Jul

12

I walked out of this man's latest film early. I had already read everything about it, and I was well aware of all of its arguments and positions. Many are valid, but the way in which he goes about making his point in his typical biased and construed fashion is absurd.

Just a few years ago I had an awful, but amazing, life experience living in a New York City hospital for approximately one month. I was literally on a death bed following a high speed collision with a yellow cab while traversing 2nd Avenue as a pedestrian. I was taken to Bellevue Hospital's trauma unit by a city ambulance and though I was unconscious, in time I learned that the facility was filled with victims of stabbings and gunshot wounds, fools suffering from self-induced drug overdoses, and so forth.

The health care I received was top notch. After all, I survived shattered left limbs and fractures to my skull, several bruised and ruptured internal organs, and some serious blows to my brain.

When I finally "came to" several days later - the coma was medically induced and extended to prevent additional swelling to the brain - my immediate thought process was to remain alert and focus on what was surrounding me. If I couldn't move my body (harnessed and tied down to a large degree to promote healing), I was at least going to keep a close watch of everything going on around me. I witnessed top notch health care being provided all over the place. Much of it to those uninsured whom Moore portrays as "victims" of the American medical establishment.

Early in my stay at Bellevue I had two roommates: Mr. D and Mr. N. Both uninsured I later learned. I believe Mr. D was working on a loading dock as a temp for cash money when a truck backed into him, knocking him down with his head landing on a cement block. No other bodily injury. But for all sense of the matter, he was ruined. The lengths to which the nurses would go to get him to focus on things as simple as putting a top on a shoe box, let alone tying a shoe, was incredible. I would watch for five minutes and pass out from my own frustrations for him. When I would wake 20 minutes later, there they would be, working on some similar elementary task with no success. He had been there for months prior to my arrival. Again, no insurance. If there was ever an unknown spirit of New York, this had to be it. But it says something much more (no pun intended).

Mr. N was another story - addiction problems. Again, the attention the nurses gave him when he would wake up in the middle of the night with seizures was incredible.

My time at the Bernard Baruch Rehabilitation physical therapy room was another fantastic experience. Again, the time and commitment the staff gave patients was incredible. Imagine watching someone learn to walk again. It can not be done alone.

The interesting part of my experience and how I challenge several of the filmmaker’s points is what I saw during several of my outpatient visits at Bellevue. I routinely had to go for internal organ scans, leg and arm check-ups, etc. Do not get me wrong, the lines and times spent to receive treatment were extremely long, even frustrating. People in considerable pain and discomfort could sit for hours, but not once did I see someone refused for care. This leads me to my main point: Personal responsibility.

Of all of the cases that I saw over my month stay at Bellevue and the several weeks worth of outpatient visits, almost all of the problems had negligence in some shape or form of an individual's responsibility to take care of his or her self: drug overdose, constipation, obesity, diet-influenced heart problems, etc.

I took a good hard look at what was going on around me, and in a fair estimation, two thirds of the problems came down to an individual's body weight one way or another. I wish the filmmaker would spend a little more time looking in the mirror, most solutions to the American medical dilemma would be found right then and there.

Yossi Ben-Dak writes:

Personal responsibility is something very different from what Moore understands or perhaps admires. His very selective use of statistics and ratings seems to be in his movies only to win an argument.

While correct in many ways concerning what can be produced in the USA for public health, it is difficult for me to forget his venom and unfairness vis-à-vis business and selecting government for solutions in some areas but not others, given his idiosyncratic taste and populist broadcasting style.

That includes his utter irresponsibility for his body and looks as James correctly points out. It makes it difficult for me to explain to my daughter that not everybody who feverishly preaches health must be eating and exercising his message. 

Steve Leslie adds:

Things that make you go hmmmm…

Michael Moore is grossly overweight, a prime candidate for heart disease, diabetes and other ailments, and laughably suggests that the health care system in Cuba is better than that of the United States.

Robert Kennedy Jr. screams out about global warming and then boards a private jet to travel to a speaking engagement.

Rosie O'Donnell raises money for the homeless and retreats to her mansion behind ten foot high walls.

Al Gore promotes a live earth concert to bring awareness on global warming and owns four homes.

Ted Kennedy wants to raise taxes on everyone, yet pays little federal tax himself. He accomplishes this through a complicated tax strategy involving offshore trusts.

The Big Dig starts out in 1985 with a $2.8 billion budget estimate and $14.6 billion of federal and state dollars have been spent to date. Recent revelations have uncovered that the epoxy glue used to support the ceiling is ineffective, causing a section of ceiling to fall, killing two people.

John Edwards speaks about the disenfranchised and poor and gets $400 haircuts.

Hillary Clinton talks about a nationalized healthcare system and Bill Clinton gets paid millions by Infosys who sells phone lists and marketing lists that target those with Alzheimer's.

Bill Clinton says "I feel your pain!" and charges the secret service $10,000 per month for security services to his compound in Chappaqua N.Y. which happens to be the same amount as the monthly mortgage on the house.

The Senate refuses to discuss privatization of social security yet has its own privately-managed pension plan.

Bill and Hillary decry the commutation of "Scooter" Libby's sentence yet refuse to discuss the Marc Rich pardon or the hundreds of other pardons handed out in the last 48 hours of the second Clinton administration.

Democrats scream about Attorney General Alberto Gonzalez and demand his firing yet forget to mention Janet Reno and Ruby Ridge, Waco, Texas, and Elian Gonzalez.

The Government suggests it can build a fence along the border between Mexico and the U.S. to keep out illegals from entering.

A new petroleum refinery has not been built in the U.S. in 30 years, yet legislation to build a refinery gets bogged down in committees. And the price of gasoline goes higher.

Charles Sorkin responds:

Should this jingoistic assortment be labeled as an example of propaganda, as a political parallel to the earnings and financial propaganda decried in the Vic and Laurel's literary works?

Does Al Gore's electricity usage imply that climate change is not real, or does not pose major problems? How does his power consumption per square foot compare to other politicians' homes?

Is Rosie is a hypocrite because she won't turn her estate into a homeless shelter? And if she did, would it really help combat homelessness? When I leave my office tonight, will I be retreating, or simply going home?

Isn't Bill Clinton entitled by federal law to charge the Secret Service $10,000 per month?

Waco, Ruby Ridge, and Elian are irrelevant to the fact that Al Gonzo is not performing in a manner suitable for his office.

John Edwards pays quite a bit of money for a haircut. How do his expenditures compare with what other politicians spend on cosmetic enhancements during their own public appearances? There are large make-up and wardrobe staffs backstage at the conventions of both parties, and at televised debates. I'll bet the services of those people are really expensive!

Alex Forshaw remarks:

If you're going to make yourself the locus of protest against carbon footprints, poverty or any other alleged injustice, you would do well to not exemplify the excesses of those most responsible for causing your "crisis" in the first place. There's a big difference between pointing out a problem ("nobody is perfect"), versus hectoring society to rise to a morally pure standard which you flout every day of your existence.

Apr

13

 I am a physician who practices Anesthesiology at a community hospital. I recently attended an academic meeting in which a well known critical care physician gave a couple of lectures relating to glucose control in critically ill patients, and evidence based medicine. The physician in question, Dr Avery Tung, is a faculty member at the University of Chicago, and discussed his collaboration with some of the members of the University of Chicago Business School. I found his observations enlightening, and I thought that some of the key points might have some relevance for this forum.

The biochemistry of glucose metabolism and insulin's role in regulating it have been understood since the 1920s. Low levels of glucose are known to be dangerous, and high levels are known to lead to atherosclerosis, coronary artery disease, stroke and peripheral vascular disease. Very high levels are known to acutely lead to acidosis and coma. It is also well known that the closer one can get one's glucose into the normal range, the less likely that one suffers long term consequences. Short term, moderate fluctuations in glucose do not demonstrate any short term disability in healthy patients. Until recently, no one thought to ask what the affect of modest fluctuations in glucose would have on the critically ill. It is not unusual to see modest increases in glucose in the critically ill who are not diabetic as a result of the stress of illness. Van de Berghe and his colleagues published an article in the New England Journal of Medicine in 2001 that prospectively put Surgical Intensive Care patients into either a "standard " insulin regimen of intramuscular insulin for serum glucose of greater than 220, or an intensive regimen of intravenous insulin designed to keep the serum insulin less than 110. Only 13% of the patients had a history of diabetes. The results of the study were shocking. The group that had very tight glucose control had a 50% reduction in mortality compared to the "standard " therapy group. No other finding published in the intensive care literature has had the potential to improve outcomes as much as this one. The key breakthrough was that someone had the insight to question whether well understood data for non-acutely ill patients held for the acutely ill. Nobody asked this question for decades.

 The second lecture on evidence based medicine covered a number of topics. I wish to discuss one point in the lecture, the use of the pulmonary artery catheter. The pulmonary artery catheter is a flow -directed catheter that is inserted into a central vein and is advanced slowly into the pulmonary artery. It directly measures the pressures in the right side of the heart and the cardiac output (the pumping capacity), and indirectly measures the pressures in the left side of the heart. Since its introduction in the early 1970s, it has ben instrumental in training Intensive Care physicians and directing treatment algorithms. One of the most difficult clinical decisions can be whether low blood pressure is the result of sepsis (infection), or cardiac pump failure. The PA catheter had been at the forefront of the decision making and treatment algorithm for this issue more than two decades. Since the mid nineteen-nineties, multiple studies have been done trying to demonstrate a survival advantage in using this monitor as part of the care of Intensive care patients, and none has been able to do so. The first key point is that it took two decades to question whether this monitor made a difference. The information didn't appear to change outcomes. The other point is that while multiple studies have come out which have not demonstrated a survival benefit, the use of this monitor, while declining, persists. There was an economic incentive to place these monitors in the past, but managed care has removed much of the economic incentive. A generation of physicians used to making patient care decisions with certain treatment algorithms may be finding it difficult to make decisions with less information, even if the outcome is no different

The lesson for traders is never to assume that a question has been asked. In looking at conventional wisdom, investigate how a consensus has been reached. The question may not have been asked, or if it was, broad generalizations made that do not pertain to smaller subsets. The most spectacular results may come from investigating and challenging long held assumptions. Data may help you in you decision algorithms, but your decisions may be no better that guessing if you don't test whether the data affect outcomes. Understanding the mindset of those using data which you know to be useless may help you to decide to take the opposite side of a trade.

Yossi Ben-Dak remarks:

It is always the particular insight that comes from taking a fresh, uninhibited look at the system as a whole but also at the components that sometimes, or actually quite often, are considered by the majority, as of less than pivotal interest, that produces the struggle with the true optimum. This is especially true in engineering an effective technology solution that benefits from other fast changing sub technologies for a constantly redefined purpose range, as compared with technologies that are more purpose-limited and are from known manufacturers.

Mar

29

No one in "international relations" in 1574 was buying futures on the Dutch Republic, and no poll at the time would have found William the Silent to be more popular than either Philip II or the Othmanli Sultan. And yet, within less than a century after the relief of Leyden by the Dutch fleet, the ever-unpopular, grasping, fat, Jew-tolerating, free-speaking soldiers and sailors of Orange had defeated the Spanish infantry and the British Navy and extended the reach of their tiny, sodden country to the Americas and Asia. The people who went long on the Middle East and traditional Europe (Spain, France, Italy) lost big. Historical parallels are as useless as CBO numbers in predicting what will actually happen, but they are a useful caution against accepting as certain what "everybody" - i.e. those with tenure - knows.

Mar

29

 I find these studies of particular meaning and interest to speculators and speculation. Given their forecasting trends that are easily copied. Today's rancorous conflicts have implications for both US behaviors and attitudes, as well as for understanding foreign dynamics.

I am more concerned with the type of information that can allow us to think through antidotes or countervailing strategies [available herein] rather than the gloom that is unfolding now more intensively than in the past five years in Palestine, Thailand, Iraq , and Central Asia, and the truly contaminated post intellectual theatre of Academia.

1. From Nationalist Battle to Religious Conflict: New 12th Grade Palestinian Schoolbooks Present a World WIthout Israel , by Itamar Marcus and Barbara Crook. A report for the Palestinian Media Watch. (February 2007; 35 pages)

2. "It Was Like Suddenly My Son No Longer Existed" - Enforced Disappearances in Thailand's Southern Border Provinces. A report by Human Rights Watch. (March 2007, Vol.19, No.5(C); 72 pages)

3. After the Surge: The Case for U.S. Military Disengagement from Iraq. Steven S. Simon for the Council on Foreign Relations (CFR) (February 2007; 64 pages)

4. U.S. Interests in Central Asia and the Challenges to Them. A monograph by Stephen Blank for the Strategic Studies Institute. (March 2007; 53 pages) 

5. Inside the Ivory Tower. A survey of opinions of international relations scholars at 1,199 colleges and universities in the U.S. on foreign policy issues. By Foreign Policy (March/April 2007; 7 pages)

Feb

20

 I thought this would indicate some stepping stones to predicting history and lessons unlearnt.

1. Islamist Terrorism in Northwestern Africa - A 'Thorn in the Neck' of the United States? by Emily Hunt. From the Washington Institute for Near East Policy. (Policy Focus #65, February 2007; 20 pages).

2. The Israel Security Agency's 2006 Report. (Shabak). This  report asserts that Hamas has taken over the Gaza Strip with the support of Hezbollah and Iran (February 10, 2007).

3. An Assessment of Growth, Distribution and Poverty in Egypt: 1990/91-2004/5 - Is Poverty Declining in Egypt? by Hanaa Kheir El-Din and Heba El-Laithy. A research paper for the Egyptian Center for Economic Studies (ECES) and Global Development Network (GDN); (December 2006; 36 pages).

Dec

17

Yossi Ben-Dak writes that “60 Minutes” will air a show tonight about a long-secret German archive containing a treasure trove of information on 17.5 million victims of the Holocaust. The archive, located in the German town of Bad Arolsen , is massive (16 miles of shelving containing 50 million pages of documents) and, until recently, was off-limits to the public. The German government agreed earlier this year to open the archives, and CBS News’ Scott Pelley traveled there with three Jewish survivors who were able to see their own Holocaust records. Yossi says it’s an incredibly moving piece, all the more poignant in the wake of this week’s meeting of Holocaust deniers in Iran. Further information is on the CBS News Site.

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