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!

Alaska Floatplane: NOW EXCLUSIVELY AVAILABLE ON KINDLE

Sunday, August 07, 2016

Trade Deficit

To burry one's head in the sands and say all is well in this best of all possible nations is part of the political correct thinking that got us were in the first place. Tha June trade deficit, just announced comes I at 44.5 billion dollars on imports of 227.7 billion and exports of 183.2 billion. Annualized that amounts to a growing half a trillion a year. What has that got to do with the economy you ask? The media continues to insist the deficit is made up by the cheaper superior imported goods and services, but the evidence says otherwise. China's military buildup, investment banking and multinational corporations are the only beneficiaries of the deficit, not the American people. Every purchase of an imported product or service subtracts from our GDP. The GDP is the better measure of our economy, not the stock market. Economists still argue over supply side versus demand side economics. In our depressed state, the only supply and demand are China and sad shoppers at Walmart.

Free trade has some benefits: it stabilizes relations between quarlsom neighbors and it increases efficiency in a free market among more or less equal trading partners. The theory first advanced by Adam Smith in his "Wealth of Nations," compared balance of trade as a producer of wealth with Smith's theory of free trade. Published in 1776 when colonialism provided abundant cheap resources and plunder, free trade thrived between large and small colonial empires with positive results for the empires, not so much for the colonies, one of the reasons we sought our own independence. 

On the other hand, today's free trade has become a means for multinationals to exploit cheap foreign labor moving US manufacturing, the only source of wealth in Adam Smith's world, to the cheapest and most receptive foreign environment, taking American jobs and the revenue from sales with them, a new form of colonialism in which we are the exploited.

Unfortunately, both political parties support the continuation of this failed experiment, the Democrats out of a sense of Utopian idealism and the Republicans out of a sense that unbridled self interest in everything economic, unregulated and privatized, results in the higher order of good, strengthened by the struggle between communism and freedom. Paradoxically both polarized political doctrines combine to perpetuate this unsustainable fantasy that the trade deficit is overall a good thing. 

Furthermore, politics as usual now swallows up the true reality articulated by both contrarian candidates -- in the primaries -- while economists still argue over supply side economics. The American people are screaming for a solution; they see problem, the well paid politicians, and media do not. Tariffs would impose an immediate solution, raining in the multinationals and the continuing loss of wealth but with unstabilizing consequences, necessitating greater security measures and a massive rebuilding of both infrastructure, manufacturing and business.

If Ireland can do it, so can we. Ireland reports a 26% growth in GDP with a big trade surplus.

Tuesday, August 02, 2016

Orion

Why would NASA promote a human space expedition to Mars when drone programs prove so successful? And to the stars, wait a minute.
Even if the crew survives, the uncontrollable cosmic radiation seriously damages both the vascular and neurological systems. Even though astronauts return younger in relation to those they left behind, the damage is not repairable. How much better to launch a drone, robotic in every respect, with the astronaught sitting comfortably and safely behind an earthbound flight deck, nine to five, evenings and weekends at home, thus solving the human factor issue and providing easier and better engineering of the space vehicle. Without the fragile and demanding attention to a survivable habitat, there would be far less space, energy and weight demand, leaving room to perfect the mechanics of the mission, mechanics that could do more than what is humanly possible. 
No longer requiring human scale, the whole project could be miniaturized, further improving the power to weight demand, never mind cost. Robotics should be the future -- a vast improvement on space probe launches in the past.
Time lag, like a satillite phone, becomes a problem with remote control. By the time a signal arrives for a maneuver, it may already be too late. Two solutions: one artificial Inteligence, and two, quantum computing, both of which are advancing rapidly. Is it science fiction to envision quantum entanglement as a means of realtime control of a drone at great distance and to what limit? -- to the stars? Artificial Inteligence seems more likely. The earthbound astronaught might discuss strategy with an onboard artificial Inteligence, 2001 without the onboard passenger or a holograph if you must, an avatar. Nanoscale might even become feasible; someone already proposed tiny space sail capsules.



Saturday, July 09, 2016

Education

Globalization, while built for the exploitation of emerging economies and the wealth of the American people by monopolies and multinationals and justified by utopian dreams, does indeed result in greater education of young people in those exploited countries. Meanwhile US education flounders despite efforts towards qualitative improvement. Budget cuts, permissiveness and cost shifting onto unenfanchised students takes priority over quantity. Simply put, we have more early dropouts and less. time in the class room whilst the rest of the world moves in the other direction, many examples. 

The massive ills of our society result directly from a lack of qualification for employment and lack of productive engagement, lack of education. The military promises the only secure escape from the street, but most do not qualify. Think prison population, drugs, homelessness and unemployment, education should be the solution. Combine education with health care, psych care and recovery strategies -- not socialism but survival of our culture.

Not privatized education, not K- 12, but a mandatory 4 through 21 year of age education, eleven months of the year, supplemented by a voluntary pre school. Play school 9 hours for infants of working single moms or dads would solve many problems. Unwanted and inconvenient children could benefit from abundant early positive social enteraction and love, experience an early model of cooperation, civility and later citizennship. Then, advanced education through, liberal arts, engineering, science or tech school would not only channel students through appropriate areas of student interest and talent, but also: explode the economy, reduce crime, treat drug addiction and eventually eliminate homelessness and poverty. Providing dormitories for homeless students, homeless adults while extending the education to all unemployed could end poverty while providing a higher quality motivated labor force for economic growth.

Monday, June 27, 2016

Globalization = Colonialism

Well, not exactly, today we are the exploited. Political idealism, political correctness continues blindly in support of globalization despite overwhelming evidence of its deleterious effect on our economy: flat GDP, half a trillion a year trade deficit, unimployment, loss of manufacturing, polarization of wealth, overburdening immigration as well as a national security risk due to economic weakness.

Meanwhile so called conservatives, the wealthy, minimize the damage to the rest of us claiming the unemployed are just lazy, a few lost their jobs, but over all free trade is a benefit. Big business profits from cheap foreign labor, outsourcing goods and services, avoids taxes by manufacturing offshore, and multinationals go a step further. Newfound foreign wealth in part comes back seeking secure shelter, enriching our bankers with their hedge funds, dark pools and shadow banking, indeed, furthering economic and political polarization.

Government favors globalization with a belief that it enhances stability and that trading partners will be less warlike and adhear to international laws and norms. Wlhile some of this is true, it comes at the overwhelming expense of our middle class. One can hardly call the Middle East stable, however. We have unleashed wave upon wave of refugees with nowhere to go. It will only get worse with global warming, over population, war and famin.

It is past time for us to take care of our own population, not nationalism, but survival. "None are so blind as those who will not see." Our media are like marionettes to the vested interest oh the oligarchy.

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Thursday, June 23, 2016

Christine Legarde

Like another elegant French lady, La Belle Poule, (The elegant French frigate fighting off the British blockade 1778) Christine, the director of IMF calls attention to US poverty, one in seven living in poverty, unsustainable, and the polarization of wealth. Christine Legarde is the first out of this whole political season to mention productivity as a solution. Our first quarter GDP growth fell to 0.5%, just short of going backwards.
Christine suggests childcare and maternity leave to bring more women into the work force and increase minimum wage, some tax credit at the low end to encourage greater participation in the economy, but the cornel of wisdom was her call for productivity.
How few pay any attention to the antecedents of productivity. First a cheap, sustainable, abundant resource, second the human resource, then capital and entrepreneurial ability, both of which we have in abundance. It is the first two where we stumble with misunderstanding and misdirection.
Think what a flood of opportunity might come from: free bandwidth, free information, cheap energy/electricity, cheep transportation, free education and cheep communication.
No business flourishes without a secure labor force, healthy, well fed, with energy and satisfaction. To that end: free or cheap healthcare, affordable food and shelter, education, safety (better law enforcement) employment, security in retirement, childcare ( pre-school) etc. If the poor had access to the infrastructure they would no longer be pore.
We can tax the wealthy to pay their fair share for public infrastructure, but none of this will work so long as we have the colossal loss of jobs to cheap foreign labor, loss of manufacturing to inequitable trade treaties, with the resulting loss of wealth from the US economy. Monopolies dominate the infrastructure, and lost wealth accrues to the so called one percent who now control the legislative process.
There remains a preoccupation with consumption. "If people would just spend more, the economy would grow/" As things stand, if people spend more, they would just run out of money. The economy runs on velocity. Spending is only a part of the equation, it's a product if you will. How many times will money change hands over a period of time. It is more a matter of churn, of energy, of optimism, an energy you can feel on the street. Instead, our political status quo brings us tattoos, obesity, drug addiction, depression, lethargy and an admonition to buy more at Wal-Mart.
More women working in the workforce and increased minimum wage are strong boosts, but they come at a price. In good times it does not require two or more family members working to provide a living. Increased minimum wage already boosts food and restaurant prices causing a strain on fixed income seniors. As the elegant French lady suggests, we need to think productivity.

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Sunday, May 29, 2016

Economics 101


The Fed goes to extraordinary lengths to stimulate the economy with very little result, thus raising questions, what is the economy and how does one stimulate it? Our economic growth barely exceeds population growth and obviously all but the very wealthy are suffering from a declining standard of living. An old tattered economics 101 text book may shed some light on the questions.
The man or woman on the street has no problem feeling the depression. Why is it that economists do not? What is the economy anyway? What is the energy that man on the street feels walking down a thriving business district in a thriving city, I'm thinking of Dublin, versus the depression felt in a manufacturing town where the plants are shut down, moved to Mexico or outsourced to China?

A text book might say, "economics is the  allocation of scarce means to alternative means," that says nothing of good economics or bad economics because the economy is the very quality of life, the standard of living. The gross domestic product, GDP, offers one yard stick for measuring the economy but falls short reflecting the quality of life, the productivity that drives the economy and the palpable feeling of energy on the street. The word product is the key. The GDP is the product of the money supply multiplied by the  yearly turnover rate, the number of times that money is spent, the turnover rate or velocity. The velocity is under appreciated and the numbers are hard to find. Divide the GDP by the M1 and you get a sense of velocity, the turn over rate, the number of times we spend and pass the same dollars from one place to another over a year's time. In good times the velocity is up around 11, in bad times, like now, it is down to like 5.

In physics E = M c squared. In economics Energy equals the GDP divided by the M1, money supply in circulation. Janet Yellen and the Federal Reserve have tried to stimulate the economy with quantitative easing pumping nearly 4 trillion dollars into the economy over seven years by way of the banking system with minimal results. The strategy does nothing for the velocity or energy side of the equation in fact velocity, i.e. energy may be lower.
           GDP       M1         E        trillions $
2016    16.49    3.2446    5.08   
2015    16.47    3.0873    5.33      
2014    16.15    2.9212    5.53      
2013    15.76    2.6414    5.97
2012    15.38    2.4586    6.26      
2011    15.19    2.1618    7.03      
2010    14.94    1.8600    8.03      
1009    14.54    1.6965    8.57      
2008    14.58    1.6034    9.09
2007    14.99    1.3711    10.93
2006    14.72    1.3849    10.63
2005    14.37    1.3869    10.36
2004    13.95    1.3025    10.04
2003    13.53    1.3025    10.39
2002    12.96    1.2187    10.63
2001    12.71    1.1824    10.75
2000    12.69    1.0896    11.65
Note that a dramatic increase in money supply drives little increase in GDP
One can hardly find any reference in government accounting for the turnover
but a dramatic decrease in the energy level of the economy, less than half since 2007
In 1998 the government stopped publishing L the factor for overall liquidity,
later they stopped publishing M3. Both would reflect the trillions sequestered in the
shadow banking, hedge funds and offshore banking; I wonder why.

Productivity drives the turnover rate, the velocity and thus the energy and the standard of living. What drives productivity? The working man can tell you, the tradesman can tell you and the farmer. 
That bring us back to chapter two. From the text book John Ise, professor of economics at the University of Kansas, a grass roots economist, Sod and Stubble, productivity comes from the land, labor, capital and entrepreneurial ability. In Kansas, land was the cheap, abundant, an exploitable resource, the abundance of virgin prairie land, sod and stubble, the resource that made our mid west the wealth producing bread basket of the world. It's more complicated now you say and indeed transportation, coal, iron, then technology and now the Internet and information serves as does land for the rich productive wheat lands.

For land substitute, a cheap exploitable sustainable abundant resource, today we think foreign labor and cheap manufacturing at the expense of US jobs and an obscene trade deficit now exceeding a half a trillion a year while ignoring our own infrastructure, energy, transportation and information grid to the benefit of legislatively sanctioned monopoly. It's like colonialism all over again. OK forget the trade deficit, focus on abundant cheap sustainable exploitable infrastructure, substance and photons, 

With the second key factor - we are doing just as bad - labor, think human resource, shelter, security, nutrition and education. There are 3.4 million homeless, incarceration and a breakdown in our legal and policing systems, near poorest nutrition of developed nations and an education system at the expense of our not yet enfranchised children, legal dropouts at 16. No business succeeds long term with a total disregard for employee welfare. A nation is no different. Stop exploiting humans and free up legitimate resources for exploitation.

Building the infrastructure, freeing up monopoly based resources and providing affordable higher education and health takes care of our two most distorted and neglected factors of production, unlocking these two basic factors will release a tsunami of productivity because we have lots of venture capital and entrepreneurial ability to supply the rest, the other two.







Saturday, February 27, 2016

Medical Records, EHRs

My job entails reading and summarizing numbers of clinical records. Most of them are VA and Tri Care computer generated printouts. Gleaning useful and valid information is a challenge. The printouts often lack a date of entry. They do, however, contain vast amounts of data regarding social,environmental and immunization information. It is difficult to determine which content is generated by a physician. Many designated contributors have no identity or an array of non M.D. acronims following their name. There may be pages between credible clinical notes about the patient's current condition. The most troubling EHR data is the Problem List without dates. There is begaining date to the problem and no date of its resolution. Without a date of origion, there is no way to tell who entered the problem or when. Was it a physician, or the patient stating the problem as a diagnosis to a team member not qualified to enter a diagnosis. Then too, without a date of resolution, one cannot determine if it is a chronic problem or one long since resolved. Furthermore, without a date the reader cannot find the data supporting the stated problem. Despite modern confidentiality rules, these problem lists are used to make various determinations of eligibility. 

Much is written about the burden of the EHR on physician's time and the quality of the record. The EHRs are enormously expensive. They are competitive. There are many companies competing for the business. They all attempt to provide the federal requirements of meaningful use with a promise of standardized data. However, in so doing, the already standardized professional expression of patient data is lost.  While the bean counters may relish the access to the data they perceive as meaningful, the information critical to patient care, continuity of care and communication between physicians is lost. There is probably no turning back, but it would seem that voice recognition with streaming physician narrative would go a long way to improve EHRs. If a problem oriented record is to be the standard, Problem Lists should be by physician input only and dated by onset and resolution. Furthermore, when multiple problems lead to a single diagnosis, there should be a simple way to edit the change or at least document the thinking. As it is, there is a lot of garbage in the system.

Clinical Genomics

The goal from my perspective would be, synthesis of the entire human genome on each of my patients with a realtime, ongoing statistical correlation between his or her genome and that person's ongoing experience with the environment, disease and longevity, known correlations with disease as well, but those existing correlations cannot be trusted due to the distorted data from insurance claims and the attempts to match individuals to a population at large. 

Legislators in their ignorance or vested interest stipulate that medical records may be destroyed after seven years or less, in some cases three. Administrators too are anxious to rid themselves of the burden of data collection and storage for both financial reasons and the burden of liability. What you can not prove is hardly actionable. A single clinician over the course of his or her professional lifetime collects some 30,000 to 50,000 clinical records, a group of physicians in a group practice obviously many more. Furthermore, groups perpetuate long beyond the life of the origional physicians creating a vast and priceless database of credible clinical information relating closely to the individual and a narrow geographic location. By contrast, massive clinical data thus far comes from customer questioners, such as from 23 and Me,  or insurance data which is so distorted as to be near meaningless.

The advancement and benefit to patient care as well as a quantum leap forward in our understanding of the causes of disease seems obvious. The rapid, affordable, access to the whole human genome makes up the other side of the above equation. So far that has been only a dream frustrated by  beaurocracy, inertia and a steep learning curve. Competition, Silicon Valley and inventiveness, however, work miracles. Unfortunately, free enterprise, the very driver of innovation, now threatens the access and developement of an affordable, rapid whole human genome device. Ilumina is suing Oxford Genomics, once a strategic partner, over patents to a promising nanopor technology, a sad developement that may significantly delay the dream. Fortunately, there are other competors knocking at the door. Hopefully, Moore's Law will prevail.

"The Oxford machines will be configured as scalable computer clusters, so that new ‘nodes’ can be added to them, so that users can customize the machines. The initial system will feature [a] nodes containing 2,000 nanopores that can read DNA at a rate of hundreds of kilobases per second, the company said. Next year, the company will begin selling nodes containing 8,000 nanopores; 20 of these combined would theoretically be able to sequence an entire human genome in 15 minutes, says Gordon Sanghera, Oxford’s chief executive." From Nature Feb 25  
Erika Check Hayden

Sunday, January 17, 2016

Dance Dance Where Ever You May Be

https://m.youtube.com/watch?v=wwdmqM3pc68

Saturday, January 02, 2016

The Big Short by Michael Lewis

Must reading for anyone who cares about the economy, maldestribution of wealth or financial crime in the banking industry. Never mind too big to fail, it's too big to prosecute.

This is about the subprime mortgage scam with an inside look at the greed, the criminal intent and the out of control monstrosity that it created. With the colorful characters, only a handful, who figured it out, this book weaves a tale that in its telling gives some understanding of the Ponzi scheme cooked up by Wall Street banks, too complex to understand, too complex to prosecute.

Michael tells his own tale of disallusionment along with the protagonists who see the certain end point of the Ponzi with disbelief attempting to inform federal prosecutors, SEC, Standard & Poors and Moody's but to no avail while themselves attempting to grasp the opportunity of shorting the subprime pyramid. The story is humerous while at the same time tragic; it gives for once an understanding of the obscene leverage in things like collateralized debt obligations, CDOs, Tranches and credit default swaps.

Lewis exonerates the home owner as victimized by the recruiting practices of the carnavail like mortgage sales organizations. These nieve buyers were manipulated into a mortgage with no down payment, interest only with the option of deferred interest on a variable rate interest arm. There was more which Lewis describes.

What the book does not tell is the number of homeless in the US today, 3.4 million, a number exceeded by the number of empty foreclosed houses. Think what would have happened if the government had supported the real victims of the subprime mortgage fiasco instead of the banks. When the mortgage packages fell to zero value, the mortgages should have been voided. 

Voiding the, what were actually criminal mortgages, would have transferred the ill gotten wealth of the banking industry back into the hands of lower middle class Americans with a boost to the economy; it would have resulted in a complete restructuring of the banking industry, which is desperately needed and shift wealth from the nonproductive hedge fund back out into the economy, the middle class, where it would contribute to jobs and the GDP.



Saturday, December 12, 2015

Social Security

Read that Social Insecurity, The benefit amount for 2016 just came out, and as I open the familiar
envelope and see that the amount remains the same, the cost of living increase has indeed been canceled by congress, I feel cheated and angry. How can we trust any current legislator or the administration. The only thing the two parties have agreed on in the last eight years was to cut Social Security.
They say Social Security will run out of funds in x number of years. That is pure BS, There are no funds in Social Security. Every year all the funds collected are spent in the general fund with the attitude that the amount collected will always cover the obligation and quite a bit more for politicians to spend. The only thing legal about it is: that is the way it has worked from the beginning.
Social Security is not a give away; we worked a lifetime contributing to the fund. It is our money. One would expect to realize a dividend from its responsible administration, not a change in the law canceling the cost of living provisions.
Is there any surprise that none of the politically correct politicians of either party have the support they need?