It's hard to fathom, but maybe things will improve, at least locally, given time...

I know I am naive, but I am always amazed at the potential for people to inflict pain on others when there is no ostensible benefit to themselves in doing so. I'm not talking the psychology of sadism, the warped motives for which ensue from sickness in the head. I'm talking about those actions someone can take that have the potential to cause subtle but widespread pain across the world.

The hackers...

I actually had an IT guy once briefly attempt to make an argument that you needed hackers to ensure internet security. This notion that hackers achieve some kind of glory by innovatively circumventing some complex encryption, firewalls or other security devices has always struck me as the most antithetical objective. With such ingenuity, persistence and innate skill, these individuals have such potential to create something positive for themselves, their family, their friends, their community...

Yes, yes, I know this is a cultural allure. The outlaw genius. The anti-establishment warrier of the new cyberfrontier. Neo and the Matrix. C'mon. I like fantasy as much as the next moviegoer. But once I leave the theatre, I return to the real world where there is no Agent Smith. The value of my life is not as an energy source for the machine world --- it is in providing for my family, helping friends, doing any good around me that I can and, in the process, enjoying life as best I can given the brief time I am here on this little planet.

I see computer viruses that crash systems, obliterating data and causing sometimes devastating expense to businesses. I see the fake Amber Alert chain mails deflecting attention from real missing children.

There is plenty of crime that I can understand has roots in someone's actual or psychologically perceived needs. Identity theft. Murder. Vandalism. Rape.

But what do hackers seek to gain? Is my only hope that hackers will one day have the epiphany that we are all connected on this planet and that what you send out into the world will INEVITABLY come back to you and you therefore must send out what is good or positive lest you perpetuate a self-destructive cycle? Are we simply at the forefront of a new era in which we cannot see the consequences of our actions and therefore do not recognize the costs?

I sometimes have a lot of foolish hope and optimism for humanity. I like to believe that what sometimes is very empirical to me will eventually be obvious to others, but I continue to be disappointed by prejudice, narrow-mindedness, vanity, greed and all manner of other persistent evils.

Ultimately, I believe that, at least for me and my family, I'm on the right track. As I mature and increase my capabilities to effect change and positively influence others, I can create a little, but expanding bubble of something positive around me.

Collection of musings for the day

Something has to be done about healthcare costs. Heard this before? As a small business owner, I am in the unique position to feel the effect of every incremental change in costs that affect my business, and nowhere do I feel such an impact as in healthcare costs. I need to strike that fine balance between being competitive in offering health benefits to my few employees (so they don't walk) and being competitive in having reasonable administrative costs to keep my business profitable. That's why this is usually the solution.

Speaking of healthcare costs, the uninsured are certainly likely to become a resurgent issue in the 2004 presidential campaign. NPR had a good segment today on approaches to keeping this issue in the forefront of the campaign, pointing up that Al Gore was a bit reticent to make the full 43 million uninsured an issue in the 2000 campaign (given his boss' disastrous foray into healthcare reform), opting instead to only focus on the 9 million children who are uninsured. John Kerry has fortunately taken the view that you can't ignore the problem.

So 33 year old Shaq is going to Miami because he's only has one more year on his contract while Kobe Bryant is a free agent who will walk if Shaq is still with the Lakers. Opting for the lesser of two evils that already removes the Lakers as a serious competitor next year, the situation is not likely to get any better with Kobe's legal woes. Jay Leno had a great take: "Kobe Bryant was so happy that Shaq was traded, he went home and had sex with his own wife!"

I'm glad I'm not the only one who is angry with the Philippines bowing to the terrorist threat of beheading Filipino trucker Angelo de la Cruz unless the Philippines withdraw their troops from Iraq. It's so unfortunate that the public pressure by protestors at home that Philippines president, Gloria Macapagal Arroyo, withdraw the troops arose because we shouldn't be in Iraq in the first place (don't get me started), yet it is the exact wrong thing to do in the face of terrorist threats.

Sigh.

Customer service?

Quiz: Which company is this?

All of our account representatives are busy...

"Your approximate wait time is 10 minutes"

We apologize for the delay
We apologize for the delay
We apologize for the delay
We apologize for the delay
We apologize for the delay

19 minutes and counting...

How can this be possible? (no, I'm not trying to buy Springsteen/U2/Hilary Duff/Metallica tickets)

Multiple choice:

a) MCI
b) SBC
c) Sprint
d) All of the above

Standard medical practice: ignore exceptions to the rule

There is a governing rule in medical practice these days. I call it the 95% rule. Put simply, if 95% of patients with symptoms X can be accurately diagnosed as having condition Y, then for those patients in the remaining 5%, there is very little likelihood you will readily find a physician who will either take you seriously or pursue the actual diagnosis with any diligence. It stuns me that when I mention this unwritten rule to people, they almost invariably say, "You know, that's just like what happened to my brother/father/friend/etc..." As an example, I have a colleague who has ichthyosis, who was variously diagnosed with amyloidosis, eczema and other skin conditions. (One physician even mildly suggested she be prescribed an antipsychotic medication.) She only knows this for certain now because she so vigorously pursued all clinical literature and experts until she was able to find a definitive match between her symptoms and those of ichthyosis. Moreover, based on this premise, she has been able to apply various treatments specific to ichthyosis and has seen stunning improvements in her condition. By the way, my colleague is an RN, which one might think would lend credibility to her premise.

Her case was exceptional only for the seriousness of the condition. I have just as often seen gross apathy by clinicians in diagnosing celiac disease (intolerance to wheat foods), cancers or suspected cancers at a variety of stages, and other conditions.

Why is this? It wasn't always this way. I won't attribute it all to managed care, but there is an awful lot of weight to the argument. It goes like this. Healthcare costs get out of control (no reasonable person denies this). Health insurance is set up to "capitate" healthcare costs. In capitation's earliest manifestations, the effect is simply to limit the amount of healthcare costs spent on each patient. The principle in the long run is that if a physician is short-sighted and misdiagnoses a set of symptoms as minor (and treatable by low cost methods), then when the symptoms are actually part of a serious condition, the inevitable progression of the symptoms to a more serious stage will result in actually higher costs to manage the serious condition (e.g., a Stage IV cancer) than if it were accurately diagnosed at an earlier stage.

It's a nice idea. Suggests that the long term view will save healthcare insurers, patients, physicians -- everyone -- money. Suggests greater appreciation in the system for sophisticated diagnostics, for more emphasis in the treatment of the disease than symptoms alone. Hasn't quite worked out that way, though. The backlash from patients and even physicians (who, in my opinion. railed less about limitations to patients's treatments than they did about an insurance administrator telling them what they could or could not do), has forced managed care into a recognition that healthcare is more complex, the dynamics of the "product" of healthcare delivery not so simple as to lend itself that healthcare can be run like a business, at least not in the way thus far conceived by managed care.

The result has been that physicians, disillusioned by the governance of their profession, either just toe the line and go with the managed care flow or they leave clinical practice entirely. Intellectual curiosity is not extinct, but very scarce. Physicians are not motivated to pursue diagnoses to their definitive clarity, and corresponding treatments. The consequence is that WE THE PATIENTS are now responsible for ourselves. In some ways, this is as it should be. Even many physicians (not all) innately understand that the patient typically has a better grasp on his/her symptoms than the physician does. Therefore, it is incumbent upon patients to challenge physicians, seek 2nd, 3rd, and 4th opinions.

Ultimately, if the patient does not take this responsibility, and if his/her symptoms fall in that 5% exception, he/she runs the risk of continued pain, frustration, financial ruin, even death.

In case you're wondering, it's for wound debridement...

Don't laugh. There's a lot of credibility here. We are usually so quick to embrace new technology that we are too quick to discount old therapies.

National Briefs - 6/29/04: "WASHINGTON -- The government has lent its seal of approval to marketing an age-old medical device -- leeches. The Food and Drug Administration said Monday that Ricarimpex SAS, a French firm, is the first company to request and receive FDA clearance to market the bloodsucking aquatic animals as medical devices. Leeches are already widely used in American hospitals, and companies that raised and sold them here before 1976 were allowed to continue doing so. However, the medical device law passed that year required newcomers to the field to seek approval."

On work

Show me a man who is satisfied with his accomplishments, and I will show you a failure.
- Confucius

Life is a journey, not a destination.
- Anonymous

Necessity is the mother of invention.
- Wish I Knew Who

"The advancement of the arts, from year to year, taxes our credulity, and seems to presage the arrival of that period when human improvement must end."
- Henry Ellsworth, Commissioner of Patents, 1843 (frequently misquoted)


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