Dark Fields

Occam's razor is a principle attributed to the 14th century logician and Franciscan friar William of Occam. It states: "Entities should not be multiplied unnecessarily." This has been rephrased by many but might be most usefully stated as: "When you have two competing theories that make exactly the same predictions, the simpler one is the better." Simplicity, of course, is very subjective but often applies to metaphysics, non-empirical understanding.

For example: Einstein's theory of special relativity compared with Lorentz's theory that ruler's contract and clocks slow down when in motion through the ether. The equations are the same but, because the ether could not be detected, by Occam's razor it had to be eliminated.

Life, of course, does not always lend itself to simplicity. Evolution proceeds in a Rube Goldberg manner: Whatever survives, stays. Hence the octopus and the camel. Nor are we humans easily simplified, to the dismay of our leaders.

A number of years ago a physician, V. S. IAnovskii, immigrated to the United States and ended up working in a venereal disease clinic. His experiences distressed him so that he wrote a book about them called, cleverly, "The Dark Fields of Venus." It was not a profound book, just a collection of vignettes about the mostly young people he treated and how the disease damaged their lives. It was "2666"-like in its repetitive, relentless focus. But, he concluded, it was not just the spirochete. There was something bigger, something more at work here as these people searched their physical health for more than physical solutions. Somehow their affliction was a small part--perhaps even a consequence--of a larger, empty yet yearning personal landscape, a dark field.

Whatever the solution, he concluded, "penicillin was not enough."

Which makes one think of Einstein's take on Occam: "Everything should be made as simple as possible, but not simpler."

Cost, Price and Crony Capitalism

 

Section 340B of the Public Health Service Act (created under Section 602 of the Veterans Health Care Act of 1992) was enacted in November 1992. Under 340B, eligible hospitals are allowed to buy drugs from drug companies at forced discounts of 25% to 50%. The hospitals can then bill government and private insurers for the full cost of the drugs, pocketing the spread. 340B-qualified hospitals have a big incentive to search for patients and prescribe lots of drugs. The costlier the drugs, the bigger the spread. Expensive cancer drugs are especially appealing. The original legislation creating 340B envisioned that only about 90 hospitals that care for a "disproportionate share" of indigent patients would qualify. But free money was being made available in a very difficult and uncertain field. By 2011, 1,675 hospitals, or a third of all hospitals in the country, were 340B-qualified.

Take the Duke University Health System. In 2011, Duke bought $54.8 million in drugs from the discount program and sold them to patients for $131.8 million, for a profit of $76.9 million. That profit was a substantial portion of the health system's 2011 operating profit of $190 million. (Only one in 20 patients served by Duke's 340B pharmacy is uninsured.)

In the process, treatment of the doctor's patients is moved from an office setting to a hospital outpatient department. Hospital care is considerably more expensive. As a result, between 2005 and 2011 the amount of chemotherapy infused in doctors' offices fell to 67%, from 87%, according to a new analysis of Medicare billing data done for community oncology groups. The share of Medicare payments for chemotherapy administered in hospitals (as opposed to outpatient oncology practices) increased to 41% in 2011, from 16.2% in 2005. Because the overhead for a hospital is higher than for a doctor's office, a patient treated in a hospital clinic incurs $6,500 more in costs than the same person treated in a private medical office, according to data from the Community Oncology Alliance. Patients who get chemotherapy at a hospital also face an additional $650 in co-pays and other out-of-pocket expenses. The price for infusing the drugs alone rises by 55%, according to an analysis of Medicare data. These inflated prices for cancer treatment inevitably drive up the cost of health insurance.

The new health-care law, The Affordable Care Act, expands 340B to cover cancer centers, new categories of hospitals and rural health centers. Since one of the ways that hospitals qualify for 340B turns on how many Medicaid patients they serve, ObamaCare's Medicaid expansion will also increase the number of 340B-eligible entities. More than 400 oncology practices have been acquired by hospitals since ObamaCare passed. Acquiring a single oncologist and moving the doctor's drug prescriptions under a hospital's 340B program can generate an additional profit of more than $1 million for a hospital.

The administration has used informal "subregulatory guidance" to expand the 340B program still further. One big change came in March 2010 "guidance" that allows hospitals to contract with an unlimited number of neighborhood pharmacies to dispense drugs through them. There is no requirement that these "satellite" pharmacies have any geographic tie to the hospital. This has created an industry of middlemen who build vast networks of pharmacies, all to expand the number of 340B prescriptions that a hospital can capture. There are now more than 25,000 arrangements between such satellite pharmacies and 340B-qualified treatment sites, according to the Health Resources and Services Administration. More, the definition of a "covered patient" for 340B purposes is so murky that hospitals are able to buy and bill discounted drugs for patients when the hospital merely serves as a conduit and doesn't give direct patient care.

Costs rising, private practices contracting, hospitals making egocentric business --not community health--decisions--these are not healthy signs. Influence peddling and graft are certainly factors here and unintended consequences of a gigantic program like this are to be explained. The problem is they do not seem to be anticipated.

(Much of this is from Dr. Scott Gottlieb's article in the WSJ.)

Education Versus Training

Rachel Jeantel, a witness for the prosecution in the George Zimmerman murder trial, when presented with a letter she supposedly wrote to the Martin family replied that she did not read cursive. She is not alone. Here are a few achievement scores from her predominately black school: Thirty-nine percent of the students score basic for reading, and 38 percent score below basic. In math, 37 percent score basic, and 50 percent score below basic. Below basic is the score when a student is unable to demonstrate even partial mastery of knowledge and skills fundamental for proficient work at his grade level. Basic indicates only partial mastery.
66.1 percent of Black students entering high school in 2006 graduated in 2010. Nationally, only 26 percent of black students graduate six years after entering college.

In a recent article, Walter Williams, the conservative economist from George Mason University, disparages the current educational system and its tendency to avoid serious testing. He is particularly interested in the failure of the educational system to test black men. He implies there is a subtle racist factor here, a lack of confidence in the black student generally. How then, he asks, do blacks do so well in two of America's most competitive and selective areas, athletics and entertainment?

In a recent discussion about this question an interesting explanation for these selective successes was presented: Coaching. Both athletics and entertainment channel talent through rigorous coaching. True, it is very selective and only the highest level proceed--which in itself might be highly selective--but there is no question during the discussion that coaching is remarkably influential on young people. And both entertainment and athletics recognize the value of training.

This is a provocative idea. Imagine an educational system with a developmental arm, a training and coaching arm, in addition to its educational one, a program of mentoring, institutionalized and permanent, perhaps rotational, perhaps permanent, perhaps chosen by the student himself, where academic and civic problems could be developed and explored starting in the first grade. It would be expensive and would become ideologically plagued and union ridden but, if the long term advantages could be kept in vision, it would be an interesting notion to explore. A few studies varying mentor numbers, time spent, mentor education requirements and the like would be simple and inexpensive to start. It would take a long time to evaluate, of course, but the current experiment certainly doesn't work and who knows what the country will suffer because of it.

 

The problem needs more than money; it needs a plan.

 

 

Piltdown Man

Piltdown Man was a great fraud in anthropology. Fragments of an early hominid skull and jawbone, said to have been collected in 1912 from a gravel pit at Piltdown, East Sussex, England, suggested the possibility of an early "ape-man," the longed for "missing link." Charles Dawson claimed he did not personally find it but that that a workman at the Piltdown gravel pit had given him a fragment of the skull found before his visit. Re-exploring the site on several occasions, Dawson found further fragments of the skull and took them to Arthur Smith Woodward, of the geological department at the British Museum. In August 1913, Woodward, Dawson and Pierre Teilhard de Chardin, a Jesuit priest and trained paleontologist and geologist, began a systematic search of the spoil heaps specifically to find missing canines. Teilhard de Chardin found a tooth that, according to Woodward, fitted the jaw perfectly. (His association with the effort ended then.)

Woodward proposed that Piltdown man represented an evolutionary missing link between apes and humans and supported the notion then prevailing in England that human evolution began with the brain. The Latin name Eoanthropus dawsoni ("Dawson's dawn-man", after the collector Charles Dawson) was given to the specimen. In 1915, Dawson claimed to have found three fragments of a second skull (Piltdown II) at a new site about two miles away from the original finds. So far as is known, the site was never identified and the finds appear undocumented.

Eventually the "find' was revealed to be the lower jawbone of an orangutan deliberately combined with the skull of a fully developed modern human. But suspicions had appeared early. In 1913, David Waterston of King's College London published in Nature his conclusion that the sample consisted of an ape mandible and human skull. French paleontologist Marcellin Boule concluded the same thing in 1915. A third opinion from American zoologist Gerrit Smith Miller concluded Piltdown's jaw came from a fossil ape. In 1923, Franz Weidenreich examined the remains and correctly reported that they consisted of a modern human cranium and an orangutan jaw with filed-down teeth. It is said the perpetrator "aged" the specimen by soaking it in tea.

There were a number of likely suspects because, surprisingly, it was assumed the site was "seeded" with the fakes and were innocently come upon. Arthur Conan Doyle, the creator of Sherlock Holmes, lived near the site and was said to have planted the material to discredit the science of evolution that he opposed as a spiritualist. Stephan Jay Gould long suspected Pierre Teilhard de Chardin himself. Subsequent research clearly points to Dawson. Archaeologist Miles Russell of Bournemouth University analyzed Dawson's antiquarian collection and determined at least 38 were fakes. Among these were the teeth of a reptile/mammal hybrid, Plagiaulax dawsoni, "found" in 1891 (and whose teeth had been filed down in the same way that the teeth of Piltdown man would be some 20 years later.) Axes, Chinese vases, cave drawings--Dawson's was a history of shameless and fearless fraud. Apparently he had hoped Piltdown would allow him to become a member of the Royal Society. One wonders how such an erudite community could be fooled so but much was at stake. The finds "confirmed" the unproven belief that the large modern brain preceded the modern omnivorous diet. And the large brain--and important ancestor--was welcome in England and Europe.

A common misunderstanding about science is that there is, strangely, something magical about it. It is seen as somehow more pure a discipline, less subject to human error and frailty. Thesis, inquiry and conclusion in science are, however, very human. And the possibility of honest mistakes is only the beginning. Ambition, as here, greed, ideology, madness--all of these factors can complicate the scientific world.

Hoyle supported a steady state universe for years. Paulson defended the triple helix. (When Watson and Crick solved the problem with the double helix, Paulson's wife scolded him, "Why didn't you work harder on it?") Lysenko locked a nation in a crazy ideological science heresy for decades.

But science is hard, a lot harder than prejudice, fanaticism, righteousness, 

"Z"

In movie long gone by and based on fact, a government, beset by a rebellion symbolized by a murdered leader remembered by the partisans as"Z"--phonetically meaning "He lives"--banned the use of the letter Z.

Voldemort in Potter, the Wendol in "The 13th Warrior"-- all frightened cultures have "The name that must not be spoken." Indeed, many cultures believe in the power of names. The American Indian have personal names that are symbols of their integrity which they will not reveal, even under torture. Names mean things to us.

Naming is important, too. According to Genesis, God gave Man the right to name all the animals and, at the same time, the right of dominion over them. Naming carries with it a sense of power, of hegemony. The Egyptian god Ptah allegedly had the power to create anything he could name.

The great Russian-French mathematician Alexander Grothendieck put a heavy emphasis on naming as a way to gain cognitive power over objects even before they have been understood.

Mathematicians often observe that, on the basis of intuition, they sometimes develop concepts that at first resist definition. These concepts must be named before they can be brought under control and properly enter the mathematical world. So naming can be the path toward that control. Egorov and Luzin believed that if they named God, they assured his existence, and similarly they thought that by naming new mathematical sets, they could make them real. God could not be defined, but he could be named. The new sets also resisted definition, but they too could be named. The Russians returned to Moscow and created one of the most powerful mathematical schools of the twentieth century. ( Naming Infinity: A True Story of Religious Mysticism and Mathematical Creativity by Jean-Michel Kantor and Loren Graham)--for those of you too suspicious of all this, Mr. Graham is from MIT and Harvard.

Politics is a wonderful source for a different type of control through words.
During the French Revolution, the Committee of Public Safety outlawed all words associated with royalty; they took the kings and queens out of the playing card deck and replaced them with Committee members. During the First World War the German shepherd dog was renamed the "Alsatian" by the British.
The hasty evacuation of our embassy in Yemen was not an evacuation but "a reduction in staff," despite what the Yemeni government said.

Terror attacks are now "man-caused disasters," the "global war on terror" is now an "overseas contingency operation."

Nidal Hasan proudly tells a military court that he, a soldier of Allah, killed 13 American soldiers in the name of jihad. but he is charged with "workplace violence."

An al-Qaida-affiliated terror attack in Benghazi becomes a spontaneous demonstration out of control.

Torture is "enhanced interrogation."

Government spending is "investment."
Lord knows what "shared prosperity" and "single payer" mean.

"But," as George Orwell warned, "if thought corrupts language, language can also corrupt thought."

Sunday Sermon 9/1/13

In the Williamstown church, big and modern with the altar in the center and huge organ pipes. An older congregation with an ancient, infirm priest. An unusual statue of the Virgin best described as winsome.

The readings sound like social advice, The Sirac readings are  particularly good (do not test beyond your strength) but, as always are more. Christ on humility is especially riveting as he urges people not to take high places in dinner then, laughing perhaps, says on should always entertain those who are too poor to return the favor.

Humility is Christ's concern today. Humility is not weakness as it is usually portrayed in culture, it is seeing life in the context of a larger whole.

That is too much for the vision for a Tamerlane.

Cab Thoughts 8/31/13

A man's admiration for absolute government is proportionate to the contempt he feels for those around him.--de Tocqueville

National Highway Transportation Safety Administration (NHTSA) testing awarded the Tesla S an average of 5.4 stars--the highest total ever achieved by any vehicle.

The Affordable Care Act will cut $335 Billion in Medicare payments. The cost of increased taxes, fees and penalties is $434.1 Billion. Total: $769.1 Billion out of the system.

Zucherberg hosted a fund raiser for Christie.

Junot Diaz on his writing habits: "I wrote my first book listening to the soundtrack to the movie Conan the Barbarian on a loop. That's how I ride."

Advanced Placement Classes: In the last five years, the federal government has spent $275 million to promote AP classes and subsidize exam fees for low-income students; states have spent many millions more. The idea seems to be that students, if given greater challenges and opportunities, will rise to the occasion. Advocates often argue that students benefit from being exposed to the high expectations of an AP class, even if they don’t pass the test. In fact, taking an AP class does not lead to better grades in college, higher college graduation rates, or any other tangible benefit — unless the student does well enough to pass the AP test, said Trevor Packer, a senior vice president at the College Board.

In the last five years, the federal government has spent $275 million to promote the classes and subsidize exam fees for low-income students; states have spent many millions more.The class of 2012 failed nearly 1.3 million AP exams during their high school careers. That’s a lot of time and money.

Research shows that students don’t reap any measurable benefit from AP classes unless they do well enough to pass the $89 end-of-course exam.

Who is....Nathanial Greene?

In Swaziland, a country in southern Africa, witches are banned from riding above 492 feet on their broomsticks.

An investigation by The Wall Street Journal found that the National Security Agency uses algorithms to filter three-quarters of all Internet traffic in the U.S. and appears to retain the content of certain emails sent between U.S. citizens within the country.

An interesting conundrum: From December 2007 to June 2013, health spending rose 14.7%. Meanwhile, GDP grew at only 4.6%. Health care's share of total employment has increased from 9.5% to 10.7%. Excluding health spending from GDP, GDP growth is only 2.7%. So health spending accounted for almost half the economy's overall gain. Here's the rub: From 1999 to 2013, wages and salaries rose 50% in current dollars while health insurance premiums increased 182%, reports the Kaiser Family Foundation. Some insurance premiums would otherwise have gone into paychecks. So we are going to save money by starving the strongest horse in the trace.

William T. Vollmann won the 2005 National Book Award for Fiction for the novel Europe Central. He was apparently suspected by the FBI of being the Unabomber (the report says "anti-growth and anti-progress themes persist throughout each VOLLMANN work.") and then the anthrax killer. His article in Harper's raises an interesting question: What are the personal liberty implications of being suspected of something really serious although you don't know?

Golden Oldies:

http://steeleydock.blogspot.com/2012/07/if-one-small-thing-is-true-then.html

Bloomberg reports that packs of the dogs have been spotted in groups as large as 20 roaming Detroit streets.

Morgan Stanley will pay a $1 million fine and compensate harmed investors to settle civil charges that the bank failed to give customers the best market prices for some corporate and municipal bonds, U.S. brokerage regulators said on Thursday. Civil charges, not criminal so no one goes to jail; the fine is paid by the huge corporation and everyone moves on. Bakshish.

Obama has a plan that would tie $150 billion each year in federal student aid to a ratings system the Department of Education will develop by 2015. Colleges that are more affordable, serve more students from poorer backgrounds and have high graduation rates, among other factors, will be rated higher and will influence the degree of government financial support.
What any of those factors have to do with education is uncertain. But, as stated by Mr. Earnest in a press conference, "So the record -- the President’s record on these issues -- he has a bias in favor of historically black colleges and universities because of the service they provide and because of the quality education that they provide to their students."

"We wanted to make a Rosencrantz and Guildenstern Are Dead of the zombie world." Simon Pegg, film writer of "Shaun of the Dead."

Combined global sales of hybrid electric vehicles (HEVs) and battery electric vehicles (BEVs) are expected to total 5.2 million units in 2020, or just 7.3 percent of the 70.9 million passenger vehicles forecasted to be sold worldwide by that year, according to a report issued by J.D. Power and Associates. For comparison, global HEV and BEV sales in 2010 are forecast to total 954,500 vehicles, or 2.2 percent of the 44.7 million vehicles projected to be sold through the end of 2010.

Sedulous: adjective: Involving great care, effort, and persistence. From Latin se (without) + dolus (trickery, guile). Ultimately from the Indo-European root del- (to count or recount) that is also the source of tell, tale, talk, and Dutch taal (speech, language).

Sometimes an assumption of power is more than arrogance and repression, sometimes it is a test. ObamaCare administrators continue to miss deadlines set by the health care law — 41 of 82 of them, according to Forbes' Avik Roy. According to the law firm Davis Polk, the administration as of July had missed 62% of the deadlines in Dodd-Frank.

According to The Montreal Gazette, Quebec is considering setting the prices of new books for nine months to give independent booksellers a chance against Amazon and bigger stores that can offer steep discounts. Several countries including France and Germany have similar protections in place. What's the next step, inspecting mailboxes?

Fix a price of something and it goes away.

AAAAAAAAaaaaaannnnnnddddd....a graph: