Archive for October 2014

Kaci Hickox Public Enemy?

October 30, 2014

Kaci Hickox’s restricted travel has now grabbed the front pages and the 7/24 news outlets. The story is perfect for the news media. It requires no intelligence or thought. It simply requires someone to hold an opinion. Is this nurse a public enemy?

Ms Hickox presents a great face for women, and for informed public health. There is no PC with Ms Hickox. She seeks no favors from the public trough and is prepared to stand her ground. Her defense, modern science and recent experience.

Medical experts have said that Ebola is not contagious until the onset of symptoms. Even then, there is a view that during the initial onset, like not feeling well or the first recognition of fever, someone is still not contagious.   It is only when the full presentation of symptoms where bodily fluids (vomit, spit, and diarrhea) come in contact with another unprotected person is there a chance to spread Ebola.

Ms Hickox apparently is confident she will recognize the onset and until then she feels she should be free to move around. Hmmm.

Maine public health officials have asked Ms Hickox to voluntarily isolate herself for 21 days. Ms Hickox has said no thanks. So what might be next?

Most likely the Maine Public Health officials will appeal to a court that Ms Hickox must be forcibly restrained. The Court will decide not on the merits but rather that the Maine Public Health organization has the regulatory power to order restraint. Hmmm.

Next, Ms Hickox side will sue the State of Maine claiming they had instituted controls not justified by the science involved (over stepped their authority). Before long one of two things will occur. Ms Hickox will come down with full blown Ebola, or the 21 days will pass with no occurrence. Maine will in that case offer to drop their charges if Ms Hickox does the same. Hmmm.

The US Ebola scare is a dry run for what might happen if we experience a real influenza outbreak.

There is a clear difference at the extremes between individual civil rights and protection of the population at large. This difference becomes harder to recognize the closer to the center one gets. Common sense and thankfully modern science can resolve this conundrum.

Unfortunately it will require leaders and not run of the mill politicians to sort this out. Even sadder, the country seems to have an excess of politicians and few leaders.

Thanks to Ms Hickox for again making this clear.

Jeb’s Last Stand?

October 27, 2014

On a Sunday talk show yesterday, Jeb Bush’s son, George, said he thought his father was gearing up for a run for President in 2016. George said his father was still assessing the decision but in all probability would decide to run. Hmmm.

As the only potential moderate GOP candidate, Jeb represents a threat to the GOP kooky conservative right. Jeb is articulate and fluent in Spanish. What could the right object to? Maybe it is that Jeb is articulate and fluent in Spanish?

There are certainly other GOP potential candidates. Governor Rick Perry has Democrats quietly hoping he steps forward. Governor Chris Christie appears poised to enter the contest with his new svelte figure. Christie has already shown his bully side and will have a hard time winning over primary voters. Governor Scott Walker and former Governor Tim Pawlenty are standing ready but lack the big stage credentials. And there is Representative Paul Ryan who is not a kook but has tied himself to a very conservative budget which will provide Democrats with red meat. Hmmm.

In this context Jeb Bush looks reasonable.

Jeb’s path forward is not a bed of roses, however. He is George W’s brother and will have a tough road to justify “W’s” 8 years. Jeb, himself, has danced a little too close to the religious fringe (remember Karen Ann Quinlan?). Jeb projects the impression of parsing his words so as to be perfectly (and politically) correct. This does not strike the most authentic of images.

More than anything, Jeb needs to think seriously about being the third Bush to occupy the White House. Jeb might be eminently more qualified than “W”, but needs to find the capacity to be comfortable with that knowledge without trying to make the run.

If Jeb does declare, and if he is nominated, most likely he will run against Hillary Clinton. In such a circumstance, Jeb will be in the position to have to speak against women seeking high office. This gender position, IMO, is actually opposite to Jeb’s real views. I suspect this conflict will show through during the campaign… to Jeb’s detriment.

Getting Ahead Of The Curve

October 26, 2014

Recently in New Jersey and Pennsylvania, two different school districts shut down their highly successful high school football programs for at least the remainder of this year. These decisions followed revelations that there had been “hazing” incidents involving new football team members conducted by veteran players. As described, the incidents were nothing to be proud about.  Ending the practiced seemed appropriate. But shutting the program down? Was that necessary?

Both school districts emphasized their zero tolerance for this type of behavior and the need to send a clear message that such behavior would not be tolerated. In business terms, the school district’s actions were an attempt to get ahead of the curve of public opinion.  The school districts worried “wha if” these hazing incidents were to have become public knowledge or to have lead to even more unacceptable behavior.

The need to punish the entire team when only a part of the team were instigators, seems excessive. School officials point out, however, that football is an extracurricular event and not the main purpose of schools. Further, officials emphasize that hazing was entirely unnecessary and this behavior to is too close to “bullying” to allow to continue. Ending the season for some students who did not participate is a small price for teaching what is right.

The New Jersey and New York Governors together have taken somewhat similar preemptive action. Governors Christie and Cuomo announced a mandatory 21 day quarantine for all persons entering the US through Newark or JFK airports who had visited Ebola infected areas. A Democrat and a Republican gave their announcement the appearance of bipartisan politics. Hmmm.

On one hand, the idea that someone could enter the country carrying Ebola, only later to develop full blown symptoms is pretty ominous. In such densely populated areas as Northern New Jersey and especially New York City, “getting ahead of the curve” has an obvious popular appeal. No one will later claim that either Governor is not a leader and willing to take action.

On the other hand, health organizations have repeatedly said that the best defense against an Ebola outbreak in the US is to eradicate it in West Africa. Americans who volunteer for this work (as well as any other visitors) will face a mandatory 21 day quarantine on their return. Where would these people stay? Who would pay for this quarantine period’s expenses?

There are two consequences one should expect. First, returning volunteers will get creative on their return routing. Newark and JFK are not likely to be their choice of entry point. And full disclosure is even less likely to occur.

Second, the prospect of an additional 21 days away from their primary occupation will likely discourage potential volunteers from volunteering in the first place. Hmmm.

Unlike the football story, messing with medical advice, is not a wise long term position for politicians. Canceling a football season is small potatoes compared with controlling an infections disease. And what will these good Governors do when an airborne pandemic influenza breaks out in Europe and arrives in the US with ship and air travelers?

Diversify Young Man

October 25, 2014

Anyone who has visited a “financial planner” has heard the words “diversification” and “diversify”. The diversification principle says that it is impossible to know the future and consequently select only investments that will pay off handsomely.

Experience has shown that by investing broadly, one can protect against a sudden market shift or self inflicted problems within the investment companies.  Diversification helps avoid a wipe out of significant value had the investor had only invested in this one area.
So, the principle of not putting ones eggs in one basket can be just as relevant in other industries. How about the auto industry?

In the early 80’s, the US auto industry began to lose share to cars made in Japan. Cars from Toyota, Honda, and Nissan (plus others) were perceived as better on quality and price terms than those of the big three. As manufacturers began to study how both quality and cost could be so superior, they found that Japanese manufacturers formed close partnerships with certain suppliers. If the supplier would manufacture parts to very tight tolerances each and every time, it turned out this company could also produce parts in a more cost effective manner.

It is many years later now. This Japanese bred quality approach has pretty much be adopted worldwide.  Major original equipment manufacturers have settled on a few major suppliers for their global businesses.  Automotive manufacturers point to these major parts suppliers offering technology and lower prices due to volume. They also promise untouchable quality. Hmmm.

Untouchable quality actual means “initial” quality, the trouble free performance of the supplier’s parts for say the first three years. The common industry wisdom was that once a car is sold by the original owner, all bets are off. Who knows what that original owner did to the car?  Compared to car performance in the years before 2000, todays automobiles are relatively trouble free.

The recent airbag recalls, however, sheds a different light upon quality. Airbags which are clearly a huge step forward in automotive safety are in fact a form of IED (improvised explosive device). At the heart of an airbag is an explosive container which when detonated, fills the airbag in fraction of seconds. This is a one time event. There is no second try for the airbag detonator.

In actual use, an airbag’s life history includes freezing cold days, steamy hot ones, and long periods of no driving at all. The airbag travels over bumpy roads, hits sidewalk curbs, and travels at a full range of altitudes. And when the crash sensor triggers, the airbag is expected to deploy the airbag flawlessly.

So, it should not be a huge surprise that if there were a design shortcoming in the airbag design, it might take a long time to actually realize there was something wrong with airbags.

Unfortunately with the Takata airbags, the rigorous quality checks confirmed that each airbag was like the one produced before. There was no way to verify how airbags would perform after several years of in place use.

So here’s the quandary.

Depending upon large suppliers like Takata, auto manufacturers obtained uniform quality at a low cost. If some thing were to go wrong with a Takata part, the defect would be present in an awful low of the auto makers products. And unlike a radio or seat cushion where a quality defect could be seen quickly, an airbag defect could only be known if the airbag was deployed. Hmmm.

For this small number of unique parts which are critical to safety but which may never be used, putting all ones eggs in one basket may not be the wisest decision.

I wonder whether automakers are studying this airbag crisis in a way that ask the question, should OEMs diversify their airbag suppliers?

Judicial Respect

October 23, 2014

There is an important but almost farcical drama playing out in Pennsylvania. This “too good to be true” situation involves a Pennsylvania Supreme Court Justice being suspended for conduct detrimental to the good image of the court. Hmmm.

Justice Seamus McCaffery was suspended from the high court because he had been implicated in an exchange of “X” rated emails with other top Pennsylvania officials. At first attention was focused upon the recipients of McCaffery’s emails and whether the exchange  represented fraternization with prosecutors. Subsequently the judicial review board has settled upon simply “conduct which would lower the publics respect for the judiciary”. Hmmm.

One might reasonably think that McCaffery would have reached that same conclusion and simply apologized and retired voluntarily. That, however, was not going to happen.

McCaffery had already been publicly reported to have hired his wife as an aide. No legal problem in Pennsylvania but nepotism is normally a warning sign about governance. But that’s not the issue.

McCaffery’s wife, a well known lawyer on her own, took the opportunity to refer potential clients to other law firms while serving as McCafferty’s aid. Hmmm.

And, yes his wife received substantial (but customary) fees for each referral. Hmmm.

The law firms receiving the referrals often represented matters which made it to the Pennsylvania Supreme Court and could be expected from time to time to actually come before Judge McCaffery himself.  Hmmm.

This conflict of interest was quickly overlooked because it was legal to refer and hiring family members was an old practice. Hmmm.
For the most part, “X” rated emails are protected speech and if sent on private computers would also be viewed as perfectly legal (although probably embarrassing just as pictures of bedroom activities might be seen if made public).

IMO, the judicial review board acted properly in suspending McCaffery but showed a huge blind spot for justification.

I cannot image anyone who would stand for election to the Supreme Court (or any elected government position) just to get a chance to exchange “X” rated emails. I certainly can understand the desire to attain these offices in order to benefit in some personal way.

The real issue with McCaffery should not be the emails, he should have been suspended long ago due to nepotism and potential conflict of interest.

The world goes around sometimes in ways we cannot predict. McCaffery, who might be a great jurist, carried too much baggage and risked creating a negative image towards the entire judicial system  He had to go, even if for a marginal issue.

21 and Counting

October 22, 2014

Just as quickly as it arrived, Ebola has left the front page. The bulk of the Dallas Hospital healthcare workers as well as those who had community contact with Thomas Eric Duncan have cleared the 21 day isolation period and are free to move around. It seems clearer now that the two infected nurses got Ebola through lapses in the protocol used to protect them. Success, a triumph for medical knowledge and common sense.

Of course there could be more healthcare workers infected from new cases just as it is possible for Ebola could be transmitted from exposed or infected overseas travelers. But other than a complete and total quarantine of the US (no boats, planes or vehicular traffic) there can be no 100% precaution that Ebola could not again enter the US.

The anti diminishing returns argument that the US needs to screen and detain all African travelers entering the US will still be made. These advocates are in fact in search of different objectives than healthcare.  We need to drown out these “sky is falling” voices.

There is a far larger issue hidden in plain sight with this Ebola outbreak. What about a real pandemic, like SARS or bird flu or any other contagion? What if Iran or al Qaeda or whomever decided to use health as the means to attain their goals?
We have been there once with germ warfare. Fortunately, the world did not employ these agents but these are different times. Beheading someone and showing it proudly on the internet does not seem to me far away from turning a biological agent loose in London or New York.

The limited experience in Dallas ought to inform everyone that hospitals that are set up to make money treating common illnesses and injuries will most likely not have prioritized how to handle contagions very high in their sights.  Protocols will be suspect as will be the necessary protective equipment.

The spin doctors, however, can create the necessary PR to keep an outbreak appear under control. The actual health care safety net has too many holes if we judge Dallas’ response.

There is certainly a limit to what medical science can do. There are no cures for some diseases. The question is what should the healthcare industry and government health officials do to contain any outbreak until the disease runs its course with minimum impact on the general population?

The Questions Not Asked

October 20, 2014

As the midterm elections approach, the prospects for Senate Democrats looks shaky at best. There are a variety of reasons that pundits are offering but President Obama seems to be everyone’s top choice. In an uncertain world when the top guy does not evoke a sense of command, its very difficult to cast your vote in support of his party.

Difficult but not impossible if voters took the time to think their choice through.

With control of both branches of Congress,

  • Do you think Republicans will again attempt to repeal the Affordable Care Act? What would Republicans do with respect to restoring the right of insurance companies to cancel policy holders’ policies or to deny insurance to anyone due to a pre-existing condition? Do you think the GOP cares?
  • Do you think Republicans will require businesses to provide insurance coverage for their workers? And what will Republicans do if many companies decide to opt out of coverage? Will they leave it to the free market?
  • And what about Medicare Part D “donut hole”? Will Republicans restore the “donut hole” and expect senior citizens to pay for the difference?
  • Will a Republican controlled Congress pass tax reform which benefits the wealthiest Americans? Or, will Republicans opt just to pass tax cuts (which will benefit the wealthiest)? And in either case, where will Republicans find spending offsets?

These are questions not being asked. Each could have a thoughtful answer but the chances are that Republicans have none. If they do have answers, then there is still time to hear them.
Voters will do well to consider the consequences of a Republican Congress. With just the house, the GOP has voted to repeal ACA over 40 times and has passed spending plans which incorporate large tax cuts for the wealthiest. Hmmm.

Potentially an even greater pitfall would be the “consent” needed for Presidential nominations… like the possibility of a Supreme Court opening. With a GOP Senate, here comes another Alito.

They Not What They Do

October 19, 2014

The final draft report of the assembly of Roman Catholic Bishops pretty much says it all. If anyone thought that Pope Francis had initiated a melting of a dead ended catholic orthodoxy, take a deep breath and look again. The big freeze is still in place.

The modern world has moved in most matters to a different place than the Roman Catholic Church. Church teachings on family planning, birth control, premarital sex, divorce, remarriage, and open inclusion of homosexuals in everyday life are glaringly out of step.  The real world is moving one direction while the church seems to be trying to swim the other way.  Hmmm.

While the Catholic Church still has many admirable practices such as tending to the sick and poor, its all male hierarchy continues to act in a mean spirited, unkind, and fundamentally uniformed manner. In the US, church leaders do not hesitate to enter the public square and use their tax exempt status to influence legislation favorable to their positions. Hmmm.

Catholic women have pretty much broken the code. Most catholic women practice birth control and family planning and simply say nothing. The local parishes can accept this providing these women do not speak out. Similarly, divorced catholics who wish to remarry understand that a proper donation to the church will produce an annulment and the potential to remarry openly. It is homosexuals who are the bane of these Bishops.

Church teaching have long reduced homosexuals to a class somewhat like the Hindu “untouchables”. This position has worked well since many homosexuals have external mannerism which call attention to their difference with the straight community. Picking upon homosexuals, in a sick way, seems to made church leaders feel more morally correct and consequently more powerful. Hmmm.

As most people with a heart beat today recognize, gays or lesbians, especially those with effeminate or manly characteristics, cannot mask their creativity or ability to contribute to society. And, as even a greater surprise, as more homosexuals “have come out”, most people are shocked to realize how many Americans are homosexual. Most Americans have noticed, but not those who are Roman Catholic clergy.

The final draft report can be seen as a business plan. The church may think it is making a statement on dogma but in fact it is segmenting the church attending market. Conservative Catholic leaders believe that the Sunday collection baskets will do best if lay members still can “sin” in everyday life. With a little “sin”, there is a ready made need for a church who can grant “forgiveness”. Sort of job security.

As part of their business plan, conservative church leaders do not care if homosexuals remain.

It is possible,although not totally clear at this point, that church leaders may instead think Catholic homosexuals will follow Catholic women examples. Live their lives as they wish, contribute to the church, and seek forgiveness often (and of course with a few coins to the local priest).

It is also possible that these older men leaders are simply not as smart or wise as the Sisters Religious.

The “Every Man” But Not The “Crisis Man”

October 18, 2014

First, apologies to women. The title, written the “every man” could also be written the “every woman” too.

The term “every man” is meant to refer to someone who can do everything, sort of the go to person. So this person could certainly be a woman.

“Every Men” have become extremely popular in recent times. They are the person picked to lead (or at least represent) an organization,especially those which undergo extensive public scrutiny. The “everyman” protects the “board” or the “CEO” or in some case, the President of the US from embarrassment and distraction when something goes astray in the organization in question. Hmmm.

The “every man” can offer lucid testimony before Congress. He is relaxed and smooth with the press. Within government meetings, the “every man” is everyone’s ally and no ones enemy. The “every man” is just great to have around.

This apparently ideal situation often comes to an abrupt and sudden end. Crises demand a much different approach. Crises are fact driven and a few hurt feelings should be expected as normal operating conditions. Crises, as the name implies, are here and now events which only get worse unless corrective measures are taken. Hmmm.

The New York Times today reported that the President is seething over the number of times aids assured him that Ebola preparations were in place, only to find out they were not as advertised. Hmmm.

  • The “every man” assumes the best in others. The “crisis man” assumes the worst (or at least the high probability of human failure).
  • The “every man” expects subordinates to work harder and to be more vigilant simply because they should. The “crisis man” expects subordinates will assume the best when there is no proof.  Therefore the “crisis man” demands evidence.

Catching our breaths, we should recognize there should be no rational fear, in spite of performance to day, whether the US medical system can control Ebola. There should, however, have been a healthy amount of skepticism that the US medical system was ready in the early stages of confronting Ebola. Pandemics are not broken legs or hip replacements.

People do not walk around with signs on their chests proclaiming themselves as the “every man” or the “crisis man”. The leader must find them.

A great virtue of any leader is the ability to spot the every man and the crisis man. It is even a greater skill to know when to use each. (Crises are not normally obvious on day 1)

While President Obama has IMO performed credibly and at times heroically during his Presidency, his choice of subordinates has tended to be of the “every man” variety. Let’s hope that the next President can build upon President Obama’s high principles with a better knack of picking subordinates for the necessary task at hand.

The Law Of Diminishing Returns

October 17, 2014

The American education system has been criticized for many shortcomings. None could be any more important that the short shrift of the Law of Diminishing Returns. Said crudely, if a little is good, a lot more must be much better. Hmmm.

How many times have we heard our political leaders recommend a solution for a problem for which there were no symptoms? Remember the voter photo ID laws or the increased regulatory controls for abortion clinics? Both of these situations could not be described as a defect where the recommended solution could be applied and its impact measured for efficacy. (In these cases, of course, the recommended solutions were for a totally different problem than advertised, voter discrimination and eliminating abortions.

America is now facing a situation where logic and scientific ignorance may lead to severe danger from unexpected consequences. Ebola is coming. What should America do?

Thanks to TV news coverage, Americans have seen the failure of a major Dallas hospital while PR spokespersons have valiantly tried to shift the responsibility somewheres else. The Dallas hospital is a large facility which apparently makes money and attracts a lot of affluent people. The hospital had structured itself to deal with a array of normal illnesses at a profit. Life was good.

Then along came Thomas Eric Duncan and life changed. The PR people knew what to do. Show confidence and keep everyone calm. Unfortunately Mr Duncan succumbed to Ebola, and even worse, apparently his care infected two other healthcare workers. Thankfully, the CDC transferred both patients to other more specialized facilities and saved the Dallas hospital from further embarrassment.

So where does the law of diminishing returns come it?

Check out the Congressional hearings. For Congress members, the possibility that some day we may look back and say we could have done more is something that’s not going to happen on their watch. If science says exposed individuals should be isolated for 21 days, then lets increase that number “to be sure”. If someone enters the country and had originally departed from one of the Ebola infected African countries, lets put those people in quarantine. And while we are at it, lets include a wide range of African countries just to be sure.
But what if the person who departed, say Liberia, in January and has been living in Paris flies to JFK (New York)?   Lets quarantine that person too. Why?

We want NO cases that could have been prevented.


The law of diminishing returns tells us that getting to zero (NO cases), will cost exorbitant amounts of money and still may not be possible. Does this mean do nothing?

Quite the opposite. What we need is for Congress members to ask the scientific community and agencies like the CDC how they can help, not what outcomes they want. If political leaders insist upon trying to play the role of “boss”, they are in way over their heads and good things are not likely in the outcomes.

Serious members of Congress as well as similar White House members must recognize that Ebola is a test run for what might happen if the US suffered a germ warfare attack. The public cannot be expected to understand the specifics or what to do to avoid or prevent the spread of illness. The role of government is make sure the best people are in charge and then to provide whatever support they may need.

Somehow I am not confident the current Congressional crowd is up to that challenge.