Hughesair (Inflection Point)

Retired physician and air taxi operator, science writer and part time assistant professor, these editorials cover a wide range of topics. Mostly non political, mostly true, I write more from experience than from research and more from science than convention. Subjects cover medicine, Alaska aviation, economics, technology and an occasional book review. The Floatplane book is out there. I am currently working on Hippocrates a Fanciful History of Medicine and Death of the Middleclass. Enjoy!


Tuesday, July 03, 2018

Next Disruptive Technology

Beyond technology and beyond medical, CRISPR DNA error correcting applications promise the most profound advancement in curing disease since the advent of molecular medicine. If you are looking for the next greatest thing, here it is. The three cutting edge equities carrying forward the research and early clinical trials, I call them the Three Amigos, already show double and triple fidget growth: Crispr Therapeutics, CRSP; Intellia Therapeutics, ITLA; and Editas Medicine, EDIT.

Monday, June 18, 2018

Trade War

Political economists cry the sky is falling. The stock market shrugs it off, so what can we expect from our imposition of tariffs?
To understand what’s at stake, consider 20 years of unsustainable trade deficits of up to 800 billion a year and beyond stripping the consumer market liquidity not to mention jobs and manufacturing. These same political economists say, the deficit does not matter; we make it up with low cost imports and greater efficiency overall — globally yes but not for us. Greater foreign investment back into the US, less by our adverceries, go all to the oligarchs, but forget all that, what will higher tariffs do to the economy that most of live in?
Short term, expect some dramatically higher prices and stress on US export businesses, mostly the big guys but some small business and farmers with an equally dramatic increase in government revenue from the tariffs. Job creation might be equally dramatic, and the results are probably inflationary.
Mid term and long term, however should see an equally dramatic flood of liquidity back into the consumer market. With the scramble to meet consumer demand with locally manufactured goods and services the energy level should be high as well. Liquidity and energy, turnover of discretionary capital, are the driving forces of the economy. History bears this out.
Furthermore tariffs are not forever. If  used to achieve balance and fairness, relaxation can follow.
Lastly, we can’t loose. We have been providing capital to the developing world. There will never be a thinks, but there is no choice, lest our democracy morph into an oligarchy and we become a third world nation.

Wednesday, May 30, 2018

Med Chest

Chest Physicians and their Thorasic Surgery counterparts, once the backbone of medical care, now displaced by Radiologists with their CT scans and needles, Cardiologists with their catheters, Pulmonologists with their respirators and Allergists with their skin tests, nonetheless remain the Super Physicians of our day. These are the long coats with a rose in the lapel or the physician who still wears a tie and does not have a stethoscope around his or her neck. If you need help, physician or patient, you would do well to find one, at least for a consultation. (Opinion)

Wednesday, May 09, 2018


As you might guess, hospitals in Alaska face a greater challenge keeping up with medical science and maintaining quality of care. Yesterday at a chamber of commerce luncheon, I listened to the Borough Mayer entheuse over his plans to promote greater cooperation between the two hospitals, both of which are partially owned by the Borough with an independent nonprofit operating board. Would a merger reduce costs, patient charges and improve quality of care?

Almost everything government has done increased healthcare cost, charges to the patients and arguably reduced quality of care. Until and unless the medical profession recaptures it’s leadership and control over health care that pattern is not likely to change. Medicine struggled for centuries with harsh control and manipulation by religion. It was only through the reemergence of Roman law and law schools established alongside medical schools that medicine was able to loosen the yoke of religious dictum.

In an effort to curtail costs, government imposed certificate of need on the building of hospitals and the addition of hospital beds with the theory that fewer beds would result in lower cost and fewer hospital days. Rather than lowering costs, the price to the patient for a day in the hospital went from a reasonable price approximating a day in a hotel to a thousand dollars or more, an unintended monopoly

The next great idea was with reimbursement. Called a DRG, Medicare now reimburses hospitalized patients, so much per diagnosis, so come what may, the hospital receives only so much for an admission based on the diagnosis no matter the care. Furthermore the amount of the reimbursement depends on a percentage of the usual and customary charges. Obviously usual and customary charges were exaggerated in anticipating a better reimbursement. Reacting to these higher charges, Medicare tried to make it a federal offense to discount charges to patients making certain hospitals actually collected these padded charges. Hospital administrators willingly complied because the reimbursement would be only a high fraction of the average charge, a heavy burden to the uninsured or privately insured patient.

Non profit hospitals are indeed nonprofit corporations. As with all corporations, their primary motive is sustainability and profit, not on the books but in the operating budget and management pay. Nurses were forced to unionize, now an almost universal reality, and administrators merged into CEOs with million dollar salaries. How did this happen? Look no further than the American Hospital Association, an exclusive club of hospital CEOs.

Will merging two competing hospitals reduce cost, reduce charges to patients and improve patient care? I don’t think so, monopoly is monopoly. Good medicine is not a business.

Saturday, March 24, 2018

Tariffs, the Argument Against

In the world of Globalism,  tariffs must not exist, they must be hidden and indeed they are. The US for 2017 averages a 1.3% tariff which is not reported in the Daily Treasury Report, DTR. The argument against tariffs comes from all sides, but sounds more political than statistical or historic. In an ideal world, trade would be fair and balanced and yield greater economic gain for all sides. The argument continues that a trade war would cost consumers far more for products, and the jobs gained would cost far more than the economic benefit from jobs gained. Economists, academics, the media and big business all advance this argument that tariffs are categorically bad and bad for the economy, and a trade war will be bad for all of us. China has beat us in a trade war for decades. Could it get worse?

Few numbers support the argument against tariffs, other than an elaborate estimate of the exorbinant economic cost of saving a single job, but you must ask, what is a single life worth? The cost of unemployment to the tax payer runs far beyond the value of the job lost, and with families, that lost job has a multiplying effect. Furthermore, the economic loss resulting from a tariff falls all to the supply side, to the companies that exploit cheap foreign labor and move manufacturing abroad while the benefits fall entirely to the market side, increasing both the market liquidity and the GDP. The purchase of imported goods detracts from the GDP whilst the purchase of American made goods adds to the GDP. There must also be some considerable value in moving sequestered capital from the overly wealthy supply side to the market side, a redistribution that is hard to achieve in an otherwise equitable way.

Critics insist upon a harmful effect to the overal economy and people as the total population, yet tariffs have a long US history exercised at many average percentage levels. When you line up the tariff rats along side of th GDP that harmful effect is not evident; in fact, some would say the opposite.

Interesting times, the teriffs will play out one way or another and we will see.

Friday, March 16, 2018

White Coat Cerimonary for Medical Students

Medical schools are now handing out white coats to freshman medical students, far too early inn my opinion, but liberal education reform, not suprisiny, takes the position that you don’t have to know anything. Traditionally white coats came after two years of intensive basic science including pathology, before moving on to patient care. Be that as it may, along with the oath, the white coat ceremony brings tears to the eyes of both students and parents, many of whom are Physicians.

Alumni Physicians donate many of the white coats, as I do every year. I cannot resist including a card with parental admonitions to wit, be first of all a scientist and humanist, the business will take care of itself. Do the PhD rout to a degreee, study genetics, don’t wear your stethoscope around your neck unless you are in scrubs and then you don’t need it - but learn how to use it, don’t talk medicine in the elevator unless you are alone and most of all keep the faith.

Monday, November 20, 2017

Daily Treasury Statement

This tip alone is more than worth the price of the book. However, readers who follow my blog, have heard it before. It's a matter of  market liquidity. The daily tax revenue acts as a fairly reliable proxy for expansion and contraction of disposable income. To be sure, one must consider the number of IPOs, stock buy backs, accusations and mergers thus taking into account extraneous market events. However, the most recent two or three days of treasury receipts compared with the same dates the year before, usually correlates surprisingly well with current market movement. Some would look at just one day; unfortunately the most re cent day posted will always be a day or two old.
Go to: / current statement, pick PDFs, scroll down to the bottom and find on the left, three boxes of total receipts, daily monthly and year to date. Write these numbers down with the date along with, on the right and up a bit the current day's national debt.
Now return to the starting page and find Archive under Current. Choose Archive, select the prior year and the relevant quarter and look for the same month and day as the current report. Note, last year comes a day of the week earlier; use the date rather than the day. Open the PDFs and copy down the same numbers as previously copied on the current. Now calculate the percentage differences. Again as a prediction of stock market movement, the daily year over percentage may predict tomorrow's market strength. Of course this will not always work; it's just a statistic, but it is frosting on the cake if you are already in the market and know what's going on.
As a bonus, looking at the increase in National debt year over, and comparing that with the year to date revenue demonstrates in exact terms the success, or lack thereof, of government economic policies, not withstanding certain unavoidable enviromental disasters.

Wednesday, July 05, 2017

0.3 degrees Centagrade

Can you imagine the energy released by warming the atmosphere only 0.3 degrees Centegrade? If that small increase in temperature effected only the top one centemeter of the ocean surface -- i ran a quick calculation based on "1 calorie is the energy from heating 1 ml of water 1 degree C." -- it looks like the equivelent of 11,000 Hiroshima size nuclear bombs, no wonder the vicious storms.

The oceans cover 510 x 10 to the 6 square kilometers.
The Hiroshima bomb was aproximately equivelent to 15 kt of TNT ( 1 kt TNT = 10 to the 12 calories.)
Please check my numbers; ther's a lot of zeros.

Wednesday, March 22, 2017

Fatal Crash Ketchikan

NTSB reports the 2015 crash in South East that killed 9 sight seers from Holland American Lines as controlled flight into terrain, indeed it was controlled flight first into instrument conditions.  There was plenty of blame all around. The pilot age 64 had 1200 Alaska hours and a reputation for caution. but flew an Otter into the mountainside near Ella Narrows, Misty Fjords and Ketchikan.

There were several issues. This was a part 135 operation. The mantra for part 135 is 500 and 2, that is 500 feet clear of clouds or terrain and 2 miles visibility. There was no way given the photograph and fatal outcome that this basic regulation, meant to insure minimum passenger safety, was even partially followed. The radar altimeter was found to be shut off, with the explanation that pilots frequently disable the device because it makes a frequent noise that frightens passengers. If the warning device was set at 500', that alone would confirm the disregard of the basic flight limitation for this level of commercial flying. Ah, but this is Alaska, home of the dare devil bush pilot where Lodge pilots, not limited by the Part 135 restrictions routinely brag about flight where overcast is "down to the grass." At 64, the pilot was a bit of an oddity with only 1200 Alaska hours, maybe he was a retired airline pilot. Airline pilots are accustomed to fling high, fast, in the system and on auto pilot. Mountain flying, low and slow under the scud is new to them. That may account for reports of his poor adaptation to down drafts and "misty conditions." More than anything this was a human factors disaster on multiple levels. Additionally 1200 hours may be a time when pilots gain some elementary level of confidence about Alaska flying which can easily turn into relaxation and over confidence. Then one sees others doing it, and one is tempted too. So much for the pilot, he paid the price. This was his third flight of the day, flight time and fatigue may have played a role as well.

Unfortunately, the blame does not stop there. The weather reports are not much better than in the 1940s. NWS still reports weather in the acronyms and hieroglyphics understandable only by themselves and pilots in a flight service briefing or on the ground. Add to that the US compliance with international weather terminology reports temperature and due-point in Centigrade whole numbers, numbers representing a wider value than Fahrenheit. NWS should report the temperature due-point spread with a decimal point to the tenth, so as to more finely describe the amount of visible moisture in the air. Furthermore, and for the same reasoning, WS reports low clouds and fog as mist, with a criteria that offers an excuse to fly into mist considering mist not to violate the 500 and 2 rule. In this tragic fatality weather service bears a significant blame due to its own reporting criteria.

Not to be left out, the FAA bears a significant responsibility. For one, they have left Alaska in the dark ages of aviation with primitive third world airfields, little or no support for float or seaplane operation, and in their twice a year inspections, the PI fails to contain the local convention of routinely violating the most basic part 135 rules. Furthermore, FAA is blind to the need for Alaska pilots flying in conditions prone to whiteout and sudden precipitation of fog over a massive area to be IFR certified and current whether their aircraft is or not. The FAA approaches IFR for air taxi operations is just say no. By saying no, as if saying no the FAA will eliminate the high likelihood that 135 pilots will encounter unintended and unavoidable instrument meteorological conditions.  When mist turns into a solid fog bank or suddenly dense cloud cover, there is no way to go except up, way up. Just last week a young  man failed to survive his vertical landing near Nome because he was not instrument capable. Instrument flying is not rocket science, in fact it is very basic.

Not so basic is a particular advanced IFR maneuver from the RAF. The Chandelle will get you turned around given enough maneuvering room; however, the Ella Narrows are apparently extremely narrow, severely limiting the pilots ability to just turn around. In discussing this issue this morning with another retired 135 pilot, I recalled having learned an IFR maneuver that was perfected by the British for bombing German installations at the head of Norwegian fjords. The Brits made use of twin engine Spit Fire bombers to run in low under the cloud cover targeting the enemy facility at the head of the fjord right in the face of the steep glacier wall. The pilots would drop their bombs and immediately climb up into the cloud cover, full power, steep to the stall point, then executing a coordinated turn to the left - always to the left, still full power, dropping off to a reciprocal heading while remaining in clouds, thus executing a 180 with minimum lateral displacement, IFR in the clouds until out of anti aircraft range. I was taught this maneuver (IFR) in an A36, by one of the owners of the aircraft as a safety measure for dealing with accidental controlled flight into instrument conditions in the mountains. The maneuver somewhat resembles the lazy 8 but much steeper and a bit more abrupt, scary in concept but easy to do, at least in the A 36, I don't know about an Otter. The stall characteristics might be a bit less forgiving -- would sure scare the passengers.

The FAA once allowed 15 minutes of IFR if visual flight rules when VFR could be had within the 15 minutes on departure and the same upon arrival in event weather changed in-rout. It now requires an extensively equipped aircraft, more extensive than needed when used only for emergency or potential emergency.

The operator in Ketchikan must be saddened, but cannot claim complete innocence or ignorance. One hopes there was not a financial motive for pressing the limits. The report mentions some significant training shortcomings and surely dispatch has a duty to red-line flights due to weather if indeed the owner or chief pilot is not available. The ultimate responsibility rests with the pilot but in a multi pilot operation, there needs to be a chief.

Time spent on the ground due to weather is not counted against your life.  Please consider these comment as generic and thought provoking, I have no personal knowledge of the incident nor the terrain in question and defer any judgement to the NTSB and their superb capability and analysis.



Sunday, February 12, 2017

The Big Fix

It remains to be seen whether or not the new Administration and Legislature will/can fix the economy.

Ever since Thomas Piketty's work, economists have grasp the meaning of accumulated capital as the cause of recurrent depressions, Simply put, the accumulation of wealth in the hands of the 1% and the 0.1% -- an accumulation of capital, some 6 times greater than National Income -- denies liquidity in the consumer market, which is nearly everything. A historical truth, the hoarding of wealth exactly correlates with the great depressions of the past; furthermore, relief, redistribution, came only in the form of revolution, war, pestilence - the plague was the great equalizer - or depression itself. These disastrous redistributing events correlate also with subsequent resumption of productivity, economic vigor, growth and consumerism.

The solution to redistribution, however, remains a modern day challenge. If the government somehow confiscates the wealth, would we trust them to redistribute it back into the consumer economy? One economist suggested in his lectures, dropping money from a helicopter.

Thomas Piketty, Capital in the Twenty-First Century, proposes a global tax on capital. In truth, we could never expect that level of cooperation, and who could we trust? We can't even trust our own government not to spend it on themselves. Tax is a bad word, so two problem: how to capture the sequestered wealth and how to distribute it. It's like a game of Monopoly, 6 hotels on Board Walk, everyone broke, game over. Speculation follows:

1.Thomas Paine in his book Agrarian Justice, suggested that every person has an equal right to the natural unimproved land and thus deserves a rent for the titled and improved use of that land during each person's lifetime -- makes sense. Thomas Paine if you have not done so, deserves a careful read, ("These are the times that try men's soles, etc." articulating the argument for equality and the American Revolution.) Paine outlines a system for collecting rent from property owners, deposited in banks, accounted for and distributed to every person during their lifetime, property rent, not property tax, thus redistributing capital equitably while avoiding the capriciousness of legislators attempting to, balance the budget after the fact, and the popular resistance to taxation.

2. Social Security struggles as a pay as you go (PAYGO) system, but if funded -- something like the Alaska Permanent Fund -- it would grow at the rate of capital growth, historically 5 or 6 times the rate of National Income and provide an equitable distribution of capital earnings. A funded Social Security could be far more generous, thus shifting capital into the hands of the consumer market and affording greater support for those who need it most including seniors. One might load such a fund through fees assigned to large financial holdings in the hedge funds and shadow banking's trillions. fees rather than tax, once funded it would be self sustaining. Capital growth is far greater than income. One might further prevent a raid on such a fund by removing it from the control of congress and placing it under the judicial system, judicial for protection of the constitutional amendment necessary to establish funded Social Security.

3. Free mandatory education to the age of 21 accomplishes not only an equitable distribution of capital but a game changer for a declining culture. It's nice to think globally, but at the end of the day, if we are to leave anything at all to our children we need to clean up our act here at home. Education probably offers the greatest return for the dollar in terms of driving growth. Furthermore, education to y21 will drastically reduce the unemployment by putting the unemployed back in school regardless of age and putting unemployed youth back in school and better preparing them for the high tech jobs of the future.

4. There are 3.4 million homeless, coincidentally, approximately the number of empty foreclosed homes. One forth of the homeless are veterans, and this is not counting the number of persons living in their cars and trailers. The banks carry the empty homes on their books at full value, not fair. A radical and somewhat dangerous solution might be to judiciously declare the foreclosed mortgages fraudulent restoring the titles to the former owners free and clear. This humanitarian act alone would transfer an enormous ill gained wealth back into the consumer market not to mention restoring housing to massive numbers of people. --- Great care would be needed to separate the investment banking capital from commercial deposits, not to trigger a run on the banks and failure of the commercial banking along with the investment side, doing so in such a way as to allow the investment losses not to affect the consumer side, the taxpayer or require government bailouts.
Commercial banking may once more need to separate from investment banking; there are many additional reasons.

5. Tariff should not be a bad word; it can fund a massive re-capture of capital and allow underdeveloped countries, that have no other source of revenue, to tax imports as well. OK, free trade, but balanced trade, otherwise it amounts to Colonialism. OK, let's also tax the obscene salaries of CEOs and add a high inheritance tax as well. According to Piketty a progressive tax rate above 50% correlates historically with a lower capital to income ratio and greater economic growth.

With enormous wealth, comes enormous power, much of it is used to rig the system, manage perception, the media, political correctness, a legal and environmental structure that furthers the Oligarchy. Globalization is Colonialism by a different name, and we are the colonists, the exploited. Furthermore,  free movement of labor into our country reduces the standard of living within our borders, adding to the exploitation and concentration of wealth -- a return full circle to the class divide of per-revolutionary Europe.

Again, redistribution happened naturally though not painlessly during WWI, the Great Depression and WWII. One way or another redistribution will happen; it will be painful, and nothing less than civilization is at stake.