In Memorial, Let’s Commit to Truthfulness: Less Elusive Than the Truth.

It seems at times that there’s no middle ground anymore. Under the cover of the freedoms that we owe in no small part to the people we are supposed to remember today, the so-called culture wars are fought with the tools of the ad man, lawyer or scam artist, not logic or a commitment to truth. And it seems to be getting worse. In this country I don’t think we are in a position to talk about the truth. The very definition of the concept runs the gambit from the empirically demonstrable to a single person’s unshakable perceptions. Objective reality is not the gold standard, not that it ever was. The egalitarian nature of modern information technology has created a world where web hits, connectivity and snarkiness outguns expertise in shaping modern opinions. Passionate screed replaces scholarly instruction. We demand that all information come to us in the form of infotainment. USA Today sized bits of fluff. We are far too busy with life’s demands such as the latest Jersey Shore episode or who’s leading the series, to have time to consider things like personal liberty, global climate change, national debt abatement, and the world economy.

We’ve lived immersed in marketing and propaganda for so long that the spin doctors finally have what they want: reality and truth are completely obfuscated by spin. We can’t even agree on a definition of truth. We live in a world where somebody can put down the ‘reality-based community’ with a straight face. Not a great way to remember our honored dead.

But I think there is a way out.

We may not be in a position to agree on truth, but we can commit to truthfulness. To honesty. We can decide to share our own feelings, fears, and motivations instead of the canned responses that we get from the spin doctors. We can demand this from our leaders and ideologues. We can insist that saying something does not make it true. We can insist on facts, not factoids. We can insist on proof not reproof.

I’m enough of an optimist to believe that if enough of us did this, with empathy in our hearts, in time we might just find the truth.

Thank You, Spirit!

You might say it’s nothing but a machine,
A nice project better now forgotten,
But it served as a vivid reminder,
Of an important tenant of this life,
That no one and no thing need be bounded,
By limits or expectations of others.

A Fly in the Ointment of Forever

“But you have to fight! It is written!”

“I don’t care. I don’t want to. God gave us free will and I’m exercising it. I’m not going to fight. I’m perfectly happy with the way things are.”

“Satan, you are insufferable! He’s waiting!”

“I know, Michael, but I’ve made up my mind and if Jesus wants to smite me he’ll just have to do it without my assistance with any of the theatrics.”

“But you know you want to rule the world because of your jealousy about His love for the humans!”

“I suppose at first that was true. At least I wanted to muck things up a bit. But I’ve had a lot of time to think, and I just don’t care that much anymore. I’m comfortable and largely left to my own devices, so I’m content.”

“Gabriel already blew his horn! We are supposed to have started 2 hours ago! It’s pride isn’t it? Your sin of pride lost you your special place. Now you are too proud to lose as it is foretold.”

“I lost my excessive pride a long time ago. Being frozen waist deep in an ice floe with three guys who never bathed in your mouth for centuries will do that for you. But that’s water under the bridge. I’m out now, made billions off internet porn and live like a king. No way I’d risk that on a fool’s errand like armageddon. Besides, nobody asked me before they did all that foretelling. I never agreed to have any part in this little guerrilla theater. I could have saved them a lot of trouble.”

“He could make you!”

“Sure, but there’s that little problem of free will. How would it look ushering in a thousand years of perfection on the back of a lie like that? Not exactly the work of a perfect being, eh.”

Well - well, He could just attack you now.”

“Yeah, but it would look really bad if his thundering army of millions stormed my office and overran my elderly secretary now, wouldn’t it.”

“I suppose so. But you are, you’re...”

“Satan. Believe me, I know.”

“This cannot be!”

“Why not? What’s so hard to understand here? Your whole belief system is based upon the notion that someone can change. That they can reject evil. Why not me?”

“THE DEVIL?!”

“Hey we all do things we regret when we’re young. He knows that most of what was done in my name had no more to do with me than the stuff done in His. I’m ready to hang up the cloven hoofs and tail and enjoy a quiet retirement.”

“Well, I’ll let him know. He won’t be happy!”

“He’ll get over it.”

“R-r-right...”

Springtime, Yet Again

The True Date of the End

I was playing cards last night with L Ron Hubbard, Joseph Smith, and Charles Taze Russell and they let slip the REAL date of the Earth's demise. It will occur on - kindly send me a cashiers check for $1000 dollars and I'll let you know...

Rapture Playlist

My friends say I have a playlist for any occasion... Here's my selection for Saturday, May 21. It forms a sort of rock opera if played in this order.

1. You've Lost That Lovin' Feelin' The Righteous Brothers
   
2. Bad Moon Rising Creedence Clearwater Revival
   
3. Monster/Suicide/America Steppenwolf
   
4. People Get Ready Eva Cassidy
   
5. Won't Get Fooled Again The Who
   
6. It's Now or Never El Vez
   
7. Save Me Queen
   
8. No Mercy Cheap Trick
9. Already Gone The Eagles
   
10. Wake Up Rage Against the Machine
    
11. Angel of Death Slayer
    
12. Don’t Fear the Reaper Blue Oyster Cult
13. Building The Perfect Beast Don Henley
    
14. Lucifer The Alan Parson Project
15. I’m Sorry John Denver (Hey! just remember who you are pleading with...)
    
16. No One's Leaving Jane's Addiction
    
17. Some Heads Are Gonna Roll Judas Priest
18. Helter Skelter The Beatles
19. Highway to Hell AC/DC
20. Knockin' On Heaven's Door Eric Clapton
21. The Battle Of Evermore Led Zeppelin
22. It’s the End of the World as We Know It R.E.M.
23. 42 Coldplay
    
24. Luck Be A Lady Frank Sinatra
    
25. Don't Come Around Here No More Tom Petty & The Heartbreakers
    
26. Some Like It Hot Robert Palmer
    

Black Water Rhapsody

Sung using the melody from the Doobie's 'Black Water'...


















Well, without no draft, I built me an army
Whole Middle East, she's callin' my name
Insurgents are jumpin'
Rotor blades are thumpin'
Black Water keeps rollin' on past just the same

Old Black Water, keep on rollin'
No bid green, won't you keep on shinin' on me
Old Black Water, keep on rollin'
Middle eastern money, won't you keep on shinin' on me
Old Black Water, keep on rollin'
Tea Party pundits, won't you keep on shilling' for me
Yeah, I’ll keep on stirring your fight
Gonna make everything, pretty mama
Gonna make them old carpets red
And I ain't got no worries
'Cause we ain’t got no oversight at all

Blood stained seats, I don't care
Don't make no difference to me
Just take out that car thats goin' up town
No doubt insurgents in that dead family
Yeah, I'd like to hear Ma Deuce stitching up that van
Smash what don’t move when we honk
And I'll be mak’in a sum like my boss’s last name

Old Black Water, keep on rollin'
No bid green, won't you keep on shinin' on me
Old Black Water, keep on rollin'
Middle eastern money, won't you keep on shinin' on me
Old Black Water, keep on rollin'
Tea Party pundits, won't you keep on shilling' for me
Yeah, I’ll keep on stirring your fight
Gonna make everything, pretty mama
Gonna make them old carpets red
And I ain't got no worries
'Cause we ain’t got no oversight at all

"Number 2, Sir!"

I know it's probably a shocker, but Pliny has some quirks. One of my strange pet peeves is the unsolicited familiarity that sales people trot out. I've always been careful not to refer to patients by their first names in the hospital. I've always felt it was more respectful. So it's always bugged me to go into some coffee shop and have them ask for my name so they can call it out when my order's ready. I know, it's a quirk but I don't care. So lately, I've started responding to unsolicited request for my name with, "Number 2. sir!". I like to think that Vernon Pinkley would be proud...

iUniverse: the Apple of my i

Supposedly, Apple is now the nation’s most successful brand. I’m not surprised. After years of carping at the Windows blue screen of death, I made the leap about 5 years ago. No regrets. A lot of people say it’s because all their technology meshes so seamlessly. While that’s true, part of my loyalty to the brand comes from the cosmic bubble that my iPhone extends around me wherever I go. A friend recently told me that his iPhone has now superseded food on his needs hierarchy; he can go without food far longer than he can be apart form his iPhone.

I made a huge leap when I bought mine. Went from what was essentially a Gitterbug to the iPhone. I was assimilated rather quickly. Games, nav. apps, email, browsers, calenders, music, etc. were now an integral part of my arm. Like those apes at the beginning of 2001, I find myself trying to perform tricks on its smooth surface to curry its favor. Come to think of it, it looks just like that monolith in 2001. Same proportions, knowledge giver. Hmmmm.



But back to the cosmic bubble. With my ear buds and the iPhone I find that I can completely remove myself from this universe for extended periods of time. Take walking and commuting to work, for example. I walk a couple of miles with the music playing at a level that would drown out the bulls at Pamplona. No commercials or talk radio to mess with my mental state. I have play lists for every mood. I can’t hear anybody calling some annoying greeting or asking about my day. Anybody I really want to talk with can gently insert themselves into my consciousness by calling me on the cell if it’s really necessary.

When I get to the station to wait for the MAX train, being preoccupied with something on the screen, keeps almost all of the panhandlers at bay as well. On the train, the music and games keep me from noticing the mentally ill people who usually ride the train talking to themselves. Historically, one had to feign appearing busy to be left alone - now I can actually keep busy with the iPhone. Anyone who dares to disturb my oasis can clearly see that I'm busy listening to Blue Oyster Cult while playing Angry Birds! I am a universe unto myself.

Think of the Healthcare System as a water pipe...

This is a simplified discussion of some of the challenges to real healthcare reform. In this first installment, I'll review some of our problems, and in the next a proposed solution. So, to start, let's imagine the health care system is a length of pipe...

The length of the pipe reflects a number of factors that determine the time it takes to get treated appropriately: time to get an appointment, how long it takes to figure out what's wrong, time to get tests and referrals, time to see if the treatment is working, etc. This pipeline serves a diverse population. As in the figure below, we can roughly divide the population into 4 categories. The first is the really healthy people - I left them off. The other 3 groups are the people trying to get seen (black), those who can’t afford to be seen (the ones in blue) and the ones who SHOULD be seen but don’t know it (the greenies). Generally, more people are trying to get seen that can be accommodated at a given time.


Why should the greenies be seen? Because the greenies may have an occult condition and not know it: hypertension, heart disease, pre-diabetes, undiagnosed cancer, etc. Or they may be at risk for some ailment(s) that could be prevented if they did the right things. The problem is that it’s hard to get people to do anything when they are feeling ok and the clinicians are already so busy taking care of obviously sick people that there is no time to do much prevention.

Why it Matters

It matters because if the condition is serious, it's a race against the clock. Keep in mind that we are already behind the eight ball because of what’s in the diagram below. Currently, a lot of time has passed from when something starts till when we notice it enough to actually call the doctor in the first place. Then it takes time to do all those things we talked about before - and that assumes nobody makes a mistake or takes extra time.


The importance of the time it takes to decide to do something and for the doc to figure out what’s wrong is reflected in next this graph.


On average, the longer it takes to get something fixed, the worse is the outcome and the higher the cost. It’s really that simple.

So if we want to really reform health care we need to shorten this timeline as much as possible. Take a look at the impact of cost and outcome to a shorter timeline.


If we can accomplish this task of compressing clinical timelines over the course of millions of lives the impact is staggering. Estimates of the cost reductions alone range from 25%- 50% of current levels! Or somewhere between $ 500 billion and $1 trillion dollars EACH YEAR! And that is just in the healthcare costs not all the societal costs associated with disease such as lost work, etc.

It makes sense but how do we do this? Well first off, you don’t just play with the payment structure or throw money at the problem (the traditional single payer approach)


Paying people less to do more doesn’t open that pipe up much. You still have people who can’t get in to the clinic and people who don’t know they need any help, still don't. Single payer may be part of the answer but it isn’t THE answer. Plus concentrating just on the costs results in some really dumb ideas - like taxing clinicians to take care of patients.

Nor can you just build a bigger pipe. Training more docs and mid levels for example takes time and costs a lot of money. Which leaves no money left to care for those without coverage. This is one of the approaches that the professional societies advocate - train more experts. The bottom line is that we can’t afford it.

Plus the bigger pipe may reduce some of the time spent waiting for an office visit but does nothing to reduce the length of the pipe itself - how long it takes to correctly get to the bottom of the problem. More doctors does not necessarily result in better decision-making by any of them.

Some compression of the timeline can be achieved using diagnostic support software. By using decision-support tools to aid diagnosis, we can in essence cut out some of the length of the pipe reducing the time it takes to get the right answer. But that alone, cannot increase the size of the pipe and the rate at which patients can be seen to the levels we need to achieve universal access.

Combinations of these approaches still fall short in some key ways. We still are left with a system we can't afford, that can't serve the whole population.


But the solution, may be in the cloud...

Next time - a cloud computing solution to health care reform.

Another Annoying Question

My wife says that I'm really dense but perhaps you can help me here. Why is it that many of the people who claim that without the control of religion, individuals cannot be trusted to police their own actions, are the same ones that think that we don't need government to oversee the actions of corporations?