Archive for the ‘personal’ Category

Feminism and Victimhood Culture.

Friday, April 8th, 2016

We are living an age when any reference to women runs the risk of violating the “victimhood” rights of feminist women.

What is “Victimhood?” It was explained by two sociologists in 2014.

We’re beginning a second transition of moral cultures. The first major transition happened in the 18th and 19th centuries when most Western societies moved away from cultures of honor (where people must earn honor and must therefore avenge insults on their own) to cultures of dignity in which people are assumed to have dignity and don’t need to earn it. They foreswear violence, turn to courts or administrative bodies to respond to major transgressions, and for minor transgressions they either ignore them or attempt to resolve them by social means. There’s no more dueling.

The “Honor Culture” requires that one avenge insults to preserve honor. The law and third parties are avoided and this culture is typical of areas where law and authority is mostly absent. A classic example is the American West in the Age of the Frontier. As law and authority became available, the culture gradually changed to one of The Culture of Dignity in which people are assumed to have dignity and don’t need to earn it. They foreswear violence, turn to courts or administrative bodies to respond to major transgressions, and for minor transgressions they either ignore them or attempt to resolve them by social means. There’s no more dueling. Lawyers have made this culture ubiquitous, even in war.

Now, we have a new phenomenon.

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The Doctor Shortage, discovered once more.

Friday, April 1st, 2016

33 - Lister

I have previously written posts about a coming doctor shortage.

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 ?

The health policy “experts” have been concerned to train “lesser licensed practitioners” and have pretty much ignored primary care MDs except to burden them with clumsy electronic medical record systems that take up time and make life miserable.

I repeatedly ask medical students if they would choose a career in primary care if it would completely erase their student loan debt. A few hands go up, but not many. In fact, for a while now, the federal government has dedicated millions of dollars to repaying loans for students who choose primary care. Yet residency match numbers show that the percentage of students choosing primary care is not increasing. Though loan forgiveness is a step in the right direction, medical students realize that by choosing a more lucrative specialty, they can pay off their loans just fine.

I proposed years ago, a health reform that resembled that of France where medical school is free. It could be arranged that service in primary care, low income clinics would give credit against student loans. Nothing happened. Except physician income has declined. And tuition has increased.

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We were pretty close.

Friday, March 18th, 2016

When we were in Brussels last September, we stayed at a nice hotel near the Grand Place called The Bedford Hotel and Congress Centre.

belgium-brussels-grand-place

I showed some of our photos here.

The Grand Place is about four blocks from our hotel which is quite central. Also fairly central is Molenbeek where the leader of the Paris terrorist attack was captured today.

brussels

To the left is the canal and across it, the Molenbeek neighborhood where the terrorists were holed up. We walked by it during our stay which was a few weeks before the attack. Our hotel was locked down for a week after the Paris attack as they searched for the perpetrators.
We were very close.

Another update on the NHS, Bernie’s favorite health plan.

Friday, February 12th, 2016

NHS

I have mentioned problems with the NHS here before.

That was about emergency care.

Last fall there was a concern about junior doctors emigrating to other countries.

Britain is already suffering from a serious, and unprecedented, shortage of GPs, on a scale that doctors’ leaders say is fast becoming a crisis.

According to figures released last week, a staggering 10.2 per cent of full-time GP positions across the UK are currently vacant, a figure that has quadrupled in the past three years.

Two-thirds of practices are now finding it ‘difficult’ or ‘very difficult’ to find locums — freelance medics — to cover the shortfall.
As our population gets steadily older, and sicker, frontline surgeries are becoming increasingly swamped.
‘We are in dire straits if we do not act to address the GP recruitment crisis immediately,’ the Royal College of GPs warned last week.

In standard government medicine fashion, the British Health Minister imposed a new employment contract that ignored doctors complaints.

The result ?

Junior doctors are threatening a mass exodus to Australia after Jeremy Hunt forced through his controversial new contract yesterday.
There has been a huge surge in the numbers seeking certificates to practise abroad and some have already lined up jobs.
Almost 760 doctors were issued with documents by the General Medical Council in the first four weeks of this year – nearly 200 a week and almost double the usual number. Although they include some older GPs and consultants, the vast majority were disillusioned younger doctors.

Becoming a doctor is a classic middle class occupational choice. Few doctors become rich and almost none do so from actual practice. There was a phase in the 1960s when doctors suddenly became much more prosperous as Medicare was introduced, providing payment for care that had been done for no charge mostly. With time, the US government has reduced compensation and imposed rules designed to reduce costs. With the imposition of Obamacare, many older doctors who do not have heavy student loan balances and whose own children are educated, are choosing to drop all insurance, including Medicare, and practice for cash.

Obamacare has resulted in many hospitals consolidating and buying up medical practices to develop a vertically integrated system of health care delivery that resembles old industrial models. The result for physicians is a trend to salary jobs and dissatisfaction with their careers.

I met a woman geriatrician, the only fellowship trained geriatric specialist in central Iowa. She had quit Medicare. That sounds a bit suicidal if all your patients are Medicare age. What had happened was she was being harassed by Medicare because she was seeing patients too often. Many of them were frail elderly living at home. She dropped out and began charging her patients cash for services. She was making a decent living after a year and was happy with her decision. I don’t know how many realize that geriatrics, as a specialty, is a university subsidized field. There is no private geriatric practice because the doctor can’t survive on what Medicare pays. She tried and had to quit. She is doing it on her own now.

That was about Medicare. The same is happening with Obamacare and the medical conglomerates that have been assembled in anticipation of the “Industrial Model” of medical care. How is that working out in Britain ?

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Will California real estate prices collapse ?

Tuesday, January 26th, 2016

I sold my house in 2010 and moved to Lake Arrowhead where I bought a house on a rare level piece of land that I fenced for my dog.

After, living there for two years, I found that I could not tolerate the altitude, even though it is only 5200 feet. I was short of breath and had trouble sleeping. I had to sell the house and move back to sea level. In doing so, I lost a lot of money and have been renting since 2012, first a small condo and now a three bedroom house in Mission Viejo. I have slowly rebuilt my funds and have started to think about buying another house. I would really like to move to Tucson but my children are in California and I would be alone in Tucson. Jill and I are back together since 2014 and so one reason for staying here is less important. I would not be alone.

The other reason why I am reluctant to buy another house in southern California is the insane level of real estate prices. In moving to Lake Arrowhead, a resort, I found the only real estate market that is NOT increasing in value. Mission Viejo, where I have lived since 1972, is in Orange County and has some very high real estate values. I have been nervous about another collapse in prices and don’t want to buy at the peak of the market.

Recently there have been a few signs that the party may be over.

In the 1980s, there was a surge of buying from Japan as Japanese used the towering real estate prices in Japan to borrow and buy expensive houses in southern California. When Japan entered the present 25 year slump, the prices of southern California homes also dropped and many were sold for a fraction of the previous price. An impressive example, is what happened at the Pebble Beach golf resort. In 1989, a Japanese investor bought the resort for an amazing price. Ten years later, he had to sell for a fraction.

The sale will end nearly a decade of Japanese ownership of Pebble Beach, which became a symbol of the exorbitant prices paid and, subsequently, the massive losses suffered by Japanese investors who flooded into U.S. real estate during the late 1980s and early 1990s.

“We think it’s the best golfing place on the globe,” said Ueberroth, who began negotiations to purchase the property in March. “I’ve been lucky enough to have played there over the last 40 years.”

The purchase of Pebble Beach Co. includes the Pebble Beach Golf Links and three other nearby courses; two luxury hotels, the Lodge at Pebble Beach and the Inn at Spanish Bay; and 17-Mile Drive, a popular tourist destination.

Pebble Beach Co. is owned by a partnership between Taiheiyo Club Inc., a Japanese golf resort company, and Sumitomo Credit Services Co., one of Japan’s largest issuers of Visa cards. The partnership purchased Pebble Beach in 1992 from golf tycoon Minoru Isutani, who bought the company only two years earlier from a group headed by oilman Marvin Davis. However, the debt-ridden Isutani was forced to sell the property at an estimated $350-million loss.

That’s a big loss and an example of what happened. Now, China is is seeing a stock market crash similar to the Japan real estate crash in 1990.

china

China is still going through a difficult transition from socialism to capitalism, meaning its government that once tightly controlled the economy is slowly letting the global market take the wheel. That’s a tough process, particularly for a government that is used to being able to turn the economic knobs as it pleases. It still likes to do so from time to time, as it did on Thursday — a currency move that will get to in a bit.

But to show how precarious things are, a relatively small tweak sent investors into a pretty steep nose dive. And when China dives, so does everybody else, as evidenced by the market declines around the world.

So, how much effect will that have on Los Angles real estate ? This much.

Prices for the top 5 percent of U.S. real estate transactions remained flat in 2015 while all other houses gained 4.9 percent, according to data from Redfin Corp., a real estate brokerage and data provider.

In the Los Angeles suburb of Arcadia, where Zhang is struggling to sell the six-bedroom home, dozens of aging ranch houses were demolished to make way for 38 mansions built with Chinese buyers in mind. They have manicured lawns and wok kitchens and are priced as high as $12 million. Many of them sit empty because the prices are out of the range of most domestic buyers, said Re/Max broker Rudy Kusuma, who blames a crackdown by the Chinese on large sums leaving the country.

And now, the Chinese market is crashing. Hmmm. Can southern California real estate be far behind ? I’m waiting. Meanwhile, I still like Tucson where prices are much lower.

For example. We are still thinking about it.

2015 is gone, thank God.

Friday, January 1st, 2016

2015-a-maes-Marty_thumb

I am content to see the year 2015 gone. I can remember as a college student thinking that 1960 would never come. That was a good year. I didn’t graduate from USC as planned but I did get married and I did get accepted to medical school.

Some of the story is here in my short biography. More of it is here in my “stream of consciousness.” The next installment is here as I describe Basic Training.

When I got back from Basic Training in December 1959, I had my first date with Irene Lynch. A year later to the day, we were married and a week later, I got a letter from SC Medical School telling I had been accepted to the class beginning in September 1961. So, 1960 was a pretty good year.

In 2015 I spent what I think will be my last year teaching medical students at what is now named “Keck School of Medicine of USC” and is where I attended from 1962 to 1966. I went back to teaching there in 1998 in a program called Introduction to Clinical Medicine, which seems to be disappearing into the “Family Medicine” Department which is a shame.

I now have a book of memoirs called “War Stories: 50 years in Medicine” and which is a Kindle book only so far. Much of my medical school experience is included along with stories from my years as a surgeon. It started to be “40 years a surgeon” but I decided to include the rest and changed to 50. In June 2016, it will 50 years since I graduated from Medical School and that seemed a appropriate.

I enjoyed my time with students and I am quitting only because of frustrations with the Electronic Medical Record, about which I used to be enthusiastic, and with changes in the County Hospital which used to be a wonderful teaching institution. The Electronic Medical Record, now more often called The Electronic Health Record, probably because much of it is not about medicine, is a big problem.

The EHR, as it is called, has acquired a bad reputation.

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Celestial Navigation

Tuesday, October 13th, 2015

CatalinaLaborDayRace

In 1981, I sailed my 40 foot sailboat to Hawaii in the Transpacific Yacht Race. That year some large yachts had what were called “Sat Nav ” receivers aboard to track a system of satellites that required continuous tracking and took quite a bit of electrical power. It is now called “Transit” or “navSat”

Thousands of warships, freighters and private watercraft used Transit from 1967 until 1991. In the 1970s, the Soviet Union started launching their own satellite navigation system Parus (military) / Tsikada (civilian), that is still in use today besides the next generation GLONASS.[10] Some Soviet warships were equipped with Motorola NavSat receivers.

My small sailboat could not use such a system. It drew about an amp an hour, far too great a drain on my battery. For that reason I used a sextant and sight tables like these, which are published for the latitudes to be sailed.

sight reduction

That volume is published for latitudes 15 degrees to 30 degrees, which are the ones we most sailed. Hawaii is at about 20 degrees north and Los Angeles is 35 degrees north. The sight tables provide a set of observations that can be compared with an annual book called a “Nautical Almanac.” As it happens, the Nautical Almanac for 1981 is used for training and is still in print.

Nautical al

The third component, besides the sextant, of course, is a star finder, like like this one, to aid with navigational stars.

The whole system is called Celestial Navigation.

The first thing one needs is an accurate clock. This is the reason why sailing ships need a chronometer in the 18th century.

Harrison solved the precision problems with his much smaller H4 chronometer design in 1761. H4 looked much like a large five-inch (12 cm) diameter pocket watch. In 1761, Harrison submitted H4 for the £20,000 longitude prize. His design used a fast-beating balance wheel controlled by a temperature-compensated spiral spring. These features remained in use until stable electronic oscillators allowed very accurate portable timepieces to be made at affordable cost. In 1767, the Board of Longitude published a description of his work in The Principles of Mr. Harrison’s time-keeper.

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Here We Go !

Monday, August 24th, 2015

ghost

UPDATE: Here is a good description of what I think is coming.

The US stock market is being buoyed upward by technology shares that are pure luxury items, a bit like the China Ghost Cities.

America’s technology darlings aren’t exactly making good on Silicon Valley’s legacy. Microsoft, Cisco, IBM and a few other businesses of the old guard have a reasonable claim to being the companies that run the world, but Twitter and Facebook? Not so much – whatever their crazy valuations.

You see, as much as global financial concerns are going to hit tech companies harder than other sorts of enterprise, so too will their own lack of ambition. The ugly truth is that Silicon Valley has largely given up trying to fix big problems and has retreated into photo-sharing apps and productivity tools. That may sound harsh, but just look at some of the absurd and pointless startups that are getting vast checks written and tell me that founders don’t need a kick up the ass and a reminder that no one has solved batteries yet.

I have been pessimistic for several years. That may be just my own psychological makeup but I am not the only one.

California is getting a bit agitated about what is happening in China.

Gyrations in the stock market have taken California’s fragile finances for a ride before — when the dot-com bubble burst, when the Wall Street crash sank the national economy less than a decade ago.

So when the market continued its dive Monday, state officials began glancing around for their seat belts.

More than most states, California depends heavily on taxes from the wealthy, pulling about half of its income tax revenue from just 1% of residents in recent years.

California is a top down society because it depends on income tax. Texas doesn’t and its state government is funded by sales tax, which everyone pays, even illegals.

The Obama Administration has been playing a Ponzi Scheme for years.

A Ponzi scheme is a fraudulent investment operation where the operator, an individual or organization, pays returns to its investors from new capital paid to the operators by new investors, rather than from profit earned by the operator.

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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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Metabolic Syndrome and Obesity.

Monday, July 20th, 2015

I spent an interesting day last Saturday at a USC post-graduate course on “premalignant lesions of the GI react.”

Part of the session discussed the question of obesity and diet. “Fatty liver” is a condition related to obesity and metabolic syndrome.

The Wikipedia definition includes.
1. abdominal (central) obesity,
2. elevated blood pressure,
3. elevated fasting plasma glucose,
4. high serum triglycerides, and
5. low high-density lipoprotein (HDL) levels

Central obesity is not the same as subcutaneous obesity, which is what we all think of. Titters out there is a racial factor with blacks more likely to have subcutaneous obesity without the central obesity involving the liver and internal organs.

Metabolic syndrome and prediabetes appear to be the same disorder, with insulin resistance as a major factor.

Other signs of metabolic syndrome include high blood pressure, decreased fasting serum HDL cholesterol, elevated fasting serum triglyceride level (VLDL triglyceride), impaired fasting glucose, insulin resistance, or prediabetes.

Associated conditions include:
1. hyperuricemia,
2. fatty liver (especially in concurrent obesity) progressing to
3. nonalcoholic fatty liver disease,a.so called NAFL
4. polycystic ovarian syndrome (in women),
5. erectile dysfunction (in men), and
6. acanthosis nigricans.

It is generally accepted that the current food environment contributes to the development of metabolic syndrome: our diet is mismatched with our biochemistry. Weight gain is associated with metabolic syndrome. Rather than total adiposity, the core clinical component of the syndrome is visceral and/or ectopic fat (i.e., fat in organs not designed for fat storage) whereas the principal metabolic abnormality is insulin resistance.

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