Posts Tagged ‘science’

The danger of models

Monday, December 14th, 2009

There is a very pertinent article today on the dangers of putting too much faith in models, based on inadequate information.

We’ve now lived through the same new disaster twice. Computer simulations, more or less universally adopted as the solution to a major problem, turned out to have been based on flawed assumptions and faulty data. As a result policy or markets became heavily skewed in an inappropriate direction. Wall Street’s risk managers and climate change scientists both acted as super-salesmen for a paradigm that turned out to be flawed. After two examples of the same error have each cost the world a substantial percentage of a year’s GDP, we’d better figure out how to avoid further examples of this syndrome.

I have previously linked to an article that compared Obama to Mikhail Gorbachev. I think this comparison is also valid and interesting.

As the credit crisis of 2008 recedes into history, the part in it played by misguided computer models, particularly in the risk management area, is becoming generally agreed. Rating agencies made assumptions about the probabilistic independence of different home mortgages that were unfounded. As a result many of their AAA ratings proved to be completely spurious, particularly in the subprime area where the loans’ vulnerability to a house price downturn was especially extreme.

Investment banks managed their risks based on the “Value-at-Risk” risk management paradigm, which assumed that the distribution of securities’ returns was approximately Gaussian (normally distributed), with a very low probability of high losses. The “Basel II” system of global capital adequacy standards for banks, which came into effect in 2008, just in time for the crash, was so impressed with these models that it ruled that any bank using such obviously sophisticated and superior modeling techniques could calculate risks on its own, without reference to the crude guidelines deemed appropriate for smaller, less mathematically attuned houses. The Securities and Exchange Commission (SEC) essentially agreed with the Basel Committee; from 2004, it allowed the largest U.S. investment banks to manage their own leverage, under the theory that no mere regulator could match the exquisite precision of a modern VaR-based risk management system.

The model and the confidence placed in it by financial managers who should know better resembles and old paradigm, confidence in machines that we don’t understand. The “black box” is an example. It had happened before. Programs were written by physics PhDs who did not understand finance for financial experts who did not understand programming.

It’s not as if Wall Street had no warning; mathematical models based on modern financial theory had caused huge losses as far back as 1987, and had caused the collapse of Long Term Capital Management in 1998. Yet the world’s best remunerated people went on using the mathematical models that had caused moderate sized disasters before, only to watch them cause a truly impressive disaster in 2008. It must have been some kind of compulsion.

Then we come to global warming and the cap and trade legislation that relies on the theory.

Turning now to my other example, that of global warming: the possibility that excess carbon dioxide, through a “greenhouse effect” might cause a global rise in temperature is based on well-established chemistry and physics. Deniers of the possibility of global warming are thus being as irrational as the extreme eco-alarmists; global warming is indeed possible because of physical and chemical processes that are perfectly well understood, indeed fairly elementary.

The difficulty arises in estimating whether it is actually happening. The rise in temperatures so far observed is well within the level of “noise” in global temperatures over a period of a century or so, let alone the more extreme fluctuations that have taken place when the observation period is extended to millennia. It is thus necessary to match the very limited temperature data we have, stretching back no more than a century on a worldwide basis, with secondary observations of such things as tree rings and ice cores, synthesizing the result with a computer model of what is believed to be the carbon forcing process in order to predict the range of possible future warming effects.

This is of course a very similar process to that undertaken by Wall Street’s rating agencies and risk managers. Assumptions and simplifications are made, without which it would be impossible to construct a model. Then the model is matched up against a few years’ observations in real time, being “tweaked” as real data comes in that does not quite fit with it. By the time this has been done, careers have been invested in the model, institutions have been built around its predictions and eminent people have become enthralled by its results. It thus takes on the appearance of a scientific reality as solid as Newtonian mechanics.

The economic effects of this model are even greater than the effects of the financial models.

The political left continues to lie about the causes of these recurrent crises, even Nobel Prize winners.

The first big wave of deregulation took place under Ronald Reagan — and quickly led to disaster, in the form of the savings-and-loan crisis of the 1980s. Taxpayers ended up paying more than 2 percent of G.D.P., the equivalent of around $300 billion today, to clean up the mess.

I’m sure that Paul Krugman knows the story of Fernand St Germain and the midnight amendment that brought down the S&Ls.

By the time Ronald Reagan took office in 1981, two-thirds of the nation’s S&Ls were losing money and many were broke. If all the problem thrifts had been shut down right then, the government’s insurance fund would have covered their debts.

Instead, the government delayed an average of two years-and, in some cases, as many as seven years-thus allowing bankrupt S&Ls to go on losing billions of dollars. This delay also gave S&Ls a chance to gamble on questionable investments, in an attempt to regain solvency. But first they had to convince Congress to deregulate them.

One night in 1980, Representative Fernand St Germain (D-Rhode Island), whose $10,000-to-$20,000-a-year restaurant and bar tab was paid for by the S&L industry’s chief lobbyist, proposed raising federal insurance on S&L savings accounts from $40,000 to $100,000- even though the average size of an S&L account was $6,000. He waited until after midnight, when only eleven representatives were still on the floor of the House; they approved his proposal unanimously.

But St Germain was just getting warmed up. In 1982, he cosponsored a bill that removed all controls on what S&Ls could charge for interest and released them from their century-old reliance on home mortgages.

That was Regulation Q.

Around the same time, the Reagan administration ended the requirement that S&Ls lend money only in their own communities, allowed them to offer 100% financing (i.e. no down payments), let real estate developers own their own S&Ls, and permitted S&L owners to lend money to themselves.

These changes were like taping a sign to the S&Ls’ backs that read, “Defraud me.

This has little to do with models but I ran across that Krugman column which is so duplicitous that I had to add a comment.

Steve McIntyre

Monday, December 14th, 2009

Here is a very nice biography of Steve McIntyre, the man who got interested in climate science and precipitated the CRU scandal.

Until 2003, nothing in McIntyre’s life suggested that he would assume a central role in one of history’s great scientific debates—yet that life, in retrospect, seems to have been equipping him for the role. The son of a surgeon, McIntyre had an impressive record of performance in math competitions as a young student attending the University of Toronto Schools. He is still proud of having once beaten older classmate Michael Spence—“he was a bit of a hero of mine”—who would eventually snag the Nobel memorial prize in economics (2001). McIntyre went on to obtain a math degree at the University of Toronto, where his social circle overlapped with that of Michael Ignatieff and Bob Rae. Graduating in 1969, he moved on to the philosophy, politics, and economics program at Corpus Christi College, Oxford.

Read the whole thing.

Here is another very damning piece by a professor of climate science pointing out fraud. Also, the data that has been available to the public is now disappearing from the CRU web site.

A pretty good statement of what I think

Monday, December 7th, 2009

My personal philosophy is pretty simple and I am not one to spend time ruminating about it. Today, I discovered a piece that sounds like something I would have written if I were to try to put down my philosophy. It also states pretty much my own opinion about politics in this country rght now. I just wish I were as optimistic as the writer.

Way back in the depths of time, Greek philosophers ended up with two basic and incompatible ways of looking at the universe. One way was materialism, which says that there is a material universe which behaves in a consistent way, and if you study it you can learn the way it works.

That’s the world view of engineers and scientists — and businessmen, for that matter. It’s the world view of people who understand and use mathematics, and statistics. It is a place where cause leads to effect. It’s the place that game theory studies. It isn’t necessarily inherently atheistic; a lot of religious people live in the materialist world.

But there are people who don’t. A different epistemological view is teleology, which says that the universe is an ideal place. More or less, it
exists so that we humans can live in it. And human thought is a fundamental force in the universe. Teleology says that if a mental model is esthetically pleasing then it must be true. Teleology implies that if you truly believe in something, it’ll happen.

This is pretty much it for me.

Another piece that I have previously referred to is appropriate to quote again here. This was a comparison of Gorbachev and Obama.

they do have one major thing in common, and that is the belief that, regardless of what the ruler does, the polity he rules must necessarily continue. This is perhaps the most essential, if seldom acknowledged, insight of the post-modern “liberal” mind: that if you take the pillars away, the roof will continue to hover in the air.

Gorbachev seemed to assume, right up to the fall of the Berlin Wall and then beyond it, that his Communist Party would recover from any temporary setbacks, and that the long-term effects of his glasnost and perestroika could only be to make it bigger and stronger.

There is a corollary of this largely unspoken assumption: that no matter what you do to one part of a machine, the rest of the machine will continue to function normally.

A variant of this is the frequently expressed denial of the law of unintended consequences: the belief that, if the effect you intend is good, the actual effect must be similarly happy.

Very small children, the mad, and certain extinct primitive tribes, have shared in this belief system, but only the fully college-educated liberal has the vocabulary to make it sound plausible.

I think these two excerpts say much the same thing. Consequences derive from wishes. If we want something, it will happen. I even remember a movie with that theme. I will add a final quote that is also pertinent.

“Throughout history, poverty is the normal condition of man. Advances which permit this norm to be exceeded—here and there, now and then—are the work of an extremely small minority, frequently despised, often condemned, and almost always opposed by all right-thinking people. Whenever this tiny minority is kept from creating, or (as sometimes happens) is driven out of a society, the people then slip back into abject poverty.
This is known as ‘bad luck’.”

– Robert A. Heinlein

I think that says it.

The answer to climate science and the questions you are thinking about

Monday, November 30th, 2009

It has all been reduced to an equation, as any engineer should be able to do.

Slide1

There !

Any questions ? Sorry about the skew but it had to be readable.

All kidding aside, Climate Audit has a post from one of the warmist side that is reasonable, if self serving.

They are criminals !

Monday, November 23rd, 2009

UPDATE # 5: More evidence that this was a fraud all along. The Chinese scientist I have referred to in other places appears to be the one mentioned.

In 1999, I had a stroke of luck. I asked one of the IPCC officials for the data from which one of their maps was compiled, and I received it. I wrote a paper analyzing the results, and submitted it to Geophysical Research Letters. They just sat on it. I instead published it on John Daly’s website. Today, it is still the only paper recognized by Google on “Regional Temperature Change.”

I now know my paper was not critical enough, since we have proof that the basic data and its processing is far more dubious than I had envisaged.

I tried to update my paper and resubmit it. Nothing doing. Since the small group — revealed within the CRU emails — control most of the peer reviewers, very few peer reviewed papers which criticize that group are allowed to appear in the most prominent published literature which dominates the academic establishment.

I have only been able to find a place to release my criticisms on the internet, now the only realm where unfettered scientific discussion is possible.

UPDATE # 4: If this is the best they can do to respond, they are toast. The evil “fossil fuel industry” is the villain.

UPDATE # 3: This isn’t a real update but a comment on how the lefty web sites, like the legacy media, have their eyes firmly closed. Not one mention, even in comments, of the CRU scandal!

Nothing on Mother Jones either.

UPDATE #2: The original climate data, on which all the models are based, no longer exists !!!UPDATE #2: The original climate data, on which all the models are based, no longer exists !!!

From the CRU web site: (That web page has now also disappeared.) What is left is this.

We are not in a position to supply data for a particular country not covered by the example agreements referred to earlier, as we have never had sufficient resources to keep track of the exact source of each individual monthly value. Since the 1980s, we have merged the data we have received into existing series or begun new ones, so it is impossible to say if all stations within a particular country or if all of an individual record should be freely available. Data storage availability in the 1980s meant that we were not able to keep the multiple sources for some sites, only the station series after adjustment for homogeneity issues. We, therefore, do not hold the original raw data but only the value-added (i.e. quality controlled and homogenized) data.

This is surely a crime.

Say what?! CRU has lost track of the original data that it uses to create its global temperature record!? Can this be serious? So not only is it now impossible to replicate or reevaluate homogeneity adjustments made in the past — which might be important to do as new information is learned about the spatial representativeness of siting, land use effects, and so on — but it is now also impossible to create a new temperature index from scratch. CRU is basically saying, “trust us.” So much for settling questions and resolving debates with empirical information (i.e., science).

To be absolutely clear, none of what I write here should be taken as implying that actions to decarbonize the global economy or improve adaptation do not make sense — they do. However, just because climate change is important and because there are opponents to action that will seize upon whatever they can to make their arguments, does not justify overlooking or defending this degree of scientific sloppiness and ineptitude. Implementing successful climate policy will have to overcome the missteps of the climate science community, and this is a big one.

I’m just not sure it is sloppiness and ineptitude. It is also a good way to hide evidence of a crime. Businessmen have gone to prison for this.

UPDATE: Another well known “skeptic” scientist comments on the scandal.

Another glimpse into what the files and emails reveal was the report by Professor Deming. He wrote, “ With publication of an article in Science (in 1995) I gained sufficient credibility in the community of scientists working on climate change. They thought I was one of them someone who would pervert science in the service of social and political causes. So one of them let his guard down. A major person working in the area of climate change and global warming sent me an astonishing email that said. “We must get rid of the Medieval Warm Period.” The person in question was Jonathan Overpeck and his even more revealing emails are part of those exposed by the hacker. It is now very clear that Deming’s charge was precise. They have perverted science in the service of social and political causes

Yes, they are criminals.

Lord Monckton, who has repeatedly challenged Al Gore to a debate on climate, now weighs in on the AGW leaked e-mail story.

This is what they did — these climate “scientists” on whose unsupported word the world’s classe politique proposes to set up an unelected global government this December in Copenhagen, with vast and unprecedented powers to control all formerly free markets, to tax wealthy nations and all of their financial transactions, to regulate the economic and environmental affairs of all nations, and to confiscate and extinguish all patent and intellectual property rights.

The tiny, close-knit clique of climate scientists who invented and now drive the “global warming” fraud — for fraud is what we now know it to be — tampered with temperature data so assiduously that, on the recent admission of one of them, land temperatures since 1980 have risen twice as fast as ocean temperatures. One of the thousands of emails recently circulated by a whistleblower at the University of East Anglia, where one of the world’s four global-temperature datasets is compiled, reveals that data were altered so as to prevent a recent decline in temperature from showing in the record. In fact, there has been no statistically significant “global warming” for 15 years — and there has been rapid and significant cooling for nine years.

This may well turn out to be the greatest scientific scandal in a century. the “Piltdown Man” was a minor scandal of no great significance to the world.

these arrogant fraudsters — for fraudsters are what we now know them to be — have refused, for years and years and years, to reveal their data and their computer program listings. Now we know why: As a revealing 15,000-line document from the computer division at the Climate Research Unit shows, the programs and data are a hopeless, tangled mess. In effect, the global temperature trends have simply been made up. Unfortunately, the British researchers have been acting closely in league with their U.S. counterparts who compile the other terrestrial temperature dataset — the GISS/NCDC dataset. That dataset too contains numerous biases intended artificially to inflate the natural warming of the 20th century.

Finally, these huckstering snake-oil salesmen and “global warming” profiteers — for that is what they are — have written to each other encouraging the destruction of data that had been lawfully requested under the Freedom of Information Act in the UK by scientists who wanted to check whether their global temperature record had been properly compiled. And that procurement of data destruction, as they are about to find out to their cost, is a criminal offense. They are not merely bad scientists — they are crooks. And crooks who have perpetrated their crimes at the expense of British and U.S. taxpayers.

I wonder if anything will actually be done to them. There is a well-known book, Extraordinary Popular Delusions and the Madness of Crowds. I wonder if it is time for another book about the madness of self anointed elites. Actually, if you read that book, you will find that almost all delusions begin with elites. There is another concept at the foundation of market economies; it is called the wisdom of the market. One who believed in this was Bernard Baruch.

It is important to “follow what the market is currently doing as opposed to following what one might personally think the market should do.” As he said, “Every man has a right to his opinion, but no man has a right to be wrong in his facts.”

The AGW theory fit the concept that a lot of people have about what is “right” and it turns out that they manipulated the facts to make the answer come out “right.” There is already enough doubt about science among people with no scientific education. Catching scientists as liars will certainly not help that situation.

Here is another valuable discussion from a scientist with impeccable qualifications.

In identifying the burning of fossil fuels as the chief cause of warming today, many politicians and environmental activists simply appeal to a so-called “scientific consensus.” There are two things wrong with this. First, there is no such consensus: An increasing number of climate scientists are raising serious questions about the political rush to judgment on this issue. For example, the widely touted “consensus” of 2,500 scientists on the United Nations Intergov-ernmental Panel on Climate Change (IPCC) is an illusion: Most of the panelists have no scien-tific qualifications, and many of the others object to some part of the IPCC’s report. The As-sociated Press reported recently that only 52 climate scientists contributed to the report’s “Summary for Policymakers.

Likewise, only about a dozen members of the governing board voted on the “consensus statement” on climate change by the American Meteorological Society (AMS). Rank and file AMS scientists never had a say, which is why so many of them are now openly rebelling. Estimates of skepticism within the AMS regarding man-made global warming are well over 50 percent.

The Erector Set

Sunday, October 18th, 2009

Glenn Reynolds today has a link to Lionel Trains in the anticipation of Christmas. I had Lionel trains and eventually had HO gauge trains, as well. When I had sons old enough to play with trains, I built an elaborate train set in my garage. Then I learned that southern California is not the place for toy trains. The boys were outdoors all the time and the train set gathered dust.

Another toy that kids today will never have the chance to enjoy is the Erector Set. There is still a small source for this toy but the glory days of the Erector Set were long ago. The toy was invented by A.C. Gilbert in 1913. The story is interesting. Gilbert was a Yale Medical School graduate and had also won a gold medal, for the pole vault, in the 1908 Olympic Games. He had a new design bamboo pole that he used in his winning vault and he sold these, as well as other toys.

Like many residents of New Haven, Connecticut, he often took the train to New York City; and on one trip in 1911 he was inspired with what would be the most popular of his dozens of inventions.

Watching out the train window as some workmen positioned and riveted the steel beams of an electrical power-line tower, Gilbert decided to create a children’s construction kit: not just a toy, but an assemblage of metal beams with evenly spaced holes for bolts to pass through, screws, bolts, pulleys, gears and eventually even engines. A British toy company called Meccano Company was then selling a similar kit, but Gilbert’s Erector set was more realistic and had a number of technical advantages — most notably, steel beams that were not flat but bent lengthwise at a 90-degree angle, so that four of them nested side-to-side formed a very sturdy, square, hollow support beam.

Gilbert began selling the “Mysto Erector Structural Steel Builder” in 1913, backed by the first major American ad campaign for a toy. The Erector set quickly became one of the most popular toys of all time: living rooms across the country were transformed into miniature metropoles, filled with skyscrapers, bridges and railways. Those kids who already owned a set would beg Santa annually for an upgrade, aiming for the elusive “No. 12 1/2” deluxe kit that came with blueprints for the “Mysterious Walking Giant” robot. It is difficult for anyone under the age of 35 today to appreciate just how popular the Erector set was for over half a century.

Now, it happens that I have a personal connection to the Erector Set. In the early 1970s, a patient was referred to me with an esophageal stricture. He was in his 90s and had been told he was too old for a major operation like that. He and his wife had emigrated from England in 1913 and he was looking for a job as an engineer. He met A.C. Gilbert who was having trouble selling his new toy. Gilbert had invented the Erector Set and had built a few samples of what could be constructed using the new kit of materials but the set consisted of lots of perforated metal pieces and machine screws and nuts.

set

Gilbert needed someone to build sample structures using the set and write instructions on how to build them. He took the job and spent years working on new designs and instruction books. The first Christmas after he began work for Gilbert, the giant New York City department stores, Macy’s and Gimbel’s, wanted sample structures to help sell the toys. My patient built a huge suspension bridge that crossed over the cash registers, which in those days were arranged like the check-out lines in today’s supermarkets. The bridge was over 20 feet long. As soon as the first store saw his bridge, they wanted one just like it. For years, he worked for Gilbert and, when I knew him, he had been retired to San Clemente for years.

He and his wife were in good health with the exception of this stricture that was so tight that he could only swallow liquids. He subsisted on apple sauce and other pureed food that would not pass through the stricture until he jumped up and down while standing against the wall. He had been told he was too old and his only option was some sort of feeding tube. Needless to say, he was skinny and the operation seemed to be feasible to me. Larry Mathis was his GP and Larry and I decided to try to fix his stricture. At surgery, his esophagus was so tight that it split when I tried to dilate it from below. There is a procedure called a Thal Patch. It is used to close esophageal perforations such as traumatic tears and ruptures, like the Boerhaave’s Syndrome. In this case, I had created the hole in the esophagus by tearing open the stricture. The surgery worked and he recovered very well.

A few years later, he presented with symptoms of acute cholecystitis but at surgery I found a cancer of the colon next to the gallbladder. About a year later he died of the cancer, having nearly reached the age of 100.

A.C. Gilbert also invented a number of other toys that were Christmas traditions for half a century. They included chemistry sets, physics sets and even a nuclear radioactivity set that included a Geiger counter. I had several of these, including the radioactive set. Those were the days before TV when children played with educational toys that were not so self-conscious about it.

What is a basic education ?

Saturday, September 19th, 2009

I have been spending a lot of time with the health reform legislation lately and have begun to wonder what people understand and what the consequences are of failure to understand some basic concepts. I’m not the only one.

What kind of education would one need to make sense of the current health-care debate? As the U.S. rethinks its academic standards and international competitiveness, this is not a bad time to ask what American citizens, voters, and taxpayers need by way of knowledge and skills to form reasonable conclusions about the hottest domestic policy issue of the day.

Today’s elites seem certain that John Q. Public is irremediably ignorant about, and perhaps oblivious to, the health-care debate, and thus susceptible to being misled, brainwashed, or cowed. Some Democrats are convinced that the insurance industry is creating “movements” bent on misleading and confusing people and planting suspicion in their hearts, while at least one GOP congressman and more than a few conservative pundits and talk-show hosts say President Obama is lying. All these folks seem to assume that the masses cannot possibly understand the debate. But must we accept that as a given? What would it take to comprehend the health-care battle?

OK, how do we get that education ? I grew up in the 1940s and 50s, went to Catholic school and still have sharp memories of my early schooling. For example, I was reading (For the 20th time, at least) The King Must Die, by Mary Renault, one of my favorite authors. It brought to my mind that, in elementary school, I learned the fact that King Minos had a great fleet and that Crete had “wooden walls” on the sea. These small items of history were common in elementary education at the time I was a child. I wonder how many children today would know what I was talking about.

I read to my children as they grew up. When they were small, I read “The Lord of the Rings” and “Watership Down,” both fantasy literature. Interestingly enough, children’s literature is now being de-monsterized meaning the scary stories are being removed so that children are not frightened by the stories. I can’t find the link right now where this was discussed but it makes clear that there is a reason why children’s literature has so many frightening stories. Those fears are part of children’s lives and working them out in fiction may be helpful in assisting children to cope with the real events of life. Most fairy tales are actually based on frightening events. Jack and Jill fell down the hill. Hansel and Gretel were abandoned by their parents in the woods. Sleeping Beauty and Cinderella both had wicked stepmothers in an era when the possibility of the death of mothers was very real.

All of my children read although reading seems to increase in attraction as they grow older. Reading for pleasure is an activity of childhood that has been devastated by television. Children who do not read a lot, have difficulty with reading and with reading comprehension. It is a skill that grows with practice. They will learn no history from television. Only reading will bring them into a historical world where things fit into place in the greater scheme of things. It was easier for me because we had no television. In fact, because my father was in the juke box business, he hated television and refused to have one in the house. When I was in eighth grade, I didn’t know who Jackie Gleason was. That was a social handicap. Eventually, a family friend gave us a TV set for Christmas and the barrier was broken. Fortunately, by that time habits of a lifetime were set and I have never been much interested in TV. At one time, with my first wife, I had a set of earphones with a long cord. I would sit and read with the earphones on as she watched TV. I mostly listened to classical music in those days. It goes well with reading.

What do we do about the poor quality of schools today ? I don’t know. Spending lots of money on schools isn’t the answer.
In 1977, when the story begins, Kansas City’s schools were in simply terrible shape. The city, like most others of its size (pop. 460,000), had experienced white flight from the 1950s on, and the school district even more so, even whites resident in the city pulling their kids out of the public schools. By 1977 enrollment was 36,000, three quarters of them racial minorities (which at that point meant mostly African Americans). The voters had not approved a tax increase for the district since 1969. In 1977 litigation commenced, members of the school board, district parents, and some token children suing the state and some federal agencies on the grounds they had permitted racial segregation. Federal judge Russell Clark, a Jimmy Carter appointee, got the case.

The solution seemed obvious.

After eight years of litigation, Clark gave the plaintiffs everything they wanted, and then some. He in fact ordered them to “dream” — to draw up a money-no-object plan for the Kansas City school system.

Dreaming is no problem for educationists. The plaintiffs — education activists and their lawyers — duly dreamt, with an initial price tag of $250 million for their dreams. This was twice the district’s normal annual budget.

It proved to be only a start, however. Over the next twelve years the district spent over 2 billion dollars, most of it from the state of Missouri, the balance from increased local property taxes. Fifteen new schools were built and 54 others renovated.

The results ?

After twelve years, test scores in reading and math had declined, dropout rates had increased, and the system was as segregated as ever, in spite of heroic efforts to lure white students back into the system.

Kansas City did all the things that educators had always said needed to be done to increase student achievement — it reduced class size, decreased teacher workload, increased teacher pay, and dramatically expanded spending per pupil — but none of it worked.

The great C-130-loads of money being air-dropped on the system also brought about waste and corruption on a heroic scale. Theft was rampant. So was overmanning: The project became a huge jobs and patronage program, with the inevitable mismanagement and scandals.

So that’s not the answer. I don’t know what it is, beyond the obvious, but I do know that an educated citizenry is necessary for a democracy to flourish and I think we are in big trouble because we have a lot of citizens who don’t read and know no history. And they vote.

A dose of cold water

Friday, August 14th, 2009

Charles Krauthammer today delivers a useful dose of cold water on the fantasy that preventive care saves money. There are a few measures that probably do save money; mammography is one. Mammography does not, obviously, prevent breast cancer but it does detect the disease at an early stage and probably saves money by avoiding the treatment of late incurable breast cancer in more women. Kaiser, an HMO with a loyal membership, was a pioneer in routine mammography and this is the most likely incentive. More on the issue of preventive care and cost here.

This brings up the difference between prevention and screening for early diagnosis. It also raises the issue of cost-benefit analysis in medicine. I have spent some time studying this subject. The analysis of such issues is called decision theory. It is very commonly used in business to decide on which investments are more likely to make money. The decision tree typically uses software that calculates the costs associated with all possible decisions that could be made. An example is here. The decision tree begins with an initial set of facts, the simpler the better. In medicine, it might be a symptom like rectal bleeding.

A patient comes in with rectal bleeding. How do we proceed ? I used to teach this sort of thing to medical students. Cost-benefit analysis can be part of this process. For example, it sometimes seems to me that junior doctors choose a spiral CT scan as the initial diagnostic event far too often. I know that one third or more of cardiology fellows, graduate physicians in training, cannot hear a systolic heart murmur. This is the most basic examination in cardiology. The stethoscope was the first instrument that allowed doctors to examine the interior of the body. Yet one-third of budding cardiology specialist are incompetent with it. Why ? They have spent years ordering echocardiograms on every patient with the least suspicion of heart disease. Here is a useful role for cost-benefit analysis.

I don’t want to conduct a seminar on this subject. If you want one, there are journal articles going back 30 years on the topic. This is where we get into Bayesian Algebra. Anyone who gets into this subject must understand the basic principles of diagnostic tests, true positive, false positive, true negative and false negative. A true positive test is positive in a patient who has the disease. False positive is, of course, positive in a patient who does not have the disease. Two groups of patients have the disease, true positives and false negatives. From this sort of thing, one calculates the sensitivity and specificity of tests. A test is the most sensitive that has the most true positives. A test that is the most specific, has the most true negatives.

That, of course, has nothing to do with prevention but prevention, aside from immunization, is not medicine anyway. It is public health plus cultural norms. A century after Columbus’ first voyage brought syphilis back to Europe, one third of the residents of Paris had the disease. The importance of virginity in a bride may have arisen from such data.

I have serious doubts that 98% of the advocates of health reform would have any idea what I’m talking about here.

Health insurance and health reform

Wednesday, August 12th, 2009

UPDATE: The eight questions I addressed below were obviously from John Mackey’s op-ed in the WSJ. Now his leftist customers at Whole Foods Markets are going nuts and threatening to boycott the store. OK by me. I thought the criticism was rather mild and I don’t shop there anyway. It does show the madness of these groups, though.

The Obama campaign seems to be morphing into “insurance reform.” There are lots of mis-statements about insurance out there so I thought I would consider some. One, of course, is the gigantic profits of the insurance companies. First of all, almost all employer based health plans are NOT insurance but are prepaid care managed by an ASO (Administrative Service Organization), almost always an insurance company. Why ? because they have the skills to do this sort of thing. There are two ways that these companies make money. One is to invest premiums and pay benefits out of investment income. That is how life insurance and fire insurance works. Long ago, that sort of thing came to an end with health insurance. Why ? Because health insurance stopped being insurance.

How does a conventional insurance company make money ? Let’s take fire insurance which was founded in this country by Benjamin Franklin. The concept was a mutual company. A group of homeowners paid into a fund that was to be used to pay for fire damage. It also paid for the fire fighters and their equipment.

The first policies had a term of seven years. After the policies expired, the premium money was returned to the policyholders. In the first year of operation, 143 policies were written. Ironically, there wasn’t a single insured property that caught fire in the Philadelphia Contributionship’s first year of operation.

What did they do with the money ? Well, if I know Franklin, the money was invested in the colony and the income from the investments was added to the fund, also called “the corpus.” Since they had no fire, the money was all returned to the investors with interest. This is how mutual insurance works. Blue Cross and Blue Shield are non-profits that were founded by the hospitals and the medical associations to pay medical claims. Mutual companies like this have no profits to distribute as they are owned by the policy holders.

What about Aetna and the other for-profit insurance companies ? Many large assets in the country are owned by these companies as they have, in the case of life insurance especially, a long period in which to earn the money to pay claims. Actuaries are economists who estimate the probability of loss for a particular insured. If I am a 40 year old male who doesn’t smoke, they can estimate my annual risk of death with considerable precision. They set the annual premium and the benefit paid can be even more than it would be if I saved the premium for 20 years. That is because of the investment income.

They can also estimate, with considerable precision, my risk of a heart attack or a stroke or even cancer. In the days before 1970, when insurance only covered events like heart attacks and strokes, it was possible to estimate these risks and to set up a table of premiums that were predictable. Even if medical prices rose, there was a way to deal with that. In 1970, many health policies were of the indemnity type. That means they paid a fixed dollar amount for a medical event, such as an operation or a hospital stay. In those days, hospitals usually billed by the day rather than the enormous, and unintelligible, itemized bills we see today.

Furthermore, for the past 25 years, those bills have meant almost nothing. The insurance companies, and after DRGs came in, Medicare, pay a fixed amount per hospital stay based on the discharge diagnosis. Outpatient surgery has become popular as a way to avoid those limits and the inefficiencies of hospitals, but that also involves contracts that include huge discounts on the “retail” price seen on the bill.

Soon, the indemnity insurance policy went into decline because they often did not keep up with doctor’s rising fees. This was a serious mistake on the part of doctors as they were agents of their own (or at least their successors’) destruction. Had the insurance companies held the line, the doctors would have had to negotiate with patients for the balance over what the policy paid. That might have required explaining why the operation was worth so much. It would be uncomfortable and it was much easier to get them to pay “UCR” rates. That stands for “Usual, Customary and Reasonable.” It’s amazing how fast “customary” can increase once the limits are off.

The insurance companies foolishly insisted on itemized bills from the hospitals and the explosion of health care inflation took off. Medicare paid the going rates for a while. I began practice in 1972 and my partner and I set our fees according to the book of rates called the Relative Value Scale established by the California Medical Association, and called “RVS.” It was begun in 1952 by a group that wanted to set up a fee schedule that could be used by any doctor in any community. The schedule simply ranked items relative to each other. It began with a “hernia unit,” the value of a hernia repair compared to other services like office visits or open heart surgery. Maybe a hernia repair is worth one tenth of a heart surgery. The young physician then took into account the cost of practice, rent and so forth, and decided on a “conversion factor.” The conversion factor for us was $100. If the RVS book said a hernia repair was 4.5 RVS units, our fee was $450. We were on the low end of the scale but did well because we were busy.

Anyway, that system worked pretty well and even Medicare adopted it in spite of the fact that the FTC sued the CMA and forced them to stop printing the RVS Schedule and then even required that they recall all the copies in existence. If you would like to consider how illogical government can get, think about doctors using Xeroxed copies of the illegal RVS schedule to submit bills to Medicare, which required the correct numbers to pay the bills.

Anyway, the real problems began in the 70s when the Nixon administration decided that the way to control costs was the HMO. Paul Ellwood provided the theoretical foundation for the concept. He based his concept on the Kaiser Foundation and the original program devised by surgeon Sidney Garfield for the California Aqueduct and the Grand Coulee Dam, the latter built by Henry J Kaiser. The HMO provided prepaid care for a monthly fee and the doctors were on salary.

Private practice pediatricians and obstetricians were worried because health insurance did not pay for their services. After all, these were not insurable events but routine care. Here, the fatal decision was made and I remember debates in the House of Delegates of the CMA. The CMA must act to protect its members and demand that insurance cover well baby care and routine delivery. I objected but, of course, I was a surgeon and we lost the debate. This was the beginning of the end because, once prepaid care was substituted for insurance, there was no way to stop the inflation. My younger son was born at Huntington Memorial Hospital in Pasadena in April 1969. This was the nicest hospital in the area and the maternity ward was new and beautiful. The hospital bill for mother and child was $375. Five years later, with insurance coverage now universal, that bill would be ten times as much.

I’m sure those who are still reading this are tired of the history so I will consider one proposal being discussed as an alternative to the Obama program.

Here are eight reforms that would greatly lower the cost of health care for everyone:

•Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs).

This would be helpful but far less important unless we get rid of the false “retail prices” that everyone sees on their doctor and hospital bill. To give one small example: I am a Medicare beneficiary now. I also have chronic pain as a result of a back injury and an extensive surgery in 1993. I go to a pain specialist. At hand, I have a May 25, 2009 EOB (Explanation of Benefits) from Medicare. He billed $140 for an office visit. The Medicare payment was $13.90; less than 10% of billed charges. They proudly list the amount I am NOT required to pay him as $126.10. He cannot bill me for the balance. Why not ? It’s illegal.

Let’s say that my pain doctor drops out of Medicare and goes to a cash practice as many internists are now doing. He could set a fee somewhere between what Medicare won’t pay him and what they do pay him, and then I could pay that amount myself and forget Medicare. Soon, that may be the only option as more and more doctors drop out of Medicare. Soem primary care internists are setting up “retainer practices.” Of course, some object to this as elitist.

UPDATE: President Obama has twice made inflammatory and ignorant comments about surgeons the past several weeks. Today the American College of Surgeons, which has been supporting his agenda, finally lashed back at him. It’s about bloody time. First, surgeons do not get the hospital bill as payment. Second, surgical fees and hospital bills have little to do with the “retail” prices that are printed in so many commentaries by non-medical people.

•Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits.

That may help although one reason why employer plans get better rates is the fact that a fully employed population is a better collective health risk than individuals who may be of varying states of health. I do agree that health care expenses should be tax deductible.

•Repeal all state laws which prevent insurance companies from competing across state lines.

This would make a huge difference but only a revolution could bring this to pass. Politicians serve no purpose in life except to do favors for contributers.

•Repeal government mandates regarding what insurance companies must cover.

This would accomplish even more for costs but it would be even more difficult to enact. I spent eight years on the CMAs commission on legislation. I saw how sausage is made.

•Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year.

I tend to think this is less important but that may be because I live in California which did a major tort reform in 1975 and has held the line well on malpractice rates. I have some other ideas on this but this post is already too long.

•Make costs transparent so that consumers understand what health-care treatments cost.

I think this is key and the reason for the lengthy post above.

•Enact Medicare reform. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility.

Yes but this has to come from the same reforms we enact for the whole system.

•Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren’t covered by Medicare, Medicaid or the State Children’s Health Insurance Program.

Nice but fluff.

I think we are headed to a market-based health care system whether or not Obama gets his bill passed. In Canada, it is happening even though it is technically illegal.

UPDATE: This is an interesting analysis of the proposed reform program. The premise is that what is going to happen, if it passes, is a commingling of all the different health care accounts, Medicare, Medicaid and middle class, pitting the classes against each other. I think it shows considerable insight.

Of degrees and science and politics.

Friday, January 30th, 2009

The National Oceanic and Atmospheric Administration is producing a report on the effects of CO2 and global climate change. Of course, the study suggests that limits on CO2 production are necessary. There has been a lot of writing and talk about how “the overwhelming number” of scientists support the concept of anthropogenic global warming and endorse the extreme measures necessary to reduce its effect. Somewhere in all this, the credentials of the scientists became a major factor. After all, if “the science is settled,” it matters who settled it.

That resulted in a bit of a flap today. The lead author of the NOAA study was described as “Dr Tom Karl”, although that bio does not include a PhD. I don’t know if the bio has been “corrected” since yesterday but there has been an impression left with many in the climate world that he had a PhD. Like here.

Day 1 / Afternoon (Wednesday, June 11, 2003: NIST Auditorium)

Session 2: Customers Speak to the Government:
Economic Benefits / Customer Satisfaction
Moderator: Dr. Tom Karl

Anyway, the report was printed with his phantom PHD until it was noticed by NRO, after which the first draft disappeared. A new version is now up with ALL degrees omitted for ALL authors.

They can’t fix this, though.

In our further exploration of the social network of authorships in temperature reconstruction, we found that at least 43 authors have direct ties to Dr. Mann by virtue of coauthored papers with him. Our findings from this analysis suggest that authors in the area of paleoclimate studies are closely connected and thus ‘independent studies’ may not be as independent as they might appear on the surface. This committee does not believe that web logs are an appropriate forum for the scientific debate on this issue.

It is important to note the isolation of the paleoclimate community; even though they rely heavily on statistical methods they do not seem to be interacting with the statistical community. Additionally, we judge that the sharing of research materials, data and results was haphazardly and grudgingly done. In this case we judge that there was too much reliance on peer review, which was not necessarily independent. Moreover, the work has been sufficiently politicized that this community can hardly reassess their public positions without losing credibility.

Hmmmm.