So Much to Be Thankful For!
That we and everyone else (two-legged and four-legged) escaped the fire unhurt.
That blogfriends gathered around and wove me a magic carpet to camp out on.
That by so doing, they gave my steadfast and uncomplaining family a welcome break from doing the same.
That my parents are not only still alive but enjoying it to the hilt. (That the state of Florida just renewed their drivers’ licenses at 86 and 92. That settles it, I know where I’m spending my golden years. VROOOM.)
That my sibs and their growing and grown kids and new grandkids are all healthy — incredible! So blessed!
That I still have my health and strength, enough to keep J home, enough to move 35 boxes of books by myself and not have to lean on everyone for everything.
Hospice, just in time.
That hospice and the Red Cross and the landlord and the emergency reconstruction/relocation service they hired have made the dislocation as easy as it could possibly be for us.
That I get to practice slash-and-burn (oh no!) housekeeping — to move into a fresh new apartment instead of cleaning up!
That my rent has actually gone down.
That J slept through all of the moving this morning, including my getting him dressed and up and into his wheelchair so the movers could move the bed.
That friends IRL are being friends this year, and making the holidays holidays instead of hellidays:
- Chris the physical therapist, who (putting to shame my complaints about her one-time no-show) warned me to mop the dust off the floor of the newly renovated apartment (she wanted to get down on her knees and do it herself, but she was going out of town; I easily did it dojo-style, scooting a folded wet towel back and forth across the floor), and who then came back and cleaned the whole kitchen for us before we moved into it; who found me a wool Oriental rug for the bedroom at the thrift shop for $100 (I was worried that J would pee on it; he already has). (Thankfully, not much.)
- Chris (another Chris), the attentive and courteous dojo student/young father in his 30s, who came over today with his wife, moved all our kitchen stuff and much more while we were at J’s gym (this I slept through), and then welcomed us back with a coffee housewarming.
- Kris (I know, it’s ridiculous, like half of Russia being named Sasha), the sole residential karate student, in his 20s, who’s unquestioningly moved stuff for us and regaled us with tales of his native Hawaiian/Southern/German/Cherokee clan. He and Chris (#1 above) are coming over for sage-and-garlic-butter-basted turkey breast tomorrow.
- Erin, another student in the dojo, young mother (including of a baby girl adopted from Somalia) who’s invited us and Kris for a second Thanksgiving on Saturday.
- Nathan, the karate instructor, and the reason we moved here in the first place, with whom we’ve had our ups and downs (which just goes to show that the relationship is a close one), but who showed an amazing efficiency at coping with crisis on the day of the fire, and who (while out of town himself) may be quietly behind this flurry of hospitality.
That after the housewarming, we wheeled into our southwest-facing new bedroom — and a rose and violet sunset.
My new tree. (More when I figure out where I put the photo-transfer cable.)
Ron! (Yeesh! So many close calls!)
Lucy!
Someone new on the way who is fiercely anticipated and celebrated (just not public news yet). A Cat, perhaps.
And neither last nor least (this list could go on and on) — mysterious rumblings of optimism from my beleaguered employer, made palpable and plausible by an unexpected paycheck in full.
I can’t improve on the way Charlie Miller’s father put it: “Yeah, times are tough for everyone […] and the world may be going to hell in countless ways — but I have never in my life had a Thanksgiving in which I was so filled to the brim with gratitude.”
Me neither! I mean, me too!
Models are fine. People stink.
Gasp, a topic I have a fair amount of experience with! I’ve built tons of models, simulations of all kinds of things, as a part of my profession for years now. I even have a certain fondness for them. But I have to admit most of them are useless in practice, and frankly I’m glad I haven’t built any for awhile, for the problem is not the modeling of a system but the people who use it.
Look, why build a model? It allows you the ability to test hypothetical things and designs for a tiny fraction of the cost of actually building them. With the best models, people give you accurate data, make their assumptions explicit, and tweak, tweak, tweak the damn thing until it more or less works the way you would like to see. This would be about one project in fifty. A well designed model clarifies the mind and makes it clear to as many people as possible why you choose to build something in a specific way. Transparency, repeatability, and explicit thoughts and designs are what you should communicate with a model. But I can count the projects where that was so on one hand.
But how do I put this? People are lazy, vain, pompous liars who want a model to be some kind of Magic Ju-Ju that somehow make the stupid seem brilliant. Nearly every person who has hired me to make a model wants me to lie to somebody; it’s a lie with a technological sheen, so they can be unquestioned by people who don’t have contradictory models, which is nearly always the case. At least half the time people have made it very clear to me how my getting paid was tied to how pretty a lie I was able to give them. They never wanted to go through the process to begin with; they were just ordered to urk up a model which would make it look like they were serious.
Groupthink, like we see in the climate people, I think is the norm, and no model will override that. When language comes up with a fool-proof way to prevent lying, then many, many things in human life will go much better than they do…
The Disease of the 21st Century?
I seem to recall coming across a quote from Martin [edit: actually Kingsley] Amis to the effect of “much of what was wrong about twentieth century literature can be summed up in the word workshop.” I find no reference to this quote online and it’s possible (verging on probable) that I’ve either mutilated it beyond recognition or invented it out of whole cloth in a fever dream. In any case … real or imagined, the quote put me to thinking about “climategate” and the significance of using computer models that cannot, in practice, be tested experimentally, to make predictions used to direct large scale social and economic change. This thought, in turn, put me in mind of the calamities wrought by the use of computer models to calculate risk in the stock and bond markets … I’m on the point of issuing my own dictum along the lines of “much of what was wrong at the beginning of the 21st century could be summed up in the word model.”
And, whether Amis actually uttered the phrase I alluded to above, or whether I only imagined it, the quote captures a parallel and essential truth – that there is all the difference in the world between a hothouse reconstruction of the world (whether in equations or the sentences of a novel) catalyzed by groupthink and untested (and untestable) by experience and the real thing (or, compare, real science that makes definite predictions).
Simulation is not science, anymore than it’s literature.
The Signal Must Be Costly.
This explains so much, somehow.
The basic idea behind [the costly-signaling] hypothesis is that animals need a means to communicate, i.e., to signal to kin and strangers their abilities, intentions, and fears. In order for individuals to trust the veracity of the information that is presented, it is argued that the signal must be costly to produce. If it were not costly to communicate, then individuals would regularly lie and cheat.
The classic costly signal is the peacock’s tail. The tail makes the bird more vulnerable to predators, but the message to the potential mate is, “I have survived in spite of this huge tail, hence I am fitter.” Similarly, it is possible that mobbing behavior is an honest signal by which adult male tarsiers advertise their quality as potential mates. The idea of mobbing as a costly signal is intriguing, because by approaching a predator, an individual can advertise very specific information. While aggregating around a potentially lethal snake, tarsier males may demonstrate their current physical condition, agility, and speed. This information would be very useful for a subadult female who is making a decision about whether to stay longer in her parental group, or disperse and establish her own group. Mobbing may be a way for young females to evaluate the ability and willingness of males to protect them and their future offspring against potential predators. The observation that males are more likely to join mobbings outside their territory [especially when subadult females are present] provides some potential indication that intense mobbing by spectral tarsiers males may represent costly signaling.
~ Sharon Gursky, “Function of Snake Mobbing in Spectral Tarsiers”
American Journal of Physical Anthropology 129:601–608 (2006)
“Frankly, I Call It Fraud”: A Guest Post on Healthcare [UPDATED]
The following was written by a woman whose husband died of a dementia similar to J’s. It is reproduced here with her permission.
Did anyone see “60 Minutes” tonight where they addressed end-of-life care? It was quite interesting and certainly appropriate for what many are going through. They were discussing whether putting people in hospitals when they were at the end of life was more costly, and one woman told of the thousands of dollars worth of bills for her mother, who was terminal with heart and liver failure; yet they did a Pap smear on her, took all kinds of tests, called in a psychiatrist because she was “depressed.” She told them that she, of course, was depressed because she was dying.
I assume it was a doctor speaking, and one of the things mentioned was that hospitals have to have beds filled and tests given to keep their profit level up. They also have several doctors “looking after” the patient, mostly so that each can bill separately.
I can certainly relate to that. When my husband first went to the hospital for a broken bone, he was immediately put on Hydrocodone, even after I told them he didn’t do well on strong pain meds. Then, they called in a psychiatrist, because he was hallucinating – duh??? [ed: This is a common feature of “our kind” of dementia — though J mostly doesn’t have it — that can be exacerbated by medications.] Each doctor referred him to another doctor, and at the end of three days, I don’t know how many doctors had supposedly seen him. Then, he was referred to the rehab hospital, where again, another psychiatrist was called and proceeded to give him several different antipsychotic drugs. Again, he was referred to several doctors, when all that was supposed to be done was rehab on his injury.
They said that many patients never read their hospital bills, because Medicare of Medicaid is paying for it. Believe me, every one of his bills was gone over by me, and I was appalled at the cost of things and the number of drugs that he had been prescribed in addition to his Aricept and antidepressant. I counted the meds they gave him, and between the meds, supplements, etc., he was given 16 different types of pills. I checked them on the drug interaction site and some of the ones he was taking should not have been used with others, and some it said not to be given to patients with dementia.
The bills from the nursing home were absolutely incomprehensible, and when I would question them, they couldn’t even answer the questions. If you don’t think there is fraud in the system, just check things out. While he was on a catheter for several weeks, they still billed for Depends. I checked them each time I was there, and the package had the same amount in it every day. When I asked about this, they told me that’s what was allowed. When he was taken off food and water on the last day of the month, they still ordered his Aricept, Celexa, Seroquel, and other drugs when they knew he was dying and were expecting it any moment. So, where did those drugs go? He certainly didn’t receive them. I could cite many more examples.
I continued to receive notices from Medicare and his secondary carrier for more than two years after his death. Some were notifications of payment to doctors I didn’t even know he had seen. One had even moved out of the area.
The hospital where he went now has hospitalists who direct hospital care rather than the patient’s own doctor. Then, they refer different doctors for each thing. So, he had psychologist, neurologist, urologist, physical therapist, and I don’t know what all referrals; each one billing separately. If I recall, they even had a different doctor that billed for his dismissal.
When I figured up all his bills for the approximately last two years of his life, they were nearly $80,000, and that did not include the cost of the nursing home care.
Needless to say, I have a lot of pent-up feelings about the medical profession, and as long as we have greedy doctors, hospitals, and nursing homes, we are going to have fraud.
Have I stirred up a hornet’s nest?
Ed.: The woman who tells this story says that she doesn’t blame Medicare or Medicaid for this state of affairs (her own experience, as I understand it, was solely with Medicare), but rather “the greedy medical profession,” “including insurance companies, doctors, hospitals, etc.,” and that her specific objection is to the unnecessary overtesting, overtreatment, overmedication, and overbilling, whether due to defensive medicine or profit-seeking.
How should sensible healthcare reform tackle this problem? It is wasteful, costly, and as often as not, harmful to the patient.
UPDATE: Ed.: I asked my doctor sister to comment. Here’s what she said:
I don’t know what to say. It’s hard to read about someone’s awful health care experience and be able to say anything meaningful. But the majority of Dr’s aren’t venal and evil or see awful end of life situations such as this as opportunities to make a buck. The hospitals I’m not so sure of.
The way medicine is practiced now is by individual specialists who take care of their little niche and don’t want to be bothered about anything else. Why? Many Dr’s avoid primary care because it’s hard to be the jack of all trades and the master of none. And the reimbursement sucks. And the paperwork is unconscionable. And more. Plus if you’re a specialist and do procedures you get paid more the more of them you do. Duh. So no one is really taking care of the whole patient, they’re just shoving their tube in their orifice of expertise.
But I also have a serious problem with patients’ expectations. Everyone wants more health and more testing and more access. What happened to common sense? When a dying demented person is admitted to the hospital the institution takes over to some degree. The nurses want the patient to be quiet and not too much bother (sorry but it’s true). The Dr’s dread the sad and often angry family who wants their loved one not to suffer and it’s up to us to FIX IT. And it’s not unusual to have several family factions who want different things and we get caught in the middle. Hospitals are terrible places for the dying and one of these health bills will also have provisions for expanding hospice care.
That would be worth a lot. I can attest that hospice is probably one of the most cost-effective, as well as compassionate, things you could do. It only kicks in when there is a condition that is incurable and eventually fatal. Heroic, expensive, and futile efforts are over or have been forsworn. They will leave no stone unturned when it comes to physical and emotional comfort, but that is mostly low-tech and relatively low-cost. SAVING is the word. It won’t save your life, but it can save money and it can save your sanity. It minimizes both expense and suffering.
Phone Store Hell, Part Deux [UPDATED]
J was sleeping soundly yesterday evening, so on my way to get milk and eggs at Whole Foods, on a side trip I darted into the AT&T phone store to switch out my defective phone. (This is the crappy model that cost $1 to make somewhere offshore, for which they charge $29.99; the “Select” button would scroll instead of select — I’d pick a ringtone, press “Select,” and it would go to the next one. I’d also have to make several tries to unlock the keypad.) All three cash registers were busy, but I managed to get a floating floor rep to cut in on one during long negotiations between another rep and a customer.
While I was waiting (the state sales tax percentage had apparently changed in the past month, making the swap mathematically challenging), I read, upside down, a printout on the service podium that was titled, I kid you not, TRIAGE. It was a script, detailing word for word how to elicit, massage, and shepherd the customer’s concerns. [wording approximate] “I understand that you are frustrated with your phone. If I can’t help you with that, I’ll connect you with someone who can.” “While you’re waiting for your [product], why don’t you take a look at this one?”
He told me I didn’t have to return the box to avoid the $35 “restocking fee,” but I did have to try one more time with the same model phone. No upgrade without punishment for having been a cheapskate the first time. I felt as if I’d married the damn phone, had gone in for an annulment on the grounds that it had misrepresented itself, and was getting marriage counseling instead.
He told me it’s a very good model and they’d never had this problem with it before. (He acknowledged that he himself had the problem when trying to work the phone.) He switched the SIM card into an identical model and, all in all, the transaction with wait time only took about half an hour. (I wondered if J was freaking out and slinging his leg over the bed railing. It can happen if I’m gone for more than half an hour. I had set up the old-fashioned corded phone for him — he doesn’t understand the cordless — but was afraid to call him because I’d put the phone in the bed beside his hip, the only place it would fit, and there was a good chance he wouldn’t be able to figure out where it was and would then freak out, if he hadn’t before. Fortunately, he was fine this time.)
When I got home I forgot to plug the phone in immediately. I’m not that into cell phones, brain tumors, etc. So maybe what happened next is my fault.
When it started peeping piteously this morning, begging for juice, I plugged it in and it immediately said, “SmartChip registration failed.”
I called the local-looking number below the store address on the receipt. Ten minutes of phone tree later, I was talking to someone in India. I hung up.
Maybe that was a mistake. Maybe the guy in India, reading from his own TRIAGE script, would have held my hand and guided me through taking the SIM card out and putting it back in. Maybe he could have sent it a remote signal all the way from Bangalore that would have straightened it up.
I just had this sinking feeling that after another half hour on the phone, he was going to send me back to phone store hell.
UPDATE: Theologically corrected, per Ruth Anne: phone store purgatory.
As I wrote in the comments: “I went over to the phone store. The guy turned the phone off, turned it back on again, and it worked. The guy on the phone in India could’ve told me that. This one was from India, too. Those guys from India are smart!”
I spoke too soon.
I got it home, and the first time I tried to do something with it, it said again, “Smart Chip Registration Failed.”
Scientific Fact, Fiction & Repression [Updated]
Debate about global warming is likely to heat up in the next few days, and not just because the Copenhagen conference is about to begin. Someone hacked into the file server at the prestigious University of East Anglia Climate Research Unit and secured thousands of files and emails dating back to 1999 and then uploaded them to an anonymous FTP server.
Start reading here at the Air Vent, one of the blogs that broke this story.
Then here. (Intimidation and retribution – that’s the ticket!)
And here. (Paranoia or preemption? – Shoot first! Ask questions later!)
And here. (When the data doesn’t fit – Massage it! Hide it! Deny it!)
Examiner.com has been covering this as well. My favorite quote thus far is the one they selected:
One such e-mail makes references to the famous “hockey-stick” graph published by Mann in the journal Nature:
I’ve just completed Mike’s Nature trick of adding in the real temps to each series for the last 20 years (ie from 1981 onwards) amd from 1961 for Keith’s to hide the decline. Mike’s series got the annual land and marine values while the other two got April-Sept for NH land N of 20N. The latter two are real for 1999, while the estimate for 1999 for NH combined is +0.44C wrt 61-90. The Global estimate for 1999 with data through Oct is +0.35C cf. 0.57 for 1998.
[UPDATE:]
Bishop Hill has a good summary, with citations, of some of the most damaging emails discovered thus far in his post Climate cuttings 33. Much of this boils down to concerted, and seemingly successful, attempts to subvert legitimate Freedom of Information Act requests. Towards the bottom of the page, one of the commenters reprints an email sent after receipt of a FOIA request asking that all parties delete all emails referencing AR4, presumably so that they could reply that none exist.
Sarah on Oprah
I recorded “Oprah” today (because it was nuts here at that hour — ask Ron) to be able to watch Sarah Palin’s first book-blitz interview, late and out of sync with the whole culture as usual. I watched it this evening.
Here’s the crazy thing:
I liked her!
It surprised me, because earlier I’d been reading The Anchoress’s tweets, and they were wince, wince, wince. She talked too much here, she was too defensive and “rattled” there. I think I know exactly what Anchoress is going through, because I’m that way with Obama: wince, wince, wince. My family thinks I’ve become a right-winger who is looking for him to fail. Actually, I want him to succeed, but I can’t lie to myself that he’s succeeding when he isn’t. If anything, I’m hypersensitive to every time he’s less than felicitous and candid and brave. He’s from the same world I am, so I hold him to a mercilessly high standard. I want him to be so much better than he is. I want him to stop clinging to the teleprompter and the cheat sheet — why is he so afraid to speak extemporaneously? I want him to wean himself from voter adulation and political trimming and act on principle. I want him to have principles to act on. I want them to be firm and generous and embracingly American. I’m so relieved at those moments when he hits a good note and I can momentarily relax my rictus of anticipatory wince. I get a cramp in my face.
In contrast, I don’t need or expect anything particular from Sarah Palin. She doesn’t have to hold up my side. [Note that the “side” I share with Obama is, as I’ve often said, not the left but the worlds-traveler — cosmopolitan, chameleon, amphibian. Oh, and the ex-left — if only.] I don’t see her as a yokel or a political savior. I’m really kinda neutral on her. And from that perspective, I didn’t see any awful gaffes in her “Oprah” interview at all. I found her voice grating at times and I did wish she’d be less coy and evasive about whether she was running for president, but aren’t they all? Hillary, too. On the whole she seemed to me authentic (for a politician), guileless yet also shrewd in her own time signature — you can hear her marching to a different drummer than the interviewer, and therefore sometimes seeming off the beat or slow on the uptake — impulsive, but also grounded. She takes off in flights like a flustered pigeon, but then circles back home.
She didn’t seem extreme to me, either. It might have been a slip when she said Bristol’s pregnancy could have been a teaching moment on the perils of “unprotected sex.” Whoops! But if so, the slip that showed was realism, realness, common sense.
Is she qualified to be president of the United States? Trick question: what are the qualifications, and how many presidents were short a few? Did she abort her developing qualification by resigning as governor? Maybe. It was a big risk to take, in particular a risk of making it all about her as a personality instead of all about the office and the country — a cult of personality that threatens to become the mirror image of Obama’s. I agree with Camille Paglia that her qualification also “will depend on her willingness to hit the books at some point and absorb more information about international history and politics.” But her candidacy doesn’t strike me as the outlandish joke it seems to be even to some Republicans. The extreme caricaturing and mockery of her that goes on strikes me as much more outlandish than she is.
Ambiance 