Society for Medical Decision Making Convention 2009 – a report

Your correspondent just returned from the annual meeting of the Society for Medical Decision Making. Their stated mission:

The Society for Medical Decision Making’s mission is to improve health outcomes through the advancement of proactive systematic approaches to clinical decision making and policy-formation in health care by providing a scholarly forum that connects and educates researchers, providers, policy-makers, and the public.

Regulars at P&aP might remember earlier this year when we talked about “Death and taxes” .  Among the topics dipped into at that time were medical decision making, cost-benefit analysis and rationing.  The SMDM is very much about that, and I saw some very intense analyses measuring quality adjusted life years (QALYs). Practically, rationing can be done by cost who pays, chooses), rationing by availability of resources (many organ transplant issues are wrapped up in “not enough donors” issues), and rationing by reasoning (does the patient really know the quality cost of those additional months of life, an issue often seen in cancer trials). It was interesting and enlightening to see how dispassionate analysts are able to rise above the simple emotional pleas for “Aunti Em” to consider true costs to individuals, to insurance companies and (most dangerously) costs to taxpayers of unstoppable government largesse.

So, the bottom line for me, today, is that I really cannot host a P&aP tonight, but surely would like to see some dialog here leading up to a discussion next week between the quants (QALYs) and the emotes (“Auntie Em”).  Questions to be answered include:

• do QALYs make any sense (I’ll have a short handout and will try to post an explanation here)
• which is the best place to place responsibility for paying for medical care?
  • in the individual
  • in the insurance industry
  • in the employers
  • in the government.

I’d like to think about some options, and we should probably send a scouting party to the Rep. Bly Health Care Forum in Northfield, this Thursday at 6:30PM in the Northfield Community Resource Center. There we will hear about a plan to make Minnesotans all fall in line for a government payer model.

So the next Politics and a Pint will be on health care, health insurance and keeping a healthy government. We’ll meet on 1 November at the usual time. We’ll find irony in the juxtaposition of the talk and All Saint’s Day, as well as the start of the Dia de los Muertos holiday.  Bring your spirits and imbibe (or not) with us as we contemplate all things mystical and mathematical.

Details:

What: Politics and a Pint
Where: The Contented Cow in Northfield
Date: 1 November 2009
Time: 6:00-7:30PM

Global Warming … myth or fiction? Next on at Politics and a Pint (20 Sep 2009)

Well, we’ve been thinking and plotting about how to present this topic, and the truth is that P&aP is not about a presentation so much as a dialog, so we are going  to plunge right into those rising oceans of heated words and swim our way toward truth in our time. One of our regulars  has posed an interesting chain of reasoning that expands the basics into a stepping stone path of intermediate conclusions leading to the final minefields of political discontent.  He suggests we take a census at each of the steps along this path, which roughly stated appears as

1. Is the planet actually warming?  Or not?
2. If it is warming, what are the causes?
3. If it is GHGs, is it really CO2, or something else?
4. Has CO2 really gone up so much?
5. What is humankinds’ role, if any, in the cause?
6. If it is warming, is that so bad?
7. If it is warming, can we really do anything about it anyway?
8. What are the consequences of warming, if projections were correct?
9. If it is warming, and we do not like the consequences, is it too late?  What can be done?
10. Who’s buying the next round? Do you want carbon offsets with that?

We need lots of references, and I may bring out the ol’ whiteboard so we can play a variation of Pascal’s wager, a way to use quantification to clarify the unquantifiable. Send me references and I’ll post them (I need link and pro/con indication).

So let’s be civil
Let’s be quick.
Let’s (not) hang Jack
For burning a candle stick.

At the next,  Politics and a Pint.

The fine print:

What: Politics and a Pint
Where: Northfield’s Contented Cow
When: 6-7:30PM, 20 September 2009

References: (to be added … send me URLs and I’ll list a few of each).

• RealClimate: Climate science from climate scientists.
• Remember to “follow the money” (at followthemoney.org and opensecrets.org).

Looking ahead … a sneak peek

Question	Yes	No
Is the planet actually warming? Or not?	Of course it it, look at Mars!	?
If it is warming, what are the causes?	Solar boosted by Green House Gases (GHG)	Solar
If it is GHGs, is it really CO2, or something else?	CO2, methane, does it matter?	Save the planet … eat a gassy cow today!
Has CO2 really gone up so much?	Sure has	But it lags temperature like an effect rather than leading like a cause.
What is humankinds’ role, if any, in the cause?	Imagine if you can … a world without people. What a heavenly world it would be.	Let’s see, 300M+300M out of 7 billion, multiply by consumption, divide by … oh, the heck with it, 30%
If it is warming, is that so bad?	Malaria in the Yukon! Yellow fever in Minneapolis! We are all gonna die (see entry above).	Just ask the dinosaurs how they would have felt about a little global warming.
If it is warming, can we really do anything about it anyway?	Fix bayonets! If the people move, shoot ‘em. Anyone driving a car, shoot ‘em. Eating meat? Bang!	Let’s be democratic, hmmmm?  300M global warming fear mongers vs 1.2B+1.2B uninterested wanna-be-rich 2nd worlders and another 6B or so abstainers.  Democracy wins! The majority have spoken!
What are the consequences of warming, if projections were correct?	We’ll read all about it. Mass migrations and extinctions like we’ve only seen a few times.	Beaches move inland a few (hundred) miles. Siberia becomes fertile again. Sahara gets really hot.
If it is warming, and we do not like the consequences, is it too late? What can be done?	“Inconvenient Truth” meets “Idiocracy” and begets “Borat”.	3-2-1-liftoff! And the first colonizing expedition to Mars is on its way. This adventure brought to you by the Sino-Russian Conglomerate in partnership with India Rockets. Napkins provided by EU Paper products using 100% recycled stuff. The announcer and the bar staff were trained at Harvard in communications (“you want fries with that?”).
Who’s buying the next round? Do you want carbon offsets with that?

Art? Who needs it? Next Politics and a Pint

Well, it’s time for our annual look at the arts. The Northfield ArtSwirl is coming back to town, and their most vocal champion, Ross Currier has once again volunteered to lead the Politics and a Pint crowd in a discussion of the role of art in the community.

Last year he  kind of looked at the history of philosophical discussion and/or academic analysis on artists and the economy. There seemed to be three phases:

1) artists save the real estate,

2) creative types save the economy,

3) artists’ mental capacities save our future.

This year, he is going to talk about the most recent thinking/writing/theorizing in this area. A rough summary includes:

1) details on what artists do for a physical community,

2) details on what attracts artists to a physical community, and

3) artists and the non-physical community.

So, we’ll be taking a good look at the arts and how an active arts culture (a probioatmospheric) adds to the wellness of the community. Come and tip a beer (but not a cow!) at the Contented Cow.

The fine print:

What: Politics and a Pint
Where: Northfield’s Contented Cow
When: 6-7:30PM, 10 August 2009

References:

• NDDC Downtown Forum, “Living the Artist’s Life in Northfield“

The rationing challenge … what are some options

One of our regulars, Steve, asks “Can we ground the PaaP discussion in a little more reality.  Let’s talk about rationing (of health care).”

Touchy subject, but should be interesting, so we’ll talk about it at the next PandaP.

Then, on the 16th August, Ross Currier will lead a discussion of Arts in Northfield as part of the Artswirl!

So come on down and we’ll pour a tall glass of good company, lively discussion and some fine brews.

When? 6-7:30 PM on the 9th of August, 2009
Where? At the Contented Cow in Northfield

Ticklers – think about these rationing options

• European model:  Ration the number of doctors and clinics.  This controls costs by limiting the overall resource.  It creates long waits for even the most routine visits.
• Canadian (other European countries):  Limit the types of locations of specialists procedures and equipment.  Very few MRI machines in the country.  People in Alberta and Saskatoon travel to Ontario for routine knee surgery.
• Cuban model:  Everyone gets unlimited technologically circa 1955 medicine / care.
• Swiss model:  Universal base-line care.  Huge numbers of lightly regulated “private” and research clinics, which must be paid for out-of-pocket. Some private insurance.
• U.S. model: Ability to pay is rationing

No special topic for 26th July 2009

I won’t be at P&aP this weekend, so have not prepared any special topics. Hope you all enjoy a bit of polite conversation and a pint of Norm’s best!

Northfield growing … again

On Thursday morning the Northfield EDA discussed a new proposed development west of town. This development would require bringing in 456 acres of Bridgewater land, mostly tilled/tillable farmland. There are several concerns about this location, and a discussion is appropriate. See reference maps below to become familiar with the land we are discussing, then see the other references for details of this proposal.

We’ll talk, and think, and consider how this fits with the various visions of what this area is. Next, at Politics and a Pint at the Contented Cow.

Details:

What: Lively discussion and good company
Where: Politics and a Pint at the Contented Cow in Northfield Minnesota
When: 6-7:30PM, 12 July 2009

References:

• LocallyGrownNorthfield discussion group.
• Overhead view of that area
  
• Map of the land owners in that area
  
• Concept
  
• Google maps of the area.
• Northfield EDA, 9 July 2009 packet
  
• Northfield News covers the story
• Northfield’s Land Use Plan 2020 (Is this out of date?) Or is it a promise to the landowners around there? I think the blurry excerpt from the legend says “Residential – Lower Density – 2 to 4 DI/Acre”
  
• Watersheds
  

Freedom!

Freedom of speech

Freedom! Let’s talk about freedom and whether we have lost sight of this valuable target in our efforts to be safe, fed and housed. Are we trading our essential freedoms for false securities?

Bring thoughts, bring posters, bring signs and join us in this most important celebration. Sure, we give Thanks in the fall, and we celebrate the changing of the four seasons, but this celebration of freedom must come first in our hearts, just as freedom must come before peace, and peace must come before justice. Though the mob calls for justice first (no peace without justice), they do so at risk of their political souls (think of the French revolution, how’s that working for ya?).

So, let’s get warmed up for a rousing debate: Can we have peace or justice without freedom? And what freedom(s) do we mean?

See you at the Contented Cow on Sunday for the next Politics and a Pint.

Details:

What: Lively discussion and good company
Where: Politics and a Pint at the Contented Cow in Northfield Minnesota
When: 6-7:30PM, 05 July 2009

Another rip in the economic fabric – 21 Jun 2009

There’s another rip in the economic fabric heading our way. So in a Potpourri Politics and a Pint, we’ll talk a little about cap-and-trade, unintended consequences and the economic house of cards we find ourselves hiding under.

Details:

What: Lively discussion and good company
Where: Politics and a Pint at the Contented Cow in Northfield Minnesota
When: 6-7:30PM, 21 Jun 2009

References:

• Guest Post: Cap and Trade Draws An Ace – Rebuilding The House of Cards, by Doug Williams, Bogus Gold
• Dude, Where’s My Cap-And-Trade Primer?, by David Kestenbaum and Steve Inskeep
• Meet Cap ‘n Trade, “Cap and Trade is the linchpin of the government’s effort to curb carbon emissions. Senior Editor Paddy Hirsch explains how the cap and trade model works.”

(More)

My comments at the House of Cards:

You [the author] nicely wrote: “But now, suddenly, through clever use of modeling against a particular set of climate data, we now have that previously elusive formula by which we can take a single variable – in this case carbon dioxide emitted – ignore every other related factor and state with certainty what its proper impact in the overall “global warming” scheme will be! Amazing!“

It’s deja vu all over again. It’s just like when Kansas declared pi was 3.0 (as opposed to 3.14159259(etc)).  The government will set a function as the standard for measuring the impact and predicting outcomes of changes in carbon emissions. The fact that the equation is not connected to reality does not impact the trading and money exchanging, but it sure makes for an ugly moving target when the real mathematics drive the system away from the predicted (and bought and paid for) behavior. Li’s equations are the latest example, but my favorite mathematics of hope winning out over the mathematics of reality is the former Soviet Union’s use of “Leontiev equations” in an attempt to plan their economy. As an analyst schooled in statistics and mathematics I tremble when “too big to fail” governments worship at the altar of hopes and dreams and ignored the realities beneath. As I tell people, “it is fun to dream of flying, but if I am at 30,000 feet I want a correctly engineered plane around me, and that usually means ‘engineering safety margins’ built in because sometimes 2+2 is just not quite accurate enough.

Memorial Day Weekend 2009 (24 May 2009)

Yesterday I bought my 2009 buddy poppy. Buddy poppies are put together by veterans for sale before Memorial Day each year.  They have special significance for me. I remember my grandfather, a World War I vet, and his poppies.  He would be visiting with us in Rochester, and as the time grew near he would start to get antsy. “I’ve got to get back to the [veteran's] home. Got to make my poppies.”  I missed the chance to talk with him about his time in the war, but did get to learn my lessons about poker, raising puppies and raising kids.  And as recently as yesterday I was missing him and my dad as I tore down an old workbench.

So, we’ll be remembering our veterans this Memorial Day weekend, at the next Politics and a Pint.

The fine print:

What: Politics and a Pint
Where: The Contented Cow, Northfield
When: 24 May 2009, 6-7:30PM

Mother’s Day … no politics this day. 10 May 09

We presume that most of our gentle Politics and a Pint Players have Mothers, or are Mothers, or know a Mother they love, and we therefore declare this day a day without politics.

Next week … back to the fray.