I occasionally read Outside Counsel– Notes on a Glamor Profession, a stimulating weblog by a New York attorney. I noticed this there today:

I have written before on the topic of physicians unionizing, (scroll down to the second letter) but it seems to be a bad idea whose time has come. Doctors want to practice medicine, and they keep thinking that the way to do this is by giving away control of their profession. We have accountants deciding whether an MRI is necessary today because the docs liked the idea of HMOs (mostly because HMOs looked like a good way to universalize health insurance, maximizing the profitability of medical practice). Now they are in businesses, and they don’t like it. Quite right, too, since one of the hallmarks of being a “professional” is being independent. Unionizing amounts to conceding that they have lost control of their profession, however, and merely substitutes one group of nonprofessionals for another. I look at this, and I marvel that there are lawyers who favor multidisciplinary practice. Accountants are the natural enemies of independent professionals– and the group-think paradigm which unionization represents is likewise no way for a professional to operate. It is frustrating that the American health care system is so disfunctional that its doctors are starting to believe they are disenfranchised– where does that leave the patients?

From my perspective as a practicing physician, I agree that it would’ve been misguided if true, but it is a gross misrepresentation to claim that the profession has willingly given up its autonomy. The managed care approach to cost containment was externally imposed; the species of HMOs that dominates today comprises ‘products’ essentially generated by the health insurance industry, not MDs. I don’t think any physicians felt it would maximize profitability in comparison with fee-for-service paradigms, and by and large MDs employed by HMOs are salaried employees, making less, and under the gun with productivity demands, working harder, than their colleagues in other sectors of medical care. Business incentives are inherently incompatible with taking adequate care of patients, and physicians have always known it (except those ‘businessmen in white coats’ whose interest has always been entrepreneurial rather than patient-care-oriented!).

I agree, the impetus to unionization is an essential acknowledgement of a loss of autonomy, but the labor movement has always represented empowerment of exploited and alienated labor. If there is a problem with doctors unionizing, it is that it does not have any ‘bite’ without the threat of a strike, and I’m not sure a work stoppage is compatible with a service profession, not that my friends who are nurses agree. I also agree that we have to be concerned about the fate of patients in a healthcare system where physicians are disenfranchised. There are some indications that the public realizes they are getting a raw deal from the healthcare bean counters. For example, see this, from the Boston Globe, regarding the mental health sector.

The Religious Experience of Philip K. Dick: “…an interesting graphic interpretation [by R. Crumb! -FmH] of a series of events which happened to Dick in March of 1974. He spent the remaining years of his life trying to figure out what happened in those fateful months.

You will find all 8 pages of this story here. The file sizes are rather large (120-140K each) so that the text was readable and the detail visible.

. …In typical Dick fashion, you will find that it raises more questions than it answers.” [via metascene]

Brain activity in ventromedial prefrontal cortex correlates with individual differences in negative affect: Overactivity in this brain region can be the source of chronic ‘bad moods’, i.e. increased intensity of negative affect. Proceedings of the National Academy of Science

Hivelogic Email Address Encoder: “Win the Spam Arms Race:

As most of you know, posting your email address on your website is a sure-fire way to guarantee a healthy portion of spam delivered to your Inbox for years to come.

This web-based tool encodes the email address using Numerical Equivalents and wraps that in JavaScript. The result will be rendered correctly by your browser, but will be undecipherable by most spambots.”

How to Fake a Passport NY Times Magazine

Working with the CIA, from Parameters, the US Army War College Quarterly:

In 1993, I had the privilege of being a CIA student at the US Army War College. During the academic year, I had some frank exchanges with my military colleagues about the intelligence community and how those military leaders viewed it, rightly or wrongly. The two principal conclusions I came away with were: (a) the intelligence community does not know enough about the military and its operations, and (b) the military does not know enough about the intelligence community and its operations.

Immediately upon graduation from the War College, I was selected as the CIA Chief in Mogadishu, Somalia. Within 30 days, I was on the ground there, trying to come to grips with the quickly evolving crisis.

This article will not be about the policy disaster that took place in Somalia, however. Rather, it will seek to illuminate the working relationship between the military and the CIA, offering some of the knowledge I gained in Mogadishu and over a career. In a way, it is the incoming brief I wish I could have given to the Ranger Task Force commander and his senior staff when they arrived in Somalia.

Also in Parameters: Caution, Children at War: “As we enter the 21st century, a new phenomenon of warfare has emerged, one quite different from the technical revolution in military affairs. While not a formal doctrine, it similarly represents a body of fundamental principles, deliberate instrumental choices, and transferred teachings. In this case, it prescribes the methods and circumstances of employing children in battle.”

E does not equal mc2: review of Who Rules In Science: An Opinionated Guide to the Wars

by James Robert Brown:

Few terms, when uttered in academic circles, are so instantly polarizing as the phrase “social construction.” Taken at face value, the notion is innocuous enough: some things that we come to know, like the rules of baseball and the letters of the alphabet, are not objective truths about the universe but products of social convention. The problem is that “constructivists,” whose ranks now include many—if not most—scholars of the humanities, are not content to stop there. From their point of view, all knowledge is subjective and all facts are arbitrary; in baseball, for example, we “construct” not only what counts as a strike, but also the trajectory of a pitch and the physiology of a batter’s swing.

For postmodern humanists, the constructivist enterprise is exciting and subversive, liberating them from the supposedly racist and sexist shackles of Western thought. For many scientists and philosophers, on the other hand, whose business it is to describe the world as it exists, the idea is confusing and absurd; in the words of the eminent biologist E.O. Wilson, it “menaces rational thought.” And not only that. To the extent that postmodernists have come to dominate the study of literature and the arts, their way of thinking has had a corrosive effect on the academy, giving rise to intellectual balkanization and a general decline of standards. Commentary

Plumb Design Visual Thesaurus: “an exploration of sense relationships within the English language. By clicking on words, you follow a thread of meaning, creating a spatial map of linguistic associations. The Visual Thesaurus was built using Thinkmap™, a data-animation technology developed by Plumb Design.”

Utah Olympic Peace Project

“You are invited to take a stand for peace by adding your name to the growing list of individuals who have signed our Declaration of Peace. We believe that the Winter Olympics are an ideal time to make a public stand for world peace. During the Olympics, individuals from all over the world will converge upon Salt Lake City. We are using this opportunity to spread our message of peace and global justice to the world as we publicly reveal the names of those who have signed the Declaration of Peace. By signing, you are joining people from around the world who believe that there are alternatives to war as well as people who are committed to working for peace and justice in their lives and communities.” Utah Indymedia

‘I Have a Middle East Dream’: James Zogby, the president of the Arab-American Institute in Washington, calls for Palestinian nonviolence in the mold of Dr. King. workingforchange.

Akilah Monifa: Abolish the Farce of Black History Month: “Black History Month has grown into an excuse to sell commercial goods and ignore African Americans 11 months out of the year.” Alternet

Molly Ivins: Play-by-play on campaign reform: “The U.S. House of Representatives is debating campaign finance reform, and it’s one of those days when all citizens should be political junkies. It doesn’t get better than this — the stakes couldn’t be higher, the tension couldn’t be thicker, the theater is superb. Passion, drama, comedy, hypocrisy, devious plot devices, splendid villains, noble heroes … this is just the best. The casting director has a spectacular imagination: Tom DeLay and Dick Armey alternating in the role of Iago — wow.” workingforchange Also: David Corn at tompaine.com asks: Is Pseudo Reform Better Than None?: “Shays-Meehan opens as many loopholes as it closes.” John Nichols writes in The Nation: “The debate on the Shays-Meehan bill provided an all-too-rare display of what an engaged Congress might look like.”

Geov Parrish: Welcome to the American Olympics: “The Olympics are supposed to be about international peace

and understanding. NBC makes it look more like a Fourth of

July parade.

” AlterNet And: Olympic Farce: ” Once upon a time, the Olympics were about patriotism and the celebration of virtue. Now they’re a multi-culti festival.” The Weekly Standard