Another Thought about Choosing a Doctor

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Seriously, you need to think about this.  We all do.  Patients of female doctors have better survival rates.

“There was ample evidence that male and female physicians practice medicine differently,” said Ashish Jha, MD, professor of health policy and director of the Harvard Global Health Institute. “Our findings suggest that those differences matter and are important to patient health. We need to understand why female physicians have lower mortality so that all patients can have the best possible outcomes, irrespective of the gender of their physician.” Dr. Jha was a senior author of a landmark 2016 study published in JAMA Internal Medicine that examined how differences in the way male and female physicians practice affect clinical outcomes. In the study, better patient outcomes were linked to care from female physicians.

[Source: Becker’s Hospital Review; JAMA is the acronym for the Journal of the American Medical Association]

A Quote for Our Times

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“Even more than what you think, how you think matters.  The stakes for understanding this could not be higher than they are today, because we are not just battling for what it means to be scientists. We are battling for what it means to be citizens.”

Atul Gawande, MD, in The New Yorker, June 2016. His essay about scientific thinking was delivered as a commencement speech at California Institute of Technology in Pasadena.  (Also cited in Becker’s Hospital Review.)

Economic Segregation in America

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tax-foundation-map-485x492.jpgAs of 2015, 13.5% of Americans live in poverty.  That’s 43 million people, most of whom require some for of public assistance to survive.

 

Most of these families are single-parent, headed by a female.  Poverty exists in all areas of the US, but tends to be clustered in rural areas and in small to medium metro areas.

 

The seven states with the highest proportion of residents living in poverty (based on income, 2015 data) are

  • Mississippi, 22.1%
  • New Mexico, 19.8%
  • Louisiana, 19.5%
  • Arkansas, 18.7%
  • Alabama, 18.5%
  • Kentucky, 18.3%
  • West Virginia, 18.0%

Rural areas have problems, only partly offset by lower costs of living.  For example, in Oglala Lakota County, South Dakota, 44.2% of residents are in poverty.  In Yazoo County, Mississippi, it’s 34.2%.

The standard metropolitan areas with the highest rates of poverty are

  • Brownsville-Harlingen, Texas, 32.4%
  • Laredo, Texas, 32.3%
  • McAllen-Edinburg-Mission, Texas, 31.5%
  • Visalia-Porterville, California, 27.6%
  • Las Cruces, New Mexico, 27.1%
  • Athens-Clarke County, Georgia, 27.1%
  • Greenville, North Carolina, 26.8%
  • Merced, California, 26.7%
  • Valdosta, Georgia, 26.6%
  • Pine Bluff, Arkansas, 25.7%
  • Pocatello, Idaho, 25.3%
  • Fresno, California, 25.3%
  • El Centro, California, 25.1%

Yes, the three worst are all in Texas.  Yes, these are all areas where every fourth person lives in poverty.

Poverty is concentrated in states that have relatively low spending on social programs and whose voters consistently vote against government spending.

That’s particularly amusing since the states most dependent on Federal spending are

  • Mississippi (42.9% of state revenue in 2013, highest in the US)
  • New Mexico
  • Louisiana
  • Alabama
  • Tennessee

The states least depending on Federal spending are

  • Delaware
  • Connecticut
  • New Jersey
  • Kansas
  • California

Basically, blue states subsidize red states.  That awareness may have added to the anger over the most recent election results.

Happy New Year.  2017 should be “interesting.”


Sources

Checking out of the holidays

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lights-1088141__340In listening to people this season, I’ve learned that there are good people who are no longer emotionally engaged in the winter holidays.  This is more than just not giving gifts.  Nor is it a function of religious affiliation.  However, this is real and each person has there own compelling reason for opting out.

Unless you listen, you may not know who these people are.  They may even put up decorations and wish others a “Happy Holiday” or “Merry Christmas.”  However, they aren’t having one themselves.

We know that (as of 2014) 9% of Americans were not giving gifts for the holidays.  That number may be understated.

  • Only 70.6% of Americans self-identify as Christian according to Pew.  Of course, Jews may give Hanukah gifts, but only 1.9% of Americans say they are Jewish.
  • Household finances are a major reason for abandoning gift-giving.

There are other reasons.  As on blogger notes

“If you’re anything like this writer, Christmas was just never a thing in your house.” Lieu

I don’t know about that blogger, but the people with whom I’ve spoken cite a number of specific reasons for loss of enthusiasm for the holiday.  This is a small sample, so I can’t quantify statistically how common these issues are, or which is more important.

  • The holiday is associated with loss of a loved one
  • Growing up in a dysfunctional home
    • An alcoholic parent who binges on the holidays
    • A workaholic or absentee parent
    • An abusive parent
  • Abuse by a minister or priest
  • Having a dysfunctional spouse (alcoholic, abusive or absentee)
  • Abusive relatives or in-laws

Any of these things can forever darken a holiday.  For the victim, the linkage is tattooed on the memory; he or she just wants to get past the day.

The best you can do as a third party is understand and show compassion.  You can’t make the person feel differently than they do.

Even compassion is hard when the victim won’t talk about what happened.  That’s where your listening skills have to be acute.  If you want to help, you need to hear “between the words.”

So the person who says “Bah Humbug” to the holiday may not be a Grinch or Scrooge, but may be someone in need of understanding. Or someone with whom to take in a movie.


Sources:

 

A Solemn Thought at Christmas

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Aristotle is usually correct.  Anything taken to excess turns bad.  Think of the examples:  too much sugar, too much poverty, too much power, too much self-righteousness.

“There is nothing superstitious in using the name of the Deity. I believe myself in those eternal principles on which human weakness reposes before it starts on the path of virtue.  These are not idle words in my mouth any more than they have been idle words in the mouths of many great men, nonetheless moral for their belief in the existence of God.”

Who would make such a statement?  None other than Robespierre, The Incorruptible, author of the Reign of Terror during the French Revolution, responsible for the deaths on tens of thousands on the guillotine.  He was the 1700s version of ISIS, using a device far more efficient than modern terrorists now use to behead victims.

Why think of him today?

An important lesson from history and from the 14th Dalai Lama is that happiness comes from within and not from material goods or conquest.  Conversely, while extremism in the pursuit of anything can produce short term gain, the gain tends to be short term, and the misery it causes is overwhelming.

So, why think of him today?

Simply, Christmas isn’t supposed to be about material gifts or about the superiority of one religion over another.  Jesus was called The Prince of Peace for a reason, and while his message may have been twisted over the last 2000 years, the promise of peace remains profoundly appealing.  Its what people need.  It’s some thing each of us can act to bring into being.

Please remember the mantra:  “change begins with me.”


Sources:

  • Scurr, Ruth, Fatal Purity, Henry Holt and Co., New York, 2006, p. 192.
  • Dalai Lama and Archbishop Desmond Tutu, The Book of Joy,Penguin Publishing Group, 2016

Body cams

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ben_franklinBen Franklin said, “Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety.”

Police body cams can save lives and lawsuits.  There’s remarkable evidence from field trials supporting that claim:

In 2006, police officers in the United Kingdom tested body cameras and found that the technology enhanced the collection of hard-to-refute evidence and resulted in fewer cases going to trial. In 2012, a similar field test took place with the Rialto, Calif., Police Department. The 12-month experiment randomly tested body cameras on officers during their shifts. The cops used cameras from Taser International, which were water resistant, captured video in full color and had a battery life of 12 hours. The test results were startling: When the cameras were turned on, use of force by officers dropped 60 percent and complaints against the police fell nearly 90 percent. [Newcombe]

635902870224132893-bodycamHowever, technology changes, and new technology raises new issues with these devices.

A new (and relatively shoddy) report from the Department of Justice confirms that some body cameras used by police have facial recognition technology as well as some ability to detect weapons on an individual.  There is no comment on the accuracy of either technology.  We know that police radar guns have a statistical measurement error, but what’s the equivalent for facial recognition?

That changes the interaction between police and civilians.

It makes perfect sense that an officer would want to know if an individual he is approaching is a known criminal or potentially dangerous.  Certainly, the officer would want to know if the civilian is armed. Heck, I’d like to know that.

If the camera can provide that information, it makes no sense that a body cam would ever be disabled on initial approach to a suspect.  In shootings where the body cam is reported to have been non-working, that becomes more suspicious.  What officer would want to go on patrol with a key piece of equipment out of service?

The body cam raises issues for civilians with permits to carry concealed weapons.  If the officer knows someone is armed, will they approach the civilian differently?  Treat the civilian more like a criminal?  Would that raise the risk of the civilian being shot?

Obviously, protestors lose their anonymity.  Any protestor — whether it’s a protest over a shooting, taxes, firing of a school teacher or flag burning — will be identifiable if in range of a body cam.  There will be an electronic record of those so identified.  How will that record be used?  There are no regulations on that today, as protest is in theory a public act.  Could you lose a job because you participated in a protest?

What controls are there on the use of body cams by private detectives and civilians, or their placement on drones?

If an officer leaves the scene of a domestic violence complaint without making an arrest or report, is there still an electronic record?  Could that record be accessed for use in any subsequent court actions?

Lot’s of questions with no answers as yet.


Sources

 

 

 

 

Another Titan Passes

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harris0581454615581I’ve had the pleasure of being able to meet and work with a number of remarkable people.  My first “real” job after grad school  was at Louis Harris and Associates in New York.  Lou had won fame as John Kennedy’s polling consultant in 1960, and when I knew him, had a nationally syndicated newspaper column on public opinion.

LHA as it was known was an incubator for many market research professionals and major research firms.  It was said that if Lou had been able to keep all of this spinoffs, his firm would have been the largest in the industry, instead of simply one of the most respected.

His emphasis was on understanding people’s motivations — the logic underneath the numbers.  That’s what is missing in a lot of studies of consumers today, and one of the key elements missing in polling for the last election.  Bluntly, if there is no logic underneath the numbers, the numbers are probably wrong.

He passed this week.  I hadn’t spoken to him  in years, but I’m still grateful for the opportunity to work with him.  I learned a lot.

There’s a lot more about him in the Washiongton Post obituary:

https://www.washingtonpost.com/politics/lou-harris-pollster-for-presidents-and-others-officeholders-dies-at-95/2016/12/19/e7f49c2a-c626-11e6-bf4b-2c064d32a4bf_story.html?utm_term=.21c1eb51ffcd