Archive for March, 2011

TRYING TO BE CIVIL DURING A CIVIL WAR

March 10, 2011

Twenty-five years ago, I went to trial for alleged malpractice.  During the trial, the plaintiff’s lawyer kept quoting a neurology book, trying to make it appear that I practiced below the standard.  Each time, I asked to see the passage, and each time, I read the paragraph before and after the lawyer’s quotation.  He was quoting out of context.  He was lying, to make a point.  The third time I asked for the book, he literally threw it at me, on the stand.  Several jurors actually gasped.  For the first time, I thought I might not lose.  I didn’t, but of course in a malpractice trial, a physician never wins: it is lose or not lose.

I question whether the U of A’s new to promote civility will be successful.  I will try to be civil in my comments.

I find it difficult to be civil to those who did not serve this country in uniform, but are quick to support our military in our many misadventures that have cost hundreds of thousands of lives and trillions of dollars.  I was among the 16% of Americans in 2003 who thought invading Iraq was a bad idea.  I was right.  I am often right on the big issues, not that it matters much.  The bullies and the jerks usually win.

I find it difficult to be civil to bullies who use ideology, rather than facts, to call those who disagree with them unpatriotic, and sold a war that has been so costly.  These bullies polarized the country.  Worse, the media supported them in the name of “balance.”  We allowed the debate on health care to be uncivil, allowing words like “death panels” into the national discourse.  My opinion piece was entirely civil, factual, and appropriate, since I have dealt with death and dying many times when my colleagues were quite happy that I, and not they, would.

During the last total lunar eclipse, CNN interviewed two astrologers, no astronomers, because the eclipse happened to occur near the solstice.  Is this what America has come to?  I will ask:  what does a total lunar eclipse require, and why does it occur?  Can you tell me why we have seasons?  Can you tell me how you would determine the number of square feet in an acre and how many square kilometers equal a square mile?  Can you tell me what case follows the word “between”?  Do you know where Guadalcanal is, why it was important and what Marine Division has it on their emblem?

I find myself difficult to be civil to those who disparage science, want to take us back several centuries, at the same time enjoying their cell phones, cars, food and water so safe we don’t think about it.  I find it difficult to be civil when I am in a minority of Americans who believe global climate disruption is occurring and man caused.  And I will not argue this with anybody, unless they (1) avoid all use of pejorative language, (2) use statistical terminology and (3) state the consequences if they should be wrong.  I have yet to find anybody who can do this. I find it difficult to disagree so without being disagreeable, for I see these people and others destroying a country that I served as an officer in uniform, and at least 98% of Americans have not.

I find it difficult to be civil, when 10 years ago I proposed a reporting and counting system for medical errors, which failed.   And do we know the scope of the problem in 2011, and have we improved our care?

I find it difficult to be civil to those who received complete data on 6th grader obesity–from 5 middle schools–promised to help, and didn’t.  Tucson has a grant to deal with this problem, when with a few volunteers from PCMS and the school of nursing, we could have obtained data from every middle school in the county–free, since I would not have charged for my data analysis.

Do we have any data this year?  None that I know.  The principal at one of those middle schools yelled at me, uncivil, although we were helping him meet his mandate.  What is happening in his school?  Is the median BMI still at the 89th percentile, rather than the 50th?  Are 14% of his students still above the 95th percentile and 7% above the 99th percentile, 3 and 7 times the expected values, respectively?  Is his school representative of the county?  Does anybody care?

What we need in America are volunteers, service, ideas, hard data, willingness to say “I was wrong,” and polite, respectful discussions with willingness to listen.   It is time we say “no more” to those who deliberately lie to push an agenda.  It is time that we and the media gasp, like the jurors did in January 1986, call these bullies out on their lies, because equal time requires equal facts.  Bullies must be stopped, whether high school students, lawyers or fat old non-veterans who deliberately lie on the public airwaves.

I took my skills out of medicine to other fields.  I now wonder whether I take myself and my skills out of this country, which I see as in major decline, because of lack of MY “family values”:  education, politeness, population control, caring for the Earth and all its living beings.

MESSING WITH THE MIND

March 10, 2011

How many people do you need in a room before any two are more likely than not to have the same birthday?

Twenty-three.

I’m sure there are those who disbelieve, saying “I know that can’t be right.”  What is disturbing is that even when a simple proof is delivered, many continue not to believe it.  That is stupid, but these days disbelief of reality by people in power is beginning to destroy this country.  The proof looks at the probability that two people don’t have the same birthday.   Here are the probabilities:

 

Number of People Prob (2 have same Bday) Probability (2 don’t)
2 0.003 0.997
5 0.027 0.973
10 0.117 0.883
15 0.253 0.747
20 0.411 0.589
22 0.476 0.524
23 0.507 0.493
25 0.569 0.431
30 0.706 0.294
35 0.814 0.196

 

A disease has a prevalence of 1 in 200 (0.5%), a sensitivity of 98% and specificity of 99%, meaning if you have the disease you test positive 98% of the time and if you don’t you test negative 99% of the time.  Not knowing if you have the disease, you test positive.  What is the probability you will have the disease?   The issue here is that having the disease and testing positive is very different from testing positive and wondering if one has the disease.  If the disease is rare, the likelihood of a positive test’s being a false positive is significant.  Here’s why, using 10,000 people and the above percentages:

 

  Test Positive Test Negative Total
Disease Positive 49 1 50
Disease Negative 99 9851 9950
Total 148 9852 10000

 

If you test positive (148), a third of the time (49) you will have the disease.  The others are false positives.  That’s why we don’t do routine HIV blood tests for marriage.  In a randomly selected individual, and that is important, a positive test for something rare has a significant likelihood of being a false positive.

Many mountaineers defend the safety of their sport by saying one can get killed in a car accident.   We all know someone who died in a motor vehicle accident, but relative to the denominator, it is small, 1 in about 7000 Americans each year.  Mountaineering is a small community, and number of climbs is a small denominator.  Every serious mountaineer has lost several friends in the mountains.  Mountaineering is far more dangerous.

The lottery is a tax on those who don’t understand probability.  The chances of winning the Powerball jackpot are approximately those of randomly picking a minute chosen since the Declaration of Independence was signed, 1 to 110 million.  Yet people continue to tax themselves because “if you don’t play, you can’t win.”

Too many Americans play “I’m sick do I see a doctor?” lottery:  I have abdominal pain, and I don’t have insurance. I hope it goes away.  But it doesn’t; instead, the pain worsens.  I call an ambulance, go to an ED and am admitted with a ruptured appendix.  The costs have increased and are well in five figures.  I’m bankrupted by the illness, nobody gets paid, and my productivity is zero for a long time.  I’ll probably never get out of debt.  If I get sick again, I’ll bet again it goes away.  I will have no other choice. I’m betting that my body’s natural healing ability will bail me out.  Maybe it will.  Or maybe it won’t.

We were once the richest country in the world.  Our annual medical costs are far more than a trillion dollars.  A trillion is roughly the number of days since the Earth formed.  How many these costs could have been avoided by timely prevention?  How many could have been avoided by universal coverage?  I don’t know.  But I do know that our system makes it impossible for at least a sixth of Americans, not Zimbabweans, to get decent, timely care and not be bankrupted by it.  If you don’t want my solution, you fix it.   Here are my metrics:  your fix has to show an increase in productivity, a decrease in emergency department overcrowding, a decrease in bankruptcies that are primarily due to medical reasons and a decrease in late diagnosis of disorders like appendicitis, that should all be picked up early–in America, not Tajikistan.

If that requires I pay more taxes, I’ll pay them.  I’d rather pay taxes for education and health care than for fighting,  foreign aid to countries who despise us and bailouts to car makers who built monstrous SUVs, when it was obvious decades ago we needed to retool.  The selfish say, “I got mine, and the hell with you.”  Liberals like me say, “I got mine, and I want to help you get yours.”

I’m a patient, and I’m tired of waiting weeks to see a physician (I thought only Canadians waited), worrying about medical errors that affected me and three family members and really tired of the bickering and the lies that stalled any meaningful reform.  It is disgusting and un-American.

The above birthday problem was solved by looking at what we didn’t want to find what we did want.  I don’t want a huge national debt.  Here are 2 thoughts:  end our wars, and enact a 90% marginal tax rate on those with incomes over $3 million.

I can live with 70%.