Suddenly, They're All Gone

"Caring for the old is just like parenting an infant, only on really bad acid. It's all there: the head-spinning exhaustion, the fractured brain, the demands and smells. Only this time with the knowledge that it won't get better." Carol Mithers, wrote this essay the other day.

I have been thinking about my mom who took care of her in-laws for several years. She gave up a lot to do this but I never heard her complain. She was 'old school' in the sense the task was not a sacrifice to her but a call from her heart. I also think of parents of severely damaged service men and women, who also are sacrificing quietly, their lives for their children.

Throughout this world, caregivers, be they family, friends or lovers are quietly giving up the best years of their lives without medals, plaques or parades for what they know will be the inevitable epitaph … They Are Gone…..

A Disease In Medicine Redux

Yesterday I discussed the Baumol's Disease as it applies to the medical professional. I did not include one of the primary drivers that can enhance or retard an efficient and safe interface between technology and patient care… medical equipment salesmen. Yep, medical equipment salesmen are as important to patient care as is the most proficient medical professionals. Motivated by incentives some salesmen and their supervisors have endangered and severely injured patients, and not indirectly.

Roni Caryn Rabin reports that in pursuit of money, medical equipment salesmen have and I believe criminally injured patients. If you read her article you may also blame the surgeons and I wouldn't dispute that argument. But, the injuries originate with the intent of these salesmen to encourage medical procedures that they know beforehand are lethal in the hands of ill-prepared surgeons. 

As it relates to the Baumol's Disease concept these criminal motivations retard productivity, retard technology advancement in medicine and injure/kill patients.

A Disease In Medicine

Jonathan Cohn writes in the The Atlantic (March 2013) about the synergy of technology and economics. More specifically about the medical profession and the above.

An intriguing part of Mr. Cohn's article is something called "Baumol's Disease" or "the Braumol effect". Essentially in most jobs, wages increase as productivity rises. We know that today there are many exceptions due to the uniqueness of the current economic environment. Productivity in the United States is rising but wages are not and in many instances because of low consumer and government spending along with bank parsimony demand is down. I digress, but another exception is the exorbitant bonuses and 'golden parachutes' given to CEO's whether productive or not. Hopefully to end soon? Anyway, in a perfect world, this is how it is supposed to operate.

The relevance of Baumol's Disease to the medical profession is that in good times and bad as productivity goes down, wages rise. Cohn explains that the medical field is very labor intensive and demand is high and increasing. Employers must retain their personnel, especially the highly trained, by continually raising their compensation. Now we come to the impact technology can have on Baumol's Disease. It can increase productivity in several ways. Highly trained physicians and highly trained support staff can increase productivity (diagnosis and execution of treatment protocals) by increasing their use of technology. Less trained staff can have skills upgraded to the point where some burdens are removed from doctors. This increases productivity.

I am not saying that technology will lower medical costs. But, what it may do is give the profession more bang for the buck. Today as Mr. Cohn notes: "… a doctor in a clinic still sees patients individually, listens to their problems, orders tests, makes diagnoses - in the classic economic sense, the process of an office visit is no more efficient the it was 10, 30, or 50 years ago."

Phil Spector HBO Review

Watched "Phil Spector" last night on HBO. The critics didn't seem to care much for it, but I found it entertaining in all phases of the production. Pacino and Mirren were good, direction and screenplay were good. The critics got onto David Mamet because it's not accurate. DUH, it was not touted to be accurate. It was just a dramatization and stated such before a word in the movie was spoken. It did cast doubt on the verdict and seemed to blame the victim for her own death which evolved in the story from suicide to a dumb accident. 

Remember those 'thingys' (usually yellow) that we put in the middle of 45 records so they would fit on an LP player. Well most of Mirren's defense team had not only no idea what they were, they thought the 45 record was something that was used in an old computer… you know, like a precursor to a CD. They weren't that young either!

Anyway, great sound track. I especially liked Rebecca Pidgeon's interpretation of 'Spanish Harlem'.

If Not You, Who?

 “A democracy should not be dependent for its major decisions on what nine unelected people from a narrow legal background have to say,” ... Supreme Court Justice Anthony Kennedy.

 I disagree. For one thing we are a Republic not a Democracy. And that's the reason you have a job, Justice Kennedy.  Ben Franklin was asked by a woman, after the Constitution was signed, what type of government was created?  Franklin replied, "A Republic, if you can keep it." 

We want a government of laws not majority public opinions. And another thing, Justice Kennedy,  the Supreme Court does not decide major decisions, it decides only cases that the court deems worthy of certiorari  [should the court listen]. Sometimes they decide on standing , but most importantly they decide if there is a constitutional question involved.[That's what Franklin was addressing.]

The courts are not and should not make decisions based on polls, or any other popular expression of sentiment. That's why Justica wears a blindfold.

It's unconscionable that a justice of the Supreme Court holds such a view. It's time to 'get off the bus' Anthony.

Justification of Nullification

In a previous post I kind of advocated for court remedies by law enforcement officials when perceived constitutional conflicts arise between jurisdictions in our federal system. But reading Adam Liptak's article yesterday I realized that sometimes using the courts to resolve constitutional conflicts may have to be accompanied by civil disobedience of those we elect to enforce laws. Probably the most dramatic example was the debate over slavery preceding the Civil War. Many law makers from the north felt justified both morally and legally to defy laws protecting slavery.

Now we come to the issue of gay marriage which will be heard before the Supreme Court on March 26. [Just read that the court will release same-day audio of this argument.] The civil disobedience was initiated by the city attorney's office in San Francisco in the face of California's voter approval of Proposition 8 which banned same-sex marriage after state courts and a lower federal court judge ruled a previous ban [Proposition 22] to be unconstitutional [The court will also be deciding on a federal law known as Defense of Marriage Act.] In reporter Liptak's referenced article I e-mailed him regarding this statement: "… the plaintiffs and defendants in both cases agree that the laws under review are unconstitutional … ". No response by reporter Liptak and I can't make heads are tails of the discussion online. So I can only assume the city attorney for San Francisco is breaking the law by not enforcing  the  unconsitutional Proposition 8?

Official nullification by government officials is a very dangerous thing, especially by law enforcement personnel. A famous case [Worcester v. Georgia] involves President Jackson and Chief Justice John Marshall. Marshall's court ruled against a case that Jackson strongly supported. He refused to obey the court and famously said: "John Marshall has made his decision; now let him enforce it!" This is the 'still point' in our form of government. The courts have no police force. The laws we live by are balanced on the knife edge of voluntary compliance and enforcement by other officials who do have police forces. 

So even though reporter Liptak won't answer me I will assume that the Supreme Court has granted certiorari [listen to arguments] in the hope that with their decision they are not told to enforce it.

Separating The Truly Gifted From The Well Prepared

Jenny Anderson reports on the competition of parents and 4-year olds to win placement at some of New York City's top private kindergarten programs.

Reporter Anderson, has brought to our attention a Mutual Assured Deception (MAD) race going on between test makers, test preparers, test takers, and test evaluators. You can read the article but essentially the test maker Pearson announced that it was changing the exam used to test 4-year olds. Almost immediately test preparers had announced a 'fix' for the test takers. Now the test evaluators are pretty much back where they started from, trying to discern the truly gifted from the well prepared.

Four-year olds are "a mercurial and unpredictable lot by nature" and assessing them is not made any easier by deceptive practices.