Dear Sir: We believe we can cure your diabetes. However, we may also have given you HIV…

A mixed-bag kind of a day for the US health care system.

US scientists have managed to rid diabetic mice of the effects of the disease using a cocktail of drugs.

The mice, who had type 1 diabetes, started producing their own insulin after taking a mixture of four drugs.

Previously the same team at Harvard University had only been able to stop the destruction of the cells which make insulin, not regenerate them.

This is good – this is flippin’ fantastic. The ability to make broken bodies regulate their own insulin? It’s an incredible discovery (and will hopefully continue to be successful through human trials).

This, however, was not-so-good:

US officials Thursday said 40,000 people may have been infected with HIV and hepatitis in a major health scare after a Las Vegas clinic was found to have re-used syringes and medicine vials.

Authorities in southern Nevada said they were notifying some 40,000 patients who received anesthesia injections at the clinic’s endoscopy center between March 2004 and January 11, 2008 about potential exposure to hepatitis and HIV.

No cases of HIV or hepatitis B infections related to the clinic’s practices have been detected yet, authorities said.

After an investigation, “the health district determined that unsafe injection practices related to the administration of anesthesia medication might have exposed patients to the blood of other patients,” it said.

“The joint investigation identified the re-use of syringes (not needles) and the use of single dose vials of anesthesia medication on multiple patients as the potential sources of contamination.”

Action has since been taken by the clinic to end such practices.

“It appears the injection practices that can lead to the transmission of hepatitis C and other bloodborne infections have been occurring at this clinic for several years,” said chief health officer Lawrence Sands.

As near as I can determine the practice hasn’t been found to be unsafe – it was always unsafe, and should not have been occurring at this or any other clinic.

The consequences certainly ought to be interesting – class-action-wise-speaking, etc.

The NEJM discusses why the government can’t do …anything?

Quite a cool editorial in this week’s New England Journal of Medicine:

The conflagration over the reauthorization of the State Children’s Health Insurance Program (SCHIP) offers a compelling example of Washington’s current inability to address even seemingly uncontroversial matters such as improved health care coverage for children.

…

Why would the President veto bipartisan legislation that does precisely what he insisted on — namely, aggressively enroll the poorest children? One might blame the poisonous atmosphere that pervades Washington these days, but other important social policy reforms have managed to get through.

One answer lies in a far larger dimension of SCHIP that is basic to any health insurance legislation — namely, the legislative architecture of the reform plan, its structural and operational approach. Viewed from this vantage point, the SCHIP battle turns out not to have been about family-income assistance levels or the mechanism for financing coverage subsidies (although both the Medicare managed-care industry and the tobacco companies weighed in noisily on the latter question).

Instead, the issue became the role of government in organizing and overseeing the health care marketplace (see graphs). SCHIP uses the power of government to form insured groups, select qualified plans, oversee plan operations, and measure results. It is this architecture to which the President was referring when he said that the legislation would move the health care system in the wrong direction.

The graphs in question are quite useful:

So enrollment (the number of children being helped) is capped out and declining, while the cost is increasing. The problem? Not health insurance at all, but health care costs themselves.

So the identification that the architecture of government intervention/support, ideologically, is the sticking point, is quite correct. The real problem, in terms practical – meaning actually helping poor kids – isn’t insurance, but costs. As previously discussed, SCHIP is the wrong method by which to achieve this outcome, when it is unnecessarily cost-increasing.

Of course, this runs into the problem of letting the government manage such a thing as hospitals. Given how well they performed on something like the mere legislation towards such an end, how much do we trust them to do anything competently at all?

Post-script: a colleague and I had been discussing an interesting piece of analysis, which neither of us will ever find the time to undertake. It is this:

1. How much money/resources were employed by the US government in pursuing this legislation? This means paper, ink, admin support, debating/voting hours – costing in entirety the politics played to get this legislation up and down the monkey-bars of “government”
2. How much health-care-for-children could actually have been provided for that money?

The idea is that actually doing something was the opportunity cost of governmenting the thing into being. We believe the numbers would – very, entirely, rightly – thoroughly embarass this or any other body of politicians.

Drinking water in Beijing. Or, if the mountain will not come to Muhammad…

…smash the drawing room to pieces!

Remember that old post about moving Beijing? If you’ve forgotten:

China really should consider moving the capital away from Beijing. Any nation, particularly a major power, should choose a location for its capital that allows growth and can respond to challenges. The historical advantages that led Beijing to become China’s capital no longer exist, and the location’s disadvantages are becoming ever more apparent.

…

Quenching Beijing’s thirst has already meant tapping the Hai River and water from neighbouring provinces. Now the Han River is to be diverted for a huge project transferring water from the south to the north. The impact of this project on the lower reaches of the Han River should not be underestimated. It will not necessarily solve water problems in the north, but it may well destroy the environment in the south. Beijing may have moved the Shougang steel plant for the sake of its air quality, but it continues to develop water-intensive industry. Why not move the industry and resources where there is more water?

Plan A, however, is still in effect.

The diversion of water to Beijing for the Olympics and for big hydropower projects threatens the lives of millions of peasant farmers in China’s north-western provinces, according to a senior Chinese government official.

In an interview with the Financial Times, An Qiyuan, a member and former chairman of the Chinese People’s Political Consultative Committee for Shaanxi province and former Communist party chief of Shaanxi, warned of an impending social and environmental disaster because of overuse of scarce water resources.

Beijing will need an estimated 300m cubic metres of additional water just to flush out the polluted and stagnant rivers, canals and lakes in its central areas to put on a clean, environmentally-friendly face for Olympic visitors, according to municipal officials.

The average annual per capita water supply in China is 348 cubic metres, well below the global average and the United Nations definition of “water shortage”, which is anything below 1,000 cubic metres. Beijing’s supply is even lower, at 235 cubic metres. Many experts say these shortages are exacerbated by artificially low prices set by the government.

“Beijing is facing a water crisis and it is fighting for water with neighbouring cities, including Tianjin and Zhangjiakou,” said Wang Jian, a Beijing government employee and activist on water issues. “The price of water does not reflect its true value, but the government has decided to control the price in order to maintain a harmonious society in the run-up to the Olympics.”

The government has launched a grandiose $60bn “south to north water diversion project” that will channel about 1.2bn cubic metres of water a year from wetter southern provinces to the country’s arid north.

Well – if we will insist upon our amusing diversions and displacement activities…

Mazda: William McDonough called…

William McDonough is, amongst other things, author of the utterly brilliant Cradle to Cradle. Short version: when we recycle, say, a plastic bottle, we do not get another plastic bottle. In fact we downcycle materials, making less and less-robust products with each iteration. We do, slowly, waste resources. McDonough’s call is for pure recycling, or upcycling, in which that plastic bottle gives us another bottle. A car, for example, can have all of its parts recovered (including paint, rubber, plastics, etc.) and used to make the same thing again on the next car.

Introductions over. I discovered another alternative universe for myself, this evening, reading this article in Wired magazine (Techno-Cowboys of the Deep Sea: The Race to Save the Cougar Ace).

Short version: incredible. And this isn’t just because I’m a weirdo who can read entire books about the Beaufort Scale while not actually liking the ocean’s role. It’s an incredibly interesting story.

However. This piece stood out the strongest, for me:

For more than a year, the 4,703 Cougar Ace Mazdas sit in a huge parking lot in Portland, Oregon. Then, in February 2008, the cars are loaded one by one onto an 8-foot-wide conveyor belt. It lifts them 40 feet and drops them inside a Texas Shredder, a 50-foot-tall, hulking blue-and-yellow machine that sits on a 2.5-acre concrete pad. Inside the machine, 26 hammers — weighing 1,000 pounds each — smash each car into fist-sized pieces in two seconds. The chunks are then spit out the back side.

Though most of the cars appeared to be unharmed, they had spent two weeks at a 60-degree angle. Mazda can’t be sure that something isn’t wrong with them. Will the air bags function properly? Will the engines work flawlessly throughout the warranty period? Rather than risk lawsuits down the line, Mazda has decided to scrap the entire shipment.

4,703 cars, reduced to nothing but unusable pills. Not a single part of the automobiles recovered or recycled. Insane.

How to keep an AUD30bn surplus

The short version: you can’t. Not (politically) tenably, at any rate.

The Federal Government could deliver a record budget surplus of between $26 billion and $30 billion under its new fiscal policy tactic for putting downward pressure on inflation.

As the Government faced calls yesterday from a business group to freeze spending, it is emerging that the surplus for next financial year is set to be much larger than the $18 billion flagged.

This would allow the Government to use the budget to sell its message that it is tightening fiscal policy enough to contain inflationary pressures despite keeping its promised $31 billion in tax cuts.

The Treasurer, Wayne Swan, said yesterday the Government would apply a “new era of fiscal discipline” for years to get inflation under control.

Mr Swan said a Business Council of Australia submission calling for no real spending increases correctly identified challenges in areas like improving workforce skills and infrastructure.

I don’t know how the government plans to pull that off. Our economy is under very serious inflationary pressure – as was well-presented only over the weekend by Ross Gittins:

When our real resources reach the point of being fully employed, the economy (gross domestic product; aggregate demand) simply can’t grow faster than aggregate supply is growing – which these days the econocrats estimate to be 3.5 per cent a year at most, and probably nearer 3 per cent.

When we attempt to grow faster than that we don’t succeed, we just generate imports and inflation.

If, for instance, the state governments decide it’s time to start making inroads into the infrastructure backlog, their extra spending is more likely to bid up wages in the construction sector than cause more roads and schools to be built.

…

So how do we reduce the likelihood of such an unhappy event? By reducing the need for the Reserve Bank to rely as heavily on the blunt instrument of further interest-rate rises by making more use of the budget’s braking power.

And that means Kevin Rudd not being so stupid as to keep his ill-considered promise to cut taxes in July.

Needless to say, now that they are in opposition, the liberal party has a different view:

the Opposition Leader, Brendan Nelson, defended the Coalition’s approach. “As a Liberal Party we take the view that those taxes [are] money taken out of the pockets of hard-working, everyday Australians,” Dr Nelson said.

“Once we’ve delivered on our commitments in defence and health, education and roads and all of the things that we need to do to look after pensioners, then that money wherever possible ought to be returned to the people who actually paid it.”

Actually, as a liberal party, you should not have set those tax revenues up in the first place, while allowing a now-probably-non-solvable export bottleneck to hold productivity back.

Budding Austrian economists! This is why (big G) Government isn’t supposed to take away more than the minimum required to do the things for which it was created. It always ends in tears, eventually. I don’t much look forward to another recession we will have to have had (I’m the Picasso of tenses, it’s true).

Given, as Gittins explains, that we are at (and, probably beyond) the non-accelerating inflation rate of unemployment, giving Australian households AUD31bn in negative taxation is not going to help much – irrespective of how much money the government isn’t giving back.

If today’s IHT is correct, the commodities boom could, soon, be boosting Australia’s income still further, as Latin America faces its own problems:

Argentina and Brazil are facing the possibility of short-term energy crises from a lack of natural gas, which is needed to fuel industries and generate electricity for residents. Bolivia is sitting in the middle, with the region’s largest gas reserves.

I’m with Gittins: the government should really consider holding onto that money for awhile. Pour it into the migration of labour within the economy, from low to high-productive areas/industries, if necessary.

This returns us to the notion of complexity, though. If you’d promised AUD31bn in tax cuts, and then I came along and explained the macroeconomic risks of delivering on that promise – the promise of tax cuts – what would you do? Unfortunately, the government is also in politics.

Want to get more people on public transport? Facilitate more driving

Which means facilitate more driving intelligently. But hey – now that you’re here…

A critical shortage of commuter car parking is forcing thousands of would-be train users on to the roads adding to Sydney’s already chronic congestion, an NRMA report says.

More than 40 per cent of motorists who otherwise drive all the way to work would rather park at a station and commute if there were an adequate number of parking spots at the station.

…

The NRMA’s audit of Park and Ride facilities, released today, shows some of Sydney’s busiest transport interchanges provide parking facilities so poor that public transport becomes untenable.

“Currently most motorists are left with no choice but to drive to work, which adds to traffic congestion, increases the weekly fuel bill and leads to more carbon emissions,” said the president of the NRMA, Alan Evans.

A report last year by the NSW Auditor-General discovered that in 2004, with so few dedicated parking stations at train stations, Sydney had the greatest number of cars parked on residential streets of any Australian city – 32,000 compared to 10,900 in Melbourne.

The report criticises the ad-hoc provision of these services, especially near poorer areas of Sydney where there are few effective public transport options.

I take issue with the suggestion that “most motorists are left with no choice but to drive to work”, but I’m an insensitive, non-driving, hippie scum. So.

I certainly understand the problem. Driving/parking and public transport are, in some ways, substitutes: we expect people to take the train to work, rather than drive. However, they are also, in other respects, complements: as more public transport is consumed, the demand for private transport (of a certain type, in this case passage to, and parking at, train stations) will increase.

People’s behaviour being what it is, we can see parking spaces being a necessary condition for the use of publc transport. People drive for convenience, for privacy – they will take a train to work, but they won’t (or won’t at all happily) take a bus to the station to take a train to work. In places like Woy Woy:

(and, yes, people commute that distance – crazy people, but people) that bus probably doesn’t exist. In most inner-city suburbs bus services exist but, having built our environments around our cars, many people just don’t live near these amenities (or, rather, sufficiently near for them to countenance using them).

Is this irrational? Oh, possibly. Driving to work, the frustration of the traffic and finding parking, the costs thereof – to me, the non-driver, the money, time and frustration are very high prices to pay. I’d sooner just take public transport and be a permanent passenger. People value their perception of “freedom” that their car affords them, though, and, if we want them to join our game, we do need to make the game itself appeal to them.

Just ask Tim Hartford (or any economist at all, actually – but he’s the famous one): for a driver, going through all the shit of driving to, and trying to park in, the city simply because it’s (most likely less) hard to do so 5 minutes from their house, is perfectly logical. If we can’t beat their logic, we need to accommodate it.

Did John Edwards have an advantage all along?

The advantage being that there are fewer sons of mill-workers – meaning he had a monopoly on the narrative (I don’t know if his father was a flour-mill-worker or not). From The American Journal of Industrial Medicine, via Reuters:

Using data from the Washington State health department, researchers found that the children of men who worked in flour mills were disproportionately female. Of 59 children born to these workers between 1980 and 2002, 37 — or roughly 63 percent — were girls.

In contrast, just over 51 percent of children born in Washington during that period were boys, according to the findings published in the American Journal of Industrial Medicine.

…

The current study found that, besides the low prevalence of male births, boys born to flour mill workers also weighed significantly less than average. Their average birthweight was 7 pounds, compared with nearly 8 pounds among girls born to flour mill workers, and about 7 pounds, 12 ounces among boys born statewide.

Unfortunately, and despite their false promises, my library either doesn’t have access, or won’t give it to me, off-campus, but from the paper’s abstract:

Background
The Washington State Department of Health has collected and coded parental occupation information on birth certificates since 1980. We used these data to search for possible effects of parental occupational exposures on birth outcomes.

Methods
We tabulated sex ratio, birth weight, and proportions of multiple births, still births, and malformations by mothers’ and fathers’ occupations.

Results
There were 59 births (22 boys and 37 girls) where the father’s occupation was specified as flour mill worker. The sex ratio of 0.373 (95% confidence interval [CI]: 0.261-0.500) was lower than the mean sex ratio of 0.512. The mean birth weight for flour mill workers’ boy babies was 3,180 g (95% CI: 2,971-3,389), compared to an overall mean of 3,511 g for all boy babies. The mean birth weight of flour mill workers’ girl babies was 3,602 (95% CI: 3,380-3,824), compared to an overall mean of 3,389 for all girl babies.

Conclusion
The low prevalence of male infants born to fathers of flour mill workers in Washington State suggests that fumigants that they are exposed to are causing testicular dysfunction. The very low birth weight seen in the male infants of flour mill fathers is unprecedented and may be another genotoxic endpoint.

This lack of access is annoying, because I really want to see the paper. Why, you ask? Well I can certainly understand that question, having just asked it myself (hat-tip to Colonel Blake).

This sort of analysis is prone to several statistical problems. The first is what we call “power”. “Power” is a function of sample size: small samples are under-powered. Why? Because a small sample has less information, possibly too little information, with which to establish properly the distribution of the data. Moreover, too-small samples are less and less likely to represent properly a population (meaning your results apply only to your sample – in this case Washington State, say – and not to the population at large). The authors are, above, using confidence intervals, meaning they’re relying upon the Central Limit Theorem. They certainly can do this, although their sample of 59, with p = .373, isn’t all that close to the criteria for textbook statistics (at nearly 50/50 probabilities, one is a lot more assured of underlying normality).

I’m just wary of small samples. I’d like to see what else they did. The proportion of males is statistically significantly less than the population proportion (we can see this because the 95% confidence interval of the proportion of males does not include 0.512), but I’m willing to bet the confidence intervals of each (p = .373 and p* = .512 overlap significantly, and I’d like to see by how much (meaning I’d like to see how the confidence intervals work using the “population” numbers, rather than the mill-worker numbers).

The other problem I’d like to see worked out is Simpson’s Paradox. Simpson’s paradox is an aggregation issue and the classic example of it, in fact, relates to low-birth-weight babies (of smokers). It basically says that, merely by dis-aggregating data, one can draw incorrect conclusions. In the case of this paper, the low-birth-weight problem, once children have been separated by gender, might not have been observed had they not been separated by gender.

Don’t get me wrong – I’m not suggesting that there’s nothing here worth responding to. At the very least it has picked up the workers of Washington State, and Washington State ought to respond – assuming the “population” numbers are also Washington State, rather than national, in which case another set of comparisons would be needed. This is more a stats-geek level of interest.

Oh, I think Edwards’ father worked at a textile mill.

The Bacon Limit: the corner of diminishing Marginal Utility

Students of Economics: you have an obligation to see to it that this enters conventional lexicon as soon as possible:

A Softer World

Hilarious.

Autonauts of the Cosmoroute: A Timeless Voyage from Paris to Marseille

New book!

From Amazon:

Autonauts of the Cosmoroute is a love story, an irreverent travelogue of elaborate tales and snapshots detailing Julio Cortázar and Carol Dunlop’s thirty-three-day voyage on the Paris-Marseilles freeway in 1982. Uncovering the freeway’s hidden underbelly, they push life and literature to surreal extremes. This shot of sun is a satire on modern travel and the great explorers, and an intimate look at one of the greatest literary spirits of our time.

From the Quarterly Conversation:

The concept behind Autonauts of the Cosmoroute is so perfectly Cortazarian in its gamelike setup: Julio Cortazar and his companion Carol Dunlop decide to spend an entire month in 1982 living on the freeway between Paris and Marseille (the “Southern Thruway,” which was the name and topic of an earlier Cortazar story), stopping at two rest stops each day and staying overnight at the second. With only 490 miles separating Paris and Marseilles, they don’t actually drive for very long on any given day. Using words and pictures, they create a scientific account of their journey, their thoughts, their experiences, of living life in a Volkswagen bus at a snail’s pace, discovering the secret pathway right next to this modern creation designed to be experienced at a blur.

It’s a mad idea, but not without it’s charm.

From the long, dark, reflective pool of my scanner (since there is no preview to be had at Amazon):

The NY Times has a review, and there are a couple of other translated works by Julio Cortazar (“Hopscotch” is recommend highly by the Quarterly Conversation).