Hospitals’ Struggles To Beat Back Familiar Infections Began Before Ebola Arrived

Last week I wrote the post, What Scares Me About Ebola Is How We Have Handled Sepsis, and Kaiser Health News and NPR has followed up with an article expressing the same concern, Hospitals’ Struggles To Beat Back Familiar Infections Began Before Ebola Arrived. The Ebola infections by health care workers in the United States reminds us that infection control is a serious, unresolved health care problem for both health care workers and patients. The article is well researched and worth the read. My favorite quote is,

Nationally, about one in every 25 hospitalized patients gets an infection, and 75,000 people die each year from them—more than from car crashes and gun shots combined.

If The American Middle Class Is A Myth Then Is The American Dream A Myth, too?

I suspect that when Marc Andressen said the American middle class is a myth in a Business Insider interview he was unaware that he was summarily dismissing the American Dream, too. It is practically impossible to separate the idea of American middle class from the aspirations of the American Dream. If we look at history we can see that the bourgeoisie of the Industrial Revolution were instrumental in transforming a large group of subsistence farmers into what we call the middle class. The bourgeoisie in Europe and the United States were the innovators who were disrupting the farming and manufacturing markets. It is hard to imagine an industrial revolution without improved farming efficiencies. If we go back even farther in history we can argue that  this bourgeoisie class was probably responsible for most of the innovation in the Europe for the last 1000 years and a pretty good reason why Islam is not the state religion of Europe. Europe’s advancements in ocean going ships did more to halt the spread of Islam than anything else. The idea that this innovative class would not exist in America is preposterous! The American middle class is the modern version of Europe’s bourgeoisie with a few American twists. As a country of immigrants America’s bourgeoisie was especially well suited to embrace the risk of Schumpeter’s creative destruction. On multiple occasions America embraced disruptive technologies that destroyed whole industries only to replace them with more efficient ones. By the end of World War I the willingness of the United States to successfully embrace new industries and subsequently dominate them, allowed the United States to surpass Great Britain as the preeminent world economic power. It was this combination of smart risk taking with the productivity gains that explains most of the wealth of the middle class and the growth of a consumer driven economy. Now the middle class could afford homes, cars, health care, and leisure activities. For over a hundred years this success is was what made America and the American Dream great. Industry giants such as John D. Rockefeller started from modest backgrounds and created great businesses. His story gets repeated over and over again but in America it gets repeated with people with different ethnic backgrounds, religious backgrounds, and color of skin. America made it work and it is impossible to separate the American middle class from the American Dream and America’s success.

What Scares Me About Ebola Is How We Have Handled Sepsis

2014-10-14 15_07_35-Wonkbook1I was looking at this AP photo on the Wonkblog last week of two hospital workers in a room. The worker on right looks like he or she was dressed up to handle Ebola and the person on the left is not. Our hospitals have a severe problem with infection control. The NIH factsheet on sepsis says that the “Agency for Healthcare Research and Quality lists sepsis as the most expensive condition treated in U.S. hospitals, costing more than $20 billion in 20115.” I personally know three people who think they caught MRSA in a hospital or clinic. If you wonder how we can spread Ebola just take a look of the guy on the left. I know the photo is an innocent, staged photo but considering the industry record on sepsis you have to wonder how many hospital workers will have to die before hospitals get their act together. Infection control is only as good as the weakest link.

Can Public Pensions Be Fair to Later Generations?

From Via Media we get this nugget, “Can Public Pensions Be Fair to Later Generations?”. Since Joe The Economist has made a pretty good argument that the idea of privatizing Social Security is an idea we can no longer afford maybe a good first step in reforming pension accounting is to embrace a more Dutch-like approach.

So many U.S. states are struggling with unsustainable public pension costs that many are probably wondering: Is an honest, fiscally sound, publicly administered pension plan possible, or are all such efforts doomed to regulatory capture, union abuse, and co-optation by politicians? At least one example suggests that, given sufficient discipline and scrutiny, pension plans can be made to work in the 21st century. An article in the New York Times today praises the Dutch version:

Dutch pensions are scrupulously funded, unlike many United States plans, and are required to tally their liabilities with brutal honesty, using a method that is common in the financial-services industry but rejected by American public pension funds.

The Dutch system rests on the idea that each generation should pay its own costs — and that the costs must be measured accurately if that is to happen. After the financial collapse of 2008, workers and retirees in the Netherlands took the bitter medicine needed to rebuild their collective nest eggs quickly, with higher contributions from workers and benefit cuts for pensioners.[...]

Notably, the Dutch central bank prohibited the measurement method that virtually all American states and cities use, which is based on the hope that strong market gains on pension investments will make the benefits cheaper. A significant downside to this method is that it lets pension systems take advantage of market gains today, but pushes the risk of losses into the future, for others to cope with.

My confidence in science is not crumbling but it is shaken!

I was reading a post over at Fabius Maximus and could not resist myself. Here was my comment.

My confidence in science is not crumbling but it is shaken. I do not remember whether I was science skeptic before college but I definitely was a skeptic after getting my engineering degree. You had to be very, very careful to get the right answer in lab experiments. It was hard, tedious work. As a result I do not have the high and lows being experienced by some other people. I have seen how easy it is to be wrong despite your best efforts. I believe what you are seeing in crumbling confidence in science is that bad science is being penalized for being wrong and that is a good thing!

Climate science is interesting example of science going off the rails. I find it amazing that even after all of these years I still remember enough of a thermodynamics class I took 30 years ago to question the approach being used by climate scientists to solving what I would call a heat transfer problem. I was not surprised to see climate scientists struggle to explain global warming with temperature graphs. If thermodynamics is settled science, why did the scientists choose this alternate approach?

I think the scientists noticed that they could not unambiguously prove whether we are experiencing warming or cooling so they went with the political group with the most passion and money. There was a fifty-fifty chance they might get the science right without actually doing any science. All they needed was for Mother Nature to continue to do what she had been doing for a few more years. Unfortunately their prayers to Mother Nature went unanswered and the warming stopped. Now these researchers have to explain how they got it wrong. I think the worship of pagan goddesses took a real tumble when the climate scientists went back to doing real science again.

I hate to be picky but vaccinations, global warming, and economic “science” are not even close to what I see as the most serious confidence problems in science. Frankly, I am not surprised that most people get economics wrong. I still hold to the belief that economics is not a science but a conspiracy to make weathermen look smart. In my mind I have been able to write off the climate science problems as problems to be solved by my son’s generation. Unfortunately my generation gets to deal with the false positive problems in health care. Getting this right is a matter of life and death for healthy people like me. The false positive problem in prostate and mammogram testing is severe enough that one part of the medical profession is recommending less testing. At the same time another part of the medical profession thinks it is better to be safe than sorry so the over-diagnosis of prostate and breast cancer is a necessary evil. My inner engineer keeps wondering why doctors are advocating less testing rather than improving their testing? When did reducing false positives cease to be a noble scientific objective? So what is an otherwise healthy person to think in this environment? When I ask my doctor he shrugs his shoulders.

I think the fundamental problems affecting my confidence in health care can be best explained with the ulcer example. Just two months ago I learned via the TodayIFoundOut podcast that ulcers should be treated with antibiotics. I am old enough to remember when the standard diagnosis for ulcers was that it was caused by stress and could only be solved by surgery. This was settled science so it is not surprising that hospitals were the biggest force that prevented ulcers from being treated with antibiotics. Ulcer surgery was a money maker for many doctors and hospitals regardless of its efficacy. From 1984 to the early 1990s Dr. Marshall and his long-time collaborator, Robin Warren, were thought to be quacks. Finally in 1994 the National Institutes of Health (NIH) held a two day summit to discuss his research and the rest is history. In 2005 Dr. Marshall received the Nobel prize for Medicine for his discovery of the bacteria that leads to peptic ulcers. From settled science to a different settled science in 21 years. Doctors were absolutely, positively sure of their diagnosis and treatment until they changed their mind to a completely different treatment. It sounds like a House script. Does anyone wonder why so many people have become born again science skeptics?

So here is the bottom line if you are looking at prostrate and mammogram testing. You are damned if you do, damned if you don’t, and hospitals make money on either outcome. Even if you opt for the safe rather than sorry route, the hospital still has a chance to collect on the daily double. My father went into the hospital after a fall and got an infection. He never left the hospital alive. I am guessing that Tricare/Medicare paid a quarter of million dollars for this mishap. Sepsis is America’s dirty little secret. The NIH factsheet on sepsis says that the “Agency for Healthcare Research and Quality lists sepsis as the most expensive condition treated in U.S. hospitals, costing more than $20 billion in 20115.” It is the mistakes in health care that shakes my confidence in science.

Affordable Health Care Is Getting Harder Every Day

Healthcare-Lunchbox128.jpgIt wasn’t supposed to be this way but affordable health care is getting harder every day thanks to the Affordable Care Act. The likelihood that I will start 2015 without health insurance is growing every day. Today I was talking to my boss about a HRA replacement and he said that Zane’s HRP idea will not work for us. Both my boss and I have grandfathered plans that are probably not eligible to be used in a HRP arrangement.

A couple of hours later Tom was commenting on my post, Affordable Care Act Loser #7 – Health Reimbursement Account, and provided a link to to a discouraging article called, Guidelines For Using Reimbursement Arrangements Under The Affordable Care Act. Although I cannot find a date for the article the author plainly makes the point that "because employer dollars (i.e., employer contributions/reimbursements) are being used to pay for health care (i.e., the individual market plan), a Section 105 Medical Reimbursement Plan is by definition a “group health plan” under the Code". Yea, that sucks! Even though I like my health care plan and the HRA reimbursement arrangement, I cannot keep either of them. I sure wish the Affordable Care Act supporters would stop trying to help me. With friends like that who needs enemies!

We Took Pew Research News IQ Quiz

My wife and I think of ourselves as above average news hounds so we were curious to see how we compared to 1,002 randomly sampled adults in a national Pew Research News IQ Quiz given on September 25-28. The results are in. My wife missed two questions and I missed one. This was better than 92% and 96% of America. Both my wife and I guessed wrong on the question, “Approximately what share of Americans currently live at or below the federal poverty line?” I guessed low and she guessed high. The correct answer was 15%. Only 20% of America got this question right. This question and the question, “On which of these activities does the U.S. government currently spend the most money”, were the two toughest questions on the quiz. I was surprised my wife missed it since the growth of entitlement spending has become such an intractable problem. There are no wise men or women in the room when the discussion gets around to how to “fix” social security.

Tomato Pie

Tomato PieThis is one of my favorite end of the growing season dishes when you still have an abundance of ripe tomatoes. This is the Simply Recipes version of the Tomato Pie. With fresh chopped tomatoes and basil from the garden this is the perfect end of the season dish. The tomatoes are topped with sautéed onions which is topped with a mixture of shredded cheese, mayonnaise, and a dash of hot sauce. Bake this dish for thirty minutes and you have wonderfully flavorful dish. There were no leftovers!

Re: The Physics of Space Battles

One of my qualifications for a great sci-fi movie is that the story has to be good enough that you do not think about things like the physics of space battles. As soon as you start wondering about the details of how they could do that in real life, the entertainment we derive from the movie is over. I purposely avoid this pitfall and promise myself to puzzle over the details after the movie is over. Here is a great resource on the physics of space battles. It also poses more questions than it answers. If sci-fi movies and video games are not good examples of space battles then our knowledge of space battles is more limited than we think. How are we going to break this rut in thinking if the physics of actual space battles is not dramatic enough for movies and video games? With this limited public knowledge how could we sway public opinion if we needed to fight a real space battle?

We Will Defeat ISIL Just Like We Defeated Al Qaeda… Yeah, that’s the ticket!

As a person who has already expressed his misgivings about the Administration’s strategy to fight terrorism as a long counter-terrorism effort, this Duffel Blog post, We Will Defeat ISIL Just Like We Defeated Al Qaeda, is way too funny. Here it is included in its entirety.

Barack Obama Official PortraitThe following is an op-ed written by Barack Obama, President of the United States.

Just over a decade ago, under my predecessor, our forces embarked on a campaign to fight the Global War on Terror after Al Qaeda terrorists attacked the World Trade Center and the Pentagon. Our military performed flawlessly in Afghanistan, routing the Taliban and Al Qaeda, and ultimately, denied the terror group a sanctuary from where it could attack us again.

Today we stand secure, knowing that Osama bin Laden is dead, and his organization of Al Qaeda is decimated, unable to operate anywhere on the earth. And with our strike against Iraq, we have deposed a dictator and brought peace and freedom to a Middle Eastern country.

Now, I was critical of the Iraq war in 2003 and strongly opposed it for many years. I felt at the time that our actions in a country where we had limited understanding of the culture could see U.S. soldiers standing in the crosshairs of a sectarian divide between Shia and Sunni.

Fortunately, that didn’t happen.

The war came to a close, and by all accounts, it was a rousing success. Our American Army defied the naysayers who likened the conflict to a Vietnam quagmire. The comparison was laughable of course, considering our involvement in Vietnam was almost two years longer than in Iraq.

But sadly, a new terror group has emerged. The Islamic State of Iraq and the Levant, or ISIL, a band of brutal thugs who have overtaken parts of Syria and Iraq, could potentially attack us at home again. Much like our medical professionals who have found a cure for cancer, we will find a cure for the cancer of ISIL.

While I don’t wish to arouse fear and hysteria amongst the public, let me be clear: ISIL is a threat to every interest we have and it is beyond anything we have ever seen. It has an apocalyptic end-of-days vision that threatens our very existence.

So that’s why I have ordered an extremely limited engagement against ISIL forces and am assuring the American people that we will not put boots on the ground. We are clearly at war with these extremists, and when faced with an enemy of such dangerous magnitude, it is the only choice we have.

You may have heard my primetime address where I outlined my strategy to degrade and defeat ISIL. In the speech, I used our efforts in Somalia and Yemen as models for what we can achieve. With drone strikes over the past few years, we have completely destroyed Al Shabaab in Somalia and AQAP in Yemen, although we’re still trying to figure out what that acronym stands for.

I’d like to highlight a few more points here to assure the American people that we will win this war against these terrorists — at some point in the future which may be three to four, or even maybe six to seven years from now, but it’s kind of hard to say at this point — and the threat will be diminished.

First, we will begin conducting airstrikes inside Syria at a time and place of our choosing. Under the direction of Gen. Lloyd Austin at Central Command, the military will target key militant facilities, armament, and weaponry, until they smarten up and completely blend in with the local populace.

While we bomb ISIL, which is fighting against the Free Syrian Army, Jabhat al-Nusra, and Syrian President Bashar al-Assad — who we don’t want to support because he’s a war criminal but we’re kind of supporting him but nevermind that — we will support moderate elements of the Free Syrian Army, which is fighting ISIL, Jabhat al-Nusra, and Assad.

We will take great pains to not enter someone else’s civil war, because that’s a first class ticket to failure.

Second, we will train moderate Syrian rebels and Iraqi security forces to take the fight to ISIL. As our experience has taught us in Iraq, the key to winning a war in the Middle East is to train up locals to “own” the battle and take charge of their future. In Mosul, we saw how our training efforts truly paid off, as Iraqi Army units bravely held ground when attacked by militants.

Our troops have long shown what can be achieved with shifting objectives, no strategic foresight, andvigorous support from the American people who don’t have to sacrifice anything. I call on each and every American to tie a yellow ribbon around a tree, bake an American flag cake, and support the troops who are fighting for your freedom.

In closing, I must stress that our war on terror began with Al Qaeda, but it did not end there. I pray that we soon reach our limited objectives in time for Hillary Clinton’s 2016 presidential run.

Thank you, and God bless America.