Archive for the ‘education’ Category

The Coming Shortage of Doctors.

Monday, August 3rd, 2015

33 - Lister

This Brietbart article discusses the looming doctor shortage.

Lieb notes, that the U.S. is only seeing 350 new general surgeons a year. That is not even a replacement rate, she observed.

A few years ago, I was talking to a woman general surgeon in San Francisco who told me that she did not know a general surgeon under 50 years old. The “reformers” who designed Obamacare and the other new developments in medicine are, if they are MDs, not in practice and they are almost all in primary care specialties in academic settings. They know nothing about surgical specialties.

They assume that primary care will be delivered by nurse practitioners and physician assistants. They are probably correct as we see with the new Wal Mart primary care clinics.

The company has opened five primary care locations in South Carolina and Texas, and plans to open a sixth clinic in Palestine, Tex., on Friday and another six by the end of the year. The clinics, it says, can offer a broader range of services, like chronic disease management, than the 100 or so acute care clinics leased by hospital operators at Walmarts across the country. Unlike CVS or Walgreens, which also offer some similar services, or Costco, which offers eye care, Walmart is marketing itself as a primary medical provider.

This is all well and good. What happens when a patient comes in with a serious condition ?

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White Privilege.

Thursday, July 2nd, 2015

microaggression

The subject of “white privilege” is very much in the news there days.

Administration officials at the John F. Kennedy School of Government at Harvard University have reached an agreement with student activists to force “mandatory power and privilege training” on incoming students during orientation.

The group, which calls itself “HKS Speaks Out,” will have a meeting this week with the dean of the Kennedy School, David T. Ellwood, to discuss the funding for the compulsory training and to “make sure this training is institutionalized” throughout the school, reports Campus Reform.

Who is this group behind the “white privilege” training session ? Well, they are disgruntled students.

The movement, called HKS Speaks Out, began in October after students expressed having “really negative classroom experiences,” according to Reetu D. Mody, a first year Master in Public Policy student and an organizer of the movement. She said the group has amassed about 300 student signatures, or about a fourth of the school’s student population, on a petition that calls for mandatory privilege and power training.

Reetu

She can’t breathe. She is a Congressional staffer but I can’t find out whose staff. Democrat if not Bernie Sanders.

Steve Sailor is not impressed.

Harvard U. is full of people who clawed their way into Harvard, so it’s not surprising that they often can’t stand each other. Fortunately, 21st Century Harvard students have a vocabulary of whom to blame for any and all frustrations they feel. From the Harvard Crimson:

Kennedy School Students Call for Training To Combat Privilege in Classroom

Whiteness !

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Another D-Day anniversary.

Saturday, June 6th, 2015

I have posted a few photos from our trips to Normandy in years past. I haven’t been back since then but have been reading about it. Here is SLA Marshall’s description of the first wave at Normandy.

It was very nearly a disaster for the whole invasion although Utah and the British and Canadian beaches were far less dangerous for the troops. One reason was the geography.

Utah Beach was nearly flat and there was no bluff as there was at Omaha. The problem at Utah was that the country behind the beach was low and the Airborne drop was to secure the causeways that controlled access to the dry ground beyond the fields flooded by the Germans. Sante Mere-Eglise was the center of the Airborne mission.

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It is much more quiet today although the famous parachute still hangs from the church roof.

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Why Doctors Quit.

Friday, May 29th, 2015

Today, Charles Krauthammer has an excellent column on the electronic medical record. He has not been in practice for many years but he is obviously talking to other physicians. It is a subject much discussed in medical circles these days.

It’s one thing to say we need to improve quality. But what does that really mean? Defining healthcare quality can be a challenging task, but there are frameworks out there that help us better understand the concept of healthcare quality. One of these was put forth by the Institute of Medicine in their landmark report, Crossing the Quality Chasm. The report describes six domains that encompass quality. According to them, high-quality care is:

1) Safe: Avoids injuries to patients from care intended to help them
2) Equitable: Doesn’t vary because of personal characteristics
3) Patient-centered: Is respectful of and responsive to individual patient preferences, needs and values
4) Timely: Reduces waits and potentially harmful delays
5) Efficient: Avoids waste of equipment, supplies, ideas and energy
6) Effective: Services are based on scientific knowledge to all who could benefit, and it accomplishes what it sets out to accomplish

In 1994, I moved to New Hampshire and obtained a Master’s Degree in “Evaluative Clinical Sciences” to learn how to measure, and hopefully improve, medical quality. I had been working around this for years, serving on the Medicare Peer Review Organization for California and serving in several positions in organized medicine.

I spent a few years trying to work with the system, with a medical school for example, and finally gave up. A friend of mine had set up a medical group for managed care called CAPPCare, which was to be a Preferred Provider Organization when California set up “managed care.” It is now a meaningless hospital adjunct. In 1995, he told me, “Mike you are two years too early. Nobody cares about quality.” Two years later, we had lunch again and he laughed and said “You are still too years too early.”

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Scariest image of the week.

Saturday, May 2nd, 2015

Nye

Bill Nye, “The Science Guy” is one of a large number of ignoramuses talking and writing about “Global Warming.”

His background is is here and includes a BS in mechanical engineering.

He studied mechanical engineering at Cornell University (where he took an astronomy class taught by Carl Sagan)[10] and graduated with a bachelor of science degree in mechanical engineering in 1977.[11] Nye occasionally returns to Cornell as a professor to guest-lecture introductory-level astronomy and human ecology classes.

He seems to have had no training or education in ecology or weather and, aside from mechanical engineering, which I had, has no other educational credentials.

Nye began his professional entertainment career as a writer/actor on a local sketch comedy television show in Seattle, Washington, called Almost Live!. The host of the show, Ross Shafer, suggested he do some scientific demonstrations in a six-minute segment, and take on the nickname “The Science Guy”.[14] His other main recurring role on Almost Live! was as Speedwalker, a speedwalking Seattle superhero.

That certainly qualifies him to talk about global warming but I don’t know about children’s sex education.

Hillary hoves into view again.

Monday, March 9th, 2015

Hillary Clinton is another radical lefty on the same pattern as Obama. She has been around longer and is better known so she may have less success even with the automatons at HuffPo. That piece is about six levels below the top at the reliably left wing blog. Even so, it may presage trouble.

The decision to address the issue comes amid mounting criticism of her use of a personal email account, which did not comply with State Department regulations issued in 2005 governing email used for official business. Reports in the New York Times and the Associated Press detailed how Clinton used a private server, housed in her suburban New York residence, to channel her emails, which are supposed to be maintained as part of a federal agency’s historic record.

Examples of some hacked e-mails from that server are here and are interesting.

That’s pretty tame and the HuffPo attention right now is on a letter sent by Republican Senators warning Iran that an agreement that is not ratified by the Senate is not a treaty and can be reversed by the next president.

Their action is a brazen, breathtaking attempt to sabotage U.S. foreign policy and stampede America into another war in the Middle East.

While U.S. Secretary of State John Kerry is trying to negotiate the most critical elements of a deal to prevent Iran from developing nuclear weapons and avoid war, the Republicans are actively trying to undermine his efforts to get a deal.

Can you imagine the reaction if members of Congress had sent a similar letter to the Soviets urging them not to sign an arms control agreement because the United States would not keep our end of the bargain?

The heavy breathing does not include mention of numerous actions by Democrats to subvert actions by Republican Presidents.

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Nature and Nurture.

Wednesday, January 21st, 2015

I have long been a fan of Steven Pinker’s books.

I have read many of them, beginning probably with his books on speech as he is a linguist first. This was probably the first as I was intrigued by his theories about irregular verbs and how children learn language.

He points out, for example, how normal construction in archaic forms such as “Wend, went and wended” have become “Go, went, gone.”
The child makes an error he or she may not understand that “Goed” is not a used form for past tense, whereas “Wend” is an archaic form whose past tense has been substituted. The child is using language rules but they don’t account for irregular verbs. He continues with this thought in The Language Instinct, which came later. Here he makes explicit that this is how the mind works. One review on Amazon makes the point:

For the educated layperson, this book is the most fascinating and engaging introduction to linguistics I have come across. I know some college students who had received xeroxed handouts of one chapter from this book, and these were students who were just bored of reading handouts week after week… but after reading just a few paragraphs from The Language Instinct, they were hooked, fascinated, and really wanted to read the whole book (and did). I wish I had come across such a book years ago…

Now, this is interesting but Pinker has gotten into politics inadvertently by emphasizing the role of genetics in language and behavior. I read The Blank Slate when it came out ten years ago and loved it.

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Medicaid for All

Saturday, November 1st, 2014

My concept of Obamacare has been that it is a transition period to a single payer that will be Medicaid for everybody. Belmont Club (Richard Fernandez) seems to agree.

One of most fascinating things about the failure of Obamacare is it has occasioned the rise of private exchanges, which are now on track to completely dwarf the public Healthcare.gov exchanges. Obamacare is becoming Medicaid for all. That is where all their expansion is coming from, the metal plans it offers, not so much.

The abolition of employer-provided insurance has led companies to simply give workers money to purchase their own health care on a private exchange. Urgent care clinics are booming because they charge much less than Obamacare network prices when a policy holder has not yet reached his deductible. What is repealing Obamacare is that people are working around it, according to their preference. Vermont, for example, is creating a single payer health care system. The Left approves, but it is a rejection of Obamacare just the same.

Thus, private money offsets legal tender. Private security replaces public safety. Private armies replace the United States Armed Forces. Private exchanges replace public exchanges. In the end, only the poor will be left with the public stuff.

I have been of this opinion since the beginning.

At least 2.9 million Americans who signed up for Medicaid coverage as part of the health care overhaul have not had their applications processed, with some paperwork sitting in queues since last fall, according to a 50-state survey by CQ Roll Call.

Those delays — due to technological snags with enrollment websites, bureaucratic tangles at state Medicaid programs and a surge of applicants — betray Barack Obama’s promise to expand access to health care for some of the nation’s most vulnerable citizens.

As a result, some low-income people are being prevented from accessing benefits they are legally entitled to receive. Those who face delays may instead put off doctors appointments and lose access to their medicines, complicating their medical conditions and increasing the eventual cost to U.S. taxpayers.

Democratic lawmakers who have promoted the law’s historic coverage expansion are wary of acknowledging problems that hand opponents of the Affordable Care Act another rhetorical weapon, said Robert Blendon, a professor at Harvard University School of Public Health and Kennedy School of Government.

That was a year ago.

What now ? The Heritage Foundation has a post about the Medicaid expansion that is Obamacare.

Heritage research shows 40 of 50 states would see increases in costs due the Medicaid expansion. If all states expand, state spending on Medicaid would increase by an estimated $41 billion by 2022.

The costs are being shifted to the states. Will that work ?

Analysis by Heritage shows that by 2022 any projected state savings are dwarfed by costs. Moreover, these projected savings assume states will further reduce payments to hospitals and clinics for uncompensated care. But, as Heritage’s Ed Haislmaier points out, it is more likely that hospitals will lobby state legislatures for more money rather than less.

It all depends on cutting reimbursement to providers. Is that likely to increase access for anyone ?

What it will do is shift those who can afford to pay into a parallel system of cash clinics and practices, Which I have predicted.

There have been other suggestions but it is unlikely that any great reform would be tolerated now after the failure of the Democrats’ attempt.

Instead, I think the Republican Congress should pass legislation to make Obamacare voluntary and let the ,market works things out.

Is Ebola airborne ?

Saturday, September 13th, 2014

Ebola has become an uncontrolled epidemic in Africa. I have previously posted on Ebola elsewhere.

UPDATE: There is now a conclusion that Liberia and Sierra Leone are lost.

But Jonas Schmidt-Chanasit of the Bernhard Nocht Institute for Tropical Medicine in Hamburg told DW that he is losing hope, that Sierra Leone and Liberia will receive the neccessary aid in time. Those are two of the countries worst hit by the recent Ebola epidemic.
“The right time to get this epidemic under control in these countries has been missed,” he said. That time was May and June. “Now it will be much more difficult.”
Schmidt-Chanasit expects the virus will “become endemic” in this part of the world, if no massive assistence arrives.

This is from a German source. Our own CDC will not yet say this.

In the balance therefore, the probability is that the virus is not airborne — yet — but it is more dangerous than its predecessors. This would account for its ability to slip through the protocols designed for less deadly strains of the disease. It’s not World War E time, but it’s time to worry.

And: This may be a new strain with more virulence.

The results of full genetic sequencing suggest that the outbreak in Guinea isn’t related to others that have occurred elsewhere in Africa, according to an international team that published its findings online in the New England Journal of Medicine (NEJM). That report was from April 2014.

Now, we have more news. From 2012, we know transmission in animals may be airborne.

While primates develop systemic infection associated with immune dysregulation resulting in severe hemorrhagic fever, the EBOV infection in swine affects mainly respiratory tract, implicating a potential for airborne transmission of ZEBOV2, 6. Contact exposure is considered to be the most important route of infection with EBOV in primates7, although there are reports suggesting or suspecting aerosol transmission of EBOV from NHP to NHP8, 9, 10, or in humans based on epidemiological observations11. The present study was design to evaluate EBOV transmission from experimentally infected piglets to NHPs without direct contact.

The study of this potential explosive development showed:

The present study provides evidence that infected pigs can efficiently transmit ZEBOV to NHPs in conditions resembling farm setting. Our findings support the hypothesis that airborne transmission may contribute to ZEBOV spread, specifically from pigs to primates, and may need to be considered in assessing transmission from animals to humans in general.

Now we have more articles appearing about this.

The second possibility is one that virologists are loath to discuss openly but are definitely considering in private: that an Ebola virus could mutate to become transmissible through the air. You can now get Ebola only through direct contact with bodily fluids. But viruses like Ebola are notoriously sloppy in replicating, meaning the virus entering one person may be genetically different from the virus entering the next. The current Ebola virus’s hyper-evolution is unprecedented; there has been more human-to-human transmission in the past four months than most likely occurred in the last 500 to 1,000 years. Each new infection represents trillions of throws of the genetic dice.

If the New York Times is publishing this, somebody is worried.

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Rape Culture

Thursday, March 20th, 2014

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The college scene is all agog about rape culture. How do we know if it is a problem ?

It’s a phrase you hear a lot. But, what exactly does it mean? Is there one general definition? Not necessarily. In many ways the phrase evokes the famous Supreme Court comment about obscenity from Potter Stewart, “I know it when I see it.”

And, you don’t have to look far to see examples of rape culture these days. Whether it’s advertising, movies, music videos or social media — images, words, concepts — it’s all out there illustrating men dominating women.

So, now we know the problem. It is men.

Popular movies are strewn with plots of men with the sole purpose of having sex. In the movie “American Pie,” the entire plot of the film revolves around teenage boys wanting to throw a party so they can get girls drunk and have sex with them.

That movie was when ? Well, it was 1999. That was 15 years ago, wasn’t it ? How old were these activists then ?

It’s also been stated by writer Adam Herz that the title also refers to the quest of losing your virginity in high school, which is as “American as apple pie.” So, it wasn’t just about girls losing virginity ?

How about porn star/student, Belle Knox ?

Despite the ordeal, Knox said she plans to continue both her porn work and her classes at Duke. In interviews, she frequently mentions working to increase the rights of sex workers.

“I really want to break down barriers,” Knox said. “I want to change peoples views on sex work. … I mean, I was the first porn star to go on ‘The View.’ This is really exciting for me.

She complains about the publicity and the reaction of others but “This is really exciting for me.” Feminism 2014 version. Another porn star success story.

Ph.D. program in sociology at the University of Nevada, Las Vegas. She does cam work, some porn, stripping, and some fetish work. Unlike Knox and L., Parreira is out about her sex work. “The department seems to be a sort of hub for sex workers and sex work research, so it has been a non-issue,” Well, that’s a relief.

Now, back to rape culture. Maybe it’s a tiny bit exaggerated ?

An early sign of an obsession with “rape culture” on campus occurred at Duke during the lacrosse case. In April 2006, in a 2000-plus word statement that declined to mention the presumption of innocence, Duke president Richard Brodhead created a “Campus Culture Initiative,” to explicate and “confirm [emphasis added] the existence of a dominant culture among Duke undergraduates.” There was, of course, no rape, but the CCI proceeded along as if there were, operating under the Orwellian slogan that “diversity makes a more excellent university.”

The Duke LaCrosse team case is a horrible example of leftist agitation in action. The whole story is here. Briefly, a hysteria descended on the Duke University campus after a stripper, later convicted of murder, accused the La Crosse team of a gang rape. The young men of the team were immediate demonized by the usual suspects of campus radicals. Fortunately, the boys came from families that could afford good lawyers.

The immediate frenzy followed the usual script.

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