Three items

[Cc'ed Tara, Adam and Tom. You guys can skip the first item and probably the second. Hope you're all having a great Christmas. Sorry I haven't mailed any letters yet. -Max]

 

Dear Jenn,

 

Three items of interest today.

 

1.) "Sun-Tzu, concerned with war on the highest strategic level, affirms that the greatest warrior is one who calculates so well that he never needs to fight. Clausewitz, interested more in the operational level, allows that war takes precedence only after other forms of politics have failed." http://www.the-american-interest.com/ai2/article.cfm?Id=289&MId=14 I know the article is more serious, but that has implications for my Axis and Allies tactics.

 

2.) Very amusing article on global warming. http://www.heartland.org/Article.cfm?artId=22430 I didn't realize the WHO had repealed the ban on DDT. Tragically and stupidly late (by 35 years), but very good news nonetheless. DDT is the most cost-effective way of fighting malaria. DDT saves lives. "Extreme optimism" prevails. (An extreme optimist is defined by John McCarthy, of Artificial Intelligence fame, as "someone who believes that civilization will probably survive, even if it doesn't take his advice" because good ideas will triumph in the end.)

 

3.) This is good and very interesting: http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande. [I hope that's a perma-link.] Anyone who cares about national health care should read pages 4 and 6. National health care will cost more than equivalent private care because you can't exclude the uninsurables, and I suspect because of increased moral hazard. On the other hand, there are notable inefficiencies in private insurance too such not covering preventive medicine, when it's actually the most cost-effective kind. (I suspect this is because insurance companies are capped in their profits--they can only charge a certain percentage more on premiums than they pay out to hospitals. Naturally this means there's no incentive to reduce the cost of medical procedures, because then their maximum allowed profits would decrease too. I could be wrong, of course, but I think I sent you a link a while back to this data on private health care "inefficiency.") Anyway, if you want to pay for national health care you need to fix other inefficiencies in order to pay for the ones you're going to introduce.

 

"In December, 2006, the Keystone Initiative published its findings in a landmark article in The New England Journal of Medicine . Within the first three months of the project, the infection rate in Michigan's I.C.U.s decreased by sixty-six per cent. The typical I.C.U.—including the ones at Sinai-Grace Hospital—cut its quarterly infection rate to zero. Michigan's infection rates fell so low that its average I.C.U. outperformed ninety per cent of I.C.U.s nationwide. In the Keystone Initiative's first eighteen months, the hospitals saved an estimated hundred and seventy-five million dollars in costs and more than fifteen hundred lives. The successes have been sustained for almost four years—all because of a stupid little checklist."

 

Anyone in the software industry should read it too--it's a great example of a problem domain where tools to reduce cognitive load have a dramatic effect on cost (and save lives too), and software is all about finding places where information tools impact the real world. There are lessons for managers and business executives, too. One final thought: hospitals don't seem real receptive to the lessons. Remind you of Ignatz Semmelweiss? [Onlookers: Semmelweiss was a 19th century physician who spent years as a pariah in the medical community because he had this crazy theory that "childbed fever," which killed many women after giving birth, could be prevented by doctors observing basic sanitary practices like, say, washing your hands after performing an amputation and before delivering a child. Obviously crazy, right? Eventually the medical community changed its mind but I understand it took years.]

 

-B.C.

 

--

"The presentation or 'gift' of the Holy Ghost simply confers upon a man the right to receive at any time, when he is worthy of it and desires it, the power and light of truth of the Holy Ghost, although he may often be left to his own spirit and judgment." --Joseph F. Smith (manual, p. 69)

 

Be pretty if you are,

Be witty if you can,

But be cheerful if it kills you.