Rafe on Rall

I usually link to or excerpt Rafe Colburn’s comments because I have little to add to their incisiveness. But in this case, there is more to say:

“I want to talk about Ted Rall’s latest effort, not because I want to join the huge chorus of people who love to bash Ted Rall, but rather because I want to bash cynicism.

Rall’s cartoon, if you haven’t yet seen it, says that Pat Tillman, the former NFL player who joined the Army in 2002, is basically an idiot who made the fatal mistake of choosing to serve in the military because he believed our lying President. In four short panels, he also manages to accuse Tillman of racism as well. Rall’s cartoon isn’t funny — Rall is rarely funny — but it also fails even to serve as pointed commentary.

You don’t have to be a very good cynic to come up with ways to disparage Pat Tillman; honestly when I heard that he’d joined the Army a couple of years ago, and again when I heard that he’d died, the bad reasons (he) might have joined came to mind only a few seconds after the good reasons he might have joined. Ultimately, we have no way of knowing what motivated Tillman to enlist. Any of us can imagine impure motives that may have led to him doing so — it doesn’t behoove us to callously point them out.

Sometimes saying things that most people keep to themselves doesn’t make you courageous or iconoclastic, it makes you an ass.” [paragraph divisions added for readability — FmH]rc3

First of all, Rall’s cartoon has served an important purpose if it gets thoughtful people like Rafe Colburn to concede and discuss thoughts like that that they usually keep to themselves. Let me go on record; even though I don’t have a clue about Tillman’s motives for enlisting and hardly knew who he was until he died, the thoughts I kept to myself were about how his death serves as a graphic illustration of the consequences of misguided patriotism. There is a venerable tradition in antiwar literature and film of rendering the tragic, misguided emptiness of the high-minded ideals for which young men are swindled into becoming cannon fodder in old men’s wars. I am surprised Colburn doesn’t appreciate this.

Tillman’s case is useful precisely because most of the other deaths in Bush’s misguided lethal adventurism have been anonymous faces, and because the relentless dysadministration spin about the usefulness of these deaths, empty rhetoric that it is, has been so persuasive. Rall is grappling, I think, with the devilish problem opponents of the US invasion have, of how to open the eyes of the American public to the horrors that are being done in their name … to Afghanis and Iraqis and, yes, to American young men and women as well. The desperation many of us feel at the fact that this nation of sheep stands a good chance of reelecting Bush (oops, I forgot for a moment of course, he wasn’t elected the first time) despite (or because of?) all it should by now be clear he has done calls for desperate measures. Rall’s is a cry of that despair and outrage. If this be cynicism, then there is probably no higher calling at the moment.

If Rafe accepted that Rall is using Tillman as an icon, because of his name recognition, for all the faceless U.S. GIs, then he wouldn’t think Rall is calling him racist per se. The American premise for the war effort is racist, Rall is saying. Debasing American ecumenism by inciting a once-great nation to collective anti-Arab hatred will turn out to be one of Bush’s most execrable legacies. If you have any doubts about that, look again at the Abu Ghraib photographs.

Finally, Rall is making the precise point that needs to be made about the degradation of the notion of heroism. It is tragic, not heroic, to die for the neo-conservatives’ delusions of grandeur. They have shown in spades that they are willing and eager to sacrifice Americans of all walks of life for their misguided aims — the GIs dying in a war based on lies as well as all US civilians, who are exposed to vastly heightened risk of terrorist attacks because of the rage the US has engendered in the eyes of all the angry dispossessed of the Third World, the monumental squandering of any good will and credibility the US had by one deceitful, intellectually crippled, morally decrepit and grossly incompetent leader. The adulation of every hapless American victim — from 9/11 onward — as a hero is a malignant effort by the leadership of the country to absolve itself of its responsibility for the pointless deaths.

One may think it cruel to Tillman’s family and friends to diminish the worship of the fallen hero. But the families who, grieving the loss of their loved ones on the battlefield in Iraq or Afghanistan, increasingly are embracing and proclaiming the pointlessness of it all and the emptiness of George Bush’s grand designs are equally heroic.

Agitprop artists like Ted Rall have done their job if they stimulate precisely this sort of troubled and troubling discussion among the rest of us.

You stink, therefore I am

“Disgust is both powerful and pervasive in our lives, yet of all the emotions that make us human, it is surely the most neglected, and the least understood.

There is an obvious reason for that — disgust is disgusting — and a more subtle one: To dwell too much on disgust is to risk losing any sense of the object of study. (In this, ‘disgustology’ resembles ‘sexology.’) …

In the last few years, however, the study of disgust has emerged from the province of specialists and their textbooks to take its place in the public square. This emergence can be precisely dated to 1997, with the appearance of The Anatomy of Disgust, by William Ian Miller, an iconoclastic professor of law at the University of Michigan whose previous book had been devoted to humiliation, and ethicist Leon Kass’s widely debated New Republic cover essay ‘The Wisdom of Repugnance,’ which made an argument against human cloning.” — Boston Globe

Liberals and strangers

Libealism is not 300 yers old, as commonly claimed; how about 10,000 years?: “Liberalism is not about how to live as a western capitalist Protestant. Its roots are to be found not in capitalism but in agriculture, in that remarkable 10,000-year-old revolution that led modern man, independently in many different parts of the world, to give up the hunting and gathering life and to found farms, villages and eventually cities. That change had a radical consequence: human beings had to learn to live and to trade with strangers for the first time. By an intriguing paradox, globalisation began when man became sedentary – for settled communities cannot hope to avoid all contact with outsiders by melting into the forest. Instead they must think systematically about defence, trade, immigration, and the division of labour on more than a local scale. This was a momentous departure: prehistoric man had lived in groups of kin or at least among familiar faces. The habits of mind and the forms of behaviour that farmers had to learn are the foundations of liberalism, and they are what we need to reaffirm today if we are to share the world with strangers without tearing ourselves apart. ” — Paul Seabright, an economist at the University of Toulouse, writing in Prospect Magazine

Playing With Sounds in Your Head

“The sound of fingernails scraping a dusty chalkboard makes a listener immediately squirm and cover her ears.

One company believes that there is real science behind such a reaction to sounds. NeuroPop is integrating neurosensory algorithms into music to create a certain mood and evoke more intense responses from listeners. The company hopes to market its compositions to the movie industry and video game companies.

Its first CD, Overload: The Sonic Intoxicant, contains tracks ranging from ‘chill out,’ meditative music to a piece that generates a feeling of motion sickness in some.” — Wired

British Troops ‘Swapped Hundreds of Abuse Pictures’

“Hundreds of photographs have been taken of British servicemen mistreating Iraqi civilians, it was claimed tonight.


Troops serving in southern Iraq have been swapping the pictures among themselves, said the unnamed soldiers from the Queen’s Lancashire Regiment who sparked furore over the weekend by releasing photos apparently showing UK personnel abusing an Iraqi prisoner….


Speaking on condition of anonymity, one of the soldiers said: “Maybe the officers don’t know what is going on – but everybody else does. I have seen literally hundreds of pictures.” — The Scotsman [via Daily Rotten]

"A Mediocre CEO…"

An excellent post from Kevin Drum:

Bush styles himself a “CEO president,” but the world is full to bursting with CEOs who have goals they would dearly love to attain but who lack either the skill or the fortitude to make them happen. They assign tasks to subordinates without making sure the subordinates are capable of doing them — but then consider the job done anyway because they’ve “delegated” it. They insist they want a realistic plan, but they’re unwilling to do the hard work of creating one — all those market research reports are just a bunch of ivory tower nonsense anyway. They work hard — but only on subjects in their comfort zone. If they like dealing with people they can’t bring themselves to read all those tedious analyst’s reports, and if they like numbers they can’t bring themselves to spend time chattering with distributors about their latest prospect.


And most important of all, weak CEOs are unwilling to recognize bad news and perform unpleasant tasks to fix it — tasks like like confronting poorly performing subordinates or firing people. Good CEOs suck in their guts and do it anyway.


George Bush is, fundamentally, a mediocre CEO, the kind of insulated leader who’s convinced that his instincts are all he needs. Unfortunately, like many failed CEOs before him, he’s about to learn that being sure you’re right isn’t the same thing as actually being right.


So sure: George Bush is genuinely committed to winning in Iraq. He just doesn’t know how to do it and doesn’t have the skills, experience, or personality to look beyond his own instincts in order to figure it out. America is about to pay a heavy price for that. — The Washington Monthly

Who Hacked the Voting System? The Teacher

“Our analysis shows that this voting system is far below even the most minimal security standards applicable in other contexts… We conclude that, as a society, we must carefully consider the risks inherent in electronic voting, as it places our very democracy at risk.”

A New York Times portrait of Johns Hopkins computer scientist Aviel Rubin, who has been called “the most important figure in the United States in articulating the security problems with electronic and Internet voting”, although of course not by anyone in the corporate hierarchy of Diebold.

Within You and Without You

This interactive java tutorial is a version of the renowned Powers of Ten film I first saw at the Smithsonian decades ago. In successive jumps of an order of magnitude apiece, you travel between a 10-16-meter view of the quark-texture of subatomic matter and a view of our galaxy from 1023-meters (10 million light years). Show it to your scale-challenged friends.

They could go further out. At least three further order-of-magnitude steps up are possible, as current thinking suggests the furthest objects are quasars somewhere over 10 billion light years distant. Are these extra steps not included because there is nothing interesting to be revealed at views of those scales? Recent discoveries suggest that there is a ‘coarse structure’ to the clumping of galaxies in the universe as a whole. Is that as far as you can go? Beyond 10-15 billion light years, by current estimation, you exceed the distance light could have travelled since the origin of the universe; given that speed limit, you run out of size there. Step out further and you arrive at…what? The face of God, most likely. Which, by the way, is waiting for you at the other end of the spectrum in the smiling visage of each quark as well, right? as you run out of size at the bottom end? [thanks, nathalie]

Save Overtime Pay

The disingenuous regulations the dysadministration finalized last month under the guise of worker-friendliness will actually be a giveaway to business by disallowing millions of hours of overtime pay to workers annually. This is of particular concern to me as a physician, since my nurse colleagues stand to be particularly severely affected, their professional associations predict (and nurses are compelled to work many many hours of overtime in the current healthcare climate).

This AFL-CIO petition you can sign with one click will tell your senators to support the Harkin amendment opposing the Bush plan. The Senate vote is tomorrow, Tuesday, so click on the link now. The campaign is being spread by word of mouth only, so spread the word. Bush has threatened to veto legislation that would compromise his plan; forcing a high-profile veto will expose his worker-unfriendliness within months of the election. — Working Families e-Activist Network, AFL-CIO

Annals of National Security

Seymour Hersh on the Abu Ghraib torture::

“Myers, who was one of the military defense attorneys in the My Lai prosecutions of the nineteen-seventies, told me that his client’s defense will be that he was carrying out the orders of his superiors and, in particular, the directions of military intelligence. He said, ‘Do you really think a group of kids from rural Virginia decided to do this on their own? Decided that the best way to embarrass Arabs and make them talk was to have them walk around nude??’ “

So, indeed, it may have been ‘only following orders’ after all. Hersh describes a longstanding pattern of illegal cooperation by the forces guarding the military prisons both in Afghanistan and Iraq and OGAs — other government agencies, their euphemism for military intelligence — in “setting favorable conditions for subsequent interviews”, if you know what that means. An earlier Army investigation of MP practices either softpedaled or covered up the level of abuse. Of the current investigation leading to Article 32 proceedings against six enlisted GIs and their commander, Hersh says:

As the international furor grew, senior military officers, and President Bush, insisted that the actions of a few did not reflect the conduct of the military as a whole. Taguba’s report, however, amounts to an unsparing study of collective wrongdoing and the failure of Army leadership at the highest levels. The picture he draws of Abu Ghraib is one in which Army regulations and the Geneva conventions were routinely violated, and in which much of the day-to-day management of the prisoners was abdicated to Army military-intelligence units and civilian contract employees. Interrogating prisoners and getting intelligence, including by intimidation and torture, was the priority.

The mistreatment at Abu Ghraib may have done little to further American intelligence, however. Willie J. Rowell, who served for thirty-six years as a C.I.D. agent, told me that the use of force or humiliation with prisoners is invariably counterproductive. “They’ll tell you what you want to hear, truth or no truth,” Rowell said. “‘You can flog me until I tell you what I know you want me to say.’ You don’t get righteous information.” — New Yorker [via walker]

"Doctors Without Borders"

Why you can’t trust medical journals anymore: “…(W)here the debate over conflict of interest in medical journals stands: Should research scientists who have financial stakes in the products they are writing about be forced to disclose those ties? To which the average person might reasonably respond, of course they should. But the more pertinent question is why scientists with financial stakes in the outcome of scientific studies are allowed anywhere near those studies, much less reviewing them in elite journals.

The answer to that question is at once both predictable and shocking: For the past two decades, medical research has been quietly corrupted by cash from private industry. Most doctors and academic researchers aren’t corrupt in the sense of intending to defraud the public or harm patients, but rather, more insidiously, guilty of allowing the pharmaceutical and biotech industries to manipulate medical science through financial relationships, in effect tainting the system that is supposed to further the understanding of disease and protect patients from ineffective or dangerous drugs. More than 60 percent of clinical studies–those involving human subjects–are now funded not by the federal government, but by the pharmaceutical and biotech industries. That means that the studies published in scientific journals like Nature and The New England Journal of Medicine–those critical reference points for thousands of clinicians deciding what drugs to prescribe patients, as well as for individuals trying to educate themselves about conditions and science reporters from the popular media who will publicize the findings–are increasingly likely to be designed, controlled, and sometimes even ghost-written by marketing departments, rather than academic scientists. Companies routinely delay or prevent the publication of data that show their drugs are ineffective. The majority of studies that found such popular antidepressants as Prozac and Zoloft to be no better than placebos, for instance, never saw print in medical journals, a fact that is coming to light only now that the Food and Drug Administration has launched a reexamination of those drugs.” Washington Monthly

High-Tech Mindreading

“Brain fingerprinting uses a headband with sensors to measure brain waves, which promoters say can help authorities determine the truth by detecting information stored in the brain.

An example is that a murder investigation could be aided if showing a picture of a murder scene to a suspect reveals brain wave measurements that indicate familiarity with the scene. The brain waves are fed through an amplifier into a computer that uses software to display and interpret them.

The hope is the results will become widely accepted as scientific and legal evidence, such as DNA tests.

Results from a test in 2000 on a man convicted in a 1977 Iowa murder showed his brain didn’t hold specific knowledge of the crime but did contain details about the night of the murder that were consistent with his alibi.” — Seattle Post-Intelligencer

And Here is a link to the Brain Fingerprinting website.

"Doctors Without Borders"

Why you can’t trust medical journals anymore: “…(W)here the debate over conflict of interest in medical journals stands: Should research scientists who have financial stakes in the products they are writing about be forced to disclose those ties? To which the average person might reasonably respond, of course they should. But the more pertinent question is why scientists with financial stakes in the outcome of scientific studies are allowed anywhere near those studies, much less reviewing them in elite journals.

The answer to that question is at once both predictable and shocking: For the past two decades, medical research has been quietly corrupted by cash from private industry. Most doctors and academic researchers aren’t corrupt in the sense of intending to defraud the public or harm patients, but rather, more insidiously, guilty of allowing the pharmaceutical and biotech industries to manipulate medical science through financial relationships, in effect tainting the system that is supposed to further the understanding of disease and protect patients from ineffective or dangerous drugs. More than 60 percent of clinical studies–those involving human subjects–are now funded not by the federal government, but by the pharmaceutical and biotech industries. That means that the studies published in scientific journals like Nature and The New England Journal of Medicine–those critical reference points for thousands of clinicians deciding what drugs to prescribe patients, as well as for individuals trying to educate themselves about conditions and science reporters from the popular media who will publicize the findings–are increasingly likely to be designed, controlled, and sometimes even ghost-written by marketing departments, rather than academic scientists. Companies routinely delay or prevent the publication of data that show their drugs are ineffective. The majority of studies that found such popular antidepressants as Prozac and Zoloft to be no better than placebos, for instance, never saw print in medical journals, a fact that is coming to light only now that the Food and Drug Administration has launched a reexamination of those drugs.” Washington Monthly

"If truth is the first casualty of war, openness is the first casualty of going public…"

What can’t you find on Google? Vital statistics: “Here’s a cheap trick to play on an audience – especially one drawn from the business community. Ask them how many use Microsoft software. Virtually every hand in the room will go up. How many use Apple Macs? One or two – at most. How many use Linux? If the audience is drawn from corporate suits, no hands will show. Now comes the punchline: who uses Google? A forest of hands appears. ‘Ah,’ you say, ‘that’s very interesting, because it means you’re all Linux users.’ Stunned looks all round.

The computing engine that powers Google is the largest cluster of Linux servers in the history of the world. If you talk to computer-science folks, you find that they regard this – rather than the number of web pages indexed – as the most interesting thing about the company. Managing such a vast server-farm is a formidable task. For example, how do you implement security patches and operating-system upgrades (much more frequent in Linux than in proprietary systems from Microsoft or Sun) on thousands of servers without causing disruption to service? Google manages to achieve this with sophisticated techniques for rippling changes through the cluster, yet achieves 100 per cent uptime. This is serious stuff, and there are a lot of IT managers out there who would give their eye-teeth to be able to do it half as well.” —Guardian.UK

The GOP’s Vanishing Breed

EJ Dionne’s Friday op-ed piece in the Washington Post describes how difficult it is to be a moderate Republican under the current hegemony:

“The 74-year-old Specter’s victory is thus a last hurrah, not the next new thing. Those conservatives gathered around the Club for Growth, a political action committee devoted to pushing moderate Republicans either to the right or out of office, can claim a tactical triumph for the nearly $2 million the group directed toward helping Toomey.

Stephen Moore, the Club for Growth’s president, always saw the effort as having a double purpose: to replace Specter with a conservative if possible, but also to demonstrate how much anguish conservatives could create for Republican moderates who did not fall into line. “

Lincoln Chafee, Olympia Snow, George Voinovich are other choice targets. Dionne suggests that the moderates will either be pushed toward retirement or, even if they hold on, succeeded by a new generation far to their right. If they choose to seek reelection they will inexorably be pushed rightward in their ideology. Dionne cites a roster of liberal Republicans who have been knocked off in primaries as the Republican Party has gotten more conservative. There is another option, however, Vermont Sen. Jim Jefford’s way — to defect from the GOP. Dionne suggests that the Club for Growth is trying to push the moderates to do just that and recreate the Republican Party in their image. Let us hope the moderates realize they should make such a choice far in advance of their retirement, which could result in incumbents shifting to the Democratic side of the aisle or a significant splintering of the Republican Party. A third party challenge that would siphon votes from the Republicans as the right wing analogue to the Nader Effect would surely be welcome, possibly even in the ‘Red States’. It is an open question how broad or sustained an appeal Rabid-Right Republicanism would have, especially as disaffection with the Bush League may be reaching a tipping point and especially if the Boy King is defeated in November. Here’s to the Club for Growth’s ideological wish fulfillment fantasies clouding their political realism. [And where is Ross Perot when we need him most?]

Scientist believes Atlantis found off Cyprus

“The quest to find the lost city of Atlantis has begun in earnest off Cyprus’s southern shores. A US-led team of explorers claims the ancient city lies on the seabed between Cyprus and Syria.

With the aid of unique underwater maps, a US researcher claims to have assembled evidence to prove the mythological island of Atlantis really existed. Using sophisticated sonar technology, California-based Robert Salmas says he has not only been able to pinpoint Atlantis to a sunken land mass off Cyprus’s southern coast, but even discern its geographical features as described by Plato.

The alleged discovery has been greeted with barely concealed mirth by the Mediterranean island’s tourism office.” ABC News

‘Mission Accomplished!’ Dept.:

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“We had no training whatsoever”. In the BBC’s coverage of the Abu Graib torture appears the following fascinating passage:

“…(O)ne of the six soldiers charged, Sergeant Chip Frederick — a reservist whose full-time job is as a prison officer in the US state of Virginia — …said he and his fellow reservists had never been told how to deal with prisoners, or what lines should not be crossed. ‘We had no training whatsoever,’ he said.

‘I kept asking my chain of command for certain things… like rules and regulations. And it just wasn’t happening,’ he said.

He said he never saw a copy of the Geneva Conventions – which govern the treatment of prisoners – until after he was charged. The Army investigation confirmed that reservists at Abu Ghraib had not been trained in Geneva Convention rules.”

The comanding officer of these military police, Brigadier General Janice Karpinski, has been suspended and is among military personnel being investigated since publicity about the torture practices emerged. Army investigators have apparently determined that her leadership failures were to blame for the abuses.

It strikes me we have come a long way from Nuremberg, when “only following orders” was offered as a defense. These barbarous sons of bitches are claiming that they would have needed to be instructed in how to take care of their prisoners humanely? And that, in the absence of guidance, their natural fallback was bestial torture? (Oh, wait, the MP interviewed is a correctional officer in his domestic life…) If the cause for concern about their commanding officer was her “lack of leadership and clear standards”, by the by, should the buck stop there? IMHO, it should proceed up the chain of command to the buffoon-in-chief in the White House himself.

Rafe is My Straight Man?

Rafe Colburn on Republican smear tactics:

“Karen Hughes was busy on CNN yesterday attacking John Kerry for things he said 30 years ago. This from the loyal retainer of a man who dismisses everything he did before age 40 as ‘youthful indiscretion,’ and who was probably saying things like, ‘Should we go out and buy a couple more six packs before the convenience stores close?’ back then. Politics is politics, but I quake at the temerity of Republicans who want to compare their candidate’s lifestyle in his early twenties to that of Kerry.”

The only thing I have to add is — he’s talking about Dubya, isn’t he? Because ‘convenience store’ doesn’t really ring true — too many syllables to trip lightly over his tongue…

And Rafe on a security issue that has bothered me for a long while:

“One popular security question used to confirm the identity of a person making a request is, “What is your mother’s maiden name?” Well Brad Graham points out that using Google, you can find that information for many people on genealogy sites. He discusses this in the context of retrieving other people’s passwords to their Gmail accounts, but it’s just as true for your credit card or anything else. The Gmail case is particularly egregious because you generally don’t tell other people your credit card numbers, but you do tell them your email address.”

Note to identity thieves: I long ago invented a different answer to the ‘mother’s maiden name’ question, which I use consistently (it doesn’t have to be accurate, just memorable…). Even if I did use my mother’s real maiden name, you wouldn’t find geneological information of my ilk anywhere on the web anyway. Not that there would be much reason to steal my identity; there’s little of consequence either in my email account or my bank account.

Billmon on the Abu Ghraib tortures:

“Granted, the Coalition hasn’t descended all the way to Saddam’s level — at least not yet. Human Rights Watch and other reasonably reliable sources have documented that summary execution was a regular part of the old prison routine at Abu Ghraib. American war criminals, on the other hand, apparently draw the line at mild torture (what the Israelis like to call ‘physical pressure’) and ritual humiliation.

But that still leaves plenty of room for the physical degradation of the prisoners — and the moral degeneration of the guards and those who command them. And we’ve only been in Iraq for a year! Imagine what we’ll look like if we remain in power as long as Saddam.”

So how much deeper into the sewer are we collectively going to climb before we finally admit defeat?”

Mendacity Watch:

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Claims vs. Facts Database: “The Center for American Progress has launched this new database project to chart conservatives’ dishonesty – and compare it with the truth. In this database, each conservative quote will be matched against well-documented facts, so that users can get a more accurate picture of the issues. And we need your help. If we’re missing a lie or distortion you know of, please submit an entry. If it checks out, we will gladly add it to the database.” [via unfutz]

‘One-Woman Hospital Efficiency Drive’

From the null device:

Life imitates Christopher Brookmyre novels: a nurse in Britain is on trial for being somewhat overzealous in tackling the bed-blocker problem, to the extent of attempting to hasten several patients’ journey through death’s door. In her efficiency drive, Barbara Salisbury is alleged to have given patients overdoses of diamorphine and withdrawn their oxygen supplies.


Salisbury, who was described by the prosecution as an experienced, capable and efficient nurse, is accused of attempting to murder Frances May Taylor, 88, in March 2002 in that she inappropriately administered diamorphine using the syringe pump, telling a colleague: “Why prolong the inevitable.”


She is accused of attempting, 10 days later, to murder Frank Owen, 92, by instructing another member of nursing staff to lay Mr Owen on his back, allegedly adding: “With any luck his lungs will fill with fluid and he will die.”


I wonder whether (assuming that the charges are true, of course) she was acting out of a personal cruel streak, or whether this is merely the most extreme manifestation of an institutional focus on patient turnover in the Thatcherite/Blairite health system in Britain (as was the plot of Brookmyre’s Quite Ugly One Morning; though, granted, Brookmyre seems to write from a Scottish-socialist point of view).

My thoughts as a physician — I don’t think it is, probably, either of the possibilities he suggests in his last paragraph. Taking the latter first, there are easier ways to free up beds if you buy into the pressure for “efficiency” (which, by the way, most patient-care health professionals, as opposed to management, do not, in my experience). In the US, it is not NHS iof course but the third-party payors and their indentured servants, the hospital administrators, who press us doctors for shorter lengths of stay. The ‘utilization review managers’ come to morning rounds to press us on patients whose continued stay the insurance company is threatening not to pay for — to dump them back on their families sooner, refer them to horrendous but less expensive rehab or nursing facilities, transfer them to public institutions where they will be on the taxpayers’ nickels, or just to street ’em.

What the insurance companies don’t realize is that holding down length-of-stay for a given patient does not save them money in the long run, for at least two reasons — (1) premature discharge before a patient is stabilized leads to inflated costs for her/his care, including potential rehospitalization, in the future; (2) more importantly, an empty hospital bed is like a black hole down which overhead is being poured without generating any revenue, so another patient will just be admitted to fill it in short order. Managed care does not overall affect bed occupancy, especially because decreasing reimbursement has made many hospitals fail and close their doors, increasing the pressure on the remaining facilities. Since bed supply in a region’s hospitals is less elastic than management options for many patients (of cours, not all; every patient presenting to the ER undergoing an acute MI has to be admitted immediately, for instance), my guess is that in most medical specialties, the insurance companies end up paying out largely the same amount overall whether they are paying for many shorter admissions or fewer longer ones.

It is particularly bad in my field, psychiatry, where beds are filled not just from the emergency room downstairs but any emergency room in the region, far and wide, searching for the first vacancy within reach of an ambulance ride. Psychiatric units usually run at >90% occupancy all the time, at least in New England. If the ER team were unable to find an open bed, they would usually scramble harder to find a solution (the one they should have found in the first place??) to allow the patient to be sent home without hospitalization, at least for the moment.


There is a sense, though, in which I am noticing that ‘legitimate’ decisions to withhold medical care and hasten the end of life, i.e. those made via the patient’s wishes not to have extraordinary measures taken to prolong their life, expressed in their advanced directives (also referred to as living wills or DNR orders), are increasingly being made on an economic rather than quality-of-life basis. The influence of a persuasive health care professional over a patient, especially in extremis, or her family to sign opt out of life-extending measures is substantial (just watch the way it is depicted on ER, one of the things the scriptwriters get right on that show, IMHO) , as is their discretion about how scrupulously to adhere to those expressed wishes in the act. Increasingly, it seems to me that health care professionals are buying into the idea that medical care is a limited resource and should be expended where it will do the most good — as if they had the crystal ball that could predict infallibly how much good an intervention will do — and that how costly a life will be to prolong should factor into whether it should be extended. This attitude is anathema to me and contrasts with a — perhaps old-fashioned and outmoded? — notion that life extension decisions and health resource allocation decisions in general should be made on the basis only of the clinical circumstances, quality-of-life, values and principles, and expressed preferences of this patient, in this bed, in front of you now.


With respect to the alternative, that it is an extreme expression of the nurse’s mean streak, these “Angel of Death” health practitioners usually rather have a misguided sense that they are being merciful, IMHO, not expressing any sadistic urges. Control and domination, playing God, presuming to know better, etc. but I don’t think sadistic.


But then again I haven’t read Brookmyre; perhaps I ought to? […do like that Scottish-socialist viewpoint…]

Apple Giveth and Apple Taketh Away

Mac iLife runs down the changes in Apple’s just-released ver. 4.5 upgrade to iTunes. Many are incensed that Apple used the upgrade as an opportunity to tighten up on the DRM rights they extend to their users —

In iTunes 4.5, you can authorize up to five Macs or Windows computers to play your purchased music — up from three. But Apple giveth and Apple taketh away: you can now burn a playlist containing purchased music up to seven times (down from ten). And the old workaround of simply changing the playlist slightly does not work.

What is not being discussed as much is that Apple seems to have found a way to defeat the widely available de-DRM hacks developed under earlier iTunes versions by changing their protection scheme. After buying music from the iTunes Store, it is reasonable to convert the protected .m4p’s in which form they arrive to .mp3’s with m4p2mp4 (which strips off the copy protection and writes plain .mp4’s — as I understand it, m4p2mp4.exe is just a Win-executable wrapper around the much-publicized QTFairUse DRM-busting code) and dbPowerAmp (which takes the .mp4’s to .mp3’s). Many have no compunctions about doing this for their own “fair use”. Having bought these songs (or the rights to them) for $0.99 apiece, the feeling is that one ought to be able to play them on a non-iPod .mp3 player or continue to listen to them after going through the fifth ‘authorized’ computer. But since iTunes’ upgrade this week, m4p2mp4.exe doesn’t work anymore; the .mp4 file it writes from an .m4p song is the right size, and it has the song’s ‘tags’, but it is empty of musical content. Anyone know of a source where the Windows installation package of the previous iTunes version is still available for download, and if deinstalling the new iTunes and reinstalling the old one will work? It doesn’t work. The fallback is to burn the purchased music playlist to audio CDs (a person ought to have a hard backup of the music they have purchased anyway, right?) and then rip the CDs into iTunes. But how long do you suppose it will be before Apple finds a way to close this ‘hole’ in their DRM?

11 Hard Questions For Bush

In which our columnist sits down with the prez for some truly tough talk. Can Dubya handle it?

“Dubya, as you’re apparently comfortable with the fact that more than 700 young U.S. soldiers have died in Iraq (over 125 this month alone!) and thousands more have been wounded and hundreds more will doubtlessly die in the coming months, not to mention the countless thousands of innocent Iraqi/Afghan civilians who’ve been killed, all as a result of your aggro-American policy to rid the world of all those who would stand in the way of your oily corporate stratagems, does this mean you are able to laugh in the face of death and mock the vagaries of time and fate?

Are you able, in other words, to transcend the physical body and the ego and attain a superhuman spiritual mastery of the earthly form? Are you a god? Or just a petty and small-minded warmonger controlled by thin-lipped master puppeteers? Did I just answer my own question?” — Mark Morford, SF Chronicle

You know me, always a sucker for some good derision directed in Dubya’s direction. Morford satisfies my thirst here… My scorn for Bush is being fueled just at this moment by the appalling dance of “disgust” at the exposure of American troops’ torture of Iraqi prisoners, with no acknowledgement of his responsibility, given that the arrogant swagger of the Boy King of the Free World’s unilateral contemptuous foreign policy translates directly into a mindset enabling — no, promoting — the attitude of the troops acting at his behest.

“You have a secret, Dubya. Deep down, you really don’t know the difference between Fallujah and a fajita. Shiites and Baathists? Sound vaguely familiar to your twangy Texas ear, reminding you of what you holler when you stub your toe and fall into the mud at the ranch: “Shee-yite! Now I need another bubble baath.” That joke always cracks you up.

This gul-dang Iraq mess has turned far more complicated and nasty and primal than Uncle Dick ever warned you it might. Don’t you wish you were back at Yale, hammered on rum and Cokes and dreamin’ ’bout baseball and playin’ Go Fish with Dad? Can you point to North Korea on a map? How about Vietnam? Never mind. “

Attacks halt rebuilding of Iraq

“Disaster facing power network as contractors pull out

Vital reconstruction work in Iraq has almost completely ground to a halt after being ‘screwed up’ by the deteriorating security situation in the country, senior coalition officials have told the Guardian.

Unless the situation improves dramatically in the next few weeks, essential work on the electricity network will not be complete before the extreme heat of the summer arrives, raising the prospect of months of power cuts similar to those that led to riots and widespread discontent last year, the officials warned.”

The Enchanted Glass

Michael Shermer:

We have a cognitive bias to see ourselves in a more positive light than others see us.
“Francis Bacon and experimental psychologists show why the facts in science never just speak for themselves…

In the first trimester of the gestation of science, one of science’s midwives, Francis Bacon, penned an immodest work entitled Novum Organum (‘new tool,’ after Aristotle’s Organon) that would open the gates to the ‘Great Instauration’ he hoped to inaugurate through the scientific method. Rejecting both the unempirical tradition of scholasticism and the Renaissance quest to recover and preserve ancient wisdom, Bacon sought a blend of sensory data and reasoned theory.

Cognitive barriers that color clear judgment presented a major impediment to Bacon’s goal. He identified four: idols of the cave (individual peculiarities), idols of the marketplace (limits of language), idols of the theater (preexisting beliefs) and idols of the tribe (inherited foibles of human thought).

Experimental psychologists have recently corroborated Bacon’s idols, particularly those of the tribe, in the form of numerous cognitive biases. The self-serving bias, for example, dictates that we tend to see ourselves in a more positive light than others see us: national surveys show that most businesspeople believe that they are more moral than other businesspeople, and psychologists who study moral intuition think they are more moral than other such psychologists. In one College Entrance Examination Board survey of 829,000 high school seniors, less than 1 percent rated themselves below average in ‘ability to get along with others,’ and 60 percent put themselves in the top 10 percent. And according to a 1997 U.S. News and World Report study on who Americans believe are most likely to go to heaven, 52 percent said Bill Clinton, 60 percent thought Princess Diana, 65 percent chose Michael Jordan and 79 percent selected Mother Teresa. Fully 87 percent decided that the person most likely to see paradise was the survey taker!” — Scientific American

"We hold these freedoms to be self-evident… "

“Do you want to block traumatic memories from scarring your mind? Perhaps you do, but would you be happy if someone else did it for you? Or how about receiving marketing messages beamed directly at you in hypersonic waves? Mind control is getting smarter by the minute, says Richard Glen Boire, co-founder of the Center for Cognitive Liberty and Ethics in California. And, as he told Liz Else, we ain’t seen nothing yet…” — New Scientist

Hacking the cheap "single-use" digital cameras

I wondered if the disposable camera craze would extend to digitals. Apparently, they are here and ‘not bad for the price’, especially because it is apparently not difficult to transform them into multi-use cameras. And you are being an environmentally responsible resource conserver in the process. “(There are) several inexpensive ($10.99 MSRP) single-use digital cameras currently on the market in the US. Picture quality is a bit lacking, but acceptable for Web images and the like, and certainly not bad for the price… The camera is easily adapted from single-use to many-use following the instructions below, and is powered by two easily-replaced AA batteries. While they are sold with the intention that you return them at some point for processing (they give you prints and a photo CD, but keep the camera), there is nothing (no contract, rental agreement, deposit, etc.) that actually requires you to return it–once you buy it, it’s yours to do with as you please.”

Many Died Saving Kims’ Portraits in Blast?

“Many North Koreans died a ‘heroic death’ after last week’s train explosion by running into burning buildings to rescue portraits of leader Kim Jong-il and his father, the North’s official media reported on Wednesday.

Portraits of Kim and his late father, national founder Kim Il-sung, are mandatory fixtures in every home, office and factory in the hardline communist state of 23 million. All adults are required to wear lapel pins bearing images of one or both Kims.” — Yahoo! News

The Fallujah Dilemma

If the marines attack, we can no longer pretend the war is over, says Fred Kaplan: “If the U.S. Marines storm Fallujah in the next few days, as they seem to be preparing to do, the act would transform the occupation and almost certainly for the worse.

It would mean, first, a resumption of war. No longer could U.S. officials speak of conducting mere “security and stabilization operations”—the Marines’ declared mission last month when they took over the area from the Army’s 82nd airborne division. SASO (the military’s acronym for such operations) is essentially police work with heavy armaments in a war, or postwar, zone. It is not an accurate term for invading a city of half a million people or strafing it with gunship fire.

Full-scale warfare would also likely mean postponing the June 30 handover of sovereignty. The transfer—which the Bush administration considers “limited” to begin with—could not occur in any measure if American armed forces are engaged in “major combat operations” (as the president called them when he proclaimed that they were over last May Day). Some have dismissed this deadline as arbitrary and the transfer itself as symbolic. But symbols are important in the Middle East. A delay, for whatever reason, will confirm suspicions that Americans simply wants Iraqi oil and will never loosen their grip. A delay caused by an American escalation of conflict will clinch the matter and, as a result, strengthen popular support for the insurgents.” — Slate

A Vision of Power

“There’s a deep mystery surrounding Dick Cheney’s energy task force, but it’s not about what happened back in 2001. Clearly, energy industry executives dictated the content of a report that served their interests.

The real mystery is why the Bush administration has engaged in a three-year fight — which reaches the Supreme Court today — to hide the details of a story whose broad outline we already know.

One possibility is that there is some kind of incriminating evidence in the task force’s records. Another is that the administration fears that full disclosure will highlight its chummy relationship with the energy industry. But there’s a third possibility: that the administration is really taking a stand on principle. And that’s what scares me.” — Paul Krugman, New York Times op-ed

R.I.P. Thom Gunn

Poet Who Left Tradition for the Counterculture Dead at 74: “Thom Gunn, a transplanted British poet identified with the San Francisco scene and the California liberated style, died on Sunday night at his home in San Francisco, his adopted hometown. He was 74…

Acclaimed as one of the most promising young poets of postwar Britain, Mr. Gunn found his own voice after he migrated to California in the 1950’s and established himself in San Francisco, his home for the rest of his life. There, he wedded traditional form to unorthodox themes like LSD, panhandling and homosexuality. He experimented with free verse and syllabic stanzas. In doing so he evolved from British tradition and European existentialism to embrace the relaxed ways of the California counterculture.

Born and educated in England, he was grouped as a young man at Cambridge in the 1950’s with a generation of writers, notably Philip Larkin, known as the Movement. Their verse was celebrated for its dry, skeptical rejection of what they saw as rhymed grandiosity.” New York Times