Sunday, November 29, 2009

On education and children -

Went to the library yesterday to select some reading for the holiday period. One of the books I selected has this little gem which I would like to dedicate to Al the Ol' Whig following his post on the topic of educating children -

On The Birth Of His Son.

Families, when a child is born,
Want it to be intelligent.
I, through intelligence,
Having wrecked my whole life,
Only hope the baby will prove
Ignorant and stupid.
Then he will crown a tranquil life
By becoming a Cabinet Minister.

Now, I can not resist the temptation...

Roughly when was that little poem written, and where?

Answer - posted 6 Dec

Su Shi (Su Tungpo) 1037-1101) China (obviously)
Quoted translation taken from "The Art Of China" - Jason Steuber.

Where to next?

At some point in the past few days I heard a radio interview with an expert on genetics. Amongst the interesting things covered in the course of the interview was the thought that Homo Sapiens as a species is an evolutionary dead-end.

Amongst the prim-misses he put forward for the delusion was the idea that H-S has evolved to the point of becoming technology-dependant. To support this, he put forward the idea that anyone trying to survive on a totally raw diet (no restrictions on content or quantity) would die within two months from starvation. Why? For the simple reason that we have lost the means of producing natural enzymes essential for the digestion of totally raw food, and also lost the symbiotic bacteria ditto.

An interesting thought. Where are we going as a species? Do we help the long-term survival of the species through our increasing reliance on technology, and especially medical advances. I have made the comment quite a few times now that 100 years ago I would have been lucky to have seen out my 40's.

In another recent discussion it was stated that the commonly accepted age of retirement of 65 years actually comes from a scientific paper of the mid-1800's based on the fact that by then 50% of all people have in fact died. Now, we have advanced to the point where mean life expectancy (50% die before reaching it) is something like 78.

Staying with the "evolutionary dead-end" for the moment, a recent death here in Auckland pointed to another aspect of the same. The Coroner this past week heard evidence into the death of a restaurant patient who had died of an allergic reaction to either peanuts or shellfish. Sad for him and for the family, I acknowledge, given the circumstances. It raised again the question in my mind (following the radio interview I started with) about the continuing viability of the species. There are any number of human deficiencies (including heart defects of the kind I suffer(ed) from) which in times past would not have been continued in the total population other than as the occasional mutation. Thinking back, allergies were almost unheard of in my childhood, there were people who "died suddenly" of "heart failure" usually, who might well have been affected by peanut allergy or bee-sting allergy or similar. Now, (if you add them all together; allergies, coeliac, auto-immune diseases like arthritis) there is an increasing proportion of the total population who survive long enough to pass on their defective genes when in time past they would not have survived long past puberty at best.

The third thought that impinges comes from my sister's efforts to eliminate "curly calf" and Neuropathic Hydrocephalus from her herd. Again, and this leads into the question of "line breeding", is the "purity of line" more important than the long-term genetic stability of a species.

So, where do we go next as a species? Should we be looking to restricting medicine and medical treatments to those who can maintain a healthy gene stock? Are we (as a species and reportedly the descendants of as few as 2000 individuals) so badly line-bred that we can not guarantee long-term survival? Evolution (as a product of adaptation) seems well gone into the past. In all likelihood, given the opening prim-misses, we can no longer adapt. We are nailed solidly to our cross of technology.

Friday, November 27, 2009

Happy Thanksgiving, America!

A little belated perhaps, but a thoughtful wish to all in America for a happy Thanksgiving. From my contact with the business world over there I know this is the last chance for a reasonable holiday before the privations of winter set in especially for those in the north.

A post by TFS brought this to mind. Being the man that he is, his emphasis is almost entirely on the religious aspects of Thanksgiving as primary. He links to another like-minded person who gives a quotation from Frenchman De Tocqueville.
The religion which declares that all are equal in the sight of God, will not refuse to acknowledge that all citizens are equal in the eye of the law. Religion is the companion of liberty in all its battles and all it conflicts; the cradle of its infancy and the divine source of its claims.

As one might expect, there should be (as I see it at least) one huge lot more than that for America to be thankful for.

It is horrendously out of context, I know, but no more so that the original quote and quite likely the translation as well. Not being a French-speaking scholar of De Tocqueville I am not going to take it any further than that.

First up, as I pointed out to TFS, that passage was written in the mid-1800’s, 1851 if Wiki is to be believed. At that time “citizen’s rights” were defined in a manner that would today rank beside the likes of Iran, 1950’s South Africa, and China.

To be clear, I am including under the heading of “citizen’s rights” such forgotten things as –

The right to vote.
The right to own property.
The right to unrestricted travel.

Those rights were not universal in the US in the 1850’s. I have to concede that the right to vote was not universal in NZ until 1869.

That being the case, the thought led me to think what would I be thankful for if a similar religious festival were in place in NZ.

First I think would have to be for the blessing (look it up in the Oxford TF, I am not going religious yet. It means “something to be thankful for…”) of having been born in this country, for its freedom, its bounty and beauty.

Immediately after that would come the people who have fought to make it, and keep it, that way. The likes of Hobson, Williams, Hone Hika, Te Whiti, as the foundation stones, followed by Kate Shepheard, Apirana Ngata, and even Richard Seddon and Michael Joseph Savage would be worth a passing thought. The servicemen and women of the six wars fought overseas – Boer, WW1, WW2, Korea, Malaya, Vietnam.

It is there that the difference would lie. I doubt that many of those listed would consider themselves “divinely inspired” apart from Williams who was a Minister and Missionary. For the rest, I suspect that much of what they achieved would fall into the “95% perspiration” category.

So it is likely that if I were in America now, I would be thanking a whole bunch of people for their work and sacrifice in building what America is today and striving to keep and better all that is good in that nation.

Friday, November 20, 2009

On being responsible for the development of a new superhuman

Hat tip to Al (old whig) for this one.

Your child is a DoublePlusHuman. Don't make him or her into any less than that. Instead, strive to grow with him or her.

I say this as someone who was a child once and who has gone through the whole process of being programmed and then deprogrammed. I was for a while a mere drone, subject to the whims of social norms. I felt rebellion so many times in my childhood and felt terribly guilty for it. Now I understand I was right. When my parents told me they love me I felt smothered because anything I do imperfectly was not enough to make up for her love. When my parents told me life was suffering I did not want to believe. Today I know I was right, about nearly everything. If there was someone to show me what I know today, many of my current compulsions which limit my present personal freedom would not exist.

Children are not blank canvases that you can paint whatever you wish on. They already are masterpieces. You just have to let them flourish.

I have two objections to this.

The first is that every child is different. While not trying to contradict the general thrust of the line of thought, the idea has to be put into the context of individual ability.

The second is that (from my experience) an enormous part of child-raising these days is predicated on the (often quite unreasonable) expectations of the parents. I must say that this is very much a two-edged sword; that sometimes the parental expectations can undershoot their child’s actual ability by a very long way.

I left Al with the thought that “There is always that very tentative balance between guiding and restricting development of a child, and providing the social skills and morals needed to cope with living in society.”

Rather than the “programmed and de-programmed” description from the author I would describe it as more of a process of “learning and refinement”. I would like to think that I was a fairly “moral” child though there could be some debate about that if I were totally honest.

I have to confess to having very little ability in social interaction, especially in my youth. I was at one level shy, backward, and felt very awkward dealing with other people. Social contact with girls was totally foreign to me, to the extent that at the age of 13 at a school social the old man had to quite literally drag me out of a film (being shown for the parents) and into the room down the hall where there was a dance. Dance? How?? With GIRLS? By the end of the evening I had sort of cottoned on to Military Two-step and Quadrille. Trying a foxtrot had me quite literally in a sweat. And as for the last waltz!! Say no more.

Five years later I wasn’t much better. I was living in Auckland, away from the family, having to cope on my own.

Five years after that, I had managed to talk a very nice young lady into marrying me so I must have learned some social skills by that time.

Another five years and I am responsible for the education and raising of my own first-born. How the h3!! do I do that??

Yes, children are very much "blank canvasses". I see my responsibility as a parent to put the frame around that canvas. To limit the development of the picture to the kind of norms I consider to be appropriate for society but at the same time to not influence the shape and form of the picture.

Friday, November 06, 2009

The massacre at Fort Hood -

Just cleaning things up at the end of the week, and with the news of Fort Hood breaking on the radio...

I am sitting here listening to Portishead "Third", and as I write the track "Machinegun" is playing, and the neighbours are setting fire to money again in the form of fireworks to celebrate the unsuccessful attempt by Catholic terrorists to blow up the Protestant-run English Parliament.


I saw a saviour
a saviour come my way
I thought I'd see it
at the cold light of day
but now I realise that I'm
Only for me

if only I could see
You turn myself to me
and recognise the poison in my heart
there is no other place
no one else I face
remedy, we'll agree, is how I feel
here in my reflecting
What more can I say?
for I am guilty
for the voice that I obey
too scared to sacrifice a choice
chosen for me

if only I could see
You turn myself to me
recognise the poison in my heart
there is no other place
no one else I face
The remedy, to agree, is how I feel

(Subject to all of the strictures of copyright etc which is why I have included the link to the source in the heading)

Those lyrics I find strangely appropriate to the sad events at Fort Hood. This was not a political or terrorist act any more than Columbine, or the Pennsylvania shootings were the work of terrorists.

It is a criminal act, carried out by a man who has to fall into at least two of the "mad, sad, bad" categories. That in no way lessens the nature of the shootings. It in no way lessens the impact on families and their community.

So that is why I put the lyrics in.

I can hear the screams of rage against all Muslims. I can imagine the more extreme wanting to lynch all of the Muslims and anyone else who dresses funny just to be sure.

I saw a saviour
a saviour come my way
I thought I'd see it
at the cold light of day
but now I realise that I'm
Only for me

If you can find a P2P copy of "Machinegun" have a listen. I enjoy Portishead's music because it makes me think

Thursday, November 05, 2009

On the state of health - 1

There was an interesting comment over at TF's place stating (and I can't for the moment think of a reasonable response to it) that the Federal government "has no place in providing health services". As should be well known to readers here, that is certainly not the case in NZ. Mind you, the commenter did continue to say that it was a State responsibility, and that perhaps is the reason why I am at a bit of a loss about it.

There is one very direct parallel between NZ and the US though, and it centres on the role of the private system and medical insurance providers.

To that end there was a very interesting and somewhat blood-chilling little article in SST this week...
RISING HEALTHCARE costs have reached crisis point, pushing families to give up their health insurance and fall back onto the straining state system, says Ian McPherson, chief executive of Southern Cross Medical Care Society.

The not-for-profit insurer saw claims rise by $61 million in the year to June and McPherson said factors behind the claims blowout included the amount private surgeons earned and costly new medical technologies with little or no proven clinical benefit.

For the time being, my salary package includes medical insurance through Southern Cross at a cost of something like $35 per week. That looks like increasing by a bit in the near future.
"How much will people be able to continue to pay and not object?" McPherson asked.

"We have seen a significant downgrading from policies that are far more general to policies covering the extreme emergencies. It is difficult for people to downgrade any more. There is a significant number sitting on the bottom rung and about to jump off into the public system again."

Rising costs for Southern Cross could also feed the already rapid rise in the state's healthcare bill. Consultant Paul Winton, author of a report in August – Health, New Zealand's untreated addiction – said current trends suggested healthcare costs could grow from 20% of core government spending to 40% in 15 years.

McPherson said Southern Cross had begun engaging with GPs on the premium-affordability crisis, and the subtext is clear – the insurer wants to see GPs direct patients away from the more expensive private surgeons.

"We are not going to tell GPs who to refer their patients to," McPherson said, but "we would like GPs to be mindful about the cost rather than referring out of habit. Giving them an incentive to help manage our budgets is something we are exploring with them now."

Southern Cross has been developing a network of affiliated providers, but McPherson said as yet it would be a step too far to require their use in the same way a car insurer would require a claimant to go to an approved panelbeater.

Now there is little wrong with the Southern Cross response to the problem so far as I am concerned.

The truth of the matter is though that McPherson's prognosis in the opening paras is only too true. Even given the present premium levels there is little chance that I will be able to afford the present cover into my retirement. There is no question that I will become increasingly reliant upon the public health service. Not that I have any problem with that, as it has certainly been "good value" for me.

McPherson said there were instances where it appeared that profit motive and not clinical outcomes were driving that price upwards.

He cited the example of robot-assisted prostatectomy surgery which costs $30,000 compared to the $15,000-$20,000 of conventional surgery, without evidence of faster recovery or better clinical outcomes.

Southern Cross's reaction in this case was to pay only a "contribution" to the cost of the robot-assisted surgery.

Why were surgeons using it? "Because it is fun. Because it is interesting. Because you can get a margin on your investment."

Hmmm, sounds a bit like "boys toys" no?

Let's set the parameters here.

First, medicine is about curing diseases, mending injuries, and providing palliative care for the dying.

Second, it is a very highly skilled and for most a stressful occupation. (I am basing that on the comments made to me by the three medical doctors in the club I belong to). People who fit those parameters in any field deserve to earn more than those of us who cruise below the radar doing little more than subsist. There is also, as any capitalist will tell you, the need and justification for recovering a return on capital invested; let's face it, I will tell you that as an accountant.
Terry Moore, president of the Private Surgical Hospitals Association, said: "We are conscious of the increases in costs which ultimately, if left unchecked will mean fewer people will be able to afford to go private themselves."

Moore said uncontestable clinical proof of new technologies could take years to emerge, but acknowledged they were stoking cost escalation along with wages and surgeons' fees.

McPherson also hit out at fees in his annual report to members last month. "We hear the argument that [surgeons] are part of a globalised workforce; we point out that if their prices increase to reflect overseas rates, fewer New Zealanders will be able to afford private surgical services."

Boscawen [right wing MP] is of similar mind, arguing that the globalised workforce is more of a westernised workforce, because the wages earned by quality doctors from India, for example, where cataract surgery is cheap, are having no effect on the fees charged by private surgeons here.

Moore countered: "Surgeons are generally independent practitioners and contractors so they pretty much set their own fees in a competitive market, but I don't think the fees have gone up much more than the medical inflation rate. They have become more efficient so they are probably earning more, but probably working harder for it and doing more procedures."

He said rising premium costs for health insurers were also driven by the sheer number of procedures being done, not just the cost of each one.

All true, well I have difficulty disagreeing with most of it so it must be. No confirmation bias here!

But there are some interesting contradictions. For example, the hospitals (Moore, above) are trying to argue that "economies of scale" ideas do not apply; "rising premium costs for health insurers were also driven by the sheer number of procedures being done, not just the cost of each one." I would have thought that (as my wife found out when she had cataracts removed from one eye) being able to "mass produce/production line" operations would lead to some savings. If it costs the insurer $4M to provide 1100 cataract operations then does increasing the number by 20% mean a 50% increase in cost? It does if "industry" is currently running at or above capacity.

There is a secondary impact too, coming out of the combination of developing technology (and that is everything including drugs and personal skills) together with societal expectations. The best indicator I can give for this effect I wrote on some while back (2006?? Sheesh!) is the example of herceptin - a treatment drug for a specific kind of breast cancer. That example ended up as a $3 million programme to treat roughly 20 women per year or about $150,000 each.

No one can blame those women for wanting (or deserving) the best possible treatment, and outcome. Exactly the same justification existed in the 1970's when open heart surgery was being developed by the likes of Barratt-Boyes and the other researchers in US, Europe and South Africa. Today, that surgery is routine. Auckland Hospital does two or three operations per day at a cost each of (I was told) about $75,000.

[To be continued...]

Tuesday, November 03, 2009

State of Health - 2

Returning to Southern Cross, the pressures of increasing demand for new treatments and higher technology solutions are having impact. It is leading to the prospect of large increases in premiums. In many cases the premiums are already too high to be affordable - note SC's own comments on people not renewing, or down-grading, current cover.

Further, these impacts are being felt in the public health system as well. The herceptin debacle was eventually funded (in the first year) out of Auntie Helen's Charity Fund (otherwise known as "The Prime Minister's Discretionary Fund") but I do not doubt that it is now an established part of Vote Health.

If we look behind the political rhetoric and wailing and gnashing of teeth there is a very fundamental problem with the provision of health services. Essentially, no one wants to die. I can't blame people for feeling that way. After all, we have the ability today to ensure the survival of some 1% of all live births who when I was born would have been "sad but inevitable consequences" of premature birth. I would be one of the last to try and suggest that we should turn our backs on that ability. We have the ability to turn around the lives and health of reprobates like the ol' probligo with what is now a relatively routine opration, complex but routine. On pure observation, there must be some 1,000 people a year whose lives are improved immeasurably if not saved as a result. Those having pacemakers fitted come into a further 1000 a year. That is just one hospital.

The problem of the cost is one that has actually been with us for a lot longer than we might want to admit. It is not limited to NZ either.

If I return to the commenter whose thoughts started all of this off, I wish him and TF and everyone fighting the good cause against Obama the very best of luck. Why? Because the choice is very simple.

Generally, private insurance and health providers are by their very nature required to make a return on their investment if not an additional return for those whose money made the investments in the first place. The argument in favour of public provision is based (in theory) on universal cover and no profit.

Irrespective of how you add those two quite different proposals there are common impacts upon how much has to be paid for them. I have covered those already.

The truth is that there is a limit between cost, availability, technology and outcome; a "mathematical" limit as well as economic and "social".

The ultimate and universal outcome for all is death. The "social" end of the limit wants that outcome minimised as far as possible and delayed for as long as possible given that it is a certainty for all (at least at present). There is much that can be argued about the causes and nature of a person's death. I do not think that this is the place for that debate other than to suggest that its inevitability has to be recognised.

The ultimate technology would have to be (effectively) eternal life. There was comment made last night on tv that in the Middle Ages the average life span was 30 years. A man of 40 would be considered elderly. A man of 60 years almost unheard of. Needless to say, aging diseases such as cancer, alzheimers, coronary heart disease were unheard of and unrecognised. In the 1800's in Europe and America, the average lifespan might have increased to 55. In the past 15 years the average lifespan for men in NZ has increased from 71 to 82; the life expectancy of a newborn is something like 62, but once past the age of 15 it increases to 85. It is expected that the number of people reaching 100 years in 60 years time will be double that of the present day. In very large part that increase in life expectancy is the result of improving technology.

The ultimate in availability is universal. It is here that most of the heat and darkness arises. "Why should I pay..." is fundamental to both sides; with the sentence ending "...for anyone else" on one side and "...more than the true cost" on the other leading to "...more than I can afford" again on the other side of the lake. What must be decided by society, not by the medical profession or the government, is who should be able to access medical services. The "rich" will always be able to afford to buy; "rich" because that is a matter of perspective as much as it is of fact (compared to half of NZ I am a "rich" man yet as I said at the beginning paying for personal medical insurance is almost out of reach).

The decision on public health services needs to come back to the fundamentals I began with - curing diseases, mending injuries, and providing palliative care for the dying.

The debate must centre on the immediate cost of treatment against the benefit to society of the likely outcome. Is that a simple judgement? Not in my book! What is certain is that it is a necessary debate. Nor can the availability of health services be limited to those with the ability to pay. There has to be a universality in health services. The scope of that universality has to be unlimited. That means that the universal care will necessarily provide services which are below the available technology and ability.

Not an attractive thought.

Sunday, November 01, 2009

On MY god-given rights -

I am sitting here listening to Fat Freddie's Drop that SWMBO has playing on the stereo, there is a tui outside with what seems at first to be a one note welcome "toot-toot" to the world. Shut off the ambient city-noise and a huge repertoir of clicks, gurgles, whistles and honks becomes apparent.

OK, so let's assume for the moment that I live in an "enlightened" country where RKBA applies. Let's assume for the time being that government imposed restrictions on road traffic do not exist.

First, forget about the killer for the moment in the three frames that follow. I want to discuss the "rights" of the victim. I want to discuss the reaction of the lady standing on the footpath. It could be a scene from any American corner store. It could be anywhere from Alaska to Florida. It could be right out of Tom Waits' "Small Change" ( rained on with his own 38).

The question has to be - "What protection would he have gained from RKBA?" The answer to that question is not improved in any way by gun controls, let's be honest about that. It does point up what I see as the total futility of RKBA as it is presented by the NRA and supporters - you know the kind of thing; "big hairy man jumps out of the shadows and makes to rape your wife... "

In a similar vein, there is a continual pressure for "Them" (the Government) to lighten up on the strictures on road users. The speed limit is the usual one; the "government revenue-rasing law". At this time the vexed question of alchohol levels are in the sights as well with proposals to impose a "zero tolerance level" for under-25's and the same "05" law as applies in Australia and many other countries. The resistance comes from groups who consider that they have a god-given right to determine the speed at which they drive. They have a god-given right to decide when they are p'd out of their tree. So, take a look at the following. The consequences; two dead, several injured, one critically. The two fatalities came from the van; thrown out by the impact. The driver of the van was a 16 y-o girl who was "pissed as a fart". But look on the left side of the photo. There is another vehicle there also badly damaged. It is the occupants of that vehicle, their rights to use the roads safely, that I am pointing up.
So there are two small reasons why, when the likes of TF start prating on about "their God-given right" to do this, that or the other, I start getting hot under the collar.

Perhaps it would be appropriate to suggest that if the paramouncy of the rights of the individual to act as he/she sees fit without regard to the rights of others is to apply then it is appropriate too that they be isolated into their own little society. There they can kill, murder, have state-imposed murder, stop abortions, stop pornography, lie, steal, and cheat, to their collective hearts' content.

If humble and somewhat "socialist" countries are able to exist without those so-called "freedoms" then those who promote the rights of the individual over all others can stay away.

It is probably significant that NZ, the Scandinavian countries, in total 82 countries, all rank higher in "freedom indices" than does the US of A.

I wonder why?

Oh, and the three photos of the shooting are actually from Italy. Not that that fact in any way would change what I have said.