Sigma recall: not a bug, a feature
09 MAR 2004 | source Frankenblog via Sigma Pharmaceuticals | permalink
MELBOURNE, AUSTRALIA—Sigma Pharmaceuticals contacted Australian doctors and pharmacists today with a warning that some packs of Codalgin Forte, a powerful analgesic, were faulty. Batches 37628, 36833, and 37630 were manufactured incorrectly and have been recalled. Tablets in these batches contain the normal 500mg of paracetamol but may have no detectable codeine, the principal active component. Sigma is negotiating with the Therapeutic Goods Administration (TGA) to help manage the recall and prevent any recurrence. Customers have been assured that the affected Codalgin Forte is safe to use as directed but may not be effective for pain relief. Sigma has apologised to consumers, as well as doctors and pharmacists, for any inconvenience caused.
To address the concerns of its shareholders, marketing chief Dr. Arnold Slither, PhD, held a press conference today detailing the plans Sigma has to deal with the situation.
"This is not a crisis," said Dr Slither. "In fact, we believe we can confront adversity and turn it to our advantage."
According to Dr Slither, the recalled packages will not be destroyed, but will be rebadged as Codalgin Holistic, with a banner strip announcing "contains Homeopathic Pain Relief!" The product will be sold at twice the normal price.
Dr Slither explained that the pricing was justified by the market. "Our analysis shows that consumers will pay a premium for natural products," he said. "And Codalgin Holistic is the pure mountain springwater of opioid pain relievers."
Sigma is confident the market will respond to the rebadging. "Far from this being a catastrophe, we now expect to make a handsome profit. It may even be the start of an entirely new marketing strategy." Sigma stock rallied after Dr Slither's announcement, reversing and then overtaking last week's price fall.
One heck of a bang
07 MAR 2004 | source Spaceflight Now via Sean Williams | permalink
Credit: NASA, ESA, H.E. Bond (STScI)
and The Hubble Heritage Team (STScI/AURA)
Miller on Lear
06 MAR 2004 | source Village Voice | permalink
Jonathan Miller is one of the most pragmatic interpreters of art. That's why I love him.
He is directing a New York production of King Lear starring Christopher Plummer, with the show done as comedy. This interview with Miller is extraordinary. Particularly useful to writers and other dramatic artists is this:
"Would you say it [Lear] has a spiritual dimension? No. That's modern, New Age drivel. Every play has a spiritual dimension by simply having human beings in it. Humans are filled with all sorts of compunctions and ideas and tendencies, which one might loosely call spiritual. Lear's about man's place in the social order."
"It's perhaps the most hushed staging of a Shakespeare play that I've encountered. A great deal of shouting on stage stems from the belief that this makes it more dramatic. There are moments when Lear shouts. There are moments when one or two characters shout, but in order to make their vehemence more noticeable, you have to have a rapid flow of normal talk. I've always tried to preserve the normal-sounding utterance of Shakespearean verse. The people in the cast, almost without exception, are accomplished Shakespeareans, and they know how to do it without making it sound like verse. I always point out that if you're ever aware of the actual prosody, then you've missed the point. If you look at a mattress, a beautiful styled mattress, the springs are placed at regular metrical intervals. When you sleep, however, you are absolutely unaware of their distribution. And that's exactly how it should be. The skillful speaking of verse should honor the metrical structure without the audience ever being aware of it."
And this ought to be mandatory reading for stage directors...
"Is Lear the apex for any director? Is it the greatest challenge? It's the easiest, really, as long as you get away from the cosmic and the primeval. Critics are often tremendously eager to see this play as unmanageably large. It's not. I have to say I had the same problem when I did Long Day's Journey Into Night, which is always seen as a modern Greek tragedy. It's just a lot of drunk Irish Broadway bums whiling away a hot night in New London. When I was doing it with Jack Lemmon and Kevin Spacey, I said, 'Look, this is not Aeschylus. It's Neil Simon's Broadway Bound.' And I was able to take an hour and 20 minutes off the running time by having them talk normally instead of having these recitations."
Five things I should have known
02 MAR 2004 | source Frankenblog
• Saxophones were not massacred after the Norman invasion.
• Pachelbel's Canon was not fired in the 1812 Overture.
• The Doge of Venice did not foment the Boxer Rebellion.
• Julius Caesar did not invent a salad.
• There is more than one viable theory of where the word "jazz" came from.
Frankenfriend Neil Ford emailed me with a list of sites giving alternative theories of the origin of the word jazz; this was in response to Frankenblog's Culture v. Science quiz. (Sorry for taking so long to post this message, Neil. My hard disk fried and I lost your email.) I think the list of sites went something like this: Jazz Etymology, Jazz Tidbits, Word Origins (J), Towards a Definition of Jazz and Jazz Style.
Newspaper prints nothing about Wolf and Bloom
29 FEB 2004 | source AAZ/Rooters
OGALLALA, NB—Editors at The Ogallala Frontiersman decided today not to run any articles, opinion pieces, or editorials about Harold Bloom putting his hand on Naomi Wolf's thigh. "There was nothing to say," said Stan Smithereen, 47, the news editor, layout designer, and accounts manager. "It's all been said already by other people. We couldn't honestly see the point in asking our regular columnists to waste their time." Smithereen denies that the Frontiersman's readers would be disappointed at missing out on a local opinion. "It's got nothing to do with us, really. This is something that happened twenty years ago in another state." Football scores, aquifer wells and other regional concerns would continue to dominate copy in the Frontiersman. Smithereen concedes that articles about the encounter might be printed, but only if there was a strong Ogallala angle such as Harold Bloom touching up a local girl.
Orson Scott Dumpty falls off the wall
28 FEB 2004 | source The Ornery American via bOING! bOING!
Orson Scott Card made himself notorious for an editorial he wrote in 1990 called "The Hypocrites of Homosexuality". In that editorial, he very carefully distanced himself from violence against gays, but he openly supported their exclusion from the Mormon Church and defended the church's stance against accepting homosexuality as normal human sexuality.
Now he has spoken out against homosexuality in another column called "Homosexual 'Marriage' and Civilization". It is unlikely to win him any new friends. It broadens its attack on homosexuality; he is no longer merely advocating that his church reject homosexuality, but that the entirety of American society reject it -- at least as far as not allowing homosexual marriage.
Card opens with a few words of satire from Lewis Carroll:
"When I use a word," Humpty Dumpty said, in a rather scornful tone, "it means just what I choose it to mean -- neither more nor less."
What Card means is that marriage is between man and woman by definition, and to confer marriage on gay couples is a contradiction in terms. I find this argument fascinating. Essentially Card is arguing that our dictionaries should be the basis of our moral code -- second only to a strict reading of the Bible, that is. Actually, that should be third behind the Book of Mormon. And the Doctrine and Covenants, and the Pearl of Great Price, not to mention "official statements of the First Presidency...[and] other official and published statements of General Authorities, especially those sustained as prophets, seers, and revelators", to quote the guidelines of the online publisher of "Hypocrites of Homosexuality." Whatever. The dictionary still ranks pretty high.
To me, this is a weak argument. The Concise Oxford defines marriage as "the legal union of a man and a woman in order to live together and often to have children," but definitions have a habit of changing over time; it hardly seems a lexical impossibility to change "a man and a woman" to "adults." After all, if Card's linguistic fundamentalism applies, then couples who live apart either by choice or necessity should not be married. The Concise Oxford says so.
It is instructive to see how Card applies his own rule...
Card: And we all know the course this thing will follow. Anyone who opposes this edict will be branded a bigot; any schoolchild who questions the legitimacy of homosexual marriage will be expelled for "hate speech." The fanatical Left will insist that anyone who upholds the fundamental meaning that marriage has always had, everywhere, until this generation, is a "homophobe" and therefore mentally ill. Which is the modern Jacobin equivalent of crying, "Off with their heads!"
Concise Oxford: Jacobin 1 a a member of a radical democratic club...b any extreme radical.
Comment: The Jacobins were the political force behind the Terrors that followed the French Revolution. They introduced a government based on fear, hatred, and execution without legal process. Apparently those supporting gay marriage are planning to behead Orson Scott Card without trial. No wonder he's so worried about them.
Card: But anyone who has any understanding of how America -- or any civilization -- works, of the forces already at play, will realize that this new diktat of the courts will not have any of the intended effects, while the unintended effects are likely to be devastating.
Concise Oxford: diktat a categorical statement or decree, esp. terms imposed after a war by a victor.
Comment: One can't categorically exclude the possibility that Card sees this as a war, but one can see that the Massachusetts Supreme Court is being asked to rule on whether to allow something, not forbid it. That is, even if the court finds for homosexual marriage, it cannot decree that homosexuals marry or that Orson Scott Card stop arguing against it. As things stand, the closest thing to a "diktat" is the interpretation of the law that categorically decrees that homosexuals cannot be married.
Card: No law in any state in the United States now or ever has forbidden homosexuals to marry. The law has never asked that a man prove his heterosexuality in order to marry a woman, or a woman hers in order to marry a man.
Internet Dictionary of Philosophy: Fallacies: Equivocation: Equivocation is the illegitimate switching of the meaning of a term during the reasoning.
Comment: Homosexual marriage is not the same thing as homosexuals marrying heterosexually, and Card should know it.
Card: So it is a flat lie to say that homosexuals are deprived of any civil right pertaining to marriage. To get those civil rights, all homosexuals have to do is find someone of the opposite sex willing to join them in marriage.
Concise Oxford: deprive 1 strip, dispossess; debar from enjoying (illness deprived him of success). [Other definitions snipped.]
Comment: In Card's universe, withholding something is not deprivation. And it's a flat out lie to disagree with him.
Card: And yet, throughout the history of human society -- even in societies that tolerated relatively open homosexuality at some stages of life -- it was always expected that children would be born into and raised by families consisting of a father and mother.
Concise Oxford: always 1 at all times; on all occasions. [Other definitions snipped.]
Comment: The Spartans sent their boys off to be raised by the military school after the the age of seven. The Ottomans selected non-Muslim boys between the ages of seven to fourteen and removed them from their families to bring them up as Janissaries. In the Baroque period, many young boys were forcibly castrated, and if they were lucky enough to survive, sent off to the conservatory to be trained as singers. Even today, many families send their children to boarding school which means that their children spend more time being raised by teachers than by their own families.
The Concise Oxford includes another definition of always -- "repeatedly; often (they are always complaining)" -- but this informal use is clearly not what Card intended; it would demolish his argument.
Card: And in those families where one or both parents were missing, usually because of death, either stepparents, adoptive parents, or society in general would step in to provide, not just nurturing, but also the appropriate role models.
Concise Oxford: appropriate suitable or proper.
Comment: So Card's comment about children always being raised by a mother and father was wrong all along. So why did he say so? And what does this have to do with homosexual marriage? Many if not most homosexual marriages will be childless, and those marriages that do involve a child to care for will usually be the result of a heterosexual marriage that has broken up because one or both of the couple was homosexual, and this sort of marriage was held up by Card as an acceptable way for gays to marry because it preserves the reproductive duty of members of society. As for the "appropriate", notice that it was inserted to protect Card from claims that gays could be nurturing parents. Sure gays can be nurturing, implies Card, but they are not "appropriate role models." And who gets to determine what is appropriate? Card, of course, and his church.
Card: [After a rant about divorce and the damage it does children.] This is an oversimplification of a very complex system. There are marriages that desperately need to be dissolved for the safety of the children, for instance, and divorced parents who do a very good job of keeping both parents closely involved in the children's lives.
Concise Oxford: oversimplify distort (a problem etc.) by stating it in too simple terms.
Comment: On this occasion, Card is using the word appropriately...which raises the question as to why he uses a rant that he acknowledges as being an oversimplification in his chain of argument. "Sure as heck it's oversimplified, but I'm gonna use it anyway."
Card: Those who are successful in mating are the ones who will have the strongest loyalty to the social order; so the system that provides reproductive success to the largest number is the system that will be most likely to keep a civilization alive.
Internet Dictionary of Philosophy: Fallacies: Jumping to Conclusions: When we draw a conclusion without taking the trouble to acquire all the relevant evidence, we commit the fallacy of jumping to conclusions, provided there was sufficient time to assess that extra evidence, and that the effort to get the evidence isn't prohibitive.
Comment: Is there any evidence for Card's dogmatic assertion that the most stable society is one in which reproductive success is most widely distributed? Since Card is drawing on evolutionary principles here, I can point to many examples of social insects in which a single queen provides the entire reproductive output of a multi-million strong colony. Is there a shred of evidence that allowing homosexual marriage will reduce the distribution of reproduction? Will pushing gays into heterosexual marriage in order to distribute reproduction result in more loyalty among Americans? According to Card, the purpose of society is to be stable (not caring or progressive or vibrant) and to do so by creating a fertile environment (forgive me) for reproduction; oh, and infertile couples and celibate priests are less likely to be law-abiding citizens.
Card: Monogamy depends on the vast majority of society both openly and privately obeying the rules. Since the natural reproductive strategy for males is to mate with every likely female at every opportunity, males who are not restrained by social pressure and expectations will soon devolve into a sort of Clintonesque chaos, where every man takes what he can get.
Internet Dictionary of Philosophy: Fallacies: Anthropomorphism: This is the error of projecting uniquely human qualities onto something that isn't human. Usually this occurs with projecting the human qualities onto animals... And Inconsistency: The fallacy occurs when we accept an inconsistent set of claims, that is, when we accept a claim that logically conflicts with other claims we hold.
Comment: Anthropomorphism: Card actually isn't indulging in anthropomorphism, he's indulging in reverse anthropomorphism. (This may be a new term, but it deserves currency nonetheless.) Card is not projecting human qualities onto non-humans, he's projecting non-human qualities onto humans. But humans are not natural Darwinian monsters held in check by legislation. We are social animals, and every human grouping has had social mores pertaining to sexual relationships, and historically most of those mores forbid or at least frown upon promiscuous behaviour. The idea that changing the definition of marriage to include more people will spark a society-wide regression into Machiavellian rutting machines is, quite frankly, ludicruous and insulting. Inconsistency: Having declared that social rules depend on successful mating, Card is now asserting that males should be restrained from successful mating. Having argued that the natural basis of society is the monogamous heterosexual couple, Card is now asking us to reject the natural basis of male reproductive behaviour. Having argued that the best way to build social bonds is to distribute reproductive success, Card now argues that a crucial role of society is to restrict the distribution of reproductive success. (If only one of a couple is infertile, then promiscuity will increase the distribution of children, which is what Card wants...and doesn't want.) And I'm even more confused as to how monogamous gays asking for their union to be recognised in law would lead to promiscuity among heterosexuals.
Card: We've already seen similar attempts at redefinition. The ideologues have demanded that we stop defining "families" as Dad, Mom, and the kids. Now any grouping of people might be called a "family."
Concise Oxford: family 1 a set of parents and children, or of relations, living together or not. 2 a the members of a household, esp. parents and their children. b a person's children. [Other definitions snipped.]
Comment: Until very recently, the concept of a family has included grandparents, aunts, uncles, cousins, stepparents, and so on. Note that the dictionary allows families to be "living together or not." The nuclear family -- one father, one mother, and children living in the one home -- was not the dominant family model until the 1950's, which happens to be the decade that Card identifies as the start of the "tragic collapse of marriage."
Card: But homosexual "marriage" is an act of intolerance. It is an attempt to eliminate any special preference for marriage in society -- to erase the protected status of marriage in the constant balancing act between civilization and individual reproduction.
Concise Oxford: intolerant not tolerant, esp. of views, beliefs, or behaviour differing from one's own.
Comment: Let's get this straight. Allowing gays to legally acknowledge a loving relationship is not just misguided, it is intolerant?
Card: They steal from me what I treasure most, and gain for themselves nothing at all. They won't be married. They'll just be playing dress-up in their parents' clothes.
Concise Oxford: steal 1 a take (another person's property) illegally. b take (property etc.) without right or permission, esp. in secret with the intention of not returning it. 2 obtain surreptitiously or by surprise (steal a kiss). 3 a gain insidiously or artfully. b (often foll. by away) win or get possession of (a person's affections, etc.), esp. insidiously (stole her heart away). [Other definitions snipped.]
Comment: Gay marriage has nothing to do with property. This drama is hardly surreptitious or insidious: it is being played out in public in the Massachusetts Supreme Court under the gaze of a mass media with voracious appetite for controversy. I can understand Card feeling uncomfortable about gay marriage -- it confronts his deepest beliefs. But I can think of few things sadder than a man who believes gays getting married steals something away from him.
We're only halfway through Card's article and I've had enough. I've counted seven misuses of a word and thrown in three fallacies for good measure. Consider the rest of the article as an exercise for the reader. I note with interest the similarity between Card's arguments and those in the 1960s against interracial marriage. Not to mention Rep. Roddenberry's 1912 attempt to make interracial marriage unconstitutional. "It's not natural. It's against God's law. It demeans the institution of marriage." (And before anyone objects, I'm not accusing Card of racism.)
Card is an extremely skilful author. He must know, on some level, that he is using these words because of their emotional impact and not because of their meaning. He must know, on some level, that it is hypocritical to accuse the gay movement of Humpty-Dumpty linguistics as a preface to doing it himself. I can almost forgive the fallacious language and the hypocrisy, but I can't forgive the dogmatism, the self-importance, the clutching at faux-Darwinian straws, and most of all, the spite revealed in his rather scornful tone.
Thanks to David Cake for the Corante link.
Why general practice is choking
26 FEB 2004 | source Frankenblog
This is definite grump mode, so beware... It was inspired by recent experiences in which my wife (who is also a doctor) received two complaints, one by a patient who had been given hours of free advice and above-the-call-of-duty care, who when she didn't get everything exactly her own way, wrote a letter accusing my wife of being callous. As anyone who knows my wife will attest, this is rather like calling the Dalai Lama greedy or Raoul Wallenberg selfish. The second complaint came from a patient whose insurance company had refused to pay the bill tendered by a specialist -- the patient did not think to send the complaint to specialist (who got the money) or the insurance company (who refused to refund it), but to my wife for telling the truth about the medical condition to the insurer. Last year, I had to deal with a complaint to the Medical Board from a person I had never treated, never even met, and despite the fact that the complaint was found to be baseless, it took me many teeth-grinding hours to respond to the Board and forced me to unsub from a public mailing list. This then, is a brief summary of why general practice is becoming less and less attractive...
Complaints and litigation
· Patient complaints are becoming more frequent and more unrealistic;
· the Victorian Medical Board has reported that complaints are booming and most of the complaints are trivial or baseless; despite this, the Board has in its own words "limited power" to dismiss complaints, even obviously frivolous ones;
· the cost of medicolegal insurance has increased by a factor of twenty since I started practice twelve years ago;
· I have a Diploma of Obstetrics but will not deliver babies; there are now almost no GPs who deliver babies, even in remote rural areas where obstetricians are not available; the cost of GP obstetric insurance was $22-24,000 in New South Wales two years ago; the Medicare rebate for delivering a baby is $333, including post-natal care for five days and even if the delivery is a Caesarean. The obstetric GP in NSW has to deliver 54 babies a year before the Medicare rebate pays for the insurance hike. You do get more if there is an obstetric emergency. If the pregnancy is complicated by severe, life-threatening emergencies such as eclampsia or antepartum haemorrhage requiring hospitalisation, the extra rebate is $22 per visit to a maximum of one visit per day. Obstetricians have it even worse -- although they can claim higher Medicare rebates, their insurance was up to $110,000 in NSW in the same period. I have heard people complain about their obstetrician charging thousands of dollars for a delivery -- but they're not paying the obstetrician, they're paying the lawyers;
· the explosion in obstetric costs comes despite the fact that childbirth is now safer for both mother and baby than at any time in human history;
· there are a number of law firms who openly advertise for clients; that is, they try to attract people who hadn't thought of suing with promises of easy money; clients can be lead into "No Win No Fee" arrangements that still cost them a small fortune in hidden costs if the claim is unsuccessful;
· certain law firms have an unspoken policy of bringing complaints that have a marginal chance of success in the hope of forcing doctors to settle rather than have their reputations damaged or forcing insurers to settle rather than pay the cost of defending the claim; as one insurer puts it, "there are times that a commercial decision may be made without admission of liability";
· in one prominent medical lawsuit, the judge allowed gynaecological oncology specialists to testify for the plaintiff about what is appropriate practice for general practitioners while refusing to allow general practitioners to testify for the defence on the grounds that they were not experts; not surprisingly, the GP was held to a standard of practice of an ultra-specialised surgeon;
· in another lawsuit, a country GP was sued when he referred a patient with a breast lump to a surgeon; the patient found it inconvenient to attend that specialist, who worked a long way from town, and did not see the surgeon; some time later the lump was diagnosed as malignant and the GP was held responsible for not making a more convenient referral;
· in yet another lawsuit, a patient sued a surgeon for not discussing the potential adverse outcomes of surgery as well as the GP who made the referral;
· one judge, on retiring, observed the landscape and warned his colleagues against losing sight of legal principles and "appointing themselves Santa Claus";
· on the other hand, many senior figures in the legal profession have stated that there has been no significant increase in medicolegal costs, no significant change in litigation outcomes, and that nothing needs to be done; I would like to put this as generously as possible, but ... you can draw your own conclusions;
· several lawyers have claimed that medical insurers have historically been charging too little and all that is happening is a readjustment; my insurer was founded in 1895 -- and I can't think of any industry where a company can survive by earning less than five percent of its outgoings for more than a century;
· the current litigation crisis was precipitated in part by the collapse of UMP, one of the major medical indemnifiers, after its aggressive, ACCC-approved strategies left it exposed when its underwriter collapsed; the government's response has been to force the remaining medical indemnifiers to stop being mutual support societies and to become normal insurance companies with all the regulatory requirements that entails; in other words, they have forced the cautious medical indemnity corporations to become more like UMP, which collapsed; the result has been an increase in insurance costs rather than a decrease, and a much greater administrative burden for everyone; this change was implemented despite the strenuous objections of the surviving indemnity corporations, the AMA, and doctors everywhere.
Shifting litigation costs
· Most medical defence organisations cross-subsidise high-risk groups such as obstetricians and neurosurgeons; this means that GPs subsidise the insurance of specialists who earn significantly more than they do;
· GPs cross-subsidising obstetricians is generally regarded as a good idea (including by me), but any attempt to prop up GP insurance with public money is inevitably described as unfair to the average taxpayer;
· the latest NHMRC vaccination guidelines recommend injected polio vaccine over oral polio vaccine; this recommendation is made because the oral polio vaccine can very rarely revert to wild polio (at a rate of about one case per million doses); the injected polio costs a lot more, is more painful, and gives less immunity, but it doesn't cause this rare complication; despite recommending the injectable vaccine, the NHRMC has not put it on the standard schedule, which means parents have to pay for it instead of the government, and we GPs have to explain to parents why it is recommended but not subsidised, whereupon parents almost invariably opt for the oral vaccine; as far as I can tell, the only purpose in recommending without funding is to shunt the risk of litigation for polio reversion off the NHMRC and onto GPs.
· Mainstream media reports of medicolegal disputes almost invariably paint the doctors as guilty until proven otherwise;
· in one notable Melbourne case, the plaintiff was described as "brave" and airbrushed into a secular saint; when the court found that there was no basis to the complaint, one Melbourne newspaper reported the court's eminently sensible reasoning on page 14, as a by-the-way, while on the front page it all but accused the court of a miscarriage of justice and devoted even more column inches to the humiliation of two doctors who had given excellent medical care;
· when elements of this case were fictionalised for an Australian TV series, a reviewer said it was an unrealistic portrayal of journalism at work -- despite the fact that at the time of the case in question, the reviewer had been the editor of the newspaper that had been most vicious in its coverage; actually, the reviewer was correct -- in the TV show, the journalists lost interest and stopped reporting when the evidence turned against the plaintiff, which was a darn sight more fair and ethical and therefore unrealistic than the behaviour under his own editorial guidance.
· The Medicare rebate for procedures is much higher when performed by a specialist than a GP -- even for the same procedure;
· while happily paying specialists more for procedures that could be performed by GPs, the government is trying to legislate to allow nurses to perform many GP functions -- because nurses are cheaper;
· the Medicare rebate for GPs was meant to be indexed to inflation; as any economist will tell you, the Australian CPI has been kept artificially low by statistical manipulation of the "standard basket" for political purposes; despite the all-time low official inflation rate, the Medicare rebate for GPs has increased at half the rate of CPI, or about 1-1.5% a year;
· non-VR GPs haven't had any increase in the Medicare rebate for more than ten years;
· during this time, specialists have had the full CPI increase passed on;
· over this period, the cost of running a general practice has been increasing at about 7-10% a year;
· a large proportion of the increase in running costs is due to government policy-making, often implemented without consultation with GPs and sometimes against their advice;
· any GP who bulk-bills (ie. charges the Medicare rebate and nothing more) is not allowed to charge for any other goods or services -- including bandages, suture material, or plaster (which can be horrendously expensive); there is an exception for vaccines, but this was only introduced two years ago;
· by the Health Department's own estimates, the Medicare rebates for GPs are just over half what they should be; despite the Health Department signing off on these figures, it has no plans to rectify the situation;
· the current government, in an attempt to take health off the political agenda, has just given GPs a bonus of $5 a consult to continue bulk-billing; this does not apply to all Australians, only pensioners, health-care card holders, and children, who make up about half of most consultations; this means that the government has decided to pay an eighth of the gap between what it pays and what it should pay; this is supposed to reverse the slide in bulk-billing; more likely, and I suspect this will be confirmed when the Cabinet minutes are made public in twenty-five years, the purpose of the extra payment is to prevent GPs from abandoning bulk-billing just long enough to get through the next election;
· while the government refuses to increase Medicare payments to GPs in any significant way, it has increased the Medicare levy to pay for the Gulf War and the East Timor expedition; thus the Australian government has been willing to raise the health care tax for military adventures, but not for health care.
Wrestling away from private billing
· Given the frustrations of bulk-billing, the obvious question is: why do it?; why not just bill privately?; but it's not as attractive as it sounds;
· while GPs are allowed to charge above the Medicare rebate, the Health Department does everything in its power to disadvantage those GPs and their patients, even where it means generating enormous and unnecessary administrative costs for the government itself;
· it is a criminal offence for GPs to bill Medicare directly and charge the patient the difference between their fees and the rebate, even though this would be simple for the GP, the patient, and the Health Insurance Commission; this is not one of those silly little laws that nobody cares about; the HIC has issued many warnings to GPs saying that they will be criminally prosecuted if they do this;
· the private-billing GP has two choices; the GP can charge patients the whole amount up front, whereupon the patients must reclaim the Medicare rebate themselves; this can be done by mail (in which case the wait is at least two months, by a cheque that must then be presented to a bank) or by attending a Medicare office in person with the receipt (which usually involves travelling to a Medicare office and waiting in a queue for at least thirty minutes);
· the other alternative is to bill the patient the gap; and then to submit a simultaneous claim to the HIC; the HIC will then send a cheque for the rebate in about six weeks; the cheque is not sent to the doctor whose name is on the cheque, but to the patient who then has to deliver the cheque to the doctor; not surprisingly, this system results in a large number of cheques lying in patients' desk drawers until they get motivated enough to drop it in to the doctor, which is sometimes never; recently the HIC has very generously started sending these cheques directly to the doctor -- but only if the original cheque has not been presented within six weeks of issue, which means at least twelve weeks after the original consultation;
· this brainless exercise generates horrendous administrative costs for the government and for GPs and forces patients to jump hoops just to get their due entitlements; the whole purpose of the exercise is quite simply to dissuade GPs from billing above the Medicare rebate, even though the government admits the Medicare rebate is half what it should be;
At least patients can claim the gap back on private insurance, no?
· Unlike specialists, GPs cannot have their above-Medicare charges reimbursed by private health insurers;
· meanwhile private insurers happily reimburse the cost of naturopaths, homeopaths, chiropractors, reflexologists, and even golf clubs and running shoes;
· as a GP, watching the TV ad that depicts a man slapping a pair of fish over a woman's back ("we cover alternative health," says the caption, and after a pause, "but not everything") does not make one smile at the clever humour (and it is clever); the thought that churns through one's mind is that homeopathy, which is no more effective than fish-slapping, is supported by our mainstream health insurers while general practice is excluded by an Act of Parliament.
Why it won't change
· The government has been forced to deal with some of the problems facing general practice, but the only strategy that could be described as being even partly successful is the new litigation measures (although even these are deeply flawed, as mentioned before); however, neither the government nor the opposition has any intention of providing the resources that would make a significant dent on the problems; here's why...
· during the last election campaign, the Health Minister (Michael Wooldridge, now retired) was asked what he intended to do about the underfunding of general practice; he said (and this was before an audience of nearly a thousand) that the government would not do anything about it because there was no media interest in it and therefore no political leverage in fixing the situation; he angered many of the doctors before him by telling them that the media would not give tuppence for their concerns so there was no point trying to make political trouble;
· the Health Minister may have been brutally confrontational, but he was correct; his comments were not reported in the mass media, not even as a by-the-way on page 14;
· a similar question was asked recently of the leader of the Democrats; his response was to say that there was no problem with funding general practice, that the whole crisis was engineered by "doctors wanting to put their third child through private school," and that his party would block any legislative attempt whatever to put more resources into general practice;
· the Democrats' response was not reported in the mass media, thus proving the Health Minister's point once more;
· a mere month after the Democrat leader's comments, he was subjected to hysterical media criticism for getting drunk, sneaking off with a bottle of wine, and seizing a Liberal Senator's arm; it wasn't just the Democrat leader who got drunk; the mass media chugged themselves legless on this personal crisis -- but hadn't shown the slightest interest in reporting his abject failure to negotiate policy in a responsible manner, which is after all what he was elected to do.
Note for non-Australian readers: The Democrats in Australia have nothing at all in common with the Democrats in the US. Our Democrats are a break-away party from the Liberals. In their twenty-seven-year history the Democrats have left conservative politics behind them and wobbled over just about every political position imaginable. Despite their rather fluid political philosophy, they have quite often held the balance of power in the Senate, and have therefore held a power well out of proportion to their electoral base. The Democrats routinely get themselves elected on the promise of "keeping the bastards honest," which is a strange political slogan for a politician to make, and means that whenever they hold the balance of power their mandate is to go along with whatever the winning party promised during the election campaign -- because voting against a promise is voting against keeping the bastards honest. The Labour Party is ostensibly left wing but when last in power it reined in the influence of unions and introduced the most far-reaching free-market policies of the last twenty years. Our conservative party calls itself the Liberal Party. It's no wonder foreigners can't understand Australian politics. We can't.
Note about general practice: Despite the grump, general practice is a challenging and often rewarding career, the vast majority of patients are fundamentally decent people, most lawyers are dedicated to helping their clients navigate the legal landscape, most journalists want to write gripping stories that are also fair and true, and most politicians enter Parliament because they believe they can improve the country. There is something odd about this particular point in history, in that politicians and bureacrats have noticed that those professions involved in providing personal care can be squeezed ruthlessly because the professionals themselves are reluctant to withhold services from vulnerable community members; this does not just apply to GPs, but also to nurses, teachers, and especially child care workers. The reward for providing health, education, and care is relatively low pay, onerous administrative burdens, unbending accountability for mistakes (sometimes even when they're someone else's mistakes), poor working conditions, and community contempt whenever an attempt is made to improve things. Meanwhile, one of Australia's richest families made its billions out of child care centres, and one of our most respected individuals is a tennis player who lives in the Bahamas to avoid paying income tax. Go figure.
Molested by alien Satanists!
25 FEB 2004 | source New York Review of Books via Arts & Letters Daily
Absolutely brilliant essay in the guise of a book review called "The Trauma Trap" by Frederick C. Crewes. Many years ago, I believed that this sort of incisive essay would utterly destroy the dangerous pseudo-scientific claptrap it focussed on. Now I have come to the sad conclusion that it will probably make very little difference. Still, even a very little difference is better than letting the Repressed Memory fanatics unimpeded access to vulnerable people, especially children.
Are you autistic?
23 FEB 2004 | source Wired via Arts & Letters Daily
Autism expert Simon Baron-Cohen has developed a clinical test for autism. You can take the 50-question test here. For the record, I scored 11 which is below the 16.4 average for the control group and waaay below the 32 average for those with autism spectrum disorders.
Tsarist Russia in living colour
15 FEB 2004 | source Russell B. Farr
This site has well and truly infested the blogmos, but I love it enough to post another link.
Towards the end of Tsarist rule, the Tsar's official photographer Sergei Mikhailovich Prokudin-Gorskii travelled across the empire taking photographs of extraordinary beauty. Even the staged and posed photographs have a sense of grandeur. Prokudin-Gorskii crafted some of the world's earliest colour photographs using a camera of his own design that took black-and-white plates through red, green, and blue filters. By illuminating the glass plates through a special projector, he was able to recombine the plates into a single colour image. This is the same principle used by colour CCD video cameras today.
There is a wealth of glory here. My own favourites, in terms of colour, composition, and humanity, are the shots of Jewish children in rapt attention to their teacher, and the melon vendor sitting in his stall, and the Emir of Bukhara. No doubt you will find a bunch of your own favourites...
Gathering the Reviews
14 FEB 2004 | source Jack Dann/TOR
Simon Brown and I wrote a story called "No Man's Land" that appeared in the international horror anthology Gathering the Bones. Jack Dann now informs me that the anthology is on the Library Journal's list of best genre books for 2003. Yippee!
While I'm in PMOTB mode (that's Pat Myself On The Back), I'll just quote some reviews of Bones.
Publisher's Weekly: In most stories the subtle and suggestive trump the physical and gruesome, such as "No Man's Land" by Chris Lawson and Simon Brown, where vividly described horrors of trench warfare prove an avenue to more awe-inducing terrors.
Booklist: Horror becomes the ultimate antiwar comment in Chris Lawson and Simon Brown's "No Man's Land."
A reader on entertainment-reviews.com: No mans land, finished suddenly, I thought there might be more to it, the ending didnt impress me at all.
Rattling John Cage
11 FEB 2004 | source Frankenblog
Don't get confused here. I'm not talking about John Cale, the co-founder and first victim of the the Velvet Underground. I'm not talking about J. J. Cale, the songwriter for Clapton's "After Midnight" and "Cocaine." No, I'm talking about John Cage, the experimental composer whose piece Organ2 / ASLSP is currently playing in St Burchardi church, Halberstadt, on an automatic organ, and since it is meant to be played "As SLow aS Possible", is expected to last 639 years -- even longer than the average Yes song.
John Cage is most famous for a piece called 4'33", four minutes and thirty-three seconds during which no deliberate sounds are produced. It is not, however, silence. Cale was inspired to write the piece when he visited Harvard University's anechoic chamber -- a room designed to absorb all sound. Cage expected to hear silence, but instead heard the sound of his own blood coursing and his nervous system firing away. He realised that there is no such thing as true silence. He could have told you, for instance, that the posters for Alien lied when they said that in space nobody can hear you scream; in fact, going by Alien there's more screaming in space than in the Royal Dental Hospital.
Cage's 4'33" was first performed by pianist David Tudor in 1952 and has been recorded several times, including by Frank Zappa.
In 2002, composer Mike Batt recorded a piece called "A Minute's Silence", which was a recording of no sounds being produced that lasted a minute. If John Cage hadn't died in 1992, he would have argued that the piece was mistitled: it was not silence. Cage's estate took Batt to court, claiming plagiarism. Batt might have had a good argument that you can't copyright silence, if only he hadn't credited the track to "Batt/Cage." It's a nice pun, reminiscent of Batt's seminal work on the Wombles, but it cost him a huge settlement.
In January this year, Cage's most famous work was performed by a full orchestra. The excitement was palpable. Although there are no plans for a release by a major label, the performance was recorded by a number of hardcore fans and bootlegged copies are being sold under the counter and circulated on secret internet mailing lists. Unfortunately, a number of blatant forgeries have infiltrated the web, so listen for a plane going overhead at 2'57" and caveat emptor.
I have laid my hands on an exclusive recording of this stunning performance, captured by a hacker known as Opensauce who hid a MiniDisc recorder in his usher disguise and sat behind a pot plant for the duration of the concert. I must have played it a hundred times. And it has inspired me. I have been playing around with the music and found some wonderful arrangements.
I particularly like it as a waltz in G.
And the energy of this arrangement is really catchy:
I just hope the John Cage estate doesn't get wind of this...
11 FEB 2004 | source Frankenblog
I've just added a link to BIOME, a gobsmackingly good site for research into medical science, including history and ethics. If you want to find out the rules for hospitals in Mediaeval Germany or need to work out a phylogenetic tree, this is the place. Outstanding.
Countdown to More Claw!
11 FEB 2004 | source Frankenblog
Further to our previous story...if you visit the Ticonderoga site, you will notice a little countdown clock ticking away until the launch date. This is very helpful. Possibly a first. Has any editor put a final, non-negotiable, your-head-on-a-plate contributor's deadline counter on the web before this?
Worth noting in passing...Ticonderoga has drawn the services of Jonathan Strahan and Lucy Sussex as future columnists. This is very exciting news. It flatters me by association, and it's a damn good reason to check out Ticonderoga on a regular basis.
04 FEB 2004 | source The American Enterprise
This is an important essay by Patrick Moore, a founding member of Greenpeace, on why he left the organisation and the damage it is doing to its own cause. This is laying the groundwork, but someone needs to do a Martin Luther and nail a set of theses to the church door. More on this in my Infinite Precautionary Principle series later...
23 JAN 2004 | source Frankenblog
Russell B. Farr has announced the relaunch of Ticonderoga Online now that he has a posse of Lee Battersby, Liz Grzyb, and Lyn Triffitt to help him. The collective has kindly invited me to be one of the regular contributors. I will be doing a science column once a year. You can visit the site now, but there won't be much action until the March launch.
Anyone who wants me to write about a particular topic is welcome to email me with suggestions, but I can't promise I'll do anything with them.
Huzzah for Punchwin!
17 JAN 2004 | source Frankenblog