Later On

A blog written for those whose interests more or less match mine.

Archive for June 4th, 2009

Doctors monitoring torture?

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It’s highly unethical for doctors to work with torturers. But apparently they do. Sheri Fink writing for ProPublica:

Evidence is emerging that medical personnel monitored the medical effects of the waterboarding of Abu Zubaydah, the al-Qaida operative who was, according to government reports, subjected to the near-drowning at least 83 times in August 2002.

The new information comes from descriptions of cables, classified as top secret and relating to the interrogation of Abu Zubaydah, that were transmitted from a Central Intelligence Agency field station to the agency’s Langley, Va., headquarters nearly every day between Aug. 1 and Aug. 18 that year.

The descriptions of the cables (here [2] and here [3]) reveal that a daily "medical update" and "behavioral comments" along with status and threat updates were sent to CIA headquarters throughout that period. On five occasions between Aug. 4 and Aug. 9, an additional cable was sent containing "medical information" along with such information as the strategies for interrogation sessions, raw intelligence, the use of interrogation techniques to elicit information, and the reactions to those techniques. The fact that medical information was included in these cables hints that Abu Zubaydah was medically monitored during or after being subjected to those techniques. Both professional organizations and human rights groups have rejected as unethical any monitoring role for medical personnel.

A summary of the 34 cables and of a handwritten log book were released to the American Civil Liberties Union earlier this month on orders of …

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Written by LeisureGuy

4 June 2009 at 2:14 pm

Why America’s medical bill is so high?

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Bottom line: doctors are beginning to act like capitalists and work to maximize profit and leave no money on the table. The result: expensive but shoddy care. The phenomenon is examined in fascinating detail in this article by Atul Gawande in the New Yorker. From the middle of the article:

… When you look across the spectrum from Grand Junction to McAllen—and the almost threefold difference in the costs of care—you come to realize that we are witnessing a battle for the soul of American medicine. Somewhere in the United States at this moment, a patient with chest pain, or a tumor, or a cough is seeing a doctor. And the damning question we have to ask is whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue.

There is no insurance system that will make the two aims match perfectly. But having a system that does so much to misalign them has proved disastrous. As economists have often pointed out, we pay doctors for quantity, not quality. As they point out less often, we also pay them as individuals, rather than as members of a team working together for their patients. Both practices have made for serious problems.

Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.

This last point is vital. Activists and policymakers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks. Here’s how this whole debate goes. Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance. Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors. No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills. Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some “skin in the game,” and then they’ll get the care they deserve. These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes. You get McAllen…

Read the whole article. It brings new information (at least, new to me) into the national healthcare debate.

Written by LeisureGuy

4 June 2009 at 2:09 pm

Is there hope for America’s prisons?

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Interesting review:

Dreams from the Monster Factory: A Tale of Prison, Redemption and One Woman’s Fight to Restore Justice to All
by Sunny Schwartz

A review by Helen Epstein

America’s prison system is in a dire state. Some 2.3 million people in this country are now behind bars, five times more than in 1978. Our incarceration rate is now higher than that of any other country in the world. Many, if not most, inmates probably should not be there. Sixteen percent of the adult prison population suffers from mental illness and should be in treatment; a similar fraction is made up of children under eighteen. Although there is little evidence that blacks are more likely to use drugs than whites, they are six times more likely to be imprisoned on drug-related charges. Of those, most have no history of violence or drug dealing, and were arrested mainly for possession of drugs.

Sexual and other forms of abuse in prison are common, reported by some 20 percent of inmates. These “monster factories,” as the lawyer and author Sunny Schwartz calls them, do little to break the cycle of violence in society and may even accelerate it. Roughly two thirds of those released from US jails and prisons end up back inside within three years. Some studies suggest that the experience of imprisonment can be so brutal and humiliating that it actually makes men, in particular, harder and meaner, so that the crimes they commit the next time around are even worse than what got them incarcerated in the first place.

Senator Jim Webb of Virginia is currently sponsoring a bill that would create a commission to review America’s entire criminal justice system and make recommendations for reform. If the bill passes, its commissioners should bear in mind a small experiment that took place in the San Francisco County Jail in San Bruno, California, some years ago. This project, the subject of Sunny Schwartz’s brief, absorbing memoir Dreams from the Monster Factory, is important not just because it dramatically reduced recidivism, but also because it could help break the tired stalemate between liberals and conservatives over punishment versus rehabilitation. In addition, Schwartz’s book is revealing about the criminal mind and its thought processes, and thus contains valuable lessons for those at risk of incarceration, and for those close to them.

Schwartz, now in her fifties, began working in the San Francisco county jails in 1980 as a student intern. She volunteered to spend two days a week writing reports on prisoners’ complaints about sentencing or jail conditions and forwarding them through the seemingly impenetrable bureaucracy of the California state justice system. After graduating from law school, Schwartz worked briefly for an AIDS service organization and then, in 1990, at the request of her old boss Sheriff Michael Hennessey, she returned to County Jail 7 in San Bruno to launch a new set of programs designed to help inmates make the transition back into society after their release.

The inmates at San Bruno were typical of prison and jail populations across America. Over half were …

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Written by LeisureGuy

4 June 2009 at 2:01 pm

Extremely tasty hummus

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From The Eldest:

I loved the Hummus that we had at Santorini, the Thursday night before the wedding.  It reminded me of this recipe, which is my favorite hummus recipe.  The ingredients are pretty standard, but the texture that you get if you follow the instructions exactly is really fantastic!

Restaurant-Style Hummus
(from Cook’s Illustrated)

1/4 c. water
3 TBSP fresh lemon juice (for a more lemony hummus, grate some of the lemon peel before juicing, and add that as well)
6 TBSP well-stirred tahini
2 TBSP extra-virgin olive oil
15-oz. can chickpeas, drained and rinsed (I use 1/2 c. dried chickpeas, cooked and drained)
1 clove garlic, minced (ridiculous – I use more!)
1/2 tsp. salt
1/4 tsp. cumin
pinch of cayenne

Combine the water and lemon juice in one bowl, and the tahini and oil in another.   Set aside about 12 of the whole chickpeas for a garnish. 

Put the chickpeas, salt, garlic, cumin, and cayenne in a food processor and process for about 15 seconds.  Scrape down the sides of the processor. Then add the lemon water mix through the feed tube with the processor running for about 30 seconds, scraping down the sides, and then 30 seconds more.  Scrape down the sides again.  Add the oil and tahini, with the processor running, and process until the hummus is fluffy.  Allow to rest an hour for flavors to blend.

Put the hummus in a bowl, garnish with the whole chickpeas, and drizzle with additional olive oil.  (Some people also garnish with chopped cilantro.)

Written by LeisureGuy

4 June 2009 at 1:52 pm

Posted in Daily life, Food, Recipes

Books & movies

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Last night I watched Night at the Museum (okay, but heavily didactic in the spirit of National Treasure). The best performances, I would say, were by Dick Van Dyke and Mickey Rooney. Yes, Mickey Rooney.

That movie wasn’t very good, so I watched Colour of the Truth, with the estimable Anthony Wong. This is a Chinese action movie and quite well done. Anthony Wong is a genius. A really great film in which he stars: The Mission, another action film that is done quietly for the most part.

I previously mentioned the spy thriller The Tourist, by Olen Steinhauer (born in Baltimore, I would add). Preceding that is a series set in Eastern Europe over a period of 20 years or more. These should be read in order. From Wikipedia:

  • The Bridge of Sighs (2003)—Emil Brod, 1948 (nominated for five awards)
  • The Confession (2004)—Ferenc Kolyeszar, 1956
  • 36 Yalta Boulevard (2005)—Brano Sev, 1966-7
  • Liberation Movements (2006)—Brano Sev, Katja Drdova, Gavra Noukas, 1968 & 1975 (nominated for the Edgar Award for Best Novel)
  • Victory Square (2007)—The final book in the series, dealing with 1989, the end of communism, and the return to the main character of the first book, Emil Brod.

I’m also reading a non-fiction memoir, Blue Blood, by Edward Conlon, which tells of his experiences in the New York Police Department and of what in his life took him on that path. He’s a Harvard graduate and writes extremely well. If you live in New York, you definitely should read this.

Written by LeisureGuy

4 June 2009 at 1:49 pm

Posted in Books, Movies & TV

Martini with pickled ramp

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From the wedding reception:

Martini-with-pickled-ramp

Click image then click again for close-up. And smell that lovely fragrance.

Written by LeisureGuy

4 June 2009 at 1:33 pm

Posted in Daily life, Drinks

Janet & Ethan’s New York Food Crawl

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A valuable resource that’s a spin-off of the wedding: The Son and The New Daughter created a map with comments of some of their favorite NYC food spots. We went to Joe’s Shanghai and had the pork soup dumplings (delightful) along with a hot turnip cake appetizer that was equally good and a delicious spicy braised cabbage served chilled. If you click on a symbol (or a restaurant name), you’ll see their comment and recommendations. If you live in or visit NYC, this is a good thing to have.

Written by LeisureGuy

4 June 2009 at 11:31 am

Posted in Daily life, Food

Bureaucrats who forget the mission

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Sometimes in a bureaucracy (private (think health insurance companies) or public), bureaucrats forget their mission and either focus on internal fights or begin to think of the consumer as the enemy. (My friend in Columbus worked in a supermarket when he was in high school, and he has many stories of the manager of the dairy section, who had grown to hate customers, who (in his view) disrupted the displays, emptied the shelves (requiring re-stocking), and the like. Seeing customers pull aside the cartons of milk to get to the (presumably fresher) cartons in the back, he started putting his old stock in the back.)

There’s an excellent example of bureaucratic in-fighting recounted in Edward Conlon’s superb book about his experience in the New York Police Department (though it was an anomaly: most of the people he encountered were truly focused on doing a good job), and here’s another, from yesterday’s NY Times:

More than a year before a twin-engine turboprop flown by Colgan Air crashed on approach to Buffalo, a Federal Aviation Administration inspector complained to his superiors about the rocky start the airline was having with that model.

The inspector, Christopher J. Monteleon, was in the cockpit when the airline got its first such plane, a Bombardier Dash 8 Q400, and put it through a series of test flights.

Three times, he said, the pilots flew the airplane faster than the manufacturer’s specifications allowed, but they initially refused to report this and have the plane inspected for damage. They flew with a broken radio and did not want to write that up in the maintenance log, as the rules require, he said, because it might delay the next test flight. And they tried three approaches to the airport in Charleston, W. Va., and “botched” all of them, failing to get the plane at an appropriate altitude, on the right path and at the right speed for landing.

“They got confused,” Mr. Monteleon said in a recent interview, as he recalled the test flights in January 2008.

But when he reported problems to his F.A.A. superiors, he was suspended from important portions of his job overseeing Colgan’s acquisition of the Dash 8 and given a desk job, he said. Mr. Monteleon has had other run-ins with his bosses, and is currently on paid leave because, he said, managers accused him of menacing an agency lawyer.

Mr. Monteleon’s complaints about Colgan, which he repeated three months later to the Office of Special Counsel, a federal agency established to hear whistle-blower complaints, foreshadowed some of the issues that emerged 13 months later at the National Transportation Safety Board hearings on the crash near Buffalo, on Feb. 12, 2009. Colgan crews were flying fatigued, Mr. Monteleon said, and were not fully focused on the tasks in front of them, two factors apparently in play in the Buffalo crash. All 49 people on board the flight, which took off from Newark, were killed, along with one man on the ground.

While the safety board usually takes about a year to issue a final report on crashes like the one in Buffalo, its hearings in early May made it clear that the quality of the F.A.A.’s regulation of Colgan was one of the areas under investigation…

Continue reading. Yet another case of a regulatory agency protecting the regulated companies instead of the consumers and the public.

Written by LeisureGuy

4 June 2009 at 10:34 am

Trip report, Part 2

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Saturday was The Day. We gathered early for the photos, with The Older Grandson using a Nintendo to amuse himself while The Younger Grandson burned off energy (running, throwing rocks—heavy rocks—at  bigger rocks, climbing the hillside: constant motion). Thankfully, TYG stayed clean until the pictures were taken, but by the time the reception was over he resembled a boy who had been playing hard and was not fussy about dirt. (He’s 5, so it’s natural.) I did get an excellent photo of him in repose, fascinated by the string trio that was playing. (He takes violin lessons.)

The site of the wedding was Blue Hill at Stone Barns (review), which The Son mentioned had originally been brought to his attention by me, via a link to this photographic report in the Amateur Gourmet. The wedding was outdoors, brief, and absolutely beautiful and fulfilling. The Son looked better (and happier) than I’ve seen him, and The New Daughter was lovely and excited. Her family and friends were of course present, including several cousins, all delighted and delightful, though there was no time to squeeze in a game of baduk with her father. One great moment: The Son and Best Man standing at the front, looking toward the guests, being serious, and when The Bride appeared, The Son’s face lit up with a beaming smile.

As we stood about the lawn and flower garden after the wedding, extremely competent wait-staff circulated with hors d’oeuvres and glasses of wine, champagne, and the like. On the advice of the son, I requested a Martini with a pickled ramp (with Plymouth gin, of course), and a waiter brought me one: superb! (Click photo and then click again for a close-up.)

Martini-with-pickled-ramp

The noshes were wonderful: broiled pork belly, with ramp, on sticks, tiny cakes made of chickpea flour with pesto and capped by a small piece of anchovy, crab-meat in crisp little baskets, broiled chicken pieces on sticks, coated with herbs. One person made the observation that the chicken (raised on the farm there) really tasted like chicken, not like an anonymous manufactured white-meat protein.

The weather, forecast as partly cloudy (with rain the previous day) was in fact gloriously sunny and cool, with a very light breeze. Perfect, in a word. And the meal… “perfect” is too mild. I have eaten at The French Laundry. This was better, both in food (and wine) and in service. The wait-staff seem to be both highly gifted and highly trained, and things went swimmingly. The meal, course by course:

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Written by LeisureGuy

4 June 2009 at 10:23 am

Posted in Daily life

The Progress

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IMG_0987

Hidden inside the box is a puck of Rivivage shaving soap, one of the best (also sold as Dovo shaving soap). With the Plisson Chinese Grey, an extremely satisfying lather, which the Merkur Progress removed flawlessly, along with the stubble. The Progress, like the Futur and Vision, seems to have a tiny echo chamber built into the blade support, so you can enjoy the subtle snaps of stubble being clipped away. Very smooth shave, with Stetson aftershave providing a fine finish.

Written by LeisureGuy

4 June 2009 at 9:33 am

Posted in Shaving

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