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Medicine and Evolution.

Friday, February 7th, 2014

A Final Word: I went by that site today to see what additional comments might have been posted after I left. Here is what remained:

I was referring to your claiming that people were being dishonest in their claims not to be YECs. It’s not that you disagreed with the values expressed by their self-identification, it’s that you didn’t accept that they were who they claimed they were. This makes productive conversation much more challenging.

Does that make sense?

I didn’t claim that people were secret YEC members. I commented that I was astounded at the vehemence of people who described themselves as “non-creationist Christians,” at attacking a person who supports and thinks evolution will be important in medicine in the next 50 years. Read some of the comments in italics below to see if I am overstating this.

I am very concerned, after this, at the role of Fundamentalist Christians in the GOP. They are far less tolerant of other opinion and resemble the global warming alarmists in the unwillingness to allow dissent.

Update #4: I am saving some of the material from the thread to remember what Ricochet is like.

The pseudo sympathy: Mike, frankly, you never had them straight in the first place. The entire thread, you thought you were fending off attacks from a group of Young Earth Creationists, but there was only one YEC among them. The rest of them were believers in one form of evolution of another, and just upset with your attitude.

Attitude !

Do you bear any of the blame for making this thread so unpleasant? I’m perfectly willing to have a discussion with you, and I’m semi-sympathetic to your viewpoint. I’m definitely not a YEC. But I can’t understand why you are being so flippant.
Flippancy is the problem !

No, you’re not. You might try reading the thread. I’ve been listing all the insults over on my own blog as a study of how this happens.

“Mike, I am personally not a young-earth creationist, but I think you are confusing two concepts here. ”

I’m always the one confused. Explained by the Ivy League.

This: “Or would he create a universe that showed millions of millennia of age, even though it was only seconds old?”

Led to this: “It’s nice that you all believe this. Good luck. Let’s hope your doctor doesn’t.”

Now that was my mortal sin to the crowd here. From that the following resulted:

“You are very flippant in dismal of my case for faith. Once again I have no problem believing that someone who believes that God put together the world in 6 days .”can also understand the significance of mitochondria. ”

I doubt that. Instead: “I have a far greater trust of a doctor who believes in God and lives it in his own life rather than one who is merely technically competent and sees the universe, and my life, as a happenstance of evolutionary doctrine.”

Now, the folks who are denying this is about creationism and is about my “attitude” seem to ignore those parts.

“Well that’s a glowing example of inability to actually argue the point. When you encounter indications that people disagree with your conflating micro and macro evolution, imply that anybody who doesn’t believe in the warm puddle or whatever the popular origin of life theory is this week is incompetent. ”

Now there’s a thoughtful statement.

” If I’m just an expression of evolutionary pressures, he might want to trim it up. (Has the advantage of being supported by all the various eugenics of recent history, including the ongoing slaughter of those unborn suspected of having genetic illnesses.)”

So now abortion has been dragged into it.

“You slander many very good doctors with your dismissive remarks.”

And I’m the problem.

“But what followed was a long-winded series of examples that do not make a case that any student of what evolution teaches must believe any of the paleo-biology tall tales about the long long ago history of this and that.”

More friendly repartee.

“In my opinion, the whole argument is silly. Humans simply don’t have the intellectual capacity to comprehend the creation. It’s like a dog trying to understand how a television works;”

More brilliance. My tolerance for this is less than yours or you didn’t read it.

“Mike has argued that we should (or, at least, he would) place professional barriers before those who disagree with his creation myths ”

Another mis-statement of what I wrote. I only mentioned my own letter writing which was not a barrier the last time I checked admission requirements.

“You are the one who said that you would keep Creationists out of med school.”

More mis-statement.

“Believing that the paleo- fields have very badly miscalculated the age of the earth has nothing at all to do with the ability of a doctor to conduct medicine. ”

I guess you agree. I don’t.

I then gave up. This colony of creationists, even those who deny they are “YEC,” wore me out.

UPDATE #3: The attacks continue and it has been several days !

I am also a Christian who doesn’t hold to a YEC point of view. (I would also add, although I hate to flaunt credentials, that I am a more recently trained physician than you, Ivy-League-trained, and hold a faculty position at a medical center that’s a bit fancier than yours.)

So there ! I have decided that I am a Libertarian and not a conservative, if that is what this is about.

UPDATE #2 The pushback has finally succeeded in making me a villain.

(Yes, I know the things I cited don’t make him right about YEC, necessarily. My point is that he’s been successful despite Mike K insisting that people like him should be prevented from being doctors.) ·

This followed a long list of accomplishments by a supposed acquaintance who had had a successful career as, as best I can tell, a pediatrician. This all began with my comment that, aside from not being willing to recommend a student who did not believe in evolution for medical school, I was neutral. I think I am no longer neutral. The “Young Earth Creationist” community seems to have a determination to oppose any evolutionary thinking by anyone. They also seem to have an very convoluted way of explaining why obvious facts are not as they appear.

UPDATE: The pushback from creationists surprised me a bit. I guess it shouldn’t have. I expected “We will just have to agree to disagree” sort of thing. Instead I got an interesting series of attacks on me.

Is it impossible for the Creator to have built all the evidences of age into His new creation? The reality of natural selection isn’t necessarily required to have a long and indefinite period of activity to apply today.

and

Well that’s a glowing example of inability to actually argue the point. When you encounter indications that people disagree with your conflating micro and macro evolution, imply that anybody who doesn’t believe in the warm puddle or whatever the popular origin of life theory is this week is incompetent.

and

There are plenty of good Christian doctors and biologists who are well-versed in cell biology and in how mutations happen and in natural selection processes that affect microbes and higher organisms.

This all reminds me of the epicycles, which were used to explain why Ptolmeic astronomy could not explain certain phenomena like the movement of planets. It took Kepler’s discovery of the elliptical orbits to resolve the matter finally.

The creationists seem determined to ignore the implications of molecular biology about evolution and maintain “Young Earth Creation” in the face of the evidence of ancient biology.

But what followed was a long-winded series of examples that do not make a case that any student of what evolution teaches must believe any of the paleo-biology tall tales about the long long ago history of this and that.

Even Copernicus wanted to learn why the planets did not follow the rules of Ptolmeic astronomy. Today, that is considered rude. I may have to reevaluate my opinion of creationists. I have considered them harmless ill educated religious fundamentalists. They are far more aggressive than I had believed in attacking any disagreement.

I accidentally got into a debate about evolution at another site today. I didn’t want to get into this as I know there are many people, many of whom share my political affiliation, who are adamant about creationism, as the left often refers to it. Still, I have posted my opinions here in the past. I think molecular medicine is going to become even more important in the future and I do not understand how a physician can understand molecular medicine without molecular biology. There are many examples of evolution that must be understood to appreciate certain areas of medicine.

I think a physician can practice as a GP and not believe in evolution. I know a few. They are not likely to understand the future of medicine but they are my age and will not be practicing for long, if they are not yet retired.

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Where health care may be going.

Wednesday, October 23rd, 2013

Titanic; Vancouver; 1912

I couldn’t resist this graphic. It’s so appropriate for the moment.

I have watched the failed rollout of Obamacare this past three weeks and wondered where it was going. I have some suspicions. There is a lot of talk about delaying the individual mandate, as Obama did with the employer mandate. Megan McArdle has a post on this today. I think it is too late to fix or delay Obamacare.

With Nov. 1 storming toward us and the health insurance exchanges still not working, we face the daunting possibility that people may not be able to sign up for January, or maybe even for 2014. The possibility of a total breakdown — the dreaded insurance death spiral — is heading straight for us. The “wait and see if they can’t get it together” option no longer seems viable; we have to acknowledge that these problems are much more than little glitches, and figure out what to do about them.

She has already described the insurance death spiral. I think it is here.

Am I exaggerating? I know it sounds apocalyptic, but really, I’m not. As Yuval Levin has pointed out, what we’re experiencing now is the worst-case scenario for the insurance markets: It is not impossible to buy insurance, but merely very difficult. If it were impossible, then we could all just agree to move to Plan B. And if it were as easy as everyone expected, well, we’d see if the whole thing worked. But what we have now is a situation where only the extremely persistent can successfully complete an application. And who is likely to be extremely persistent?

Very sick people.

People between 55 and 65, the age band at which insurance is quite expensive. (I was surprised to find out that turning 40 doesn’t increase your premiums that much; the big boosts are in the 50s and 60s.)
Very poor people, who will be shunted to Medicaid (if their state has expanded it) or will probably go without insurance.

Levin points out: It is now increasingly obvious to them that this is simply not how things work, that building a website like this is a matter of exceedingly complex programming and not “design,” and that the problems that plague the federal exchanges (and some state exchanges) are much more severe and fundamental than anything they imagined possible. That doesn’t mean they can’t be fixed, of course, and perhaps even fixed relatively quickly, but it means that at the very least the opening weeks (and quite possibly months) of the Obamacare exchanges will be very different from what either the administration or its critics expected.

The insurance industry is already reacting to Obamacare and this will quickly become irreversible. This article is from September.

IBM, Time Warner, and now Walgreens have made headlines over the past two weeks by announcing that they plan to move retirees (IBM, Time Warner) and current employees (Walgreens) into private health insurance exchanges with defined contributions from employers.

The article calls it “maybe a good thing” but that supposes the exchanges will function. What if they don’t for a year or more ? What will health care look like in November 2014 ?

What happens next — as we’ve seen in states such as New York that have guaranteed issue, no ability to price to the customer’s health, and a generous mandated-benefits package — is that when the price increases hit, some of those who did buy insurance the first year reluctantly decide to drop it. Usually, those are the healthiest people. Which means that the average cost of treatment for the people remaining in the pool rises, because the average person in that pool is now sicker. So premiums go up again . . . until it’s so expensive to buy insurance that almost no one does.

Will that be apparent a year from now ? I’m sure the administration, and the Democrats, will do almost anything to avoid that. What can they do ? They’ve already ignored the law to delay the employer mandates. It’s too late to delay the individual mandate because individual policies are being cancelled right now.

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Posted in education, health reform, medicine, politics, science | 3 Comments »

Teaching in a majority black high school.

Saturday, July 6th, 2013

This essay has been around for a while but I saw it for the first time today. It is powerful but depressing. I wonder how applicable it is to the Chicago school system? I have a nephew who has a step daughter in a public school that is about half black. Her mother has to go to the school about once a week to complain about bullying. Catholic schools’ tuition is far higher than it was when I lived there.

Here it is.

A few excerpts: Until recently I taught at a predominantly black high school in a southeastern state.

The mainstream press gives a hint of what conditions are like in black schools, but only a hint. Expressions journalists use like “chaotic” or “poor learning environment” or “lack of discipline” do not capture what really happens. There is nothing like the day-to-day experience of teaching black children and that is what I will try to convey.

Most whites simply do not know what black people are like in large numbers, and the first encounter can be a shock.

One of the most immediately striking things about my students was that they were loud. They had little conception of ordinary decorum. It was not unusual for five blacks to be screaming at me at once. Instead of calming down and waiting for a lull in the din to make their point — something that occurs to even the dimmest white students — blacks just tried to yell over each other.

This must be an impossible place to try to teach. Are there any kids who want to learn?

Black women love to dance — in a way white people might call gyrating. So many black girls dance in the hall, in the classroom, on the chairs, next to the chairs, under the chairs, everywhere. Once I took a call on my cell phone and had to step outside of class. I was away about two minutes but when I got back the black girls had lined up at the front of the classroom and were convulsing to the delight of the boys.

Many black people, especially black women, are enormously fat. Some are so fat I had to arrange special seating to accommodate their bulk. I am not saying there are no fat white students — there are — but it is a matter of numbers and attitudes. Many black girls simply do not care that they are fat. There are plenty of white anorexics, but I have never met or heard of a black anorexic.

“Black women be big Mr. Jackson,” my students would explain.

“Is it okay in the black community to be a little overweight?” I ask. Two obese black girls in front of my desk begin to dance, “You know dem boys lak juicy fruit, Mr. Jackson.” “Juicy” is a colorful black expression for the buttocks.

The attitude toward learning is totally negative. That is “Acting white.”

“Once I needed to send a student to the office to deliver a message. I asked for volunteers, and suddenly you would think my classroom was a bastion of civic engagement. Thirty dark hands shot into the air. My students loved to leave the classroom and slack off, even if just for a few minutes, away from the eye of white authority. I picked a light-skinned boy to deliver the message. One very black student was indignant: “You pick da half-breed.” And immediately other blacks take up the cry, and half a dozen mouths are screaming, “He half-breed.”

I have been teaching medical students for about twelve years. About 1/3 to 1/2 are black, most of them are foreign born, either Africa or the West Indies. Most are more dark than the average American born black but some, as those from Ethiopia, may be quite light skinned. The foreign born blacks have a totally different attitude than the American blacks. Of course, with medical students, I am seeing the highest achievers.

Even so, I have met college students who are from Africa. One, I remember quite well, was attending Dartmouth in the mid-ninties. He worked the night shift in the dining hall, which was open 24 hours at the time. He could not understand white students who would come to the dining hall at 3 AM drunk. What were they doing at such a prestigious and rigorous college ?

I also examine recruits for the military in Los Angeles. I talk to these kids and about 1/4 are black. Hispanics seem to be about twice their share in recruits but both groups are highly motivated. Some of the blacks are foreign born and I have spent some time talking to them. They show none of the social pathology I see in this article but, of course, it would be hopeless for such kids to try to join the military even if they wanted to. One young man I talked to last month is 25 and has 17 half-siblings. He said he never wanted to see any of them again. He is drug free and trying to improve his life. He was raised mostly in foster care and, I suspect, was luckier than most in his situation to had that upbringing.

Most of the blacks I taught simply had no interest in academic subjects. I taught history, and students would often say they didn’t want to do an assignment or they didn’t like history because it was all about white people. Of course, this was “diversity” history, in which every cowboy’s black cook got a special page on how he contributed to winning the West, but black children still found it inadequate. So I would throw up my hands and assign them a project on a real, historical black person. My favorite was Marcus Garvey. They had never heard of him, and I would tell them to research him, but they never did. They didn’t care and they didn’t want to do any work.

Anyone who teaches blacks soon learns that they have a completely different view of government from whites. Once I decided to fill 25 minutes by having students write about one thing the government should do to improve America. I gave this question to three classes totaling about 100 students, approximately 80 of whom were black. My few white students came back with generally “conservative” ideas. “We need to cut off people who don’t work,” was the most common suggestion. Nearly every black gave a variation on the theme of “We need more government services.”

My students had only the vaguest notion of who pays for government services. For them, it was like a magical piggy bank that never goes empty. One black girl was exhorting the class on the need for more social services and I kept trying to explain that people, real live people, are taxed for the money to pay for those services. “Yeah, it come from whites,” she finally said. “They stingy anyway.”

Is there any hope for these people ?

My department head once asked all the teachers to get a response from all students to the following question: “Do you think it is okay to break the law if it will benefit you greatly?” By then, I had been teaching for a while and was not surprised by answers that left a young, liberal, white woman colleague aghast. “Yeah” was the favorite answer. As one student explained, “Get dat green.”

There is a level of conformity among blacks that whites would find hard to believe. They like one kind of music: rap. They will vote for one political party: Democrat. They dance one way, speak one way, are loud the same way, and fail their exams in the same way. Of course, there are exceptions but they are rare.

Whites are different. Some like country music, others heavy metal, some prefer pop, and still others, God forbid, enjoy rap music. They have different associations, groups, almost ideologies. There are jocks, nerds, preppies, and hunters. Blacks are all — well — black, and they are quick to let other blacks know when they deviate from the norm.

Reading this essay, and I recommend it, has made me a little more comfortable with the concept of amnesty for illegal aliens.

My black students had nothing but contempt for Hispanic immigrants. They would vent their feelings so crudely that our department strongly advised us never to talk about immigration in class in case the principal or some outsider might overhear.

Whites were “racis’,” of course, but they thought of us at least as Americans. Not the Mexicans. Blacks have a certain, not necessarily hostile understanding of white people. They know how whites act, and it is clear they believe whites are smart and are good at organizing things. At the same time, they probably suspect whites are just putting on an act when they talk about equality, as if it is all a sham that makes it easier for whites to control blacks. Blacks want a bigger piece of the American pie. I’m convinced that if it were up to them they would give whites a considerably smaller piece than whites get now, but they would give us something. They wouldn’t give Mexicans anything.

We live in interesting times.

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Posted in Chicago, education, immigration, politics, racism, social issues | Comments Closed

How to respond to the IRS scandal

Wednesday, May 15th, 2013

Washington DC seems to be convulsed this week with scandals. Most of us were well aware of the Benghazi disaster and coverup. The IRS scandal is new and does a lot to explain the quiet status of the Tea Party groups that were so active in 2010. Many of us expected to see more of them last year in the run up to the 2012 presidential election, as well as the other races for Senate and House. Now we know what happened.

The Tea Party groups that filed for 501 (c) 4 status were harassed and threatened by the IRS. 501 (c) 4 status does NOT grant tax exemption to donations, contrary to the statement of Nancy Pelosi, not a good source in any situation. It only allows tax exemption for activities intended to education the public on issues of interest to the organization. From the IRS web site:

The promotion of social welfare does not include direct or indirect participation or intervention in political campaigns on behalf of or in opposition to any candidate for public office. However, a section 501(c)(4) social welfare organization may engage in some political activities, so long as that is not its primary activity. However, any expenditure it makes for political activities may be subject to tax under section 527(f).

The Tea Parties were organized for political and educational activity, not as lobbies. There are plenty of lobbies. Other organizations singled out by the IRS in this scandal included those concerned with “The Constitution” or other philosophical topics. Several examples are included in this article.

Kookogey’s organization, Linchpins of Liberty, is one of several groups still awaiting approval of their applications for tax-exempt status after more than three years. Linchpins, a conservative mentoring program for high-school and college students, has received extensive and intrusive requests for information about the organization. Unlike most of the groups targeted, however, Linchpins of Liberty was seeking status as a 501(c)(3) educational non-profit, as opposed to a more overtly political 501(c)(4) “social welfare” group, and had no direct “tea party” affiliation. The group’s stated mission is “to challenge the imagination of the rising generation” through “the study of books about the human condition and about civic order.”

I see no evidence of lobbying intent there.

The agency sent him more than 30 questions in response to his application, including some that defied comprehension. “They asked me to identify the students I’m teaching and what I’m teaching them,” he says. “Now, imagine the disservice I’d be doing to the parents of these kids if I reported their children to the IRS. It was clearly meant to intimidate.”

This is far beyond the role of a tax agency.

How do we deal with this ?

First, donations to 501 (c) 4 organizations are NOT tax deductible for the donor. The organization benefits from the fact that its own activities are tax exempt. It cannot conduct a business that returns profits to the organization although educating members and charging for that service may be permissible.

Under this technical instruction program (pdf) the social welfare group would be allowed to engage in business as a means of financing the social welfare program. The business might consist of holding seminars on politics.

I was president of such an organization years ago. It was the Orange County Medical Association. It was tax exempt and, when we began to organize a subsidiary that would provide health care for low income persons, we made the subsidiary a for-profit company and allocated all business expenses related to the provision of health care as expenses to that subsidiary. We had no IRS trouble although Reagan was president and the IRS was not political as it is under Obama.

My suggestion is to contribute and help the Tea Party and similar organizations to organize themselves under another model. Perhaps legislation to allow educational organizations to function free of harassment would be in order although Democrats in the Senate would probably try to block it. Complaining about the IRS will only accomplish so much. The history of misuse of the IRS is long and goes back to Roosevelt

President Franklin Roosevelt used the IRS to harass newspaper publishers who were opposed to the New Deal, including William Randolph Hearst and Moses Annenberg, publisher of the Philadelphia Inquirer. Roosevelt also dropped the IRS hammer on political rivals such as the populist firebrand Huey Long and radio agitator Father Coughlin, and prominent Republicans such as former Treasury Secretary Andrew Mellon. Perhaps Roosevelt’s most pernicious tax skulduggery occurred in 1944. He spiked an IRS audit of illegal campaign contributions made by a government contractor to Congressman Lyndon Johnson, whose career might have been derailed if Texans had learned of the scandal.

Andrew Mellon, Treasury Secretary under Coolidge, was harassed by FDR until he died. After his death, Mellon was exonerated completely.

The administration of President Franklin D. Roosevelt subjected Mellon to intense investigation of his personal income tax returns. The US Justice Department empaneled a grand jury, which declined to issue an indictment. Roosevelt hated Mellon, as the embodiment of everything he thought was bad about the 1920s; Mellon vehemently denied the charges. A two-year civil action beginning in 1935, dubbed the “Mellon Tax Trial”, eventually exonerated Mellon, albeit several months after his death.

We should support the Tea Parties and get tax lawyers to construct a standard application with responses to legal and appropriate questions.

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Posted in corruption, financial, politics | 2 Comments »

The Connecticut Massacre

Saturday, December 15th, 2012

There is information still coming to light about this awful case. Early reports, such as the name of the shooter and the alleged murder of the father, were predictably wrong. It turns out that the shooter, named Adam Lanza, a 20 year old with a history of odd behavior and some evidence of mental illness, such as autism, was living with his mother who was his first victim. There are a number of suggestive reports, that she decided to “stay home to care for” her 20 year old son.

The treatment of severe mental illness in this country has been altered for the worse by a movement that began in the 1960s when mental illness began to be described as a “civil rights ” issue. Several books and movies described abuse of power in commitment of the mentally ill. The first such movie was “The Snake Pit” in which a young woman is committed for what sounds like schizophrenia. The treatment of the time (1948) can be seen as barbaric but there was nothing else available. She did recover, although we know that without adequate treatment, recovery from schizophrenia is unlikely.

The movie that really devastated the mental hospital system was called “One Flew Over the Cuckoo’s Nest” and starred Jack Nicholson.

As I type this, a black professor of psychiatry is talking on the TV and discussing gun control !! His mention of mental illness is brief and noncommittal.

The movie was powerful in showing the Nicholson character as a guy who just is “different” and harmless.

The film was the second to win all five major Academy Awards (Best Picture, Actor in Lead Role, Actress in Lead Role, Director, and Screenplay) following It Happened One Night in 1934, an accomplishment not repeated until 1991 by The Silence of the Lambs.

In 1963 Oregon, Randle Patrick “Mac” McMurphy (Jack Nicholson), a recidivist anti-authoritarian criminal serving a short sentence on a prison farm for statutory rape of a 15-year-old girl, is transferred to a mental institution for evaluation. Although he does not show any overt signs of mental illness, he hopes to avoid hard labor and serve the rest of his sentence in a more relaxed hospital environment.
McMurphy’s ward is run by steely, unyielding Nurse Mildred Ratched (Louise Fletcher), who employs subtle humiliation, unpleasant medical treatments and a mind-numbing daily routine to suppress the patients. McMurphy finds that they are more fearful of Ratched than they are focused on becoming functional in the outside world. McMurphy establishes himself immediately as the leader; his fellow patients include Billy Bibbit (Brad Dourif), a nervous, stuttering young man; Charlie Cheswick (Sydney Lassick), a man disposed to childish fits of temper; Martini (Danny DeVito), who is delusional; Dale Harding (William Redfield), a high-strung, well-educated paranoid; Max Taber (Christopher Lloyd), who is belligerent and profane; Jim Sefelt (William Duell); and “Chief” Bromden (Will Sampson), a silent American Indian believed to be deaf and mute.

Here is the picture of mental illness as a matter of civil rights. It was shown in 1975 when the deinstitutionalizing was already well along and it convinced the public, few of whom know anything of psychology, that mental hospitals should be closed. State governors, like Ronald Reagan in California, were only too happy to oblige. This is why I was not a Reagan fan before he was elected in 1980.

The new drugs, like Thorazine made all this possible. Patients on Thorazine made almost miraculous recoveries. at least until the side effects appeared.

The introduction of chlorpromazine into clinical use has been described as the single greatest advance in psychiatric care, dramatically improving the prognosis of patients in psychiatric hospitals worldwide[citation needed]; the availability of antipsychotic drugs curtailed indiscriminate use of electroconvulsive therapy and psychosurgery, and was one of the driving forces behind the deinstitutionalization movement.

Actually ECT or “shock therapy” was, and remains, effective for severe depression. When used on psychotics like schizophrenics, it often provided a period of a “lucid interval” that lasted for hours when the psychosis seemed to relent. The symptoms recurred but the hope of longer intervals resulted in repeated sessions. It was often depicted with convulsions and other horrendous effects but, in reality, anesthesia and muscle relaxants were used to avoid such scenes. Even insulin coma, which has a risk of damage from low blood glucose, was effective for periods when nothing else worked.

The alternative offered was outpatient centers, in California authorized by The Short-Doyle Act of 1957. There was never enough money and governors saw the closing of state hospitals as a budget issue, not a medical issue.

Throughout the 1970s and 1980s counties contended that the state was not providing adequate funds for community mental health programs. In addition, several counties were receiving less funds on a population basis than other counties. This disparity was addressed, with varying levels of success, in both the 1970s and the 1980s with the allocation of “equity funds” to certain counties. Realignment enacted in 1991 has made new revenues available to local governments for mental health programs, but, according to local mental health administrators, funding has lagged behind demand.

And As a result of declining hospital population, three hospitals (Modesto, DeWitt, and Mendocino) were closed. Legislative intent was to have the budget savings from the closures go to local programs. The “money was to follow the patient.” This did not happen in 1972 and 1973 as a result of the Governor’s veto.

The patients released from state hospitals ended up living in the streets as “the homeless problem” exploded. Others filled the jails. In 2000 I was told by directors of homeless shelters in Los Angeles that 60% of the homeless were psychotic, 60% were drug addicts and half of each group was both. About 10% of the homeless are neither and are quickly moved to shelters and “SRO” hotels, especially if there are children.

What percent of shizophrenics are violent or capable of it ? A national study suggests that the number may be higher than we are usually told.

The 6-month prevalence of any violence was 19.1%, with 3.6% of participants reporting serious violent behavior. Distinct, but overlapping, sets of risk factors were associated with minor and serious violence. “Positive” psychotic symptoms, such as persecutory ideation, increased the risk of minor and serious violence, while “negative” psychotic symptoms, such as social withdrawal, lowered the risk of serious violence. Minor violence was associated with co-occurring substance abuse and interpersonal and social factors. Serious violence was associated with psychotic and depressive symptoms, childhood conduct problems, and victimization.

Since schizophrenia is life-long, usually beginning in teenage years in males and a bit later in females, the total period of exposure to the risk of violent behavior is high. Treatment with modern drugs reduces this considerably but most schizophrenics who are not under good supervision do not take their drugs.

The mother of the shooter was the registered owner of three guns, two of them pistols and one a “bushmaster” rifle. These are military lookalikes that are mostly in 5.56 NATO round calibres. They are also very expensive rifles. The rifle found in the shooter’s care was described as .223 calibre and the Bushmaster site does not include any of this calibre. UPDATE: I did not recognize the .223 as the same calibre as the 5.56 NATO round. It is the same. The .223 is in inches and 5.56 is millimeters. A momentary lapse.

He did not use the rifle anyway but what was the mother doing buying this for her autistic son? Pistols might have been for her own protection but the rifle doesn’t make sense except as evidence of enabling behavior by the mother.

I will add to this post as more information comes out. This looks to me like an incident of mass violence by a schizophrenic 20 year-old male with possible assistance by his mother in allowing him access to guns.

The mother is now being described as a “survivalist” and used to target shooting. That does not explain why she had guns around her psychotic son. “Autism” does not develop during teenage years. It is a phenomenon that is recognized in infancy. The term may have been used by the older brother as it is a less “disreputable” term for schizophrenia. If this represents a form of denial by the family, it may be significant.

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Posted in media, science | 7 Comments »

Decision theory

Sunday, July 8th, 2012

About 17 years ago, I spent a year at Dartmouth Medical School getting another degree in medical outcomes research. I had retired from the practice of surgery after a 14 hour spine fusion. In college, I had a fall in gymnastics class that sent me to the student health center. They x-rayed my neck but not my back below the neck. When I began medical school, we all had to have chest x-rays and mine showed that the fall had caused a three level compression fracture in my thoracic spine. After 18 years in practice and 25 years of standing at an operating table, I had begun to have trouble with my back. It began with pain but continued to signs of spinal cord compression. In 1994, I went to UC San Francisco to consult David Bradford, who had written a number of papers on newer techniques in the surgery I needed. He agreed that I needed it and we arranged for me to have the surgery after Christmas 1994. It involved a lengthy recovery so I retired from my practice and turned it over to a younger associate. I had planned to return part time and see office patients only but he had other ideas, which were not well thought out but there was little I could do about it.

I had been interested in medical quality measurement for years. Now, with no activity planned once I recovered, I got interested in the Dartmouth program. It was called “Center for Evaluative Clinical Sciences,” a rather clumsy name. It is now called something else, but the idea is the same. Jim Weinstein, who is now CEO of the Dartmouth-Hitchcock medical center, was in my class that began in 1994.

The program included some remedial math for us oldsters. Although I had been an engineer it had been in the 1950s. We got a lot of statistics education and some health policy. The Dartmouth folks had been involved in the design of Hillary Clinton’s health plan and I had some fundamental disagreements about policy with them. Like so many academics, they were convinced that they knew how to run a top-down system and I was not so sure. However, the methodology training was, I thought, to be invaluable to me.

Two new areas, in my own experience, were very enlightening. One was survey design, in which I learned a lot about surveys, and incidentally, about polling. The other was decision theory. I had had no idea how important this was to be in health care.

(more…)

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US education compared to other countries

Tuesday, January 11th, 2011

This post at Powerline is so good and so complete that I am going to copy it here without further comment. I do this to keep it for future reference, not because I want claim any credit.

We frequently read about how poorly the United States does when it comes to K-12 education. Our educational system is said, based on this or that study, to be lagging behind those of other developed nations, thus placing our economic competitiveness at risk.

As with certain other metrics through which the U.S. is sometimes compared unfavorably to other countries, I always wonder whether the comparisons that find our education system lacking are “apples to apples.” In other words, do they compare how well various countries educate similarly situated populations?

Robert Samuelson sheds some light on this question in the context of a recent study of the reading skills of 15 year olds in 65 school systems around the world. It shows U.S. students doing slightly above average among the 34 relatively wealthy nations in the study. We’re well behind Shanghai and South Korea, and we trail Japan and Belgium as well. But we’re slightly ahead of France, Germany, and Great Britain.

However, the picture looks different if one examines the American scores by race and ethnicity. Non-hispanic whites in this country score as well or better than non-hispanic whites in Canada, New Zealand, and Australia – all of which are in the top ten worldwide overall. In other words, I submit, these countries rate ahead of the U.S. not because they are better educators but because they have a much more homogenous population.

The same picture emerges if one compares the test scores of Asian Americans to the test scores of students in Asian countries. Here, we remain below Shanghai, but surpass Japan and South Korea.

I don’t mean to say it’s okay that blacks and hispanics do poorly as long as non-hispanic whites do well. The achievement gap is a problem that should be addressed through expanded school choice and other reforms.

But, as Samuelson argues, there are real limits to the ability of schools to compensate for external problems such as broken homes, lack of assimilation, and indifference to education. And if the issue is how well our schools are doing compared to schools in other countries, the comparison really should be based on similarly situated student populations.

There are similar statistics about other social pathologies like murder. The non-Hispanic white murder rate in the US has been lower than Europe’s for many years.

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The education bubble and science

Sunday, January 2nd, 2011

I like George Will’s writing and his insight. I watch the ABC Sunday news commentary show to see him make pithy comments containing more wisdom that the rest of the commentary combined. His column this week is an example of his insights.

Deborah Wince-Smith of the Council on Competitiveness says: “Talent will be the oil of the 21st century.” And the talent that matters most is the cream of the elite. The late Nobel laureate Julius Axelrod said, “Ninety-nine percent of the discoveries are made by 1 percent of the scientists.”

With populism rampant, this is not a propitious moment to defend elites, even scientific ones. Nevertheless, the nation depends on nourishing them and the institutions that sustain them.

U.S. undergraduate institutions award 16 percent of their degrees in the natural sciences or engineering; South Korea and China award 38 percent and 47 percent, respectively. America ranks 27th among developed nations in the proportion of students receiving undergraduate degrees in science or engineering.

He goes on to recommend support of the “elite universities,” by which I suppose the Ivy League. I think there is another point of view that should be considered.

There’s a lot of work ahead to enable the United States to meet the coming challenges. I’m reasonably confident that we remain the best placed large society on earth to make the right moves. Our culture of enterprise and risk-taking is still strong; a critical mass of Americans still have the values and the characteristics that helped us overcome the challenges of the last two hundred years.

But when I look at the problems we face, I worry. It’s not just that some of our cultural strengths are eroding as both the financial and intellectual elites rush to shed many of the values that made the country great. And it’s not the deficit: we can and will deal with that if we get our policies and politics right. And it’s certainly not the international competition: our geopolitical advantages remain overwhelming and China, India and the EU all face challenges even more daunting than ours and they lack our long tradition of successful, radical but peaceful reform and renewal.

No, what worries me most today is the state of the people who should be the natural leaders of the next American transformation: our intellectuals and professionals. Not all of them, I hasten to say: the United States is still rich in great scholars and daring thinkers. A few of them even blog.

The number of hard science and engineering students at major and/or “elite” universities is a small fraction of the total enrollment. Harvard, for example, only recently revised its engineering curriculum.

The A.B. in engineering degree teaches students how to solve problems and builds confidence doing so, explains Cherry Murray, dean of Harvard’s School of Engineering and Applied Sciences. The degree is a good bridge to further education such as business, law, government, architecture, and medical schools, she says, and draws people who might not normally be interested in more narrow engineering subjects. Another benefit of the broader curriculum: Murray says 38% of the A.B. enrollees at Harvard are women, almost double the national average in regular engineering programs.”

I’m sorry to say that doesn’t sound like a rigorous engineering program. What about MIT ? The list of majors is reassuring, although I don’t know why anyone would major in Theater Arts at MIT.

My own personal favorite is Cal Tech. In 1956 I was accepted and even had my dorm room assigned but my father refused to provide any financial information so I was not able to get a scholarship and there were very few loans in those days. It’s one of two missed chances that I cannot forget. Cal Tech is serious science and engineering education. I’m sorry to have missed it.

There are many excellent state university engineering programs so the emphasis on “elite” universities is an example of provincialism on Will’s part. Stanford is considered elite these days and has excellent engineering programs. The University of Southern California, where I was a student, has good engineering programs, especially chemical and petroleum engineering. In the days I attended it was an inferior program but I had a scholarship so that’s where I went. I eventually switched to medicine and that was excellent for the times.

The biggest problem, and one hinted at by critics of the “Education Bubble,” is the plethora of weak majors, like the “studies” programs, which enroll students with weak scholarly skills and produce graduates with large student loans who cannot find a job. A recent book by Charles Murray, of Bell Curve fame, makes the point that too many students are attending college today under the fallacious impression that all are equally entitled to a college degree. His theory is that there is a minimum IQ below which a college education is probably a poor choice. There are many trades that can provide a good stable income and real pleasure in performing tasks that suit one’s ability. The role of vocational education has been minimized the past 40 years and there are few vocational high schools anymore that teach the basics of manual trades. This may suggest that the smaller number of male college students, compared to female, may in fact be the result of better choices on the part of the young men.

Women fill the classes in weak majors like Women’s Studies and Sociology. Many undergraduates in big universities are expected to digest a steady diet of leftist politics before they can get to the serious part of their major field of study.

There is something to be said for limiting student loans to certain fields of study. Engineering and hard science should be eligible for loans without restriction. For other majors, especially the weak ones, the loans should be limited to those with high grades. If a student wants to continue in a weak major, they or their parents should be responsible. Limits on student loans might even bring tuition inflation under control.

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The crisis of the intellectual

Saturday, December 11th, 2010

I was directed to an excellent post by Walter Russell Mead today. It is on the subject of the American social model and the coming era of tumultuous social unrest as the old welfare state model collapses. Europe is already seeing this collapse as nations like Greece face bankruptcy and England deals with the consequences of severe cutbacks in social spending to avoid it.

The US is facing similar economic consequences if the level of spending is not addressed soon. The 2010 elections show that the people recognize the crisis but the “political class” seems less concerned.

“It’s telling to note that while 65% of mainstream voters believe cutting spending is more important, 72% of the Political Class say the primary emphasis should be on deficit reduction,” Rasmussen said.

“Deficit reduction” is code for raising taxes. Spending is heavily embedded in the culture of the political class.

Mead is concerned that the intellectual demographic, those with advanced degrees and careers denominated by thinking rather than doing, is unable to cope with the new situation.

There’s a lot of work ahead to enable the United States to meet the coming challenges. I’m reasonably confident that we remain the best placed large society on earth to make the right moves. Our culture of enterprise and risk-taking is still strong; a critical mass of Americans still have the values and the characteristics that helped us overcome the challenges of the last two hundred years.

But when I look at the problems we face, I worry. It’s not just that some of our cultural strengths are eroding as both the financial and intellectual elites rush to shed many of the values that made the country great. And it’s not the deficit: we can and will deal with that if we get our policies and politics right. And it’s certainly not the international competition: our geopolitical advantages remain overwhelming and China, India and the EU all face challenges even more daunting than ours and they lack our long tradition of successful, radical but peaceful reform and renewal.

No, what worries me most today is the state of the people who should be the natural leaders of the next American transformation: our intellectuals and professionals. Not all of them, I hasten to say: the United States is still rich in great scholars and daring thinkers. A few of them even blog.

His concern is that the intellectuals seem caught in a mind set that goes back to the 19th century and the Progressive Era.

Since the late nineteenth century most intellectuals have identified progress with the advance of the bureaucratic, redistributionist and administrative state. The government, guided by credentialed intellectuals with scientific training and values, would lead society through the economic and political perils of the day. An ever more powerful state would play an ever larger role in achieving ever greater degrees of affluence and stability for the population at large, redistributing wealth to provide basic sustenance and justice to the poor. The social mission of intellectuals was to build political support for the development of the new order, to provide enlightened guidance based on rational and scientific thought to policymakers, to administer the state through a merit based civil service, and to train new generations of managers and administrators.

It’s interesting that one of the comments, a lengthy one, exactly restates this issue but supports this model and argues with Mead that it is still superior.

Second, there are the related questions of interest and class. Most intellectuals today still live in a guild economy. The learned professions – lawyers, doctors, university professors, the clergy of most mainline denominations, and (aspirationally anyway) school teachers and journalists – are organized in modern day versions of the medieval guilds. Membership in the guilds is restricted, and the self-regulated guilds do their best to uphold an ideal of service and fairness and also to defend the economic interests of the members. The culture and structure of the learned professions shape the world view of most American intellectuals today, but high on the list of necessary changes our society must make is the restructuring and in many cases the destruction of the guilds. Just as the industrial revolution broke up the manufacturing guilds, the information revolution today is breaking up the knowledge guilds.

He goes on to criticize medicine as a guild but I think he is unaware of the rapid changes going on in medicine today. The image of the family GP is quickly shifting to the multispecialty group with primary care provided by nurse practitioners and physician assistants. Those who want a personal relationship with a primary care physician, or even a favored specialist, will increasingly be required to pay cash for the privilege as many doctors who want to continue this model of practice are dropping out of insurance and Medicare contracts because of the micromanagement and poor reimbursement.

In most of our learned professions and knowledge guilds today, promotion is linked to the needs and aspirations of the guild rather than to society at large. Promotion in the academy is almost universally linked to the production of ever more specialized, theory-rich (and, outside the natural sciences, too often application-poor) texts, pulling the discourse in one discipline after another into increasingly self-referential black holes. We suffer from ‘runaway guilds’: costs skyrocket in medicine, the civil service, education and the law in part because the imperatives of the guilds and the interests of their members too often triumph over the needs and interests of the wider society.

Almost everywhere one looks in American intellectual institutions there is a hypertrophy of the theoretical, galloping credentialism and a withering of the real. In literature, critics and theoreticians erect increasingly complex structures of interpretation and reflection – while the general audience for good literature diminishes from year to year. We are moving towards a society in which a tiny but very well credentialed minority obsessively produces arcane and self referential (but carefully peer reviewed) theory about texts that nobody reads.

Once again, costs in medicine are a subject by themselves but the solution does not lie in controlling doctors incomes. With respect to the academic institutions, I have personal experience here and will describe some of it. The Humanities have been hollowed out by a trend to both politicize and to leave the subject behind as “critical thinking” goes on to analysis that has little to do with it. The Sokol Hoax is but one example.

The Sokal affair (also known as Sokal’s hoax) was a publishing hoax perpetrated by Alan Sokal, a physics professor at New York University. In 1996, Sokal submitted an article to Social Text, an academic journal of postmodern cultural studies. The submission was an experiment to test the magazine’s intellectual rigor and, specifically, to learn if such a journal would “publish an article liberally salted with nonsense if it (a) sounded good and (b) flattered the editors’ ideological preconceptions.”[1]

The hoax precipitated a furor but did not result in much improvement in such publications. My daughter had personal experience when her freshman courses in English Composition and American History Since 1877 both contained numerous examples of political and “social justice” alteration of the subject matter. For example, she was taught that the pioneers in the west survived by “learning to live like the Native Americans.” The fact is that the pioneers were mostly farmers and ranchers and the Native American tribes of the southwest were hunter gatherer societies who did not use agriculture or animal husbandry. She was also taught that the “Silent Majority” of the 1960s were white people who rejected the Civil Rights Act of 1964. Thus they were racists. Even Wikipedia, no conservative source, disagrees:

The term was popularized (though not first used) by U.S. President Richard Nixon in a November 3, 1969, speech in which he said, “And so tonight—to you, the great silent majority of my fellow Americans—I ask for your support.”[1] In this usage it referred to those Americans who did not join in the large demonstrations against the Vietnam War at the time, who did not join in the counterculture, and who did not participate in public discourse. Nixon along with many others saw this group as being overshadowed in the media by the more vocal minority.

She has since transferred to another college.

The foundational assumptions of American intellectuals as a group are firmly based on the assumptions of the progressive state and the Blue Social Model. Those who run our government agencies, our universities, our foundations, our mainstream media outlets and other key institutions cannot at this point look the future in the face. The world is moving in ways so opposed to their most hallowed assumptions that they simply cannot make sense of it. They resist blindly and uncreatively and, unable to appreciate the extraordinary prospects for human liberation that this change can bring, they are incapable of creative and innovative response.

I think this is the source of the “media bias” so prominently referred to by the Right and by many who are not politically focused. This is why talk radio and Fox News have been such huge successes to the consternation of the political class and their supporters. Charles Krauthammer famously said, “Rupert Murdoch (owner of Fox News) found a niche market that contained 50% of the population.”

The Tea Parties are another manifestation of the frustration of the general population with the political class but also with the intellectual class that seems to be wedded to the first. The university community is, at least in the non-science segment of it, to be increasingly isolated from the concerns of the society that supports them. CalTech has for many years had a Humanities program to expose science and engineering students to culture. Unfortunately, a student in a large university will find much less culture and much more politics in Humanities departments these days.

A couple of other blog posts are worth reading on this subject. One is here and the other is here. They are both worth reading in full.

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The Education Bubble.

Monday, September 6th, 2010

There has been quite a bit of discussion on various blogs about the rising cost and declining utility of a college education, especially outside the “hard sciences.” Even the left is beginning to notice some of the problems.

And if colleges are ever going to bend the cost curve, to borrow jargon from the health care debate, it might well be time to think about vetoing Olympic-quality athletic facilities and trimming the ranks of administrators. At Williams, a small liberal arts college renowned for teaching, 70 percent of employees do something other than teach.

Complaints about athletics are old news in leftist publications but that number for non-teaching employees is an eye opener.

Tuition is part of the problem.

No one can look at that curve and miss the magnitude of the problem. Roger Kimball has a nice summary of the problem and the comments are almost as interesting as his post.

I went through college and medical school mostly on scholarship. I did lose my scholarship one year through the effects of too much extracurricular activity. I was taking a calculus course from this little Indian professor. He was difficult to understand but I thought we had an agreement. If I got an A on the final, I would get a B in the course. I had been delinquent in turning in homework assignments but had finally seen the light. The final exam came and, since I had finally begun to study systematically, I got the A. All my life, I had gotten by with minimal study. I was finally motivated enough to do the work necessary instead of just enough to “get by.”

Well, I went over to the Math office (In those days a small bungalow painted a dreary sunshine yellow as all the temporary university buildings were.) and the posted grades were up. I had gotten a C. I needed that B to keep a B average and my scholarship. I was doomed. I made an appointment to talk to the professor. He didn’t show up. I made another with the same result. A couple of days later, I was walking down University Avenue when I saw him across the street. I called to him and started to cross. He saw me, his eyes bulged and he started to run the other direction. I didn’t think I would improve my grade by chasing him so that was it.

In those days, there were no student loans except some private funds that I knew nothing about. My father had left high school at the age of 15 to join the Navy in World War I. I have a picture of him in his uniform. When the war ended, he wanted out of the Navy so he told them he was only 15. He never went back to school, which is a shame because he was a very bright man and could have been a very good engineer. As it was, he did pretty well in the middle years of his life and disdained education. I never saw him open a book.

My mother had graduated from high school (In 1915) and from “Business College,” which taught her to type fast enough to be a legal secretary. She could type my high school papers as I dictated them at normal speaking speed. She encouraged me to study and to think about college but nobody knew how you went about it. I knew I wanted to be an engineer and I knew I wanted to go to Cal Tech, to me the pinnacle of engineering (I still think so).

I can’t believe how naive I was about getting funding but I just didn’t know anything. My father declared himself early. He took me down to his basement bar and recreation area and had a serious talk with me. “Son, I want you to get this idea of going to college out of your head.” He wanted me to be a golf pro. One of his standard greetings to me was “Get your nose out of that book !” so this was no surprise. I had never counted on him, anyway. I didn’t know at the time that he would have one more blow to administer to my hopes.

That year, 1956, was the first year a new national scholarship program was in effect. It was called The National Merit Scholarship Program and that became my chief goal. Of course, I didn’t realize there were only 100 scholarships that year. It began with the SAT. There were no SAT prep courses then. We were lined up one day and marched into the study hall, a classroom that was unique in that it had theater style seating. We took the exam and about a month later, I was notified that I was a finalist for the National Merit Scholarship.

What I didn’t know was that a packet was sent to the parents of finalists. One item in the packet was a statement of income, although the scholarship was not based on need, apparently that was one criterion. My father refused to fill it out. It was no one’s business how much money he made, which wasn’t very much by that time. His prosperous career was pretty much behind him. A few months later, I got a letter congratulating me, and informing me that, since I did not need financial aid, I was getting a certificate of achievement. In the meantime, I had been interviewed by a Cal Tech professor who traveled to Chicago, my dorm room had been assigned and I was ready to go except for the lack of ability to pay the tuition. I look back in wonder at my own naivete in not contacting the school after my mother told me about the uncompleted financial statement. Maybe they would have helped. I just didn’t know enough.

A month or so later, I was contacted by the Chicago group of USC alumni. I was vaguely familiar with the University of Southern California and, since my prospects were otherwise dim, I accepted. I was interviewed by Robert Brooker, then a vice-president of Sears, and was awarded a full scholarship plus a $500 stipend for living expenses. My high school’s unfamiliarity with my new university was exhibited by the fact that they sent my records to UC, Berkley. I got a letter from Berkley accepting me for admission and asking me to submit an application. We finally got that straightened out and I arrived in Los Angeles about two weeks before classes began to find a place to live.

I eventually, settled in a fraternity house, Phi Gamma Delta, because, in those days at least, fraternity houses were the cheapest place to live and, of course, the fact that they asked me. I had been staying there at the request of my local sponsor, a UCLA Phi Gam alum, while I looked for an apartment. USC in those days had almost no dorms for men, unless they were football players. When I was asked to pledge, I accepted. It was a good decision in many ways (I needed socialization) but it didn’t help studying. I often wonder how I would have turned out if I had made it to Cal Tech.

Engineering at USC was a weak department but I did not take sufficient advantage of what was there. When I lost the scholarship, I was somewhat at sea. What was I to do ? The tuition was $17 a unit, about $272 a semester. I didn’t have it but, at that time, it wasn’t out of reach like it is now. I got a job. I went to work for Douglas Aircraft at what was called a Mathematician I. This was a junior engineer. I had a couple of fraternity brothers who were working there, working their way through the last year of engineering school. In those days, and the point of this stream of consciousness, is that you could work your way through school in those days, even a private university.

My job was in the wind tunnel facility. I spent most of the day with a Marchant desk calculator and the rest programming an IBM 650 computer. This was about the era when the term “bug” was first used for computer malfunctions. We were told that it derived from the fact that one of the COBOL programmers had spent weeks trying to solve a programming error only to find that a moth had gotten into the machine and was contacting random connections.

After six months at this job, I decided to go back to school at night. I was lying on the beach at Playa Del Rey (now under the take-off zone of LAX) in January talking with my roommates about my future. They were both pre-med majors. I had begun thinking about it several years before, even before dropping out of school. John Paxton, whose father was a surgeon, suggested I take a basic biology course (My high school had zero biology) and another advanced course called “Comparative Anatomy.” The latter was a junior level course and maybe too tough for me but, he said, it would be the closest thing to medical school I would find in undergraduate.

I signed up for both courses, paying the $119 tuition myself. It was a good decision. That was January 1960. A year later, I had been accepted to medical school.

Now, there is no way I could do that and the alternative would be thousands of dollars in debt.

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