health care issues

Today we read in the NY Times, "Mammologists wanted" that delayed diagnosis of breast cancer is the most common and second most costly claim against American doctors. And therein lies a big problem. First of all, I disagree with the consensus that early diagnosis improves survival in breast cancer (or almost any cancer for that matter). Although it sounds plausible enough, this idea is based on a faulty hypothesis about the way cancer develops, spreads and kills. It is also caused by warped statistics and the fact that we do not know the natural history of malignant looking lesions.

So here is the first issue. American doctors, eager to help patients, and esp. militant patients as one finds in breast cancer, have popularized the notion that early detection is key. That it saves lives. Several agencies and scientific bodies have lent credibility to this nonsense and it is now generally accepted that early detection is necessary.

The second issue is even more daunting. And once again it rests on a faulty assumption. And that assumption is that cancer grows locally until it hits a certain size, at which point it will start spreading. But many cancers do not evolve that way. In many cases, finding the early lesion is not trivial. But it is rather easy to go back (hindsight is 20/20 as they say) and "find" the earlier lesion that -now by definition- someone must have "overlooked." I.e. a vague shadow may not be identifiable when you look but when you come back months later and know it is there, well that is a different story. Now that you know the right answer, interpretation is easy.

Can you see where this is going? We treat too many people who then survive, but would have survived anyways. These people add to the statistics and make it more plausible that we should think early detection is key. Now lots of women whose cancers are found "late" start complaining that their lesions were overlooked and go see "legal help." Enter the lawyers, another highly paid profession that has no business in medicine or healthcare. Someone has to pay these lawyers, and the exorbitant fees they charge and the even more ridiculous and exorbitant "settlements" they get.

Once the lawyers are in, the docs start practicing more "defensive medicine," doing even more tests and more procedures so as to make sure nobody can come after them later. Before you know it the whole system is dangerously and expensively out of whack. Ironically enough nobody benefits from this, certainly not the patients. Many more of them suffer complications, while others are told they have "cancer" and need expensive treatment and lots of anxiety for lesions that would regress naturally if left alone. These people not only suffer tremendous mental anguish, they also undergo needless chemo -and some die or get very ill- and they no longer qualify for most healthcare after that. Not to mention all the extra economic hardship they suffer.

And who pays for all this? Your healthcare system. Your premiums.
You pay for unnecessary treatment, for longer than necessary treatment, for high malpractice insurance fees, for experts and more experts to read and re-read xrays, etc. etc.

And what does it buy you? Has survival improved? Except for a few cases, it hasn't. If you include the iatrogenic morbidity the end result is probably zero. That is the long and short of it.

ronnie

As every schoolchild in America knows, Ronald Reagan defeated communism. His innovative policies also caused the current financial crisis but that is another matter. Let's stay positive for now and focus on the good parts of this story. Ronnie is after all one of our most beloved Presidents and he is the one President all Republicans aspire to equal-surely none would dream to surpass him as that is impossible. No doubt many Republican faithful lie awake at night wondering what has happened to their country and hoping for a second coming of their Messiah. Ronnie is as enduring a hero of capitalism as his famous namesake Ronald McDonald. Both stand for everything that is right in this country.

It is hard to sack nice people, no matter how badly they mess up. That is the advice I was once given by a senior executive when faced with having to let go of a person who was universally loved but incompetent. Nice guys just smile at you and make you forget everything else. And that is the problem when dealing with Ronnie. Who could forget his infectious grandfatherly smile? Not even the Berkeley students of the sixties who faced a much more grimacing governor. What better icon to have than a smiling superhero who defeated the most evil of economic systems and showed once and for all that communism is an abject failure.

Unfortunately, Ronnie is long dead and buried but communism is alive and well. The People's Republic of China just celebrated its 60th anniversary on October 1. And China is not just any communism. China's brand is seen by many as the quintessential and purest form of communism. The vile economic system that leads to poverty and despair. But we better stop here lest we upset our Chinese friends who now hold so much of our debt. Growing at double digit rates, theirs is an economy that keeps many in the West awake and drooling. China of all places appears to be the only big nation on the planet to have weathered the current economic downturn. A recession so big it evoked memories of the Great Depression. But weathering is putting it mildly. The Chinese economy is still growing.

So it is perhaps appropriate to revisit an old cliche:
Ronnie: Communism is dead
Communism: Ronnie is dead.

green navy

The Navy is now running ads touting how green it is. Well, there you have it, if the Navy can do it so can you. And I mean that very literally. Because unless you are a multi-national corporation with obvious disregard for the environment -an oil company for example- chances are you already are a few orders of magnitude greener than the Navy. So why not tell everyone about it?

I am sure many will take this message to heart and sign up for the Navy so they can help the environment. People signing up for the military tend to have a weak spot for protecting our natural resources. But they also contribute in other ways.

The Navy kills people, which does help with the overpopulation issues, and hence does contribute to less pollution. Unfortunately, they tend to do so in a very wasteful manner. They also preferentially kill people from third world countries so sadly the net balance is not in their favor. People in third world countries just don't have the means to cause much pollution over their lifetimes. And last but not least, even though the Navy has an impressive kill record, the numbers just don't add up. There are just too many people on the planet for them to have an impact that matters. But perhaps the new sonar will help kill enough wales to make up for it?

It appears the Navy is also trying to support proponents of nuclear energy. Their angel of good tidings is a woman nuclear engineer. That is a sweet touch. The Navy of course has a lot riding -or shall we say sailing- on nuclear energy. Its aircraft carriers, warships and submarines are powered by nuclear reactors. And the Navy is also a proud tester of nuclear weapons. Those of you not born yesterday, probably heard of Bikini Atoll, a true testament to environmental stewardship.

There, under the banner of operation Crossroads, the Navy managed to demonstrate its green thumb in way that was hard to beat. Even if you never heard of it, chances are you saw a picture of the famous Baker shot. It was a test like no other. Here is one radioactive fish, courtesy of Baker, that the Navy may want to use to light up their future green commercials.

good for your health

A story posted on CNN today confirms what I have been saying all along. Recessions are good for you. You smoke less, eat less, eat out less, and drive less. Add in less shopping and more exercise and you can see why we all need a recession. Given the current wave of obesity, make that a long recession. Nothing will do more for public health than a severe reduction in consumption.

The recession has other beneficial effects as well: it decreases air pollution and the production of greenhouse gases. It slows global warming. There is less traffic and less cargo being shipped around. We decrease ocean pollution. All those things are good for the planet (which really means our habitat on the planet, because the planet itself does not really care) and ourselves. Another good thing is that people rein in their reproduction and that helps with overpopulation.

It appears that even the increased stress from losing one's job, or worries about providing food and shelter for one's family is rather insignificant compared to the gains we make elsewhere. Remember, there is no free lunch, ever. And to stay on theme: suicides do increase during recessions and depressions, but that effect is so small as to be negligible.

If anything, the research confirms how flawed, misguided and unhealthy our economic model really is. Rather than bring good things to us -isn't that the way we think about a thriving economy? That it is good for us?- a thriving economy cuts down on our life-expectancy, both as individuals, and as a species on this planet.

No, you are not better off when you have a bigger house, a bigger SUV, a bigger TV, and a bigger stereo. You are not better off when you can buy all the soda and food you like. You are not better off when you can travel to faraway places. Those things don't make you healthier or happier. All that talk about health and happiness is just false advertising and it is about time that someone cracks down on it.

You will not feel better if you eat out. You will just get fatter and fatter. You will not be better off if have a faster car. Quite to the contrary, you may feel frustrated more often in the inevitable traffic jams. You will not be healthier if you have a bigger house. You will just have a bigger headache to worry about and you will have to yell louder to find your family members. You will not feel better if you take long hot showers, you are drying out your skin and may contract a deadly lung infection. The list goes on and on.

boycott ebay

Meg Whitman wants to take California back to the stone age. These aren't my words. These are the words of a Republican governor by the name of Arnold Schwarzenegger. And he is right. Why on earthy would Meg want to overturn the few environmental regulations we have? To create new jobs? You got to be kidding? Destroying the environment cannot bring long lasting value-creating jobs. It is always a stopgap measure.

Meg is not kidding however. She wants to use her "own" money, up to $100 million of it, to roll back the times. That $100 million is money she "earned" as founder and CEO of eBay. It is money, we the people put in her pocket and now she is going to use it against us. I say we teach her a lesson. And it will be a win-win.

eBay has long since stopped being a place for good bargains. I routinely find better deals running a Google search. And Google is better in more ways that one. They ignore spaces and other variants of spelling to get you the information you need. No surprise there, Google is not for nothing the best search engine on the web. And unlike Bing, it lets you make your own decisions.

I sure hope the people of California are smart enough not to support an environmental disaster like Meg Whitman. And I also hope they teach her a lesson by taking back some of that money they pumped into eBay. She doesn't deserve it.

so you thought it was over?

It amazes me how easily people give in to wishful thinking or are swayed by a bit of summer optimism. There are those who seriously believed the recession was over. You could add the White House, the Fed and some associated economists, but of course one does not know whether those guys really believed it (I hope not) or whether they were just doing what they are paid to do, i.e. be super-optimistic and give rosy forecasts.

In any case, even my friend Krugman seems convinced we have averted disaster. And that may well be true, we may have averted a sudden collapse of the financial system with all the havoc that would produce. However that does not mean we are out of the woods. Far from it. For several decades now Americans have lived as if there were no tomorrow. They have outspent themselves and accumulated debt. More than half of the households in the country have zero net worth. All of that in an economy that depends on consumer spending for 3/4's of its value. It is not something you can remedy in a few months, or even a few years.

There is a silver lining to all this. I already noted that greenhouse gas production -as well as habitat destruction- is dropping. That is good. People are also consuming less. That is good too, even though it will cause more hardship in the short run. Hopefully it will cause enough hardship so we make some changes to our economic system. And that is what worries me the most. Change is always hard and changing this economic system will be super, super hard to do. To be honest, I hope it will happen, but I am almost certain it won't.

It may be impossible to change the current economic system unless the US collapses or revolution ensues. That is the lesson we learn from history. No matter how much trouble a country is in, and or how many people rebel, the rich tend to get richer and the poor poorer until the latter are so downtrodden and destitute and so numerous that a revolution is inevitable. We are a long way from that scenario.

The other option, a loss of economic driving force, the disappearance of the engine, resulting in a collapse of the empire, seems far off too. Although the latter is the more likely scenario for the US, it is at least fifty to a hundred years out. Waiting for such an event is not a smart thing to do. We should try to remedy our problems before they run out of control.

So what can we do to change?

The solution is quite simple. We need to learn to live within our means. We need to consume less and we need to focus on our local area when it comes to shopping, production and jobs. We need to stop driving, flying and shipping stuff around so much. We need to remove the non-value creating parts of the economy, the ones that depend on cheap oil and environmental destruction.

Unfortunately that is not what we see happening. Instead people are desperate to keep up their life-style and they revert to shopping at Walmart instead. That is the wrong thing to do. These people are behaving like drug addicts who will settle for a cheaper fix, as long as they get some fix.

What we need to do is do away with chain stores like Walmart that destroy local economies and sell goods below cost. We need to replace them with smaller stores that pay fair wages and sell local goods, not trinkets shipped in from China. That would lead to a revival of local job opportunities and jobs that create real value instead of churning through excesses. We need to disable most of our financial institutions. These guys bring no value whatsoever. Apart from causing regular boom and bust cycles they make everyone poorer on a daily basis by charging fees while creating nothing of value.

We need to let of go of this crazy economic system that just shuttles wealth around instead of creating it.

sick economy

The IEA estimates that greenhouse gases will drop by more than 2% for 2009. About 3/4 of that drop is due to the recession. The anticipated fall is greater than any previously recorded. Something is clearly working when it comes to climate change. We can reduce our economic activity for example.

If the drop proves anything it is how sick our "economy" really is. How it is an economy of consumption and waste. And to think that some people would like to fix it. To what purpose? So we can make the planet uninhabitable sooner rather than later?

Don't get me wrong. Economic activity is good. Humans need a thriving economy. But it has to be an economy that creates long term value. And that is not something our present economy does. Quite to the contrary. We have an economy that is all about slash and burn. It is all about waste and consumption.

Now you may argue, so what it has served us well. But has it? Not unless you are one of the richest 1% in the country. Otherwise your net worth has most likely decreased rather significantly. You may not feel that way (yet) and the constant brain washing in the media will certainly try to make you think otherwise, but the facts are in. Everyone is constantly getting poorer while the richest of the rich get wealthier.

It has also not made you happier. Here too the facts are undeniable. More people than ever are depressed or suffer from stress. It is a stress imposed by trying to keep up with the consumer society. Trying to outdo the neighbors by buying new stuff and spending more money. Companies constantly try to get you to spend money you don't have. It is called credit. And if you indulge in it, it will enslave you forever. It is worse than heroin.

Our economy does two things really well: 1. it destroys our habitat and threatens our long term survival on the planet, and 2. it shifts wealth from the masses into the hands of a very select few. So select that you, the average American citizen, are not one of them. Not by a long shot. You are one of those being robbed blind and you may not even notice it.

So while you may hope for economic recovery because you need a job to pay your bills, you should think about what you are getting yourself into. Because you are not an innocent player. You, with your consumerist habits, are part and parcel of this economy. Your desire to always throw out things and buy new stuff is the "engine" of this economy. And it does not have to be that way! You can easily put a stop to it.

Begin by buying local. Only buy stuff that has value and will last. Get rid of your cars and do some exercise. Throw out your TV. The list of things you can do to help is endless. And guess what? Doing these things will create local jobs. Real jobs that have value because they are worthwhile. Think about that!

Cheap imported stuff is the problem, not the answer. Walmart is not the solution. Walmart is the problem. Walmart is a big machine that serves only one purpose. To make the Walton's richer. And it does so by ripping off the poor. Walmart can sell you stuff below cost, because it does not pay the full cost of what it buys. It does not pay for the waste and pollution it creates. And it uses cheap offshore (read slave) labor to create its widgets. But Walmart is not alone. It is just one of the many corporations that form the core of our sick economy.