November 30, 2003

Mottoes

"Live dangerously. Carefully"
--James Michener


"Fear no food."
--Anthony Bourdain

Posted by Carey at 09:22 PM | Comments (2)

SEC budget slashed

It's comforting to know that Martha Stewart hasn't been forgotten.

Unfortunately, it's looking like the Bush Administration (predictably) has no interest in prosecuting corporate crime beyond merely staying out of the way as Martha Stewart is lamb-ified and sacrificed.

Nathan Newman links to a story (via The Big Picture) about the cutbacks in the SEC's enforcement budget. As Newman puts it: "Thank god for New York Attorney General Elliot Spitzer, who is about the only force out there putting any check on corporate corruption of the financial markets."

Posted by Carey at 09:00 PM | Comments (0)

". . . of doom"

So, thanks partially to me but (for shame) thanks mostly to someone else, I have acquired a new title. I am so proud. This is going to go on the business cards and, of course, on the resume. Right below my name, and above my address.

My path of advancement has just been greased.

I am one of only two

GOLDEN GARGANTUAN GERIATRIC GRANDAMES OF DOOM!

Posted by Carey at 06:15 PM | Comments (0)

November 27, 2003

U. of Colorado medical school in turmoil

As an alumnus, I've been keeping my eye on the controversies that seem to plague the University of Colorado School of Medicine:

[T]his school has been in a state of internal strife and turmoil for so long that the national medical community must wonder what's next - pistols at high noon?
While waiting for the answer - and perhaps signs of life from the regents - a national accrediting panel has put the school's neurosurgery residency program on probation. In doing so, it cited extraordinary conflict surrounding Dr. Issam Awad, the former chairman of neurosurgery, and other problems.

Turmoil at the school has not been confined to the saga involving Awad, however. A year ago, for example, the faculty erupted in protest when Dr. Robert Schrier was fired as chairman of the Department of Medicine by the Dean, Dr. Richard Krugman. Schrier responded with a lawsuit (the school's doctors seem to hate lawsuits only when they're not filing one themselves) and a nasty court case ensued in which the university prevailed.

So just what is going on, and is the present medical school leadership up to the task of restoring the institution's reputation?(emphasis mine)

The turmoil over the medicine and neurosurgery programs doesn't exhaust the range of controversies facing the school. The M.D. curriculum, for example, has come under intense scrutiny by the national board responsible for accrediting medical schools, and has been, essentially, given a unanimous thumbs-down by the members of the Faculty Senate:

The Liaison Committee on Medical Education, the nation's major accreditor of medical schools, said too many topics are repeated and too many ignored because CU's departments don't talk to each other.

The committee agreed to continue CU's accreditation, but will be back in 18 months to make sure things are improving.

. . . .

Dr. Gerald Merenstein, CU's senior associate dean for education, noted that while CU's incoming students have higher scores than medical students nationally, they rank right in the middle when they leave CU.

"We're adequate, but is mediocrity our goal?" Merenstein asked. "At the end of the third year, there were a lot of things our students couldn't do."

He noted that students are taught about HIV before they're taught about AIDS, about chemotherapy before they're taught about cancer. Second-year students last week were given the almost identical lecture twice in three days. "The lack of integration drives our students nuts."

In the face of this upheaval, we shouldn't forget that CU's medical school is full of dedicated and inspiring faculty members like Drs. Deterding and Merenstein. These people teach basic science, supervise clinical instruction, and serve as members of the administration. They make the school an excellent place to learn medicine. If they are given the support they need from the top leadership, I'm confident that the medical school will thrive.

If not, I'm not sure when the turmoil will end, or what might be the cost to the school's reputation.

More on the Awad controversy can be found here, in an excellent example of sustained investigative journalism by the Rocky Mountain News.

Follow-up articles are here and here.

Posted by Carey at 03:15 PM | Comments (0)

November 26, 2003

Orrin Hatch

Thanks to the Philosophical Scrivener for calling our attention to the obscenity of Orrin Hatch.

Posted by Carey at 10:39 PM | Comments (0)

Thanksgiving

I thought I'd get with the holiday spirit and post a Thanksgiving blog entry.

So, here it is!

Posted by Carey at 05:56 PM | Comments (0)

Education in Colorado

My home state of Colorado is magnificent in so many ways. In other ways, my home state embarrasses me. Its senatorial contingent is embarrassing. So is its non-commitment to education.

Simply put, the state does not adequately fund education.

K-12 funding is weak. Colorado ranks 50th (last) in K-12 spending per $1000 of income. Here's more gloomy numbers from the Colorado Legislative Council.

Funding for higher education is similarly weak. Colorado's public universities would be downright atrocious were it not for the fact that they are in Colorado. Location gives the state a powerful recruitment edge that has attracted top-flight faculty in many disciplines. Unfortunately, the state of Colorado chooses to use its location as an excuse to skate by, rather than as a basis for building world-class institutions.

Its law school and medical school both exemplify this lack of commitment.

Colorado's law school has been caught with its pants down. The ABA is threatening Colorado with the loss of its accreditation if it does not find a way to replace its "inadequate" law building, hire more full-time faculty, and increase faculty supervision over student internships, among other things.

Of course, the law school points out that funding a new building is difficult with the budget shortfalls that Colorado and virtually all other states are facing. Not all schools, however, are faced with replacing inadequate campus buildings, and it's reasonable to ask why Colorado allowed the problems with the Fleming Law Building to fester for so many years.

It is true that resident tuition for law students at Colorado is among the lowest in the country. As the state's only public law school, the decision to emphasize access over excellence might be defended--except that Colorado also chooses to emphasize its exclusiveness and student selectivity. It's not clear just what kind of school the University of Colorado is trying to maintain.

The medical school has similar problems. It is instructive to read about the school's Denison Library:

Due to the meager level of state funding it receives, Denison Library struggles to maintain the range and depth of information resources required by the many specialized programs of the campus.

"Struggles?" Certainly compared to its peers:

Other significant developments in this period include. . .comparisons with peer institutions that indicate budget and staffing levels below the norm.

Tip: if a university can't support its library, something's probably wrong. The trick is identifying what, exactly, the problem is. One problem, clearly, is inadequate support from the state. Just like the law school, the medical school is faced with a state legislature that's tougher to squeeze money from than water is from a stone.

But what else? Have the deans of the two institutions been effectively selling the value of their schools to the legislature? Or have they been content to use the legislature's stinginess as an excuse for their own lack of effectiveness and leadership?

Questions like this beg to be asked. Until they are, Colorado's universities will do OK, but it won't excel. The law school won't improve. The medical school, despite its move to the Fitzsimons campus in aurora, won't ever be an elite research school.

Posted by Carey at 09:56 AM | Comments (0)

November 25, 2003

John Kerry. Joe Lieberman.

From The Bloviator:

John Kerry and Joe Lieberman, by abstaining from voting on the most important piece of legislation in their political lifetime, should be ashamed of themselves, and are completely undeserving of the Democratic nomination.

What else can be said? There is no excuse for this.

Posted by Carey at 01:25 PM | Comments (1)

November 24, 2003

That's more like it...

This is what a law student blog entry should be all about...

Posted by Carey at 04:08 PM | Comments (1)

Browsing the medical blogs

GruntDoc has changed the style of his blog. . .

DB's Medical Rants discusses the expensive and unneccesary clinical skills exam for medical students:

During a time when we urge students, residents and all physicians to base their practice on evidence, the NBME has added a new expensive examination without first collecting any evidence of its importance.

Let's not forget that the American Medical Student Association has opposed this exam for the past five years. Bravo, AMSA!

Posted by Carey at 03:46 PM | Comments (1)

The Shire?

Stuart Buck points out an article about a Tolkien-inspired subdivision in Wisconsin.

Joseph Niebler, a self-professed J.R.R. Tolkien fan, wants to build The Shire, a neighborhood of 42 $500,000 homes named after the land of the Hobbits in Tolkien's epic tale. With streets named Rivendell Drive, Misty Mountain Parkway and Lorien Court, The Shire would be built on 48 acres of a Superfund site surrounding the former Brookfield Landfill.
Posted by Carey at 03:43 PM | Comments (3)

Yummy Turkey

Well, it's not so yummy anymore--

Because of their monotonous diet, their flesh is so bland that processors inject them with saline solution and vegetable oils, improving "mouthfeel" while at the same time increasing shelf life and adding weight. . .

And you can't really say it's what the Pilgrims ate--

These turkeys' immune systems are weak from the start, and to prevent even the mildest pathogen from killing them, farmers [sic] add large amounts of antibiotics to their feed. The antibiotics also help the turkeys grow faster and prevent ailments like diabetes, respiratory problems, heart disease and joint pains that result from an unvaried diet and lack of exercise. Because the health of these turkeys is so delicate, the few humans who come in contact with them generally wear masks for fear of infecting them.

And it's, well, kind of mutilated--

In order to fatten it up quickly, farmers [sic] clip the beak, transforming it into a kind of shovel. With its altered beak, it can no longer pick and choose what it will eat. Instead, it will do nothing but gorge on the highly fortified corn-based mash that it is offered, even though that is far removed from the varied diet of insects, grass and seeds turkeys prefer.

But at least it's heavy, available, and cheap! So this Thanksgiving, bow your head and thank the industrial factories and the mass-production technologies that put that yummy turkey on your dinner table.

Posted by Carey at 09:59 AM | Comments (3)

Creeping, cancerous, Christmas

The more I think about Thanksgiving, the more I depend on my childhood memories to keep me safe from the bald cynicism that the modern version of the holiday inspires.

Even Thanksgiving consumerism isn't what it used to be. I remember when autumn's progress could be measured by the progression of holiday decorations in the stores -- the witches and black cats of Halloween, followed by the turkeys and cornucopeia of Thanksgiving, and then (finally) the trees and Santas of Christmas.

Now, the Christmas consumer orgy has broken the traditional Thanksgiving barrier, and it's a rare store or public place that bothers to put out the cardboard turkeys and pilgrims. The naked consumerism of Christmas is already lapping up against the shores of Halloween, and in a few years I won't be surprised if the Christmas lights and reindeer get brought out after Labor Day and the jack-o-lanterns of Halloween start to seem like a quaint anachronism.

The Starbucks in my neighborhood is an instructive example. Sure, they restrained themselves this year and waited until the day after Halloween to set out the Christmas cups and the Santa pens and the tiny Christmas tree in the middle of the store. Sure, they are careful to refer to "the holidays" but it doesn't seem like a coincidence that the store is decorated in red and white and green. Where is the yellow and red and brown of Thanksgiving? Nowhere. People don't traditionally buy home coffeemakers and espresso machines for Thanksgiving, after all.

Make way for Christmas! Buy early! Our retail sector depends on you! And if you should happen to forget all about Thanksgiving, well. . .we must all do our part for the sake of the Nation's economy. I'm sure you understand.

Today's young children won't even miss it.

Posted by Carey at 09:47 AM | Comments (2)

November 23, 2003

"...it changes everything"

I could tell you how great the Extended Edition DVD release of The Two Towers is. But you'll be more likely to credit the opinion of Kansas City Star chief critic Robert Butler -- he hated the theatrical version of Two Towers.

All too often the special DVD "director's cuts" are of movies that were too long to begin with and certainly don't need additional padding.

But the new extended DVD version of "Lord of the Rings: The Two Towers" is a case where more is better. In fact, it changes everything. . .

. . .So what at first struck me as a tentative and under-inhabited spectacle now emerges as a truly gripping work that succeeds on a much more human, emotional level.

Watching the three hour theatrical version was a chore. But this nearly four hour DVD cut seems to fly.

In short, it's a great way to get pumped up for next month's opening of "The Return of the King." And, yes, Peter Jackson is a genius.

The Extended Edition DVD release of the Two Towers is not just great; it's indispensible.

Posted by Carey at 02:58 PM | Comments (1)

November 19, 2003

Iraq Index

Although the debate about American involvement isn't centered on whether or not we're repairing public utilities or getting the gas to flow, this Iraq Index by the Brookings Institution could be helpful...

The Iraq Index is a statistical compilation of economic and security data. This resource will provide updated information on various criteria, including crime, telephone and water service, troop fatalities, unemployment, Iraqi security forces, oil production, and coalition troop strength.
Posted by Carey at 09:44 AM | Comments (0)

November 18, 2003

private health insurance fails us

Calpundit discusses the impending Medicare reforms:

But here's the problem: in theory, private companies can deliver services more efficiently than the bad old federal government bureaucracy and can therefore deliver those services at a lower cost. But if that's the case, why does the bill have to pay them a bribe of $12 billion to get them to participate?

The answer, of course, is that the idea of competition in the Medicare market is a mirage. Private healthcare companies plainly don't believe that they can, in fact, provide services any more efficiently than the feds, and since the goal of a private company is to make money, that means that the only way for them to maximize profits is to reduce benefits and do their best to insure only the healthiest people.

This is, of course, completely correct and very well-stated. I would add that even if we acknowledge the efficiency gains that private insurers would generate (and this is certainly debatable), we still cannot justify getting rid of the government's role entirely.

Unless, of course, we change our minds about the people who are sick, poor, and uninsured by the private insurance industry. Despite our laissez-faire rhetoric, we are not willing to simply let these people die. Instead, we allow them to suffer from lack of timely preventive care until they are on the verge of death, and then we admit them to the ICU through the ER.

This always costs big money. Hospitals can't eat this cost, so they either pass it along to the government (us) or to their other patients (again, us). Either way, we pay for our unreasonable ideological commitment to the private healthcare insurance market. It would make far more sense to insure these patients early and get them the preventive and continuing care they need, rather than wait to spend gobs of largely futile money on them at the end of their lives.

This doesn't mean there is no role for private healthcare insurers; far from it. Rather, it simply means that we should not allow any segment of our population to depend entirely on the private market. Medicare, Medicaid, and the various state children's health insurance programs (SCHIPs) run under Medicaid are all acknowledgements that the private market has failed the old, the poor, and the children of the poor. The evidence is that it is also failing young working adults, who constitute the majority of the uininsured in our country.

We don't even have to think that healthcare is a "right." Even if our main concern is efficiency and cost-control, a universal, government-run system of basic health insurance is the best solution.

Posted by Carey at 04:04 PM | Comments (2)

From where I sit

Here's some of the things I've seen people doing on laptops during class:

1. buying shoes
2. looking for jobs
3. IMing friends about... (I tried to crane my neck but the font was too small)
4. criticizing Supreme Court decisions
5. reserving plane tickets
6. trading players on their fantasy football team
7. reading Slashdot
8. downloading new wallpaper
9. playing pinball/solitaire/etc. etc.
10. posting on the PR board (that was me!)

Alas, I have not yet seen anyone actually updating their blog during class. I may have to do it myself...

Posted by Carey at 12:53 PM | Comments (3)

We're on our own




Thanks to the church sign generator via Turquoise Waffle Irons in the Backyard.

Posted by Carey at 12:41 PM | Comments (1)

November 17, 2003

Privatize air-traffic control?

After the terrorist attacks of September 11, the nation rushed to federalize the nation's baggage screeners.

Now, we're having to beat back the Bush administration in their rush to privatize the air traffic controllers.

The FAA wants to contract out more air-traffic control jobs in the name of "efficiency." Translated from Bush-speak, this means "eliminate labor protections."

But there was optimism among several lawmakers that negotiations with the Bush administration would yield a temporary moratorium on privatizing more air traffic centers and break the legislative deadlock as early as Tuesday.

Senate Democrats are outraged that a Republican-led House-Senate negotiating committee stripped language from the final version of the bill passed by both houses this summer that would have prohibited the Federal Aviation Administration from contracting out more air traffic jobs.

President Bush threatened to veto the bill if labor protection provisions were not removed from the final bill.

Apparently, Bush's "war on terrorism," which justifies the infringement of civil liberties and the unprecedented preemptive invasions of oil-rich nations, doesn't justify abandoning the far-right ideological commitment to eliminate worker protections everywhere.

Posted by Carey at 08:27 PM | Comments (0)

political compass

Another political survey here; for the grid full o' blogs, go here.

Posted by Carey at 06:14 PM | Comments (0)

Find the flaw

Via ProfessorBainbridge.com, here's a creative proposal for financing a prescription drug benefit by extending patent terms for Big Pharma:

While this may not produce a perfect system, I believe that the long term benefits would outweigh any negative factors. Yet there are smarter people than me paid large sums of money to think up such policies. So I presume that my argument has a fatal flaw. Can anyone point out what it might be?

Where's the flaw?

Posted by Carey at 10:06 AM | Comments (1)

November 16, 2003

Why Howard Dean?

In response to a pointed question from a reader, I thought I'd talk about why I'm so excited about Howard Dean.

Back in 2001 or thereabouts, when I was still a medical student, the word on the street was that the only potential presidential candidate that might actually support universal health care was the obscure former governor of Vermont. To be a Dean supporter back then was utopian. It's very, very exciting to support an obscure candidate early and watch as he methodically earns his status as front-runner.

After browsing his policy statements on his website, I realized that I could do no better than to quote Howard Dean himself, and to urge people who wonder what all the fuss is about to visit his website themselves.

On health care:

For a year now, I have been traveling this country advocating a repeal of Bush's tax cuts so that we can provide universal healthcare and restore fiscal discipline.

I believe. . . that given a choice between having health insurance or keeping all of the Bush's tax cuts in place, most Americans will choose health insurance. My plan will cost $88.3 billion -- less than half of the president's tax cut -- with money left over to pay down the deficits run up by this administration.

.

On foreign policy:

Last October, four of the major contenders for the Democratic nomination supported the President's preemptive strike resolution five months before we went to war without, as we now realize, knowing the facts.

I stood up against this administration and even when 70% of the American people supported the war, I believed that the evidence was not there and I refused to change my view. As it turned out, I was right. No Democrat can beat George Bush without the same willingness that John F. Kennedy showed in 1962. A President must be tough, patient, and willing to take a course of action based on evidence, and not ideology.


On Rural Communities: (and who else is even talking about rural communities?)

The bottom line is, though George Bush may choose his words to appeal to America’s heartland, his actions are starving it. We must decide whether we will be a country that lives in fear of the slow destruction of our agricultural base, or whether will we honestly address the reasons it is falling apart.

I believe that we cannot give up on our nation’s ranching and farming communities. In addition to restoring those measures that Bush has tried to undo, I believe we can foster an economic revival in rural America.

Posted by Carey at 10:12 PM | Comments (1)

November 14, 2003

Brother Bear

I just saw a great movie. Better than the Matrix.

It's called...

Brother Bear.

I know, I know. A Disney movie.

But the reason it's great is that the story could have been (and probably was) lifted directly from a folktale of the tribes of the Pacific Northwest. Something about it rings true, once you get through the layers of Disneyfication.

Oh, and the animation is great. Beautiful scenery.

Brother Bear.

Worth it!

Posted by Carey at 11:29 PM | Comments (0)

Don't forget to boycott Amazon.com, too

If you support the Borders strike, remember that the union is asking that you also boycott Amazon.com and Waldenbooks.

Since I'm on the subject, I note an amusing comment on the above link by "anonymous." Let's disuss, shall we?

Forcing Border's [sic] hand this way would harm the market and cause an increase in book prices, eventually harming every reader.

Supporting the union does not mean that the prices of books will increase. Let's remember that under the economic model that 'anonymous' is apparently so enamored of, Borders will price its books at whatever level will maximize its revenue.

The point at which revenue is maximized is some function of the price per book sold and the number of books sold. That has nothing to do with how much Borders pays its employees. If they're paid more, prices won't go up assuming that prices are already at the level which maximizes revenue.

Now, Borders is also trying to minimize its costs. And this is why it's trying to pay its employees as little as possible. If the person who makes your latte or helps you find that book you wanted gets no benefits, Borders doesn't reward you by lowering the price of your book. Borders pockets the extra money as profit.

There's nothing wrong with profit. Without profit, Borders wouldn't be running their store in the first place. But Borders isn't guaranteed any entitlement to the marginal profit increases it gets by systematically undercompensating its workers. After all, it's the workers who open up the store every day, unpack the books, set them on the shelf, help you find them, serve you latte, clean the restrooms, run the registers, and make your visit to Borders a pleasant experience. They work hard, and they earn their money.

I would even volunteer to work for free until your silly strike ends in all of you being unemployed.

And you can work for free because....? Are you a trust-funder? Or are you adequately compensated at your real job? If you enjoy adequate and fair compensation, why shouldn't everyone else? Do you own or run a business? If so, ask yourself how easy it would be to run your business without the labor of the people you employ. The work that Borders employees do for the store has value, and they should be compensated fairly for it.

I am even arranging "sit-ins" of the #1 store- My friends and I will cross the picket lines just to enjoy a hot coffee and the nice atmosphere inside finally freed from all the whining we normally hear.

Let the strike go on long enough, and the clumsy manager making your latte will start whining when he or she learns how it really is to work in the Borders coffee shop all day, selling lattes to people like you. They'll start to whine, too.

Posted by Carey at 06:11 PM | Comments (9)

Borders Readers United

Visit their blog here.

Posted by Carey at 05:16 PM | Comments (0)

"Schumerism"

Lawrence Solum (many posts), Crescat Sententia (Curmudgeonly Clerk et. al.), and many others have been getting hot under the collar about the "politicization" of the judicial confirmation process. I have argued (more than once) that this concern is misguided, and I continue to believe that it is. Hence, it's good to find Nathan Newman with an eminently sensible take on the issue:

There is no reason in a democracy why either superior virtue or intelligence entitles you to office. Judges have too much power in my view to not be judged based on their views before given lifetime appointment. As things stand, the appointment process is the one check on judicial power for the lifetime of a judge. It should be a tough check for that very reason.

Some other persuasive arguments come from, as usual, Brian Leiter:

It's hard not to feel that our public culture, and our public discourse about law, would be a lot healthier if the truth of legal realism were more widely acknowledged. Consider the battle over federal court nominations: if we're realists, then we can say plainly that these are battles over life-time appointments of government agents who will be called on to make moral and political judgments, by which the force of the state will be brought to bear against the parties so judged. Ergo, it is perfectly reasonable, indeed, appropriate, for Senators to oppose nominations on moral and political grounds.

Three cheers for Schumerism! (and for legal realism!)

Posted by Carey at 05:03 PM | Comments (0)

medical malpractice panel, v.2

I just got back from a panel discussion on medical malpractice reform. I'm glad to see that hospital life goes on as usual. This means residents and medical students rushing into grand rounds with their take-out lunches, gobbling down the food while they look at xeroxed New England Journal articles, and occasionally getting paged in the middle of the presentation.

There were actually some residents who weren't reading or getting paged, and who actually seemed to be paying attention to the presentation, so don't let me give you the impression that no one was listening (in other words, this wasn't the typical internal medicine grand rounds...).

Anyway, back to the discussion. The first speaker tried to convince us that the current system was broken, with some interesting statistics:

>50% of physicians will be sued at some point in their careers
<5% of other professionals get sued (lawyers, accountants, etc.)

(Suggests that medical malpractice is somehow unique...)

<10% of the patients who are injured actually sue
>50% of patients who sue have not been injured
>75% of suits result in no payment

(Suggests that the current system is woefully inefficient...)

The debate that followed was essentially concerned with this question: how bad does our current system have to be before we should take the inherent risk entailed by trying something different?

As usual, some speakers pointed to the problems with the current system and asked, "we must try to do better!" And others gravely responded, "but trying something new entails the risk that we might make things worse, so let's not try anything!"

One panelist forcefully and articulately advocated a Swedish-style system of administrative (and not judicial) compensation of injured patients. As I understood it, every injured patient would be paid out of a common pool of tax revenue set aside for the purpose, but would retain the right to sue in court. This system would ensure that virtually every patient was reliably compensated, instead of just those patients that take the initiative to sue and who are lucky enough to prevail in court.

It was immediately objected (and rightly, I think) that patients in this country wouldn't trust the system. Most of them would contest whatever offer of compensation they received on the theory that (duh!) whatever was offered was less than what they deserved. This of course is the "Americans live in a society centered around competition and conflict and thus see every transaction as a win/lose proposition" argument. Of course, the cooperative and reasonable Swedes don't think this way, which is why their system works for them. It can never work here.

It was objected that no one wants a tax hike to fund another bureaucracy. True, but the bureaucracy is supposed to replace the privately-funded litigation that we have now. The argument is that less money overall would be spent on medical malpractice compensation under an "administrative" system than under a "judicial" system. (Too bad no one made that argument.)

The discussion suffered from two major inadequacies. First, the scope of the issues wasn't focused enough. The debate ended up being about "change" vs. "no change" broadly speaking, without enough discussion about specific issues.

Second, the panel suffered from the lack of representation of two important groups. Unfortunately, the insurance company CEO was not there, and as a result too little attention was paid to the role of malpractice insurance firms. The panel would also have benefitted from a representative of an "injured patient." As it was, we heard a lot about what patients want, but al of that could have been made more concrete with a patient on the panel.

Overall, a good discussion. My own hunch is that the current health care system is unsustainable and will collapse sooner or later, mandating wholesale change from the ground up whether we want it or not. The only question is, when? We might have some time to try some piecemeal changes, or we might not.

Posted by Carey at 04:19 PM | Comments (5)

November 13, 2003

Israel and the Palestinians

Arafat and Sharon: old warriors who can't, it seems, make peace.

Posted by Carey at 07:40 PM | Comments (0)

medical malpractice crisis

You may have heard, somewhere in the background of the daily barrage of complaints which plague your life, a low noise, a din, a grumbling that seems omnipresent but which rarely grows so loud that you are forced to pay any attention. I'm talking about the "medical malpractice insurance crisis."

This panel discussion tomorrow will bring the problem to the fore and hopefully offer some interesting ways of thinking about it.

In brief, the problem is that doctors are being charged a lot for malpractice premiums, causing some of them to leave high-risk (and high-premium) practices like obstetrics.

That's it. That's the problem.

"What?" you say, "that's it? Aren't you going to say anything else?"

Nope. In fact, I've probably already said too much. Virtually every element of this "crisis" is contested. The doctors' groups (like the AMA) maintain that high premiums are the result of runaway jury awards in malpractice suits. The trial lawyers say that's ridiculous; the problem is that insurers are charging too much and scapegoating the jury awards that justly compensate patients who've been victimized by negligent doctors. The insurers accuse the trial lawyers of taking all the money awarded by juries, leaving none for the patients.

And a few policy wonks (can anyone say, glorfindel?) think it's unlikely anything will get better until a) patients and juries feel they have some degree of control over what they believe to be a health care system built for everyone but them, and b) the medical profession finds some rational way of addressing medical error that doesn't involve sweeping it under the rug or denying that devoted doctors ever screw up.

But that's enough for now. I'll go to the discussion tomorrow, and post more on this topic later.

Posted by Carey at 06:27 PM | Comments (2)

"10 Commandments Judge" kicked off the bench

Roy Moore, the Alabama Chief Justice who defied a federal court order to remove a display of the Ten Commandments from the state Judicial Building, was stripped of his post today.

The decision is a good one. Moore himself would not support a litigant's bald refusal to comply with an order handed down in his courtroom; neither should Moore expect to disobey a federal court order to remove the religious display. If Moore disagrees, he can appeal the order, he can attempt to have the law changed. He can even (as in this case) choose to disobey and to suffer the consequences. Losing his job as Chief Justice is an appropriate consequence.

Judges who willfully disobey judicial orders shouldn't be giving judicial orders themselves.

Posted by Carey at 03:05 PM | Comments (6)

Michigan football coach to Borders workers: Up Yours!

Borders browsing is a no-go for me until the strike is over.

Michigan football coach Lloyd Carr, unfortunately, seems not to care:

Sightings of football coach Lloyd Carr outside the football arena are usually few and far between, so it came as a surprise when Borders union supporter and alum Irfan Nooruddin told the Daily that Carr was spotted last Saturday crossing the picket line at the East Liberty Street Borders bookstore. While Carr’s position on the ongoing strike is unknown, what is clear is the message he is sending: Picket lines are of no consequence.

Read more from the Michigan Daily.

Posted by Carey at 10:00 AM | Comments (1)

Howard Dean earned it

Nathan Newman describes why Howard Dean got the SEIU endorsement, and how this shows that Howard Dean may be the most electable Democrat.

Brian Leiter is right; Newman's blog is no-bullshit.

Posted by Carey at 09:40 AM | Comments (1)

Pfizer v. Bristol-Meyers-Squibb

From an article in the New York Times reporting a study which shows Pfizer's cholesterol-lowering drug Lipitor might be superior to Bristol-Meyers-Squibb's version Pravachol.

Pfizer sponsored the study, but Dr. Nissen, who prides himself on his independence from financial conflicts of interest, insisted that he control the study and its data analysis, and had the right by contract to publish the results whether positive or negative for Pfizer.

Whew; that's a relief. What's sad is that we can't assume the kind of independence Dr. Nissen claims to have. The pharmaceutical industry has corrupted the process of biomedical research. This analysis and the study it describes gives a flavor of how this corruption works:

Typically, when a firm is studying a therapeutic in human clinical trials, it enters into a contract with an academic institution to perform the studies, and it is these contracts that the report criticizes. The survey found that in only 10% of contracts did site researchers have a say in how data was collected and monitored, and in only 5% did they influence how the data was analyzed and interpreted. In addition, fewer than 1% of contracts guaranteed that results would be published and that an independent committee would control publication.

These survey results describe why researchers like Dr. Nissen feel the need to proclaim their innocence when announcing significant findings. The corporate sponsors of clinical trials, the ones who stand to gain from positive results, are often the ones who do the analysis and interpretation of data. If the results aren't favorable to their commercial position, they aren't published at all. From the New England Journal of Medicine:

As CROs and academic medical centers compete head to head for the opportunity to enroll patients in clinical trials, corporate sponsors have been able to dictate the terms of participation in the trial — terms that are not always in the best interests of academic investigators, the study participants, or the advancement of science generally. Investigators may have little or no input into trial design, no access to the raw data, and limited participation in data interpretation. These terms are draconian for self-respecting scientists, but many have accepted them because they know that if they do not, the sponsor will find someone else who will. And, unfortunately, even when an investigator has had substantial input into trial design and data interpretation, the results of the finished trial may be buried rather than published if they are unfavorable to the sponsor's product. Such issues are not theoretical. There have been a number of recent public examples of such problems, and we suspect that many more go unreported.

While some medical journals have taken steps to ensure that they won't become the patsies of the corporate research sponsors, the medical schools and teaching hospitals haven't been as aggressive. Until they do, we should receive studies like the Lipitor/Pravachol comparison with a healthy dose of suspicion.

Posted by Carey at 08:57 AM | Comments (1)

November 11, 2003

Geek Test

According to this fun-to-take Geek Test, I'm at 32.1499% - a Total Geek.

I need to practice so I can do better next time...

Posted by Carey at 05:13 PM | Comments (5)

Rumsfeld preparing to duck out the back door?

Remember way back when Donald Rumsfeld was getting media attention for leaning on the generals to tell him what he wanted to hear?

Before we invaded Iraq, Rumsfeld wanted to hear that the invasion could be done with a smaller number of ground troops than some of his generals were suggesting. Famously, Rumsfeld and his neocon civilian advisers in the Pentagon publicly undercut former Army chief of staff Gen. Eric Shinseki by suggesting to a Senate panel that Shinseki's estimate of the troop strength required for Iraq was too high. A good chronology, with links, can be found here.

Rumsfeld, it seemed, thought the Army leadership was mistaken about America's defense needs both in the specific case of Afghanistan and Iraq and in the general case of weapons procurement and defense spending broadly construed. A good summary is here.

Now that things might not be going so well in Iraq, Rumsfeld is portraying himself as relying upon the advice of his generals--something he never seemed to want to do before.

"Needless to say, if at any moment the military commanders indicated that they need more U.S. troops, I would certainly recommend it to the president and we would increase the number of troops but the advice we're getting is just the opposite. . ."

Asked if U.S. commanders might be sugarcoating their reports, the defense secretary insisted: "What I want to hear is the truth. And I hope they're telling the truth and you believe they're telling the truth and if they're not, they're not serve their country very well because I have no bias one way or the other."

Might Rumsfeld be setting up the field commanders to take the fall for bad consequences in Iraq? It's not a conclusion we're compelled to accept by the claims of his recent "deference" to the advice of his generals. But it's something we should remember if Rumsfeld and the Bush Administration attempt to duck the responsibility for a less-than-perfect outcome, while claiming all of the credit for the successes.

Posted by Carey at 12:55 PM | Comments (0)

November 10, 2003

ok, I'll play

The results of my blogging personality test.


You are a Megnut.

You help to empower expression while getting money for commentating and speaking -- or trying to anyway.

Take the What Blogging Archetype Are You test at GAZM.org

Posted by Carey at 04:31 PM | Comments (0)

Bush apprend à découper et à colorier

My French isn't superbe, but it's good enough to make me laugh at this.

Posted by Carey at 01:24 PM | Comments (2)

Wal-Mart throws its weight around

Wal-Mart is using its tremendous influence in the marketplace to compel suppliers to adopt radio-tag technology.

Is this compatible with a "free market?" It depends on your conception of what a free market really is.

If "free" means "unregulated," then any private compulsive power, like Wal-Mart, is OK.

If "free" means that each participant in the market meets the other participants on a roughly equal footing for the purpose of negotiations, then maybe Wal-Mart is incompatible with a free market. Maybe they just have too much compulsive power.

But maybe not. Is anyone compelled to shop at Wal-Mart? Does Wal-Mart have power only to the extent that they seem to be the choice of a large number of shoppers?

Posted by Carey at 11:54 AM | Comments (0)

Chickenblogger down

Follow the link from Atrios.

Posted by Carey at 11:31 AM | Comments (0)

November 08, 2003

dual booting

I use a laptop that dual boots Linux and OSX. Problem is, the damned bootloader won't stop and wait for me to choose which operating system to boot. If I'm not there at the right time to push the "x" key, it will default to Linux after about 2 seconds.

I need to get it to stop and wait while I go get coffee. When I wander back, I want to be able to scratch my crotch and think to myself: "Linux? Or OSX? Hmmm....."

Clearly a project for winter break.

Posted by Carey at 09:22 PM | Comments (4)

Terri Schiavo debate

But not by me.

Some great posts in the blogosphere are here and here.

Posted by Carey at 04:22 PM | Comments (0)

Can we try to persuade others that a law is bad?

A reader called my attention to Conant v. Walters, a case in the 9th Circuit upholding a permanent injunction against the Government's investigation of physicians merely because they choose to discuss marijuana with their patients.

The majority based its holding on the first amendment rights of doctors and on the protection of physician-patient communications. Along the way, the opinion quotes language from the district court's ruling that supports the rights of people to discuss information as a prerequisite for deciding whether they will petition the government to change the law:

"Petitioning Congress or federal agencies for redress of a grievance or a change in policy is a timehonored tradition. In the marketplace of ideas, few questions are more deserving of free-speech protection than whether regulations affecting health and welfare are sound public policy. In the debate, perhaps the status quo will (and should) endure. But patients and physicians are certainly entitled to urge their view. To hold that physicians are barred from communicating to patients sincere medical judgments would disable patients from understanding their own situations well enough to participate in the debate."

Now that's a pro-democracy ruling if ever there was one. Thank you, Ninth Circuit!

Posted by Carey at 02:39 PM | Comments (6)

Desultory and Perfunctory

After seeing Matrix Revolutions last night, I felt I needed to get a better grasp on the meaning of two words: desultory and perfunctory.

Desultory: "Moving or jumping from one thing to another; disconnected"

Perfunctory: "Done routinely and with little interest or care"

Hence: "It was disappointing to learn that the story of the Matrix, which in the beginning showed the obvious love of the Wachowski brothers for their story, has been concluded in such a desultory and perfunctory manner. There was no love or passion in this story -- none between Trinity and Neo and none for the story by the scriptwriters, directors, and studio."

Posted by Carey at 01:33 PM | Comments (1)

November 07, 2003

Confirmation politics, v.2

I posted some of my thoughts on the judicial confirmation process a few days ago, in the context of the nomination of Janice Brown to the federal appeals court. Here's a collection of other comments. Since then, George W. Bush has signed the partial-birth abortion ban into law and reminded us of why it's important to focus on a judge's ideology.

Regardless of your views on partial-birth abortions (or, to maintain my political neutrality, "partial-birth abortions"), it is the case that the judiciary has appropriated for itself significant authority over this area of policy. If the judges think it should be legal, then it will be, in the absence of a Constitutional amendment. And their determination of its legality will turn on their ideology--there are principled judges with respect for the law and a disdain for "results-oriented" jurisprudence that come out on both sides of this issue.

We care about this because the question of abortion goes to the heart of our moral views.

The suggestion that the confirmation process should not consider a nominee's ideology is asking us to stop caring about whether fundamental rights are respected, or whether we're tolerating murder for the sake of convenience.

If there's one thing people on both sides of the abortion debate agree on, it's that the compostion of the judiciary matters.

Now, if the judiciary as a whole were to step back and say, "we aren't going to say anything about abortion, period," we might be able to disregard ideology in the confirmation hearings.

Oh, wait. I spoke too soon. In order for us to completely disregard ideology in confirmation hearings, the entire judiciary would have to say "we disclaim all authority to issue any binding rulings on any subject that touches upon what any citizen believes is fundamental and of great importance."

Until then, ideology will be, and should be, central to any confirmation hearing.

Posted by Carey at 03:37 PM | Comments (2)

November 06, 2003

private police?

Minnesotans, apparently, are already living in The Matrix.

Posted by Carey at 02:54 PM | Comments (1)

Medical schools need a civil procedure course

Yesterday's discussion in my civil procedure course was focused on the the consequences and rationales for who should make what decisions in civil litigation, the judge or the jury. It was fascinating. So many substantive consequences flow from the structure of our justice system, as the judge vs. jury discussion reveals.

It's very similar, I think, to our health care system. The results are in part determined by the structure and by the procedures.

Believe it or not, though, many medical students aren't taught anything about the health-care system in this country. There is no commonly available analog to a civil procedure course in the medical curriculum. A medical student can graduate without any knowledge of how patients end up seeing this doctor over that one; who pays the bills for the treatment the doctor renders, and who the major decision-makers are. It would be analogous to a legal education that completely ignored the court system and the rules of procedure, focusing almost entirely on the questions of whether this particular client was tortiously injured or deprived of a legal right. The stuff that's taught would be valuable, but it would leave out too much of the big picture

Medical schools need to have a "civil procedure" course. I remember once suggesting such a thing to my medical school dean; his response was that this would be useless because the structures are changing so rapidly that any instruction would be outdated too quickly.

By that logic, genetics should not be taught in medical schools. Indeed, this answer is inconsistent with the medical profession's recognition that physicians need to be "lifetime learners," and that one of their professional responsibilities is to stay current.

Nonetheless, some medical schools do not recognize the need to teach student doctors about their profession in general terms, and how it relates to health care delivery generally. No wonder many physicians are heard to whine about "the system" and yet feel inadequately equipped to engage in the debate beyond merely asserting that "I need more time to see patients; my reimbursement isn't high enough; etc."

A medical school "civil procedure" course would help.

Posted by Carey at 09:41 AM | Comments (0)

political compass

I've been plotted on the political compass, which has led to the discovery of some great blogs, Phersu, for example.

Posted by Carey at 09:16 AM | Comments (0)

November 05, 2003

Gothic buildings I've lived in

One of the factors to consider when deciding whether to attend this school or that school is, "will I get to live in a Gothic building?"

Living in such buildings is cool. And you don't even have to be interested in vampires.

I've been lucky. The first Gothic building I was fortunate enough to live in was Hitchcock Hall at the University of Chicago:

(Thanks to UChicago student Jesse Friedman for the picture...)


After that, I got to live in Burton-Judson for a while. This was, unsurprisingly, also at the University of Chicago:

After an inconveniently long period of not living in a Gothic building, I moved into my third Gothic building: the lawyer's club at the University of Michigan Law School:

I'm sure I'm a better person because I've been able to live in Gothic buildings. It's so tragic that we don't build more of them. I don't know if it's cost, underappreciation of the architecture, or just because people are dumb, but I say: everyone deserves to live in a Gothic building at least once in their lives.

It enhances your humanity.

Posted by Carey at 08:10 PM | Comments (4)

November 03, 2003

The ideology of a judge still matters

As a 1L who has just read Lochner for the first time, the debate over Janice Brown's nomination to the federal appeals court has caught my attention. As an embryonic lawyer, my layperson sense of things hasn't been educated out of me yet, and this layperson sense is telling me that what some of the academics seem to want is both impossible and undesirable.

Much of the debate is centered on the question of whether Justice Brown's views on Lochner are outside the legal mainstream. What I want to address instead is the concurrent debate over whether her ideology should be the focus of the confirmation process.

Lawrence Solum and David Bernstein think not. They criticize the New York Times editorial that argues against Justice Brown's confirmation, and suggest that the proper criteria for evaluating her fitness for the bench is, as Solum puts it, whether or not she tries to decide cases "on the basis of the law and not on the basis of [her] own political ideology or views about what the law should be."

While I agree that this is an admirable (and perhaps an indispensable) attribute for an appeals court judge, I can't agree with Solum that we ought to simply disregard the nominee's ideology when we consider whether or not to confirm her nomination. Nor can I agree with what I (provisionally) believe to be another of Solum's points: that once we find a judge with the "judicial virtues" that he describes, the ideology of this judge will have no substantial effect on the results of the cases she decides.

Why ideology matters (now, more than ever)

If you ask an educated citizen (as opposed to a legal theorist) whether a judge's ideology should matter, you'll almost surely hear a vigorous "yes." Remember, we haven't forgotten Bush v. Gore, where all the conservative justices lined up behind a per curiam ruling that they knew would make George W. Bush President, and the liberal justices all dissented from this ruling. The average well-educated citizen knows that big political questions can be and are decided by the courts. They know that the conservative judges often bring about the kinds of results that conservatives are fond of. Lawrence v. Texas demonstrates that the liberal judges do the same thing.

For the average citizen, the analysis typically stops here. The question of whether any of these results are founded on good or bad reasoning is irrelevant. After all, why should it be? A result is a result, both the well-reasoned and the poorly reasoned ones, and the results that judges arrive at carry the weight of "law." Which means that, well-reasoned or not, we all must live in accordance with them. There are many reasons for the bitterness in the Judiciary Committee over judicial nominations, but first among them is that the Senators' constituents know that the choice of federal judges will probably affect their lives in significant ways. And they also know that the ideology of a judge is often a good predictor of whether or not these affects will be welcome or not.

The widespread belief that the legislative process has been captured by special interests, and is not responsive to the general political will of the people, only increases the importance of a judge's ideology. If it were the case that the public believed the legislative process was responsive to their interests, they might be more easily be persuaded that the damage created by "bad" judicial decisions--and by "bad" they mean decisions producing the "wrong" result-- could be mitigated more easily. The legislative branch, at least, would be on their side. But if the legislative branch isn't a reliable advocate for their interests, it is all the more important that the judicial branch be an advocate. Or at least, that the judiciary not be actively promoting undesirable policy.

All this will, I think, make some legal theorists cringe. After all, if the public is uninformed about the differences between principled judicial opinions and opinions based solely on ideology, that is no reason to shift the focus of judicial confirmation hearings from "judicial virtues" to ideology.

At least, not if you believe that judicial virtues can be separated from ideology.

Judicial virtues can't be separated from ideology

Here's the short, pithy argument:

One of the most esteemed and widely-valued judicial virtues is a love of justice. Justice is inextricably a matter of ideology, almost by definition. Since even a 1L knows that "the law" isn't just there in the text of a case or of a statute, anyone asked to interpret a case or a statute must interpret the text. A virtuous judge will try to interpret the text in the way most consistent with justice. But since a judge subscribing to ideology A will inevitably hold a view of justice colored by her ideology, her opinion of the most "just" interpretation will not necessarily be the same as a judge subscribing to ideology B who interprets the same text with the same concern for justice.

To believe otherwise is to bury your head deep in the sand.

Of course, this is not to say that if you group all judges with ideology A together and ask them to interpret the same text, that those judges who possess more of the "judicial virtues" would always arrive at the same result as those judges who share their ideology but have less of a concern for justice, less of a "judicial temperament," or less "learning in the law." Ideology isn't dispositive. But neither are those things which Solum calls the "judicial virtues." Ideology still matters.

Should we look for virtuous judges? Of course. Should we attempt to "de-politicize" the judicial confirmation hearings in the Senate? We can't, and we shouldn't.

Posted by Carey at 09:34 PM | Comments (0)

November 02, 2003

Is employer-provided health insurance a good thing?

There's some interesting points made here.

Posted by Carey at 06:32 PM | Comments (0)

When is cardiac surgery unneccesary?

Tenet Healthcare is innocent until proven guilty, but the multiplicity of investigations into whether they have performed unneccessary cardiac surgery makes me want to keep an eye on this story.

How could prosecutors prove that unneccessary surgeries were performed? How clear is the generally accepted medical standard for concluding that surgery is necessary in any particular case? We can imagine cases where it would be easy to tell; if anyone performed bypass surgery on me, for example, most docs would think that was unnecessary.

But what about the typical patient with some evidence of coronary atherosclerosis and some symptoms? It seems you could make an argument for or against surgery in most cases like this.

And what about the patient? Deciding whether surgery is necessary or not depends significantly on what the patient wants, right? How does the patient weigh the risks of surgery against the potential benefits? What about the risks of postponing surgery?

Can any of these calculations be determined by a chart review? Would prosecutors have to find the patients and interview them? Would they change their story now that surgery has been performed?

It seems to me that the prosecutors have an uphill battle here.

Posted by Carey at 06:29 PM | Comments (0)

November 01, 2003

the Tom Bombadil controversy

Of all the mysteries in Tolkien's Lord of the Rings, I'm most fascinated with the question of Tom Bombadil.

People who are only casual readers of Tolkien usually treat him with scorn and derision. Out of context, it's not hard to see why:

"Hey dol! merry dol! ring a dong dillo!
Ring a dong! hop along! fal lal the willow!
Tom Bom, jolly Tom, Tom Bombadillo!"

I mean, come on; this is goofy.

So what are we to make of this conversation during the undeniably weighty council of Elrond:

"'Could we not still send messages to him and obtain his help?' asked Erestor. 'It seems that he has a power even over the Ring.'
'No, I should not put it so,' said Gandalf. 'Say rather that the Ring has no power over him. He is his own master.'"

Or this, from Tolkien's letters:

"...he represents something that I feel important, though I would not be prepared to analyze the feeling precisely."

Some people even claim that Bombadil is Iluvatar himself!

A wonderful mystery. Check these out:

Enclyclopedia of Arda

What is Tom Bombadil?

Who is Tom Bombadil?

Posted by Carey at 09:15 PM | Comments (1)