don't necessarily notice the relationship, but we would if it weren't there. That is, everything would go suddenly "flat," and be robbed of the extra dimensions that we only apprehend because of the conscious/unconscious resonance and dialectic."

Artificial Intelligence Will Not Lead to a "Singularity"

2011-02-17T10:11:00.001-08:00

The singularity is simply a type of immanentized escheaton that is a product of the Western/Faustian Grand Style where we focus on infinity. One way of thinking of Western Culture/Civilization is to view the collective memetic superstructure as having a boundary condition of thoughts that tend toward the infinity.

For example, the entire “faster, stronger, bigger” = Better. Supersize me!

Now, with respect to computer “intelligence”, it helps to remember that what is being addressed is a specific slice of the overall realm of intelligence. Computers are extremely useful tools, but they are tools and useful only in the realm of thought that deals with logic. A better way of thinking about is that computers are basically a form of technological “left brain” that has no underlying personality.

Individuals make decisions based on their underlying personality structure. Individuals also exercise free will. To the extent that computers are given “free will” it will amount to the randomness aspect of the physical universe. That is to say, the free will inherent in a random number generator.

I do not think that the people who deal with AI have even started to look at the real problem, that of artificial personality, or AP. To the extent computers become “more intelligent” than people, I would argue that we already have experience having such people in our midst. I call them autistic savants.

The only thing that AI will accomplish is the creation of mechanical hypersavants, which will be quite useful to helping us solve problems that can be solved by savants. But there will be no “singularity”.

A Pleasant Dream

2011-01-22T14:08:00.000-08:00

Sorry if this sounds a bit like transcendental ridiculosity, but I had a dream last night that seemed to indicate that the saloon needed a visit. It was quite a warm, pleasant dream that was apparently strange enough to raise me to a conscious state that I actually remembered it the next morning. These omens should be heeded ;)

And behold, JP and Dr. John had actually responded to my New Year's lament posting!

Dr. John was concerned about the future. As any sane person would be. Humanity has gotten itself into a cluster@#$& economically and politically. I just about start screeching in public (requisite bathrobe donned and donut crumbs in my hair) when people talk about "Recovery". It can't be recovered! The base has been ravaged (i.e. abundant and resiliant natural resources, shadowy NGOs buying untold squidillions of debt, etc.). Bidden or unbidden, change is coming.

Hell, instead of being terrified, let's make it entertaining! Together we can come up with the most outlandish, fantastic, and ingenious method for surviving The Change.

For transport of materials, I suggest the crazy-ass Australian Skylifter .

To which you might ask, "Dink, where the hell are we going?". And this would be a fair question. We'd have to do some reconnaisance at the time and see how stable the local populations were. Assuming, not at all stable (my default assumption), we'll need to stick to isolated areas. Northern Canada in the Summer and Amazon in the Winter? Sure, why not ;)

Then you might ask "What the hell will we be skylifting?". Perhaps you saw this on CNN.com a few weeks ago as well. Behold, The Ark . Apparently, we can "lyophilizize" (sp?) all sorts of food. Get some medium-scale desalinization equipment and we're good to go.

Please do feel free to add on any madness that you like; I'd love to hear about it. Its fun to idea-play. That's what the saloon was always meant for. I'm glad the dream reminded me of that. I better stop writing now before I get all sappy.

Pleasant dreams, y'all ;)

The Dread 2010 Is Now Over

2011-01-01T14:03:00.000-08:00

And it is over in all time zones on the planet. I try not to be superstitious, but I could not help but to feel that 2010 cursed in some hugely, actively malevolent way. Though I experienced new levels of anxiety through a few truly nasty individuals, 2010 main method of attack seemed to be stomping on my friends. And being just a standard human creature, I was unable to defend them.

Perceptional bias, you might argue. 2010 wasn't dread for every living entity during every second of the year. I would be too tired to argue the point. I would nod politely to feign agreement so that I continued to appear fair and rational, but I would secretly continue to believe that 2010 was a bastard the likes of which I hope to never come across again. I feel greatly relieved that its 2011.

Clearly It Is Going To Suck....

2010-11-09T10:29:00.000-08:00

I just caught up on a few of my favorite econ blogs. And of course we had the recent midterm elections. I am disturbed by the number of people who think that there is a way to avoid a drastic change of our current quality of life.

We are thermodynamic thieves living wholly unsustainable lifestyles. With the magic of easy oil (and the remarkable generosity of outside entities lending us money to fuel astounding social programs) we have built a wonderland of greater and greater complexity. It has been stable for so long that it appears that many have mistaken it for nature; the natural order of things.

I fear that one of the two major political parties believes that we can stop some of this debt (more likely just redirect it) by ending social problems and "nature" will hold. Heck, they believe our lifestyles will actually improve. A wealthy theocracy will ensue!

I fear that the other major political party believes that we can continue things exactly like they are. Heck, maybe we could even have more social programs and "nature" will hold. None will suffer the consequences of their actions!

There seems to be a growing third party that believes that the system will collapse, but their personal lifestyles can continue because they were bright enough to buy metals with strange properties. I got mine, Jack!

But all seem to be denying the interrelated matrix of factors that have provided our fantastic lifestyles. I recently at the grocery store looking for my favorite organic cheese flavored (but no MSG) corn chip indulgence. An entire aisle devoted to brightly colored bags of chips and I was getting surly because I couldn't locate the ones with my very specific qualifications. How lucky! When the poor are rioting and farmer's don't have oil for tractors I suspect my choices in caloric intake will have to be modified.

Perhaps I should start the "Soft Landing" political party. We will seek the smoothest transition into national sustainability. Our motto will be "Clearly It Is Going To Suck, But Let's Try To Be Rational About It".

Advice?

2010-10-19T23:08:00.000-07:00

Feeling stressed here in Seattle. Y'all got any philosophy/mantras/tattoos that you get through when you're in a funk?

Race to Nowhere

2010-10-10T15:39:00.001-07:00

A recent article from the Washington Post talks about a documentary by a lawyer who is raising kids, kids who are experiencing extreme stress due to pressure to succeed. This is pretty well what I remember from my high school experience back in the 90's.

From the article:

"It was as if their private worries had come to life on screen: Teenagers so pressured to get A's, to fill their college resumes with sports and music and language, they start losing their grip. Long nights of homework leave them exhausted. Stress becomes stomach pain and anorexia and depression. Some turn to cheating or pills. Others just give up...

... The film is attracting notice from New York to California, where mom-turned-filmmaker, Vicki Abeles, a 48-year-old lawyer, launched the documentary project as she set out to understand the stresses her children, now ages 16, 14 and 11, were experiencing.

One daughter had become physically sick as she struggled with the demands of school. Then, several months into Abeles's effort, a teenager in her community committed suicide after getting a failing math grade, a tragedy Abeles says intensified her commitment to making the film.

"I think there is tremendous pressure on all kids to get the grade, to get the test score ... which is creating an epidemic of unhealthy kids who are also arriving at college and at the workplace unprepared," Abeles said in an interview.

Race to Nowhere

Some of this Race to Nowhere has to do with the nature of professional schooling and the fact that you can still make a decent salary in America if you can get into and graduate from the "right" professional school - law school/med school/dental school.

However, the entire American high school - college - law school treadmill has severe problems associated with it, namely that the number of new lawyers minted every year far outstrips the actual demand for lawyers.

In law school, you need to get the highest grades and go to the best schools in order to get a high paying "BigLaw" job ($165,000 in NYC these days) when you get finished. Not that these jobs are pleasant, but they do allow you to pay off student loans.

For many new lawyers it's worse than a Race to Nowhere, given the overproduction of lawyers and the failure of the bubble economy to reflate.

The equation for this economy is Stress (High School) + More Stress (College) + Even More Stress (Law School) + Six Figure Debt = No Job + Six Figure Debt.

And one of the problems is that the higher education system, particularly law schools, only has to worry about the continued issuance of sovereign debt to fund the student loans. Law schools don't have to worry about whether the students can actually repay the debt. So tuition can go up year after year at a significant premium to the rate of inflation.

And the problem is continuing to get worse as the economy continues to fail to recover.

At least interest rates are low these days, right?

Okie can probably add his own insights from his entire law school/law firm adventures.

(Limited) Faster than Light Coordination Is Possible

2010-10-01T14:28:00.000-07:00

Anyway, now that we have established that Spooky Action at a Distance exists, there is apparently still general consesus that you cannot have information exchanged faster than the speed of light.

From Wikipedia (Faster-Than-Light-Communication):

"Superluminal communication is the term used to describe the hypothetical process by which one might send information at faster-than-light (FTL) speeds. All empirical evidence found by scientific investigation indicates that it is impossible in reality."

Well, that's not quite right.

You might not be able to have direct superluminal communication, but you sure can have superluminal coordination.

First, you have to remember that we now established that quantum entanglement exists.

From Wikipedia (Quantum entanglement):

"However, in an entangled pair when the first particle is measured, the state of the other is known at the same time without measurement, regardless of the separation of the two particles. This knowledge of the second particle's state is at the heart of the debate. If the distance between particles is large enough, information or influence might be traveling faster than the speed of light which violates the principle of special relativity. One experiment that is in agreement with the effect of entanglement "traveling faster than light" was performed in 2008. This experiment found that the "speed" of quantum entanglement has a minimum lower bound of 10,000 times the speed of light.[5] However, because the method involves uncontrollable observation rather than controllable changing of state, no actual information is transmitted in this process. Therefore, the speed of light remains the communication speed limit."

Oh, and "minimum lower bound of 10,000 times the speed of light" really means that it's acually happening simultaneously regardless of where the entangled particles are located in the universe. This means that if one particle is in one galaxy, and it's entangled counterpart is in another galaxy, they will immediately influnce each other. Physical distance is completely irrelevant.

This expierment shows that there can now be some degree of coordination that occurs faster than the speed of light.

You can't send a message, but you can coordinate actions. Say you have two actors who are one light minute away from each other. Say there are two separate targets that they want each want to hit with a laser at the exact same time and the tagets that are located halfway between them, Target 1 and Target 2. They want to make sure that they each hit a different target, but they have each agreed that they will not decide beforehand which target to hit.

Now, if they each have an entangled particle of a pair, and one is found to have positive spin, the other will automatically have negative spin.

So, if they agree beforehand that they will each target and fire their laser at the same time (assuming their clocks are coordinated to the second) and they agree that they will not determine the spin of the particle until five seconds before their respective laser fires (to give them a few seconds to pick the right target), and they agree that the one who has the particle with negative spin will hit Target 1 and the one who has the particle with positive spin will hit Target 2 they will always each hit a different target.

And there you have faster than light coordination.

Neither actor has picked the target more than five seconds before firing, each target is 30 light seconds away from the lasers, and both targets will always be hit.

Coordination has occured faster than the speed of light.

Wave Men

2010-08-29T10:47:00.000-07:00

So Deb wanted to know where the hell everyone was. I suspect we have become Ronin or "wave men". Samurai who have lost their fractal master so now wander the internet aimlessly.

I've read some great books, vacationed, and found some sites to lurk on. But I haven't really found any place to regularly interact. I've considered some posts to create; its satisfying to write even if it goes unread.

I do hope you all are well; especially Dr. John with his gastric scourge.

Redefining Tolerable

2010-08-10T09:35:00.000-07:00

I took a long weekend to a very isolated part of Washington state. The room at the inn didn't have a TV, phone, or even alarm clock. There wasn't any cell phone coverage.

What it did have was a group af about 35 guests and a very prepared staff. We ate dinner on a porch with long tables filled with great food and flowers. Small conversational groups formed and disbursed frequently as people wandered about taking walks or playing cards.

This simplicity would have made me insane when I was younger. It would have been prison. But now that I'm 40 it seemed like such a relief. No chasing pride or running from shame with ego-pursuits such as fashion. Just friendliness while standing next to rivers.

And with internet access and Fedex I could still indulge in the benefits of civilization if I lived there long term. It certainly gets the mind wandering with possibilities.

The Problem With High Fructose Corn Syrup, Part 2

2010-08-03T17:02:00.000-07:00

Cancer cells slurp up fructose, US study finds

Aug 2 (Reuters) - Pancreatic tumor cells use fructose to divide and proliferate, U.S. researchers said on Monday in a study that challenges the common wisdom that all sugars are the same.

Tumor cells fed both glucose and fructose used the two sugars in two different ways, the team at the University of California Los Angeles found.

They said their finding, published in the journal Cancer Research, may help explain other studies that have linked fructose intake with pancreatic cancer, one of the deadliest cancer types.

"These findings show that cancer cells can readily metabolize fructose to increase proliferation," Dr. Anthony Heaney of UCLA's Jonsson Cancer Center and colleagues wrote.

...

U.S. consumption of high fructose corn syrup went up 1,000 percent between 1970 and 1990, researchers reported in 2004 in the American Journal of Clinical Nutrition.

Damn Dynamics

2010-07-24T09:45:00.000-07:00

A morning last week I walked into an office that is normally pretty sedate and immediately felt the pressure of a tensioned atmosphere. I asked someone what was up and she responded with a forced smile "Oh,....dynamics".

I wanted to flee the building. That word. It conveys so much so succinctly. Individual personality systems creating friction as they interacted in a group system. Too exhausting to tolerate on an otherwise very tolerable summer day.

Of course, everything is a system and all systems are dynamic. But we use to word to mean bad dynamics. The system not operating as we want it to. Nuts and bolts flying, electronics sparking, jaguars raining from the sky, asteroids careening into space stations. Chaos.

It reminds me of a vague memory of someone explaining that entropy isn't so much increasing disorder, just a different order than the one we preferred.

So when "dynamics" are proceeding in the intended order we ignore it/them. It falls into the background of our conscious; then its just "nature" or "order". Essentially, its classified as The Expected. And then when things don't go as expected we screech about those damn dynamics. Symmetry being broken?

I hope I understand. It really is fascinating to realize that your thinking is a Swiss watch ;)

More Summer

2010-07-13T15:45:00.000-07:00

see more

I have nothing even remotely smart to say at this time.

Summer

2010-07-02T12:24:00.000-07:00

Just wanted to let y'all know that I'll be AFK (away from keyboard) until the 12th. I wish Dr. John resolution from his infernal stomach issue so he may enjoy his backyard pizza oven. I'll leave you with something very funny to amuse yourselves with until the 12th:

A Fondness for Earth

2010-06-25T07:43:00.000-07:00

(I'm grabbing this from Econolicious' comment to Hell's most recent post. Upon reading it I had one of those "I'm glad somebody finally said it" moments a la The Emperor's New Clothes.)

We must stop viewing the issues of sustainability and climate change as good or evil and we must stop viewing this planet Earth as a servile entity, a slave that we can dominate and beat into submission. If we don't criminalize the battering of the planet and coerce the ignorance that allows this battering into submission, we risk the loss of our species on this planet. The survival of our species on this planet can not be achieved through democratic means. This planet Earth, is simply not going to allow us the timeframe to build consensus and vote for solutions to this problem.

We can either step up to the plate "right now" and conserve, preserve and reclaim the damage we have done to this planet by whatever means are necessary and recruit the receptive, persuade the skeptic, coerce the ignorant and eliminate the recalcitrant, or we can leave it to the wisdom of our natural environment to eliminate our entire species, both the so called good and the so called evil, in the same fashion that we eliminate viruses that endanger our species.

I think that vegetarianism is a given on our planet with 7B humans. I've given up all meat except fish for the last 7+ years and its honestly not that bad. I still have to kick fish and dairy, admittedly.

Other things humans may have to give up: Alcohol (encourages us to make bad decisions and is wasteful), creating offspring before age thirty, using more that 5 gallons of gasoline a week, the entire fashion industry, and non-recyclable plastics. Please feel free to fight with me in the comment section.

To Keep Our Brains Fresh and Springy

2010-06-21T11:36:00.000-07:00

Surely Thai wouldn't have wanted us moping around pathetically. Katherine has added a few of the speeches from his service on Remembering Thai and I'm in awe with how much he managed to do with his 43 years besides entertain and educate us here in the saloon and on Sudden Debt.

So in that spirit I'm taking a look at Science Daily daily to look for things that would have doubtlessly set him off. And there are many. On the political/economic spectrum I'm referring to a site he once mentioned called Some Assembly Required . Its a horrific daily summary of humanity's misdeeds with a zippy little punchline at the end of each factoid to keep you from total despair.

So read up and then come back here to rant and rave ;)

An Article About Thai!!!

2010-06-15T15:16:00.000-07:00

Thai McGreivy appreciation

By John Donnelly

On May 29, at 8:18 p.m., Dr. Thai McGreivy posted a guest blog on the Street Rat Crazy Saloon site titled, ``OK, my first short health care thoughts.’’ The item wasn’t so short, it wasn’t just about health care, but it was vintage McGreivy – provocative and piecing together seemingly disconnected big issues.

He wrote that municipalities were in budget crises and they might take aim at Emergency Medical Services. It made sense, he said, because spending had risen rapidly for EMS, but those extra costs weren’t resulting in improved survival rates.

Less than two days later, on Memorial Day, McGreivy, 43, suffered a massive heart attack while biking on Goldsboro Road in Bethesda en route for a long ride to Poolesville. EMS paramedics rushed to the scene, where he lay unconscious with no pulse. They did everything possible, including getting him to an emergency room at Suburban Hospital as quickly as possible. There, a team revived his heart.

McGreivy, an emergency room physician himself, remained in a coma as his heart showed signs of recovery. Four days after his collapse, doctors performed a critical test – a CAT scan on his brain, and the results were heartbreaking: severe brain damage due to a long period of oxygen deprivation. Nearly one week after his heart attack, officials pronounced him brain dead and his family authorized doctors to harvest all salvageable organs for those in need.

In death, McGreivy gave life – two kidneys and enough tissue for roughly 20 medical applications -- and his family and friends are grateful for the exemplary work of the EMS crew. They kept him alive against all odds.

But his guest blog post wasn’t wrong – not in terms of the metrics of public health. And therein lies a story about a relatively young man who left a mark on the quality of health care around the region precisely because he was unafraid to challenge anyone or anything, especially when it came to health care. In a very real sense, long before the national health reform debate, McGreivy was a one-man reformer – about a host of national issues around budgets and health and energy.

McGreivy, a husband, father of four boys, California born, was passionate about figuring out what made things work and what were the underlying factors that influenced outcomes, ranging from emergency rooms to global economic crises.

``His mind never stopped – ever,’’ said his wife, Katherine, softly laughing. ``I loved him dearly, but sometimes he was exhausting. He never stopped thinking and analyzing, and he always wanted to talk about ideas, and after hours of this, I would be, like, `Can’t we just gossip about the neighbors?’’’

He was chief financial officer of Medical Emergency Professionals (MEP), a 100-plus-employee company based in Germantown that runs five emergency rooms in Maryland – Shady Grove Adventist Hospital and Germantown Emergency Center in Rockville; Washington County Hospital in Hagerstown; Western Maryland Health System in Cumberland; and St. Mary’s Hospital in Leonardtown.

In all, the group, which started in 1997, oversees the emergency-room treatment of 300,000 patients a year; it contracts with each hospital, assuming all costs of ER service (which often run at a huge deficit to hospitals in part because of the numbers of uninsured) for no fee.

In each hospital, McGreivy and his partners strove to find cost-saving efficiencies while also improving patient care. In both Hagerstown and Cumberland, their system saved hospitals hundreds of thousands of dollar a year and shaved time off how long patients had to wait to see a doctor or nurse. At St. Mary’s Hospital, surveys showed patient satisfaction doubled over the past five years, now reaching levels of more than 90 percent reporting being satisified with their care.

McGreivy, said hospital CEO and President Christine R. Wray, ``was a tremendous catalyst to help St. Mary's Hospital change for the good. He was a terrific advocate in pursuit of excellence through data analysis.’’

Dr. Angelo Falcone, CEO of MEP, said McGreivy frequently pushed his peers. ``He always talked about how we had to make the hard decisions from an efficiency standpoint, and make sure they positively impact patients’ health,’’ he said.

One example rose in the Hagerstown hospital recently – a puzzle as to why doctors were seeing fewer patients than targets set by the group. At first, McGreivy and others hired $20-an-hour scribes to take notes for doctors, but that did not get the desired results. McGreivy studied it some more, discovering an anomaly at the hospital: physician assistants were seeing an unusually high number of patients. This was a problem because some of those patients could have gone straight to the doctor, and the doctors, in the meantime, had too much time on their hands. They could have been more productive – a cost savings to MEP and also, ultimately, to patients.

``There were a lot of moving parts in trying to figure out what was going on – 15 to 20 variables,’’ said Dr. Michael Cetta, MEP’s chief of business development. ``But he was able to think out of the box, and identify why it wasn’t working as well as possible. At our last management meeting, just a few weeks ago, he had figured it out, and now we are trying to fix it.’’

That was just one part of McGreivy’s impact, said his peers.

Justin Shaper, chief technology officer at PSR, a Dallas-based company that worked with MEP to help it manage its business, recalled how he and McGreivy developed software to standardize reviews of doctors’ charts of patients. Today, MEP and roughly a dozen other doctors’ groups around the country now use this more scientific approach to better evaluate doctors’ performance.

``There are a lot of overachievers out there, but what was special about Thai was that he never lost sight of the human connection in things – he kept coming back to the patient quality of care,’’ Shaper said, talking on his cell-phone while driving into downtown Dallas. He started to choke up. ``I’m sorry,’’ he said finally. ``Let me tell you a story about a dinner that we had together.’’

Seven years ago, Shaper, his wife, and their two children were eating a meal with McGreivy during a break in a conference in the Florida Keys, in Islamorada. ``At one point, Thai, who is an emergency room physician, one of a group of people who work under phenomenal pressure, who make life-and-death decisions, who make life better for people every day, he turns to my kids and says, `I hope you know your dad is helping save people’s lives.’’’

Shaper wept over the phone. ``That was the thing about Thai – while he was really into all these intellectual things, he still had an appreciation for what others were doing, and he let them know they were a part of doing something important.’’

And so it was, too, in his blog on EMS for Street Rat Crazy Saloon, when after writing about the questionable costs of EMS services, he wrote, ``I truly think most of the men and women in EMS are heroes.’’

In the hours before doctors removed McGreivy’s organs on June 6, Katherine McGreivy, in a waiting room with Falcone, decided to look up her husband’s most recent blogs on an iPhone. She found the EMS post.

``It gave me goose bumps,’’ she said. ``While we’re waiting for the whole surgery and the donation, we’re reading about his thoughts on EMS, and do they make a difference in outcome. Because he was saved from an almost certain sudden death, two people are getting a kidney, many others are getting tissues. It did make a difference – with him. He was still giving life even in his death.’’

A memorial service for McGreivy is scheduled for Thursday June 17 at 3 p.m. at the Bethesda Theatre at 7719 Wisconsin Avenue, Bethesda. The family has set up a memorial fund in honor of McGreivy that will fund educational scholarships for excellence and intellectual curiosity in science, mathematics and economics. In lieu of flowers, our family will request donations to this fund.

The Thai Experience

2010-06-11T07:49:00.000-07:00

Being that he had insatiable intellectual curiosity, he voraciously tore into the internet. In his numerous internet wonderings he came across a certain blog that fascinated him and he began voicing his ideas in the comment section. People with similar curiosity began responding to his comments; the comment section became boisterous. A community was formed.

One of the members gave Thai the nickname “The Fractal Rabbit”. It pleased him greatly. He had a reputation for an obsession with fractals, hence the fractal part of the nickname. He also had a habit of letting his curiosity lead him into “rabbit holes” a la Alice in Wonderland. He would come across a new idea and dive into the internet rabbit hole with frenzied intention to learn all he could about the new subject. Therefore the rabbit part of his nickname. The rabbit part was also apt because he was FAST! He would encounter his new subject, study it ruthlessly, post his findings on the blog, and demand you consider its relationship to the universe. By the time you had started your first query into Google to try to catch up with him, he had already repeated the process with a different new exciting idea. And likely correlated the two and demanded that you consider that as well. You couldn’t help but be infected by his enthusiasm for new ideas.

What was he searching for ultimately? I believe he wanted to make sense of the world and then fix it so people could be safe and happy. At least in the “big picture’ this seems to summarize what he was subconsciously driven by. In the more “normal daily life” perspective I think he just found it to be fun and fascinating ;)

Not being a religious guy, he couldn’t just adopt a preformed view of the world (in fact, when one blogger suggested it would be interesting to discuss the Old Testament he replied that “he’d rather stick his hand in a blender”. Tres amusant, no?). So this left him with the difficult job of crafting his own world view.

Physics. Chemistry. Evolutionary biology. Great, that set the stage of the universe and created the actors in it. The actors then did some really strange things for a couple hundred thousand years. Groups formed different systems of doing things. Politics. Economics.

Yet, there was something odd. In all these different areas he was seeing patterns. Whether driven by the laws of thermodynamics or the nature of humanity, these various systems were similar to each other in some way. He came across the concept of fractals and was entranced. This is what keeps happening!! Define the boundaries of a system, insert or remove energy, and the results are predictable. Every iteration that the system cycles will be similar to the previous and next iteration. Fractal self-similarity.

This fractal key became how he made sense of the world. So on to fixing the world to make people safe and happy. Humanity is a system like any other system. How to make it the best system it could be…..

If the members of a group were not cooperating there was a lot of misspent energy that could have been better used. If they cooperated all that energy could have been used forging ahead to a new layer of complexity (which is good- the library of a major university in 2010 is more complex than the three books some guy in a village 15 km away has in 1510). To cooperate requires rules. For people to follow rules they have to be perceived as fair. How do we determine what’s fair? How do our brains do that? Language seems critical to the process for humans. How do our brains know what language is? Down more rabbit holes!!!!

He didn’t get to finish the puzzle. I type that with terrible sadness. He was 43 years old. I’ll always wonder what he would have come up with if he had another 43 years to search and ponder. With every new scientific discovery I’ll think “Man, he would have gone ballistic on the blog over this!”. Bittersweet.

And it wouldn’t be right to not mention his life outside cyberspace. Both his mother and father had terrific adventures ( his mother was sent to Thailand by the Peace Corps so “Thai”) and were educated at UCLA which was also his alma mater. He met his wife when they were both still in school and he adored her for more than twenty years. She went with him all over while he finished medical school. He had some wild experiences working in Emergency Departments. He had four kids that he doted on tremendously. He read truckloads of fiction and non-fiction. He watched TED conferences online. He listened to NPR. His energy for learning was matched only by his energy for enjoying people.

How lucky I was to become his friend. You’ll be remembered fondly, Buddy.

Velveteen Rabbits

2010-06-09T18:03:00.000-07:00

This header for this blog post was inspired by Thai's widow, Katherine (by the way, that was also my mother's name), who in an e-mail to me said this:

"I want you to know that you had actually, like the velveteen rabbit in the children's story, become real to me."

This was in response to my e-mail to her where I reminded her that she referred to me as Thai's "imaginary friend." We are all now becoming real to her, just like the beloved rabbit in the story. And just like the rabbit in the story, The Velveteen Rabbit, we are all shedding a tear for Thai now.

Meeting Thai

It was the fall of 2008; I was working out of an office in Somerset, Pennsylvania. It was a great time for me. I was staying in this tiny little town called Mill Run. It was just four miles from a famous Frank Lloyd Wright home called Fallingwater. This project allowed me to explore a large part of the country that I had never been to before.

Anyway, Thai had suggested that we meet for lunch. I didn't want to waste an opportunity so I left in the morning and drove to Hagerstown, Maryland, to meet him at a little hole in the wall (and I do mean hole in the wall) deli. The entrance was down an alleyway and wasn't much to look at inside or out. But Thai had assured me that it came highly recommended by his peers at work.

I showed up about 10:45, and expected to wait the 15 minutes until the agreed upon meeting time of 11:00. Well, 11:00 comes and goes; no Thai. I think Thai calls me around 11:15 and says he just arrived. But he doesn't know where the deli is at. (Wait, you mean you suggest a place and you don't even know where it's at...?) He tells me he is out on the main road, and I walk down the alleyway to the sidewalk. I should interject here that I have some PTSD due to an angry driver trying to run me over with a car. While walking down the alley, someone in a car drove up behind me. In the alley, there was nowhere to run. So I had to face my fear and step to the side as far as possible. I get through it. Heart pounding and panting with fear, but I get through it.

So Thai tells me what he is wearing (and I am looking all over the place as I am in a strange place and not feeling completely safe) and I finally spot him waving at me. I can't remember the explanation exactly as to why he is late. I think it had something to do with his kid being sick, or getting up late, or something.

But anyway, we finally sit down to eat lunch. He isn't scheduled to go to work until 2:00 or something. We talk for 2 full hours about a whole number of subjects. Everything from the debt issues, to my work, to medical issues and everything in between. We part, having talked fully about all of the issues that interested us both. We were going to meet again in Cumberland, where Thai had another hospital he worked at, but by the time Thai got around to working over there, I had already been sent home. You know, I never did get to take that train ride in Cumberland like I had planned.

A Friendship Develops

After that, Thai and I started exchanging e-mails and phone calls regularly. Besides discussing the political and financial issues of the day, we exchange information on a professional level. I would ask him medical questions (often about my own health issues). And he explained medical concepts in a way that would be understood to a ordinary person (like me).

The phone calls became so frequent, that on the day that RKohn announced Thai's death in the comments over at Sudden Debt, I was just about to call Thai and tell him the good news that I had lost 20 pounds in the last 5 weeks. I had also noticed that he had not been posting here at Street Rat (I had just assumed he was busy with work.) I was also going to ask him to explain some other medical issues that another friend's dad had suffered from.

Anyway, I had asked him how to lose weight. "Calories, calories, calories" was his answer. So I have cut my caloric intake to 1000 calories per day and have been walking at least two miles per day in the summer sun (with a sauna suit on). And usually another two miles in the evening (without the sauna suit). But, being next to the lake here, it is hot and muggy in the evening. Just right to cause a lot of sweating. It seems to be working, at least so far. But I still have a long way to go.

The Kübler-Ross Model (the five stages of grief)

I suspect we are all experiencing some -- or all -- stages of the Kübler-Ross stages of grief right now. I know I am.

1. Denial – My initial shock of "No, it can't be true!" This passed quickly as reality set in.

2. Anger – For me, this manifested itself in the form of "How could you deprive me of another (expected) 30 years of intellectual challenges and stimulation?"

3. Bargaining – I didn't really suffer from this stage (yet). As I realize that I am helpless to change anything now.

4. Depression – This is the stage I am most likely in. I already miss Thai and want that expected time back (bargaining?). But I realize there is nothing that I can do but go on. But who will I find that can challenge me like Thai did? An intellectual equal isn't as easy for me as you might think. And in Thai's fractal world, he always had to be the blog hog and make the Pareto half of all of the comments (do the math, if you don't understand, ask about it in the comments and I'll explain).

The Pareto Principle is related to fractals. I think it was one of the subjects that got us talking to begin with.

5. Acceptance – I am sure I will reach this stage eventually. It is just so hard to see it from here.

Thai's death, coming when it did, reminded me of my mother's passing near Memorial Day.

A Song That Keeps Going Through My Head

I think that this song expresses our sentiments pretty well.

But there never seems to be enough time
To do the things you want to do once you find them

Jim Croce: Time in a Bottle

And, a happier song that seems to explain Thai's understanding of fractals:

He was in search of an answer
The nature of what we are
He was trying to do it a new way
He was bright as a star
But nobody understood him
"His numbers are not the way"
He's lost in the deepest enigma
Which no one's unraveled today

But he knew, he knew more than me or you
No one could see his view, Oh where was he going to
And he tried, but before he could tell us he died
When he left us the people cried,
Oh where was he going to?

He had a different idea
A glimpse of the master plan
He could see into the future
A true visionary man
But there's something he never told us
It died when he went away
If only he could have been with us
No telling what he might say

But he knew, he knew more than me or you
No one could see his view
Oh, where was he going to
But he knew, you could tell by the picture he drew
It was totally something new,
Oh where was he going to?

Kansas: Portrait (He Knew)

Goodbye, my friend. I hope that someday all of our questions will get answered. You certainly left us too soon. You will be missed.

In some spiritual way, I hope that we can meet again and finish exploring all those ideas that you have left asked and unanswered.

An Unspeakable Loss

2010-06-08T09:46:00.000-07:00

I just found out this morning. I am so sad. I will write a proper salute when out of shock.

Buddy, you will be missed.

Redux redux?

2010-06-04T09:45:00.000-07:00

Really, this is awesome.

JS Mills Redux

2010-06-02T23:15:00.000-07:00

http://www.colbertnation.com/the-colbert-report-videos/309925/june-01-2010/ayaan-hirsi-ali

*I tried to embed, but it wouldn't take

Sol Invictus

2010-05-31T11:59:00.000-07:00

The Invincible Sun. In better moods, this is how I see the human "spirit".

As demonstrated by a former Seattle Times columnist that I always enjoyed

Mercy

2010-05-30T10:28:00.000-07:00

Surely we all want to be compassionate cooperators. Yet also pragmatic, system-evaluating thermodynamicists. Is it possible to reconcile?

Observation #1: Giving money to people who don't have enough money seems like a nice thing to do. Assuming that the only problem is the intake of money and once they have it they'll manage it wisely. Perhaps the problem is more extensive (intake and spending) or even the opposite (just spending). In these last two options, giving them money almost seems like a sick joke on them.

Observation #2: Americans don't seem to have a clear vision of what poverty actually is. In other places on the globe people starve to death. That is actual tragedy. It seems Americans have come to define any sort of threat to self-esteem as tragedy. I have heard people with cell phones cooler than mine, in jeans more expensive than my Levis, bitching about the cost of insurance on their cars that are newer than mine. Perhaps they are not aware of the geek option? Perhaps there should be reality TV shows called Real Lives of the Solvent?

Observation #3: We have had this national identity of self-reliance, rugged individualism, and free will. But we gotta be realistic. If someone throws themselves on the mercy of the collective, the collective has the right to set some boundaries. I seem to have some hazy recollection of a proposal to require welfare recipients use birth control; there was backlash that this was infringing on their free will. OH COME ON!! If you someone tells the collective "I can not manage my life right now" then they're lucky if the collective offers to step in and manage it for them. Lucky, I say!! If your decisions thus far have gotten you into this situation, maybe you need a break from making decisions. So yeah, pee in this cup.

Hmmm. I'm not sure if I'm becoming a Libertarian or a Communist....

Still paying for his/our sins...

2010-05-29T22:55:00.000-07:00

So Nixon really did get rid of the line item veto...

All I can say is "WHAT A FU"(!)ING !)!0T@#!!!&(!!!"

Nixon permitted the repeal of a functional line item veto used since the time of Thomas Jefferson.

... Of course you could argue (and I would agree) that we voters really did it to ourselves in our overzealous wish to "throw all the bums out". E.g "down with imperial power" and all, etc...

By the way, take a closer look at when US Federal debt really did start to take off in earnest lest you think there might be no correlations:

The first rapid uptick in federal debt started in 1973-74, right when impoundment was eliminated. And while it is true that federal debt briefly dropped (a little) in 1977-78, I think we all see this drop was both small and brief.

OK, my first short health care thoughts

2010-05-29T20:18:00.000-07:00

So here is my first line of thinking...

A little background for those with their head in the sand: municipalities nationwide are approaching bankruptcy.

Nuff background.

And while it is true that spending is spending and therefore ANY spending cuts will help a budget crisis, still I chose to believe that high value spending is not at as great a risk as low value spending. This is my first model assumption.

... For all my cynicism, I truly think it is rare to meet someone who is evil. Selfish people are rather common, evil ones are truly rare.

So with my first assumption, we also know firefighters and in particular EMS represent one of the larger budgetary items in any municipality's budget. Indeed in my own county, EMS spending (which is 85% salaries) has increased almost 100% over the last 8 years while staffing has only increased by about a third (you can guess where the money went).

Well what if I told you there was almost zero evidence that paramedics improve outcomes?

In truth I am over stating my case (a little) as there are a few things that paramedics do which have been shown to improve outcomes (but only a few).

Don't believe me?

Think I'm being "sensational"?

Take a look at the keynote address at their own 2010 Gathering of Eagles Conference. Look at the data yourself.

So I ask again (municipalities are in desperate need of cash, they are spending lots of it on EMS, they are getting very little bang for the buck, etc...): "what would you do?"

PS- To top it all off, most administrative energy in EMS (which is actually quite a few resources) are centered around whether people follow process.

Let me repeat this again so it sinks in: follow process on procedures that add little or no value.

I kid you not.

It matters not whether what is done improves outcomes, it only matters whether process was followed.

You can kill the patient as long as you used the correct procedure. ;-)

Indeed, as I think on what has happened in the world of EMS, perhaps the best financial industry analogy I can think of is the synthetic CDOs on CDSs on sub-prime mortgage backed bonds. The underlying bonds themselves may be worthless (like a lot of EMS procedures) but the energy is focused on the overlying structure of process that rests atop the worthless processes and procedures (like a synthetic CDOs made from worthless CDS on top of worthless bonds, etc...).

You can't make this stuff up.

I will start looking at who supplies EMS when I get some free time. ;-)

PPS- For all my views on America's health care bubble, do not misunderstand me either. I truly think most of the men and women in EMS are heroes. I truly think they do want to help people (whatever else may be going on with their unions, pensions, etc...). I simply also think they can't (though sometimes they do) and that their inability to help is no fault of their own. But no matter how much water you put in your gas tank it will not run your car, so too will throwing money at EMS not help the underlying problem it is trying to solve. Good people get caught up in bubbles along with everyone else.

Is it any wonder our economy is a mess?

2010-05-29T05:14:00.000-07:00

I'm sure I do not need to remind any of you of what has happened to basic science in the US?

The drop in both % American high school students entering sciences as well as the drop in their absolute numbers is well documented. I just want to add that in 2008, America spent $140 billion in basic science R&D, just under 42% was non-defense.

And I do hope you put $142 billion into perspective, it is estimated that the American diet industry alone is between $40 and $100 billion. Marijuana alone is $120 billion a year market.

Clearly we have priorities we must keep.

... Next time you read about how it was either Clinton or Regan or Bush or Obama who got the country going again with either tax cuts, or universal health care, or it was the bankers, etc... or some other such policy win:

I think this graph makes quite clear that GDP growth has been dropping for quite some time despite fiscal gimmicks.

Bubble bubble toil and trouble...

2010-05-28T20:30:00.000-07:00

Blame the heterosexuals...

2010-05-28T14:03:00.000-07:00

Moral of the story, it's time to:

A. Change median American sexual mores.

B. Abort female fetuses.

C. Reduce female fertility.

D. License womens' ability to bear children and selectively re-bestow this right amongst them.

Strategic dilemmas

2010-05-28T10:51:00.000-07:00

What to do? What to do?

H/T- Tyler Cowen

Another one bites the dust...

2010-05-28T10:22:00.000-07:00

And so I'm guessing you all saw this?

PS- I think I have chosen my tools to hedge the coming collapse of the health care bubble: LEAPS and (of course) puts. I have a bunch of work ahead of me back testing certain stock prices and LEAP prices/put prices against major recent medicare votes. I'll let you know.

Why JS Mill Matters

2010-05-26T16:15:00.000-07:00

Thanks to Dink for inspiring me to post on my hero John Stewart Mill. I will not attempt a Wiki redux for this great man but simply make a few comments about why his writing matters so much to me and has to many at least in theory.
I actually came across "On Liberty" for the first time when my work as a psychiatrist compelled me to involuntarily detain pts created what we in this business call "cognitive dissonance". (I hated my work) One argument that Mill develops further than any previous philosopher is the harm principle. The harm principle holds that each individual has the right to act as he wants, so long as these actions do not harm others. If the action is self-regarding, that is, if it only directly affects the person undertaking the action, then society has no right to intervene, even if it feels the actor is harming himself. This is an extremely complex idea and I cannot do it justice in this post but after 20 years of watching Govt. make attempts at trying to coerce people into certain behaviors and spending huge sums of money in the attempt, I have come to the conclusion it is a massive failure on almost every conceivable level. i.e. "The Drug War"

As seminal a work and as influential in political philosophy as "On Liberty" has been, Mill's work "A System of Logic" is perhaps equally as impressive. In it he formulated highly influential principles of inductive reasoning which outlined the basic tenant of science: To unify disparate theories to explain the widest possible range of observations with the simplest of explanatory models. The more I study the history of physics the more I find how influential Mills work was to 19th and 20th century scientific philosophy.

"On Liberty" is on my shelf with a few other treasures I consider to be the most critical works I have ever come across. Sadly, I think it's concepts are as alien to most now as the day it was written.

JS Mill

Externality quote of the day...

2010-05-26T04:55:00.000-07:00

"I’m no prude but it’s probably not the safest idea in the world to have a mobile strip club distracting drivers."

- B.S. Report

Yuck

2010-05-26T04:25:00.000-07:00

Plugging oil leaks, Russian style

2010-05-26T04:03:00.000-07:00

I guess this is one approach.

... To think Russia tried this 5 times.

Oy vay!

Are we "the mark"?

2010-05-25T18:15:00.000-07:00

Pick a bar, any bar...

Interesting piece on gold in Salon.

So here is my question to you, as we should always be honest with ourselves as much as possible:"are you and I are 'the mark' in a global game of Three Card Monte played by TPTB?"

Think about it

Get those Guillotines ready!

2010-05-25T14:45:00.000-07:00

Let them eat cake!!

Along the quest to find the BEC in my head...

2010-05-25T06:58:00.000-07:00

A delightful gentleman suggested I take look at this. ;-)

Be well

It's bad enough that Rush Limbaugh is our distant cousin...

2010-05-24T18:40:00.000-07:00

But now we are literally distant cousins of the slime mold??????

... I'm just saying that some cooperation is going to be a bit tougher than others.

Finally!! I have been wondering this forever.

2010-05-24T17:15:00.001-07:00

It's about time!

I mean how long have we been waiting for evidence of this????

... It wonderful when fact and theory come together.

Yet more evidence we live in a fractal world and that the singularity is coming. ;-)

War is fractal

2010-05-24T16:53:00.000-07:00

Health Care Bubble Ideas

2010-05-24T09:31:00.000-07:00

I'm going to start research into the subject of value in health care spending (a moral minefield if ever one existed which actually makes it rather interesting to me). In particular, I'm going to start looking at where I think some of the lowest value spending resides in health care and what public companies/bonds currently exist in these spaces and what/how they are supported by this low value spending.

I'm simply curious to know if any of you have ever had any thoughts on this subject.

For just like everything else, health spending value is non-linear. Some is low value and some is high. And just as low value sub-prime was the first part of the housing system to blow wide open, so too will low value products and services be eliminated in the health care shake out.

Please share any and all thoughts.

PS- One of the nicer things about the internet is how much of the work others have already done for you. ;-)

(This is an Excel file from UK's NHS NICE Website which says where they think the low hanging fruit lie)

Do you agree?

2010-05-23T19:15:00.001-07:00

Thoughts

Why the fractal nature of health care will doom health reform

2010-05-21T05:11:00.000-07:00

Health care spending is fractal; I won't belabor this point further.

I didn't always think this way, but as I spent more time in "the numbers" of health care and health care finance, this "fact" has became pretty obvious.

My group staffs 5 different emergency departments within a 125 mile radius which means the two furthest facilities are about 250 miles apart.

250 miles may not seem all that far but it in the world of medicine, it is worlds apart. So while a casual observer might think "they're just emergency departments", e.g. plain vanilla, let me add there is actually a world of difference between various vanillas. Or as a friend of mine who runs two emergency departments in Waco Texas likes to often say "all medicine is local".

Each of our department is unique. Not only are the communities and therefore the patients very different, so too are the facilities' staff, the facilities' capabilities,etc... I mean unique.

And as a medical bean counter for my group, where even my own natural tendency is to make everything "process, process, process", this uniqueness poses particular challenges to policy wonks. I can attest.

With that background in mind, reading Maggie Mahar today will make you smile.

Looks like the policy wonks are catching on to the fact that there are a few more levels to the fractal after all. Not only is the doctor the problem, now it's the region's doctors and how they cooperate with each other. Now its the patients.

... I wonder what they would find if they lumped clusters of regions together as well? Would these differ? You know my own view. ;-)

-"We have met the enemy and he is us."

All I can repeat is "all medicine is local" and we docs have know this for a very long time. Changing one person's behavior (like your own when you want to loose a few pounds) is hard enough. Changing entire communities' behavior is something entirely different. Having personally been down this very road many times (and I am only talking about 5 hospitals 250 miles apart where I know all the providers by first name), I can verify that it is really really really hard changing groups of people.

Here is an example: if people would stop shooting each other, this would save a boat load of money. So why not change this behavior?

Yet somehow they wonks think they can change the health provider behavior of entire regions of the country?

Will they use money to change behavior?

Oooohhhh, money! In our evil "money driven medicine" culture? (Sorry, I had to get that dig in, Maggie can be... I'll let it go) Now we will use the root of all evil to solve "their" problem?

PhD policy wonks are so good at seeing the interchangeable nature of people within their own models. I only wish they would cooperate with a few MBAs so they could see that people are not always as interchangeable as they often would like them to be.

Perhaps the military term that comes to mind to best predict what will happen is "fragging".

... And by saying this I most certainly do not want to imply in any way that I will personally "frag" policy wonks in their attempts to change collective behavior. Indeed far from it, I actually really do support their general goals and will try my darnedest to help them out.

But do I think it will work?

Do I think they will change enough people on a regional basis to change regional differences?

I might again ask if we are still shooting each other? Do we still use plenty of drugs as a society?

Are there regional differences in these behaviors? ;-)

I will be very interested to see if the people of New York or Miami will truly be willing to change their own collective attitudes towards uncertainty. Will they become as comfortable as someone from Minnesota with statement from their doctors like: "yes, you might have heart disease but what are we really going to do about it anyway so don't go looking for something that isn't a problem. If you do, you'll save someone else money."

... Indeed in a kind of twisted version of this logic, why not get rid of screening all together? ;-)

All I can say is that Gallipoli comes to mind. (start at 5:35)

I do not think policy wonks see how providers will frag them on this issue which is a shame. Providers are not their enemies.

Think about your own family, what you would be willing to hear a physician tell you and then tell me what you think?

... Or maybe if the physician tells you a different way. After all, physicians do not really serve you, physicians serve the collective. We all know this. ;-)

Terrific Disorder?

2010-05-20T19:50:00.000-07:00

This billboard started showing up in Akron recently. I am deeply confused by it. What exactly are we supposed to think about this disorder? I cannot imagine seeing a billboard selling an upside to necrotizing fasciitis. Who is paying for these and what are they trying to accomplish and how are we to understand it given the billboard on the left which I have also seen in the area?

Why don't we do more of this?

2010-05-20T19:30:00.000-07:00

No one wants to admit it but we really need more of this...

2010-05-20T19:25:00.000-07:00

From Tyler Cowen's: "much cheaper, almost as good".

If something does 80% of what is needed for only 20% of the price, there would be a great many situations where this absolutely makes sense.

Of course this kind of thinking is currently illegal in this country as it runs contrary to the concept of "standard of care" (unless we modify this concept) and if it were pursued by a physician, (s)he would loose their license.

When will we grow up?

Well, we finally did it...

2010-05-20T12:47:00.001-07:00

Unleash the philosophical dogs of war, the day has finally come.

PS- I'm in the "and this is a good thing" camp but I see there is going to be a firestorm.

It is what it is

PPS- JP, any thoughts on patent issues you care to share?

Wouldn't you just love one for your backyard?

2010-05-19T19:47:00.001-07:00

PS- I don't think they could do this without fractals ;-)

Saying "thanks" to the Flying Spaghetti Monster...

2010-05-19T18:29:00.000-07:00

Sometimes we must stop and truly say "thanks".

Trying to be a good dad, a few years ago I went in with a couple of buddies and purchased Washington Wizards season tickets. The Wizards are no LA Lakers but the games are fun and the team was improving (a few years ago). Then this past season, Gilbert Arenas decides to go all postal on his fans: talk about your Black Swans!!!.

All I can say is "it was a very long season" this past winter. Arenas literally destroyed the team.

PS- a buddy of mine is their chief legal council (he negotiates all the trades) and the stories I could share but won't...

Let's just say the Wizards were in rebuilding mode this year. Watching JP's Miami Heat spank us was simply beyond truly painful.

Last night everything changed as the Flying Spaghetti Monster decided to touch us with his appendage and bestow THE NUMBER ONE DRAFT PICK!

Now I'm not saying I know they will pick John Wall as I really don't know and my friend won't say.

But if they don't, I'm not sure that I'm renewing my season tickets this year as they are no longer worthy of my attentions being such FU(#@!!NG MORONS!!!!!

Here is hoping they don't do something stupid; you can lead a horse to water but you can't make it drink.

And crazies say immigrants are the problem?????

2010-05-19T18:09:00.000-07:00

Clearly someone we all wanted on our team.

On this issue Krugman can go FU(&$!! himself as he worries about who is entitled to what benefit which he and his buddies get to control delivery of.

This is really sad...

Bummer, Kramer's on board. It looks like gold has peaked.

2010-05-19T06:12:00.000-07:00

I hope you all have really secure mattresses.

How many times do we have to go throught this!!!!!

2010-05-18T20:51:00.001-07:00

Sorry if you read this post John as I know this is day 1 medical school. Please feel free to skip this post. It's just that this issue drives me nuts as I continue to read these misleading media reports and am dumbfounded that readers still haven't woken up to basic issues concerning statistics. I already discussed the issue of study power here when I spoke about tPA in stroke- nuff said. Yet here we go again.

OK, with that in mind, I'm sure you have all read about the latest on cell phones and brain cancer. All I can ask is "was it P.T. Barnum that said 'there's a sucker born every minute and none of them ever die?'"

Just read the very first sentence of the entire article:

"A long-awaited study of cellphone use and brain health has finally been released, but the data are raising more questions than answers."

Long awaited??????

While it is possible that the people running the study were a bunch of bumbling idiots and simply could not execute on the data they had, "long awaited" is medical speak for "It took the researcher a long time to enroll enough patients to be able to even say that they had something to say".

Now this can only mean one of two things:
1. It was hard to find patients to enroll in the study because they are very rare, etc... and therefore hard to find.
2. They enrolled lots of patients in the study but whatever effect they noticed was so small and insignificant that they needed to enroll a very large number of patients before they could even say that they had something to say.

I'll let you decide whether cell phones are rather common and therefore whether it would likely be hard to find people who use them and enroll them in a study.

Let me just share my own personal bias: THERE ARE A TON OF PEOPLE USING CELL PHONES SO ENROLLMENT IS NOT A PROBLEM!!!!!

This leaves only scenario B. Whatever effect they found was small

Now is the effect real? That is another issue entirely. But whether it is real or not, it is not likely very meaningful.

So I'll let you decide for yourself whether it is real and/or whether meaningless to all might still be still meaningful to others, but in the mean time I will personally worry more about bigger problems like whether I'm going to get killed by a drive who is texting while driving, etc...

What do we need to do to get people to understand this relatively simple issue?

Sometimes...

PS- lest you think this issue "unimportant", think again.

Touche!

2010-05-18T16:42:00.000-07:00

I'm not sure you saw this post by David Andolfatto reacting to Ron Paul's comments that the Fed can create money "out of thin air"?

-H/T Economist's view.

Just in case you missed it, it is worth a "touche" chuckle.

If you just want the Cliff Notes money shot:

"But I am missing the point: The Fed has the ability to create money "out of thin air!" Whenever I hear this expression, I chuckle. We all have the power to create debt out of "thin air." When Microsoft creates shares to finance an acquisition, it creates the shares "out of thin air." If you bum a beer from a friend and promise to repay him next week, you create a debt obligation "out of thin air." Ooooo..."out of thin air!"

PS- Do you think Ron Paul has a response? I don't follow Paul closely though I do find he has certain endearing qualities. How can you not admire someone who votes "no" 95% of the time? Predictability can be good.

The dangers of retrospective modeling...

2010-05-18T10:37:00.000-07:00

As an owner of index funds (really ETFs), I am as guilty of drinking the Kool-Aid as everyone else. Alas we all know that reductionist models using inductive reasoning can have their own risk, especially when everyone else seems to be using the same model.

With this thought in mind, Felix Salmon has an interesting piece in Reuters today that is well worth reading (H/T Megan McArdle)

PS- All medicine is retrospective modeling hence the old adage: "Half of what is taught in medical school is wrong, but no one knows which half."

PPS- Any of you see areas where you think inefficiency exists. JP has spoken about "personalized" medicine based on better information and this is a very interesting topic

Social Cohesion As The Ultimate Policy Goal

2010-05-17T22:10:00.000-07:00

H/T 4-Block World

Glen Beck is an Idiot!

2010-05-17T22:07:00.001-07:00

The Daily Show With Jon Stewart

Mon - Thurs 11p / 10c

Back in Black - Glenn Beck's Nazi Tourette's

www.thedailyshow.com

Daily Show Full Episodes

Political Humor

Tea Party

She Won't Float But She'll Feed the Hungry

2010-05-16T16:33:00.000-07:00

Ok. Thai got his boat post. This is mine.Just finished the stone work although I have been honing my skills with the oven since last fall. Pizza wood fired with cherry and hickory. My dough proofs all day. The best San Marzano Tomatoes charred topped with fresh basil and mozzarella. The crust is crisp and light as air with a perfect chewy texture. The wood gives it all a hint of smokiness. If you were all close I would make you some pies.

Thought for the weekend

2010-05-15T19:48:00.001-07:00

So all this chat on non-zero sum/zero sum has me thinking about a phenomena I'm sure you have noticed as well...

Is there a relationship between zero-sum and the particular attraction people have towards the idea that Jesus Christ died for your sins?

How often do you hear "he died for you"?

I can't be alone in this experience.

All thoughts appreciated

So now I'm not such a fool after all?

2010-05-15T12:46:00.000-07:00

It may not be a full on "pop", but it sounds at least like a little hiss to me.

This is the way the world ends
This is the way the world ends
This is the way the world ends
Not with a bang but a whimper.

-- T.S. Elliot

Curse those doctors!!!

2010-05-15T11:38:00.000-07:00

Looks like many of us chose to practice in the wrong country!

So I need to make $2,000,000/year to finally get a small break!?#@!?

2010-05-15T06:27:00.000-07:00

Sheeze,

Let's hope nationalized medicine comes quick as I'm getting a little weary and baby needs news shoes. ;-)

My question for ANY of you (as I don't know the answer)...

2010-05-14T20:04:00.000-07:00

Are there any other scenarios where you can see non-zero sum cooperative economics without:

A. Creating an externality that exactly equals the non-zero sum gain?

i.e. (non-zero sum gain) + (externality created) = 0

B. Increasing the risk of an individual who cooperates with another person(s) to benefit from non-zero sum economics such that the increased risk of no gain + loss of energy put into the cooperative failure exactly offsets the non-zero-sum gain?

i.e (non-zero sum gain)(probability of cooperation succeeding) + (loss from non-zero sum failing)*(probability of cooperation succeeding) = 0

Both of these examples should probably be thought of as non-linear integrals but the single instances I have highlighted have exemplified the problem well enough

Is this a kind of universal law for all economics? The equivalent of saying "there is no free lunch" for all of cooperation? Or am I missing something?

I don't really know what it is as I can't think of an example so any comments/thoughts would be greatly appreciated.

PS- It is kind of depressing if true

This is why they call it the dismal science

2010-05-14T19:49:00.001-07:00

... Another piece for the "not quite sure where to file this" file.

People have too much time on their hands (and I read too much)

Interesting Automatic Earth Post Today

2010-05-14T19:33:00.000-07:00

In case you are interested

Have a great weekend

The more things change, the more they stay the same

2010-05-14T19:21:00.000-07:00

Try practicing a little perspectives flipping. ;-)

When we don't coopeate...

2010-05-14T15:39:00.000-07:00

This is what happens.

As a 4th generation Californian, I'm simply astonished.

My heart goes out to everyone, including The Governator

This is really sad

Defending the undefendable

2010-05-13T16:02:00.000-07:00

Now let me add up front that I certainly do not think of myself as a spokesperson for the Pharmaceutical industry- not that my self image is worth anything. Further, in the interest of complete financial disclosure, my 401k has a total stock market index fund so I guess you could say I have pharmaceutical investments. Again, I have never thought of my index funds in this manner, but this conflict of interest should be highlighted up front.

That embarrassment off my chest, I want to comment on this rather tiring attack on one of the more ugly of the uglies in our world today. We all know them: Big pharm.

They are bad.

Let me further get out of the way that I'll answer "yes" to any and all questions you may have regarding their sleazy sales practices. As I think on this, the makers of Invanz brought the entire emergency department sandwiches from Panera Bread the other day and handed many of us all their plastic logo pens (I think I still have one in a bag somewhere). I ate my entire sandwich.

My bad

That embarrassment off my chest, I want to address a common wisdom known as "do not use an expensive drug when a cheaper alternative is available".

For just like in the last post, where I said: "the sum of the parts equals the whole, yet when you only look at a single part you can easily miss the whole", do any of you see the problem this kind of logic misses?

... I'll admit, it is subtle and easily overlooked. That said, it is not insignificant either.

Hint:

1. Life is lived forwards but understood backwards
2. Price is not the same as cost of production

Paul Says "No"

2010-05-13T15:56:00.000-07:00

Krugman has an interesting piece on Greece. Long story short, he thinks the parallels are over blown.

It looks like the health bubble has a few years left.

Be careful what you wish for...

2010-05-13T14:58:00.000-07:00

Being a hospital based specialist, I'm always interested in stories like this. And for the record, I really don't have a problem with this kind of approach. But in the classic spirit of "the sum of the parts equals the whole, yet when you only look at a single part you can also easily miss the whole", do any of you see the obvious problem with this bill?

And while I wouldn't really have any issues if such a proposal came from a Republican- there would be a certain consistency to the proposal- it is interesting such a bill comes from a Democrat. I suspect he does not understand health care very well though I freely admit I could be wrong.

Hint: we live in a non-linear world

PS- John, don't spill the beans too soon ;-)

What a Waste.

2010-05-13T12:57:00.000-07:00

I wish we had this money and the last 40 years we wasted on this back

Sometime I just love Tyler Cowen

2010-05-13T07:20:00.000-07:00

More assaults on national sovereignty ;-)

2010-05-13T05:48:00.000-07:00

Well worth reading

2010-05-12T16:54:00.000-07:00

Fascinating Hypothesis by Dani Rodrik I came across on Mankiw's blog

I highly recommend it

A Nightmare on Wall Street

2010-05-12T03:50:00.000-07:00

The Daily Show With Jon Stewart

Mon - Thurs 11p / 10c

A Nightmare on Wall Street

www.thedailyshow.com

Daily Show Full Episodes

Political Humor

Tea Party

H/T Calculated Risk

Keeping things in perspective

2010-05-11T20:51:00.001-07:00

PS- I still think it's the dentist's fault

TED didn't come down

2010-05-10T17:29:00.000-07:00

Look for yourself

A demon of our own design

2010-05-10T06:02:00.000-07:00

H/T Greg Manikw

All the "other" things I like are only 23%!

I think everyone needs to stare in awe at a 12th Sigma event

2010-05-10T05:36:00.000-07:00

Even in this time of everyday turbulence, sometime I simply must stop to smell the roses for a few minutes. A 12th sigma event is one of those times.

Why we think we can tame a hurricanes is beyond me?

So the ECB is buying bonds and Europe went overdrive with the STOXX 50 up almost 9%, the Euro back above 1.29, gold down a bit and oil following with a lackluster 3.5%.

Of course one must ask: where does this money come from?

Now if any of you can explain this last last link to me I would be most grateful. Trying to understand when things are QE and when they are not can be most maddening.

... And of course you could have predicted Jesse's take of all this.

Krugman can be so darn helpful at times... I may not always share his values but I'm very fond of him and I do think one day we minions of the blogoshere should bestow on Paul (and a few others, like Jesse) honorary "thank you" degrees or something.

PS- Interesting older Yves piece on Naked Capitalism for the fractalholics amongst us.

Health care has definitely been bubbling for 40+ years now ;-)

Can you derive Ought from Is?

2010-05-08T14:35:00.000-07:00

Sean Carroll says nonsense

More "Have we lost our marbels?" links

2010-05-07T05:35:00.000-07:00

Salaries

Benefits

And the real SOS screaming emergency in all of this: now they are outpacing professionals... Them's fighting words! ;-)

Anyone care to guess what percentage of GDP consumption total public spending now constitutes here in the US?

PS- While I totally support this, I don't think it will make much of a difference anymore. What percentage of public consumption goes to things that politicians can actually touch?

PPS- Another fractal fanatic

"The more things change, the more they stay the same" ;-)

PPPS- Now this one really pisses me off! I had no idea. Did any of you?

Krugman thinks Greece will withdraw from the Euro anyway

2010-05-06T20:17:00.000-07:00

The fact he even thinks it means others are thinking it too...

The first rule of disasters is don't panic.

The second rule of disasters is if you are going to panic, you better be the first to do so.

Britain is not in much better shape and with a public sector that now accounts for more than 52% GDP, Britain has issues.

This is quite interesting in light of the following report from the UK's own NHS, health access disparities have significantly increased in the UK despite equality being a primary goal of the NHS.

So what will happen to US banks?

Have they sufficiently looted the US Treasury to withstand a collapse of US treasury funding?

I guess the better question to ask is: where are the stable war-chests?

This is getting scary. Maybe Edwardo is correct and we should all keep some physical bullion in a can at home.

... My wife will never agree to this btw.

Symmetry and Spontaneous Symmetry Breaking

2010-05-06T05:42:00.001-07:00

Artistic Merit

2010-05-04T22:02:00.000-07:00

Might I suggest some Netflix choices?

Visually stunning, The Fall offers art without too much art geek obnoxiousness.

Kind of a Russian thriller with a style a la Matrix, Nightwatch and its sequel Daywatch. I didn't invest too much into following the supernatural plot, but I still enjoyed.

Mongol was made by a Russian director using mainly locals for the cast. I can't speak for historical accuracy, but being Genghis Khan didn't look all that fun.

And for equal parts martial arts and plain art, Hero (English Title) was worth the time.

For Dr John: the problem of prediction

2010-05-03T20:16:00.002-07:00

As I said, we can't :-(

Another one for Okie

2010-05-03T19:53:00.000-07:00

A great website to explore.

And this is really a great video series shamelessly lifted from their site:

Be well

Yet another practical use for fractals

2010-05-03T18:22:00.001-07:00

Think of the mischief you can do with this.

Harry Potter, watch out

You simply gotta love anything named "metamaterials"

PS- this one is for Okie

... I said I'd share with Okie how quarks are fractal and thought an actual image might make the point best of all. But then I realized I'm not sure there are any images of quarks- this is the most microscopic actual fractal image I could find. If any of you ever come across any actual images of quarks, please share.

For Budding Fractalists

2010-05-03T18:12:00.000-07:00

This is a great website to share with your little ones to start the addiction at an early age.

Never too young to get the little ones hooked. ;-)

Oil Spills

2010-05-03T17:15:00.000-07:00

Here is a very interesting Nature article from 2008 on the issue of oil spills.

I'm always interested in reading these from the perspective of prediction. Prediction accuracy is a very real issue to all of us as I'm sure we can all agree.

FWIW, I had no idea 160,000 tons of hydrocarbons were released from the sea floor annually. It does make sense.

"That is more than 53 times the total for offshore extraction and about 4.5 times as much petroleum as was released when the Exxon Valdez tanker ran aground in Alaska in 1989. That said, the natural sources are far more diffuse and thus not necessarily as disruptive as concentrated slicks."

Here are also some images from NASA's JPL satellites. They estimate the current spill releases 5000 barrels/day though I have read reports the number may be much higher.

... FWIW, I never know what to think when I read such reports since I absolutely know such reports can be true and at the same time I also absolutely know the news media makes a living off hype. That old prediction thingy keeps rearing its head.

Also, if you too were having the same conversion troubles I had, 1 metric ton is 7.2 barrels so a 5000 barrel/day spill is approx 694 oil-tons/day.

Finally, here is today's Nature article on the impact.

Sad

The Time Paradox

2010-05-02T19:33:00.001-07:00

And yet another reason I REALLLYYY hate Rush Limbaugh

2010-05-02T18:13:00.000-07:00

H/T Paul Krugman

Thought of the day

2010-05-02T18:11:00.000-07:00

Unexplainable.

2010-04-29T17:13:00.000-07:00

It is hard to even come up with a reasonable account for such behavior. I would be interested in the thoughts of others as to the opinions offered in the article. I will say the Chinese take little time in handing out punishment. I found it interesting they make mention of all the people in China with "mental health disorders" but in the next paragraph make mention that there was "no history of mental illness" in the executed murderer. Why even mention "mental health disorders"?What horror.

Not really sure which file to classify this one in...

2010-04-28T20:10:00.000-07:00

Don't you just love Virginians?

I generally find them polite (if not a bit wild as drivers). But now I can thank them for even more job security just as I was beginning to get anxious.

Sometimes I simply have to scratch my head in wonder at how we ever made it beyond tadpole as a species.

Though to be fair, regional variation in genetic differences are a reality. Perhaps Virginia politicians simply have a few extra copies of this residing their cellular nuclei.

I guess it could explain things.

Maybe it will work out for the best if Virginian's form a pay as you go fund which pays for this (Keynesian stimulus package?) with more casinos? ;-)