Later On

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

Archive for May 9th, 2015

Wrecking someone’s life for no reason

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The Federal government does not seem to consider the damage it does to people’s lives. Nicole Perlroth reports in the NY Times:

On Monday, Oct. 20, 2014, Sherry Chen drove, as usual, to her office at the National Weather Service in Wilmington, Ohio, where she forecast flood threats along the Ohio River. She was a bit jet-lagged, having returned a few days earlier from a visit to China. But as she headed to her desk, she says, she had no reason to think it was anything other than an ordinary day. Then her boss summoned her.

Once inside his office, a back door opened and in walked six agents from the Federal Bureau of Investigation.

The agents accused Mrs. Chen, a hydrologist born in China and now a naturalized American citizen, of using a stolen password to download information about the nation’s dams and of lying about meeting with a high-ranking Chinese official.

Mrs. Chen, 59, an adoptive Midwesterner who had received awards for her government service, was now suspected of being a Chinese spy. She was arrested and led in handcuffs past her co-workers to a federal courthouse 40 miles away in Dayton, where she was told she faced 25 years in prison and $1 million in fines.

Her life went into a tailspin. She was suspended without pay from her job, and her family in China had to scramble for money to pay for her legal defense. Friends and co-workers said they were afraid to visit. Television news trucks parked outside her house, waiting to spot a foreign spy hiding in plain sight in suburban Wilmington, population 12,500.

“I could not sleep,” Mrs. Chen said in a recent interview. “I could not eat. I did nothing but cry for days.”

Then, five months later, the ordeal abruptly ended. In March, just a week before she was scheduled to go on trial, prosecutors dropped all charges against Mrs. Chen without explanation.

“We are exercising our prosecutorial discretion,” said Jennifer Thornton, the spokeswoman for the United States attorney for the Southern District of Ohio. She added that last year the Justice Department filed 400 indictments and “criminal informations” — charges filed in connection with plea agreements — and dismissed 13 of them, including Mrs. Chen’s. The United States attorney would not comment on the investigation, but there is little question that law enforcement is facing new pressure to pursue any lead that could be related to trade-secret theft. . .

Continue reading. It’s a fairly lengthy article.

This seems a lot like bullying at a high level. I hope she brings a civil suit for this baseless harassment. Clearly the presumption of innocence—of requiring proof that someone is guilty—is going by the wayside. Charge first and ask questions later seems to be the new order.

Written by Leisureguy

9 May 2015 at 2:14 pm

Overkill from medical care

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Atul Gawande writes in the New Yorker:

It was lunchtime before my afternoon surgery clinic, which meant that I was at my desk, eating a ham-and-cheese sandwich and clicking through medical articles. Among those which caught my eye: a British case report on the first 3-D-printed hip implanted in a human being, a Canadian analysis of the rising volume of emergency-room visits by children who have ingested magnets, and a Colorado study finding that the percentage of fatal motor-vehicle accidents involving marijuana had doubled since its commercial distribution became legal. The one that got me thinking, however, was a study of more than a million Medicare patients. It suggested that a huge proportion had received care that was simply a waste.

The researchers called it “low-value care.” But, really, it was no-value care. They studied how often people received one of twenty-six tests or treatments that scientific and professional organizations have consistently determined to have no benefit or to be outright harmful. Their list included doing an EEG for an uncomplicated headache (EEGs are for diagnosing seizure disorders, not headaches), or doing a CT or MRI scan for low-back pain in patients without any signs of a neurological problem (studies consistently show that scanning such patients adds nothing except cost), or putting a coronary-artery stent in patients with stable cardiac disease (the likelihood of a heart attack or death after five years is unaffected by the stent). In just a single year, the researchers reported, twenty-five to forty-two per cent of Medicare patients received at least one of the twenty-six useless tests and treatments.

Could pointless medical care really be that widespread? Six years ago, I wrote an article for this magazine, titled “The Cost Conundrum,” which explored the problem of unnecessary care in McAllen, Texas, a community with some of the highest per-capita costs for Medicare in the nation. But was McAllen an anomaly or did it represent an emerging norm? In 2010, the Institute of Medicine issued a report stating that waste accounted for thirty per cent of health-care spending, or some seven hundred and fifty billion dollars a year, which was more than our nation’s entire budget for K-12 education. The report found that higher prices, administrative expenses, and fraud accounted for almost half of this waste. Bigger than any of those, however, was the amount spent on unnecessary health-care services. Now a far more detailed study confirmed that such waste was pervasive.

I decided to do a crude check. I am a general surgeon with a specialty in tumors of the thyroid and other endocrine organs. In my clinic that afternoon, I saw eight new patients with records complete enough that I could review their past medical history in detail. One saw me about a hernia, one about a fatty lump growing in her arm, one about a hormone-secreting mass in her chest, and five about thyroid cancer.

To my surprise, it appeared that seven of those eight had received unnecessary care. Two of the patients had been given high-cost diagnostic tests of no value. One was sent for an MRI after an ultrasound and a biopsy of a neck lump proved suspicious for thyroid cancer. (An MRI does not image thyroid cancer nearly as well as the ultrasound the patient had already had.) The other received a new, expensive, and, in her circumstances, irrelevant type of genetic testing. A third patient had undergone surgery for a lump that was bothering him, but whatever the surgeon removed it wasn’t the lump—the patient still had it after the operation. Four patients had undergone inappropriate arthroscopic knee surgery for chronic joint damage. (Arthroscopy can repair certain types of acute tears to the cartilage of the knee. But years of research, including randomized trials, have shown that the operation is of no help for chronic arthritis- or age-related damage.)

Virtually every family in the country, the research indicates, has been subject to overtesting and overtreatment in one form or another. The costs appear to take thousands of dollars out of the paychecks of every household each year. Researchers have come to refer to financial as well as physical “toxicities” of inappropriate care—including reduced spending on food, clothing, education, and shelter. Millions of people are receiving drugs that aren’t helping them, operations that aren’t going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm.

Why does this fact barely seem to register publicly? Well, as a doctor, I am far more concerned about doing too little than doing too much. It’s the scan, the test, the operation that I should have done that sticks with me—sometimes for years. More than a decade ago, I saw a young woman in the emergency room who had severe pelvic pain. A standard X-ray showed nothing. I examined her and found signs of pelvic inflammatory disease, which is most often caused by sexually transmitted diseases. She insisted that she hadn’t been sexually active, but I didn’t listen. If I had, I might have ordered a pelvic CT scan or even recommended exploratory surgery to investigate further. We didn’t do that until later, by which time the real source of her symptoms, a twisted loop of bowel in her pelvis, had turned gangrenous, requiring surgery. By contrast, I can’t remember anyone I sent for an unnecessary CT scan or operated on for questionable reasons a decade ago. There’s nothing less memorable.

It is different, however, when I think about my experience as a patient or a family member. I can readily recall a disturbing number of instances of unnecessary care. My mother once fainted in the Kroger’s grocery store in our Ohio home town. Emergency workers transported her to a hospital eighty miles away, in Columbus, where doctors did an ultrasound of her carotid arteries and a cardiac catheterization, too, neither of which is recommended as part of the diagnostic workup for someone who’s had a fainting episode, and neither of which revealed anything significant. Only then did someone sit down with her and take a proper history; it revealed that she’d had dizziness, likely from dehydration and lack of food, which caused her to pass out.

I began asking people if they or their family had been subject to what they thought was unnecessary testing or treatment. Almost everyone had a story to tell. Some were appalling.

My friend Bruce told me what happened when his eighty-two-year-old father developed fainting episodes. . .

Continue reading.

Doing a little Googling shows that the “Colorado study finding that the percentage of fatal motor-vehicle accidents involving marijuana had doubled since its commercial distribution became legal” is dubious at best. I won’t post all the links, but I suggest some reading and research.

Written by Leisureguy

9 May 2015 at 12:41 pm

Posted in Medical

When laws don’t match social change: Legal Marijuana Faces Another Federal Hurdle: Taxes

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Jack Healy reports in the NY Times:

Money was pouring into Bruce Nassau’s five Colorado marijuana shops when his accountant called with the bad news: The 2014 tax season was approaching, and Mr. Nassau could not rely on the galaxy of deductions that other businesses use to reduce their tax bills. He was going to owe the Internal Revenue Service a small fortune.

“I had to write a check for $275,000,” Mr. Nassau said. “Unbelievable.”

The country’s rapidly growing marijuana industry has a tax problem. Even as more states embrace legal marijuana, shops say they are being forced to pay crippling federal income taxes because of a decades-old law aimed at preventing drug dealers from claiming their smuggling costs and couriers as business expenses on their tax returns.

Congress passed that law in 1982 after a cocaine and methamphetamine dealer in Minneapolis who had been jailed on drug charges went to tax court to argue that the money he spent on travel, phone calls, packaging and even a small scale should be considered tax write-offs. The provision, still enforced by the I.R.S., bans all tax credits and deductions from “the illegal trafficking in drugs.”

Marijuana business owners say it prevents them from deducting their rent, employee salaries or utility bills, forcing them to pay taxes on a far larger amount of income than non-marijuana businesses with the same earnings and costs. They also say the taxes, which apply to medical and recreational sellers alike, are stunting their hiring, or even threatening to drive them out of business.

The issue reveals a growing chasm between the 23 states, plus the District of Columbia, that allow medical or recreational marijuana and the federal bureaucracy, which includes national forests in Colorado where possession is a federal crime, federally regulated banks that turn away marijuana businesses and the halls of the I.R.S.

While President Obama and top federal officials have allowed states to pursue legalization, marijuana advocates say the dissonance between increasingly permissive state laws and federal prohibitions is creating a morass of complications and uncertainty.

The tax rule, an obscure provision referred to as 280E, catches many marijuana entrepreneurs by surprise, often in the form of an audit notice from the I.R.S. Some marijuana businesses in Colorado, California and other marijuana-friendly states have challenged the I.R.S. in tax court.

This year, Allgreens, a marijuana shop in Colorado, successfully challenged an I.R.S. policy that imposed about $30,000 in penalties for paying its payroll taxes in cash — common in an industry in which businesses rely on armed guards and cash-stuffed safes because they cannot get bank accounts.

“We’re talking about legal businesses, licensed businesses,” said Rachel Gillette, the executive director of Colorado’s chapter of the National Organization for the Reform of Marijuana Laws and the lawyer who represented Allgreens. “There’s no reason that they should be taxed out of existence by the federal government.” . . .

Continue reading.

If only the US had a Congress that actually functioned.

Written by Leisureguy

9 May 2015 at 12:22 pm

Soap Commander and RazoRock Baby Smooth

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SOTD 9 MAY 2015

Soap Commander Love shaving soap, which has an excellent rose fragrance. I read someplace that he was going for the same fragrance as the now-discontinued Klar Kabinett, a very nice shaving soap.

The lather was immediate and excellent, thanks in part to the Vie-Long brush shown. And the RazoRock Baby Smooth is a superb razor. I was hoping that these would be in plentiful supply, being (I imagine) easier to make than the Stealth slant, but these, too, are precisely machined, and I think the same shortage of machine availability that restricts the supply of Stealths also affects the availability of the Baby Smooth. It’s a shame, because it really is excellent and, at $45, very reasonably priced for what it is.

Three passes to perfect trouble-free smoothness, a good splash of Saint Charles Shave Savory Rose, and Saturday gets underway.

Written by Leisureguy

9 May 2015 at 11:39 am

Posted in Shaving

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