High Gas Prices

OK, I can’t stand this. Once again the price of gas skyrockets and all we can think about is “drill baby drill.” So drilling short term for petroleum and methane makes good sense for the economy, but long term petroleum is obviously a dead end. Natural gas is cheap and abundant. It’s a cheap abundant exploitable energy resource that the economy desperately needs, but long term we can do even better.

Like it or not, we are in competition with other potential super powers. We need to retain leadership not politically, militarily and wasting our resources, but economically and technologically. Whichever nation makes the transition to an advanced energy source or sources will dominate economically. Energy is, to a basic extent, a critical common infrastructure. That is, warmth and shelter remains a common need and must be affordable for all no matter the circumstances. So, energy must first and foremost be cheap, abundant and exploitable.
MIT has done marvelous research in developing an energy source analogous to the green leaf. It captures sunlight and converts water to hydrogen, oxygen and carbohydrate, removing CO² from the air. You can’t do much better than that, but you are still left with the problem of storing the H₂ and burning (oxidizing) it as a fuel.

The beauty of H₂ is its energy content. Hydrogen by weight contains more thermodynamic chemical energy (enthalpy) than any other element. That’s good, but the trouble is, at ambient temperatures hydrogen is a gas. As a gas, each molecule of H₂ occupies one cubic meter of space at normal temperature and pressure. The only way to store it in anything like a usable container is under enormous pressure or at a low enough temperature that it exists as a liquid. (-253^o C)

The MIT way of the leaf is a means of reducing water to hydrogen. That’s great, but hydrogen is already the most common element on earth. The trick is to get it into a concentrated and oxidizable state without all the cost and energy required to compress it or freeze it into a liquid. Is there another model in nature that does that with the efficiency of MIT’s green leaf?

As a matter of fact, there is. Animals do a fine job of storing hydrogen and converting it into energy. My first year medical students just got through their biochemistry exams, a course in which they learned about the carboxylic acid (Krebs) cycle and the conversion of ADP and ATP to muscle energy. It’s all about the mitochondria. The mitochondria store protons (single atoms of hydrogen, no longer a gas) in a chemical cascade that ends in water. The mitochondria are tiny but contain a great number of H ions; they are the animal’s furnace. Simply put, the animal ingests carbon based food, harvests out the hydrogen, stores it in the mitochondria and delivers energy on demand. The byproduct of oxidation is water and carbon in a solid form appropriate for fertilizer. The green leaf on the one side and the mitochondria on the other make up the biological cycle of reduction and oxidation, the life cycle of the planet.

Challengingly, we just need to figure out how to create big mechanized mitochondria that store protons in a form readily available for use --- the other half of the MIT project. Call it a proton drive. Ideally, the medium will be a liquid or a solid.

Intriguingly, one might dump garbage into a hopper, the device strips off the protons (hydrogen ions) and stores them in the artificial mitochondria and then burns them on demand to create electricity, heat or both, and out comes fertilizer and water on the other end.   

Political Insanity

The current challenge for the medical profession seems no different than what Hippocrates faced 4,540 years ago when he proposed the scientific method for health care as opposed to the mythology, rituals and disingenuous quacks of the day.

When Rick Santorum suggests that we should stop funding anti-natal care because it might lead to abortion, one wonders if there can be any political solution to our current medical care problems much less complete disaster. We already score a third world ranking by infant mortality, perinatal mortality or longevity. Can any polarized political mythology possibly make it better?

Greek Austerity

http://alphanow.thomsonreuters.com/2012/02/austerity-measures-take-bites-out-of-the-greek-economy/

The Republican platform pundents of austerity might take note of the experiment with Greek austerity.
This real-time experimental data tell it all. A notion cannot cut infrastructure enough to recover from over indetedness with a stagnent economy. The only solution is productivity and growth. That growth cannot happen with deflation.

Honda Civic Hybrid gas milage

Re: The class action suit

From my experience, this claim seems spurious. I have nothing to do with the plaintiff or the Honda Motor Company, but I do have extensive experience with my 2006 Honda Civic Hybrid with 64,200 mi in Alaska.

First, I still get 51mpg but only under ideal conditions. Ideal conditions are reasonable: summer driving, level smooth dry highway with little or no obstructing traffic or stops. It goes without saying that one must use the specified premium fuel and 0-20 weight oil preferably synthetic. In addition, tire pressure must be as specified or higher along with appropriate summer tires. Snow tires will not do it. The air dam must still be in place and the full-length aerodynamic pan beneath the undercarriage.  Wind resistance degrades milage severely above 55mph and with a headwind.

Secondly, the Honda gives me 50mpg under these conditions between 55 and 60 mph in summer driving. I get 47mpg if I push it to 65-70. Town driving yields 39-43 in the summer with the hill climb. I live on a 850 ft. hill which also degrades my milage going to town.

Alaska winter is another story. Most people fail to consider the increased horsepower and thus fuel consumption at colder temperatures.  The added power is noticeable and so is the higher fuel consumption. Rain, snow, gravel or ice degrades milage considerably as do winter tires, oversize tires and studs.  In winter, I will get 43 mpg highway and 35 mpg in town including the hill climb. These numbers are still achievable after the change in computer setting to preserve battery life.

 I do not consider this a failure to experience the published HCH milage at all but rather expected changes due to conditions.

yvette prieto: Breaking the Light Barrier

Thus far Michael Jordan holds the record for faster than light basketball defying all laws of physics to become an all time legend. Yvette Prieto may be Faster than Light 2 with her engagement to the Michael.

Meanwhile a less reported faster than light2 experiment threatens the same law of physics, namely the light barrier. As I understand it Einstein's equations are such that nothing can exceed the speed of light.

Some experiments can show that adjacent waves can propagate faster than light, but physicists argue that information or matter cannot travel that way. Quantum entanglement would seem to break the light barrier also. There again physicists argue against the phenomena; Einstein called it "spooky behavior at a distance."

Recently the OPERA experiment measured the speed of neutrinos between CERN in Geneva and Gran Sasso National Laboratory in L'Aquila, Italy, a distance of 730 k, at a speed faster than C, the speed of light. This claim was widely questioned with all sorts of doubting questions of error. However, on November 17 investigators repeated the experiment with even finer measuring devices confirming the earlier experiment.

Physicists still remain doubtful. The Fermilab in Batavia, Illinois plans an attempt to duplicate the results in early 2012.

From an aviation standpoint the light barrier looms as just one more challenge, as was the romantic conquest of the Michael -- and best to you both.

The links to the Nature blog are worth following.
http://www.nature.com/news/2011/111005/full/news.2011.575.html
http://www.nature.com/news/neutrino-experiment-replicates-faster-than-light-finding-1.9393

Yersinia pestis

A draft genome of Yersinia pestis from victims of the Black Death maps the genome from the plague of 1347-8. Researchers obtained DNA from the teeth of plague victims buried in a mass grave in East Smithfield, (originally the Churchyard of the Holly Trinity) near the Tower of London.

Alexander Yersin linked Y. pestis to bubonic plague in 1894. However, controversy and doubt exist over the identity of the plague organism in part because today’s plague does not match the virulence of the Black Death that ravaged Europe in the 1300s. The sequencing by an improved technique (molecular capture assay) apparently establishes that the organism of the Black Death is the same as today’s plague with minor differences.

The bubonic plague existed in Asia with appearances in the Middle East and the Justinian plague in Rome and Constantinople in 541-542. Hippocrates describes a plague in Athens in 430-426 BC. Sanskrit tablets describe plague in Asia as early as 600 BC. Jewish physicians even associated plague with rats in the Tara also about 600 BC. Neither ancient plague, nor modern plague, 19th century to the present time manifested the virulence and devastation of the Black Death of 1347.

The diversity of today’s plague in China suggests that the Far East may have been the reservoir with appearances in Europe carried down the Silk Road and through the Mediterranean by rats aboard ship. The configuration of large Phoenician trading ships may have further enabled the spread

Doubters question whether the plague prior to 1347 was even the same organism. One researcher suggests that the ancient plague in Athens was Salmonella. A look to the history of clinical medicine could end the controversy at least from a practical standpoint. The clinical acumen of Hippocrates in 450 BC was sufficient to distinguish Typhoid from the plague as well as small pox, malaria and TB. There may be historical confusion and laboratory doubt but the clinical picture of plague was and is so distinctive that physicians of that day should not have confused plague with other infections.

The issue of virulence in the case of the Black Death seems explainable by the minor differences in the genome then and now. It would be interesting to see which changes correlated with the change in virulence. With its rapid spread, Y. pestis had an ideal environment in which to evolve taking advantage of weaknesses in the host population. With that evolution, came increased virulence, which shortened the duration between onset and death. The shorter time of infectiousness inhibited the further spread of the epidemic. Thus, the epidemic faded away. Furthermore, the population at risk diminishes as those most susceptible to the infection die off leaving those with minor expositors and resulting mobilized immune systems -- and those with genetic resistance to the disease in the first place -- in greater numbers relative to the further spread of the disease.

One might further speculate that faced with a diminished population, it was to the organism's advantage to devolve into a less virulent form in order to give greater expositor to others and thus a greater chance of continuing its presence and preserving its DNA. I would suppose that process of devolving to be the mechanism of dormancy in China or elsewhere in East Asia.

I do not think that it would have been essential that Y. pestis devolve along the exact genetic lines that it used in achieving greater virulence. The change in strategy might explain the dichotomy in the sequencing of today’s Y. pestis DNA with that of ancient DNA.

My epidemiology professor speculated that the Black Death Y. pestis achieved a level of virulence in which it spread pneumatically, thus the name pneumonic plague. One might further imagine that with a pneumonic form, the cyanosis would turn the victim black in death.

If indeed the above considerations proves relevant, it would not be surprising to find today's Y. pestis devolved to a less virulent form than the Black Death which so devastated Europe.

http://www.nature.com/nature/journal/v478/n7370/full/478465a.html

Apology

Sorry, the blog went inactive when I moved my email. Network Solutions hosts my URL; they do a good job. I have been with them since 1994 without error, so I can find no fault. In fact I would recommend them highly.

Anyway I have been down for a couple of weeks without knowing it. I'm now up and running again  with lots to say about a lot of stuff.

Thanks for your patients,
Clancy Hughes

Cold Clouds and polar aviation, polar stratospheric clouds, PSCs

Otherwise known as polar stratospheric clouds, PSCs, these striking images occur at FL 360 to 720 in extreme arctic cold, around 195K (-78deg Centigrade). These cloud pictures result from particles in the atmosphere. They also warn of extreme cold weather altimeter error and now possible ozone holes in the Arctic.[1] I wonder what implications for military or commercial pilots flying a polar rout at these altitudes. I would think the military helmet visor with complete peripheral protection against infra red would be sufficient, never mind the cosmic. Airline captains might consider goggles with peripheral protection in place of sun glasses and possibly closing the passenger window shades. Look out for the mountains below. "The mountains grow taller in the winter in Alaska and the arctic!"

"Scientists recently discovered that polar stratospheric clouds, long known to play an important role in Antarctic ozone destruction, are occurring with increasing frequency in the Arctic. These high altitude clouds that form only at very low temperatures help destroy ozone in two ways—they provide a surface which converts benign forms of chlorine into reactive, ozone-destroying forms, and they remove nitrogen compounds that moderate the destructive impact of chlorine. In recent years the atmosphere above the Arctic has been colder than usual, and polar stratospheric clouds have lasted into the spring. As a result, ozone levels have been decreasing.[2
[2] NASA http://www.giss.nasa.gov/research/features/200402_tango/
[1] Nature 478, 469-475 (2011) Gloria l. Manney et al.
[3]Upper photo:http://www.nature.com/nature/journal/v478/n7370/full/478462a.html

What's Wrong with Medical Care

Book Review

John Wennberg's book, Tracking Medicine, a researcher's quest to understand health care, challenges anyone interested in health information technology or the Affordable Health Care Act to a `must read.` Wenneberg spent 40 years applying statistical analysis to the care given in various U.S. locations. Wennberg discovered an extreme variation in the manner and quantity of medical services rendered. He applied the science of epidemiology and statistics to understand these differences. What he found was a fundamental contradiction in the patterns of medical practice. These contradictions surprise and shock the medical establishment and others who believed that for healthcare more is better.
Patient satisfaction, outcome and longevity -- even in some teaching centers - proved inversely related to the intensity of medical, surgical and hospital services. Furthermore, Wennberg found that the greater the capacity of the facility and number of specialists per capita, the greater the intensity of care. Intriguingly, he found that providers were completely unaware of this variation. Present day Certificates of Need, required for expanding the number of hospital beds -- and in large measure many other provisions in the Affordable Health Care Act - indeed reflect much of Wennberg's research.
Wennberg together with the Dartmouth Institute of Health Policy and Clinical Practice proposed four policies to improve clinical medicine and quality. They suggested:

1. Organized local systems
2. Decreasing overtreatment by shared decision making between patient and doctor
3. Strengthening the science of health care delivery
4. Constraining undisciplined growth in health care capacity

Variation Capacity and Outcome

Striking variations in the frequency of certain surgeries occurred in adjacent communities. Tonsillectomies, prostatectomies and hysterectomies varied by large factors. The surgical rate varied in proportion to the number of beds and or surgeons per population. Wennberg called this phenomena "supply sensitive care." A consistent and validated inverse relationship existed between the oversupply of providers versus patient satisfaction and outcome. Chronic disease appeared to be the greatest problem wherein institutions provided high cost acute care -- Wennberg called it "rescue care" - while neglecting lower cost managed care by primary care physicians, patient involvement and patient education. An even greater expense associated with intensity of care, based on capacity appeared to place terminally ill patients in ICU often against their wishes but with the same terminal outcome.
Communities with a high number of specialists per capita experienced worse outcomes than populations with a constrained availability of care. This statistically validated phenomenon flew in the face of conventional wisdom and the belief that American hospitals are best and more is better. Controversial, to say the least, and argued by some of the most respected medical centers, the striking variation in treatment, the relation of excess care to capacity, and the surprising inverse relation of more care to poor outcome and poor patient satisfaction, remains a valid and highly reproducible statistic.

Reasons to reform:

1. Over reliance on rescue care
2. Acute care hospitals for chronic illness
3. Excessive capacity per population
4. The establishment of more skilled nursing facilities, outpatient, and home care has not reduced inpatient use, ICU, and a high tech death.
5. Over use will not go away - getting worse
6. Not just Medicare but private fee for service as well
7. Organized care does not reduce the over use of ICU
8. Cross market subsidy of insurance premiums; that is, low use areas of care pay equally with high use populations in effect subsidizes unnecessary care.
9. Increased co-pay in high use areas a burden on patients in these areas of overuse
10. Overuse equates to decreased life expectancy for the patient

Wennberg makes the point that organized care with shared savings may be able to "rationalize the black box of supply sensitive care." He advocated practice and hospital networks, but cautions that cost may not always decrease with decreased capacity due to cost shifting. He suggests that the major cost to Medicare and other insurance stems from ICU care for terminal patients. Wennberg believes that encouraging a patient's fully informed participation in medical decisions puts the brakes on overtreatment and is the way to reign in excessive and sometimes harmful care. Such participation, however, calls for a radical change in the culture of doctor patient interaction.
Wennberg's final list of remedies

1. Fully informed participation of patient in decision
2. Constrain spending on supply sensitive care
3. Constrain preference sensitive surgery
4. Decrease the number of doctors, specialists and hospital capacity.
5. Adjust insurance premiums by local area spending
6. Feedback of information about practice variation, tracking both the variation and outcome

Wennberg particularly likes the provision in the Patient Protection and Affordable Care Act of 3/2010 specifying an Innovation Center within Centers for Medicare and Medicaid. His final suggestion cautions not to train primary care physicians in centers failing to limit overuse and patient choice if the primary care physicians are to become skilled in coordinating care.
John E. Wennberg, M.D. Peggy Y. Thomson Professor (Chair) for the Evaluative Clinical Sciences, Professor of Community and Family Medicine (Epidemiology) and of Medicine Department of Community and Family Medicine and The Dartmouth Institute for Health Policy and Clinical Practice Educated Mc Gill University, MD 1961 Johns Hopkins School of Hygiene and Public Health, MPH 1966

------------------------------------

This book makes a huge contribution to our understanding of the problems with US medical care. The statistics speak for themselves. They fly in the face of conventional wisdom of providers, well-meaning planners and patients' families many of whom take exception to some of the end of life research, proposed in the Affordable Care Act.

I am not a statistician, but I was a primary care clinician and manager of an efficient primary care clinic. I managed other physicians and consultants, -- not an easy task -- and I wrestled with the contentious changes that took place in the late 80s and early 90s. As such and with considerable time to think it over, I suggest that many more problems plague our health care delivery system, problems that need validation and in some case adjudication. While I am enthusiastic about reform and much of the good in the plan, I am not at all certain that the Affordable Health Care Act solves all of these problems.

For example, let me list some of the problems that seem largely overlooked:
1. The US ranks embarrassingly low in all measure of public health statistics among industrialized nations. The U.S. ranks 37th in Life Expectancy and 46th in Infant Mortality Why might that be an important issue for the CIA?
2. We pay little attention to European health care systems all of which seem to be out performing our own
3. The well-established routine of increasing usual and customary fees to an ever higher and higher level to offset the discounted reimbursements, to both hospitals and physicians
4. The uninsured receiving all of their health care in the emergency room, because the ER cannot refuse care - widely acknowledged to be the most expensive form of medical delivery.
5. Hospital charges spiraling higher and higher due to the above
6. HMOs requiring referral only to the HMO listed specialists who are much less qualified, as a rule, than specialists referred to by the primary care doctor and who due to their abilities do not need the problems of contracting with an HMO.
7. The extreme discrepancy between primary care reimbursement and specialist reimbursement, which has lead to a dearth of primary care physicians and an overabundance of specialists
8. The very high liability insurance premium paid in advance by all providers but especially by the high risk surgical specialties
9. The difficulty for treating physicians to access current medical terminology, criteria of diagnosis etc at the time of patient contact
10. The expense of journals, CME and even Internet access to current medical journal articles
11. The increased competitive capacity and less scientific medicine engendered by patients migration to alternative medicine, alternative practitioners, autonomous physician extenders etc. decisions often based on the attraction of lower cost and in some cases a desire to return to nature. (Natural childbirth at home without anti natal care might be an example)
12. The abuses of drug companies: outrageously high prices -- semi-fraudulent re-patenting of popular drugs, who's patent is expiring, in order to extend their high prices and keep these products out of the generic drug market
13. The failure of insurance companies to provide a demand side restraint on healthcare coast thus enriching their own revenue with ever higher premiums
14. The characterization of medicine as a business and a free market rather than as a profession and a critical infrastructure
15. Using the threat of antitrust action, Health and Human Services and Hospital administrators, CEOs ended the local medical societies ability to censure its members and hold accountable member's behavior both in and out of the hospital.
16. The loss of medical society input in hospital staff credentialing and privileges
17. Medical conditions, which fall outside the prevue of the specialist or between specialties leads to missed diagnosies.
18. The inaccuracy of reported medical diagnosis, thus a corruption of the data base leading to erroneous statistical analysis and attempts to draw conclusions from insurance reports
19. Misdiagnosis resulting in protracted illness or worse
20. The requirement for a qualifying diagnosis to justify a laboratory test
21. Excessive CAT scans may be in part economically motivated and driven by malpractice law suits while sadly delivering excessive radiation exposure
22. The C-section rate and a continuing high hysterectomy rate
23. The poor distribution of physicians in relation to population Physicians migrate to attractive geographic locations with per capita income and amenities
24. General lack of Clinical Pathological Conferences, CPC or Morbidity and Mortality, M&M conferences, (except in major teaching hospitals and medical schools)
25. Rare or nonexistent autopsies We once judged hospitals by their autopsy rate. The autopsy and the CPC accounted for much of our past glory of U.S. scientific medicine. The risk of lawsuits based on autopsy and CPCs, although protected in theory, may be a factor.
26. Does not address the patient's unhealthy attitude towards self-care whilst demanding a pill or a procedure to bail him or her out of an unsustainable life style
27. Government takes a punitive rather than educational approach to regulation of the system

Greed dominates the healthcare economy, not so much by mainstream providers as by an opportunistic periphery, a tsunami of players entering the Health Care industry to take advantage of its commercialization. Health Care is not a Free Market! It is a profession and vital U.S. infrastructure. Opportunists view the health care industry as free money from Medicare and by much of the enabling health insurance industry, free money that comes out of the taxpayer's pocket, as a hidden tax on employers, or persons seeking to protect themselves with individual health insurance.
The Patient Protection & Affordable Health Care Act strives to eliminate many of the insurance abuses. However, we continue to interdict access to the big dollars by policing access but the core issue is no different from the flow of illegal drugs from Mexico and South America. The drug producing countries are not the problem - America's appetite for illegal drugs is the problem. In medicine, all of the above crises are indicative of the greed and mentality of entitlement that drives them.

Punitive efforts to curtail overtreatment and abuses of the system paradoxically enable and promote the greed by gaming around the regulations. Solving any of these problems requires a change in both the culture of Medicaine and the culture of Regulation - in favor of graduate education, information technology and a commitment to excellence. A public option by the states, run by the state's medical schools in partnership with Public health with salaried physicians run in competition with traditional fee-for-service may be the best way to get there. A serious look at European Health Care systems may tell us what works. I suspect it will require a major reeducation of our population in healthy life styles. Infant mortality will be a useful barometer to measure progress.

"The commission -- created by President Obama to address America's fiscal challenges -- predicted that, by 2035, federal outlays for Medicare, Medicaid, the Children's Health Insurance Program, and the health insurance exchange subsidies will account for 10 percent of U.S. gross domestic product (GDP), up from 6 percent in 2010.... If historical rates of growth continue, U.S. spending on health care from all sectors... will surpass 20 percent of GDP within five years and eat up the entire GDP by 2082...something... dramatic will have to happen between now and then..."[1]

---

[1] Rand, James A. Thompson

Corporate Taxes, the unintended consequences

Why do I keep writing economics? Nobody's listening. What do I know anyway? In one way knowing is living through it. That's the economics of the street.

An observation anyway: the higher than the rest of the world corporate tax structure in the US (35%) introduces two unintended consequences. One, a corporation including its officers can retain more of their collective income by paying sky-high bonuses thus reducing corporate income, that is, providing the officer's tax rate is substantially lower than the corporation's tax rate. Given a corporate tax rate of 35% that would be a probability. The solution would be to lower corporate tax levels below those of the executive officers, vise versa or a combination of both.

Sequestering foreign revenue from overseas factories in overseas accounts retains more of the corporate earnings whilst enjoying overseas tax rates far below our own. The corporation finds no way to bring those earnings back home, so if invested at all, the earnings are invested outside the US. The solution would seem to be a lower US tax rate than the foreign tax rate. It would not hurt to give a one time tax exemption for corporations to bring their earnings home.

Is there any wonder?

Cloud Computing for Medical Record

How will cloud computing accommodate confidentiality and permissions to use the data for data mining?
Assuming it can, the thing most needed is a linked database containing a complete and continuously updated list of every disease and syndrome known to man. Thus any provisional diagnosis or problem could in real time list every related entity (differential diagnosis) meeting the same of similar basic criteria. The inaccuracy of initial diagnosis remains an ongoing problem in US medicine, 15-17% missed or wrong diagnosis by current studies. A statistically derived differential diagnosis would go a long way towards inducing the clinician to look for possible error or deeper consideration.