Science – Page 49 – artdiamondblog.com

Disruptive Innovation in Medicine

Source of image: http://online.wsj.com/article/SB114540135592529301.html?mod=home_personal_journal_middle

(p. D1) The dysfunctional doctor’s office is getting a makeover.

A growing number of programs around the country are helping doctors redesign their offices to wring more profit out of their practices and fix problems that have long frustrated patients: weeks-long delays to get appointments, hours in the waiting room, too-brief visits with the doctor, and the near impossibility of getting the physician on the phone. While the goal is to improve care, the programs also aim to avert a looming shortage of primary-care doctors who are frustrated with low pay, long hours and rising overhead costs.

The new programs borrow lessons from other industries to help doctors work more efficiently, especially those in solo and small group practices who account for the majority of outpatient office visits. One approach employs calculations used by airlines, hotels and restaurants to predict demand: The idea is that doctors can cut patient waits much the way restaurant chains seat diners and turn over tables efficiently. Others involve relatively simple changes, such as leaving afternoon appointments open for urgent visits, or having patients fill out paperwork ahead of time online.

Managed-care giant Kaiser Permanente is launching a program to help 12,000 doctors that contract with its health plan increase their efficiency with a new electronic-medical-records system. Portland, Ore., physician Chuck Kilo, whose GreenField Health Systems helps restructure medical practices, and is assisting with the program, says that too many doctors’ appointments take up valuable office time with follow-up that could be accomplished with phone calls and email.

Other models involve more-radical change, such as one called "Ideal Micro Practice" that sharply reduces or even eliminates support staff. With this blueprint, doctors rely on electronic health records and practice-management software to quickly dispense with administrative tasks. And they may run their offices solo, greeting patients personally as they come in the door.

"The office practice hasn’t changed much in 50 years," says John Wasson, a Dartmouth Medical School professor and practice redesign expert who is helping to launch a national program to expand the Micro Practice concept. "This is a disruptive innovation that can lead to increased quality and reduced costs."

For the full story, see:

LAURA LANDRO. "Cutting Waits at the Doctor’s Office; New Programs Reorganize Practices to Be More Efficient; Applying ‘Queuing Theory’." The Wall Street Journal (Weds., April 19, 2006): D1 & D3.

Source of graphic: http://online.wsj.com/article/SB114540135592529301.html?mod=home_personal_journal_middle

“life is too short”

Source of book image: http://www.amazon.com/gp/product/customer-reviews/0738204315/ref=cm_cr_dp_2_1/104-9985403-1047968?%5Fencoding=UTF8&customer-reviews.sort%5Fby=-SubmissionDate&n=283155

The Cluetrain Manifesto is a thought-provoking, entertaining, uneven, overly-mystical, somewhat dated classic on the impact of the internet on business and life. Here is the book’s startling start:

WE DIE.

You will never hear those words spoken in a television ad. Yet this central fact of human existence colors our world and how we perceive ourselves within it. "Life is too short," we say, and it is. Too short for office politics, for busywork and pointless paper chases, for jumping through hoops and covering our asses, for trying to please, to not offend, for constantly struggling to achieve some ever-receding definition of success. (p. 1)

Locke, Christopher, Rick Levine, Doc Searls, and David Weinberger. The Cluetrain Manifesto: The End of Business as Usual. Cambridge, Mass.: Perseus Books Group, 2001.

Radiologist Outsourcing Is Mainly a Myth

David Leonhardt. Source of image: http://www.nytimes.com/2006/04/19/business/19leonhardt.html?_r=1&oref=slogin

A few years ago, stories about a scary new kind of outsourcing began making the rounds. Apparently, hospitals were starting to send their radiology work to India, where doctors who make far less than American radiologists do were reading X-rays, M.R.I.’s and CT scans.

It quickly became a signature example of how globalization was moving up the food chain, threatening not just factory and call center workers but the so-called knowledge workers who were supposed to be immune. If radiologists and their $350,000 average salaries weren’t safe from the jobs exodus, who was?

On ABC, George Will said the outsourcing of radiology could make health care affordable again, to which Senator Charles E. Schumer of New York retorted that thousands of American radiologists would lose their jobs. On NPR, an economist said the pay of radiologists was already suffering. At the White House, an adviser to President Bush suggested that fewer medical students would enter the field in the future.

"We’re losing radiologists," Representative Sherrod Brown, an Ohio Democrat, said on CNN while Lou Dobbs listened approvingly. "We’re losing all kinds of white-collar jobs, all kinds of jobs in addition to manufacturing jobs, which we’re losing by the droves in my state."

But up in Boston, Frank Levy, an economist at the Massachusetts Institute of Technology, realized that he still had not heard or read much about actual Indian radiologists. Like the once elusive Snuffleupagus of Sesame Street, they were much discussed but rarely seen. So Mr. Levy began looking. He teamed up with two other M.I.T. researchers, Ari Goelman and Kyoung-Hee Yu, and they dug into the global radiology business.

In the end, they were able to find exactly one company in India that was reading images from American patients. It employs three radiologists. There may be other such radiologists scattered around India, but Mr. Levy says, "I think 20 is an overestimate."

Some exodus.

For the full story, see:

Leonhardt, David. "Political Clout in the Age of Outsourcing." The New York Times (Weds., April 19, 2006): C1 & C4.

Endangered Fish Thrive on Oil Platforms

Large numbers of rockfish and other fish near the Gilda oil platform off the Ventura coast. Source of image: http://www.lovelab.id.ucsb.edu/Check.html

SANTA BARBARA, Calif., March 11 – A marine biologist has found that 27 oil platforms off California’s Central Coast may be havens for bocaccio, cowcod and other fish.

. . .

Since the 1950’s, when heavy fishing began in the region, some species have been reduced to 6 percent of their previous numbers, Dr. Love said. Overfishing has led to an economic disaster, leading some fisheries to close.

Dr. Love films fish around the platforms from a submarine and then counts them in his laboratory.

Among his findings are that large fish prefer crevices at the platforms’ base, and smaller ones like the middle section above their predators.

At Platform Gail, which stands in 739 feet of water nine miles off the Ventura coast, Dr. Love found what he believes to be the highest density of two species of overfished rockfish in Southern California.

Dr. Love emphasizes that his research does not draw conclusions about whether the platforms should be removed. He says his personal view is that the rigs should stay in place, cut below the waterline so that ships can pass safely over them.

Dr. Love gets about 80 percent of his research money from the government, and the rest from the California Artificial Reef Enhancement Program, a Sacramento nonprofit group financed almost entirely by oil companies. The group has contributed about $100,000 a year to his research since 1999, said its executive director, George Steinbach. Dr. Love said oil industry money could not sway his research.

For the full story, see:

"Citing Oil Rigs as Fish Havens, Companies Resist Removal." The New York Times (Mon., March 13, 2006): A18.

Doctors Erect Barriers to Keep Out Competition

A Bangalore radiologist. One of three radiologists in India known to be reading U.S. scans. Each of the three has a U.S. degree, as required by U.S. law. Source of image: http://www.nytimes.com/2006/04/19/business/19leonhardt.html?_r=1&oref=slogin

(p. C1) Radiologists seem like just the sort of workers who should be scared. Computer networks can now send an electronic image to India faster than a messenger can take it from one hospital floor to another. Often, those images are taken during emergencies at night, when radiologists here are sleeping and radiologists in India are not.

There also happens to be a shortage of radiologists in the United States. Sophisticated new M.R.I. and CT machines can detect tiny tumors that once would have gone unnoticed, and doctors are ordering a lot more scans as a result.

When I talked this week to E. Stephen Amis Jr., the head of the radiology department at Montefiore Medical Center in the Bronx, he had just finished looking at some of the 700 images that had been produced by a single abdominal CT exam. "We were just taking pictures of big, thick slabs of the body 20 years ago," Dr. Amis said. "Now we’re taking thinner and thinner slices."

Economically, in other words, ra-(p. C6)diology has a lot in common with industries that are outsourcing jobs. It has high labor costs, it’s growing rapidly and it’s portable.

Politically, though, radiology could not be more different. Unlike software engineers, textile workers or credit card customer service employees, doctors have enough political power to erect trade barriers, and they have built some very effective ones.

To practice medicine in this country, doctors are generally required to have done their training here. Otherwise, it is extremely difficult to be certified by a board of other doctors or be licensed by a state government. The three radiologists Mr. Levy found in Bangalore did their residencies at Baylor, Yale and the University of Massachusetts before returning home to India.

"No profession I know of has as much power to self-regulate as doctors do," Mr. Levy said.

So even if the world’s most talented radiologist happened to have trained in India, there would be no test he could take to prove his mettle here. It’s as if the law required cars sold here to have been made by the graduates of an American high school.

Much as the United Automobile Workers might love such a law, Americans would never tolerate it, because it would drive up the price of cars and keep us from enjoying innovations that happened to come from overseas. But isn’t that precisely what health care protectionism does? It keeps out competition.

For the full story, see:

Leonhardt, David. "Political Clout in the Age of Outsourcing." The New York Times (Weds., April 19, 2006): C1 & C4.

Chernobyl Accident Cannot Occur In U.S. Type Reactors

Twenty years ago (April 25, 1986), the Chernobyl nuclear accident sent a plume of radiation into the air above Ukraine. The word "Chernobyl" remains the most emotionally charged argument used by the opponents of nuclear energy. But if examined carefully, the main lesson from Chernobyl may be that what happened there cannot occur in the better designed light water reactors used in the United States, and most of the rest of the world. William Sweet, the author of the commentary below, has also authored Kicking the Carbon Habit: Global Warming and the Case for Renewable and Nuclear Energy.

(p. A23) . . . , though it went unnoticed at the time and has been inadequately appreciated since, Chernobyl also cast into relief the positive features of the reactors used in the United States and most other advanced industrial countries.

The reactor at Chernobyl belonged to a class that was especially vulnerable to runaway reactions. When operating at low power, if such reactors lost water, their reactivity could suddenly take off and very rapidly reach a threshold beyond which they could only explode. Making matters worse, surprisingly little more pressure than normal in the machine’s water channels would lift its lid, snapping the vital control rods and fuel channels that entered the reactor’s core.

On the night of April 25, 1986, poorly trained and supervised plant operators conducted an ill-conceived experiment, putting the machine into the very state in which reactivity was most likely to spike. Within a fraction of a second, the reactor went from being barely on to power levels many times higher than the maximum intended.

This kind of accident cannot happen in the so-called light water reactors used in the United States and most of Western Europe and Asia. In these reactors, the water functions not only as a coolant but as a "moderator": self-sustaining nuclear chain reactions cannot take place in its absence. This is a very useful passive safety feature. If coolant runs low, there is still a danger of a core meltdown, because the fuel retains heat; but the reactor will have automatically and immediately turned itself off.

For the full commentary, see:

WILLIAM SWEET. "The Nuclear Option." The New York Times (Weds., April 26, 2006): A23.

The reference to Sweet’s related book is:

Sweet, William. Kicking the Carbon Habit: Global Warming and the Case for Renewable and Nuclear Energy. Columbia University Press, 2006.

Source of book image: http://www.amazon.com/gp/product/0231137109/sr=8-1/qid=1146071688/ref=sr_1_1/104-5668094-9083929?%5Fencoding=UTF8

Hurricanes Not Caused by Human-Induced Climate Change: More on Why Crichton is Right

The Alfred P. Sloan Professor of Atmospheric Science at MIT analyzes the case for human-induced global warming:

(p. A14) There have been repeated claims that this past year’s hurricane activity was another sign of human-induced climate change. Everything from the heat wave in Paris to heavy snows in Buffalo has been blamed on people burning gasoline to fuel their cars, and coal and natural gas to heat, cool and electrify their homes. Yet how can a barely discernible, one-degree increase in the recorded global mean temperature since the late 19th century possibly gain public acceptance as the source of recent weather catastrophes? And how can it translate into unlikely claims about future catastrophes?
The answer has much to do with misunderstanding the science of climate, plus a willingness to debase climate science into a triangle of alarmism.
. . .
To understand the misconceptions perpetuated about climate science and the climate of intimidation, one needs to grasp some of the complex underlying scientific issues. First, let’s start where there is agreement. The public, press and policy makers have been repeatedly told that three claims have widespread scientific support: Global temperature has risen about a degree since the late 19th century; levels of CO2 in the atmosphere have increased by about 30% over the same period; and CO2 should contribute to future warming. These claims are true. However, what the public fails to grasp is that the claims neither constitute support for alarm nor establish man’s responsibility for the small amount of warming that has occurred. In fact, those who make the most outlandish claims of alarm are actually demonstrating skepticism of the very science they say supports them. It isn’t just that the alarmists are trumpeting model results that we know must be wrong. It is that they are trumpeting catastrophes that couldn’t happen even if the models were right as justifying costly policies to try to prevent global warming.
If the models are correct, global warming reduces the temperature differences between the poles and the equator. When you have less difference in temperature, you have less excitation of extratropical storms, not more. And, in fact, model runs support this conclusion. Alarmists have drawn some support for increased claims of tropical storminess from a casual claim by Sir John Houghton of the U.N.’s Intergovernmental Panel on Climate Change (IPCC) that a warmer world would have more evaporation, with latent heat providing more energy for disturbances. The problem with this is that the ability of evaporation to drive tropical storms relies not only on temperature but humidity as well, and calls for drier, less humid air. Claims for starkly higher temperatures are based upon there being more humidity, not less — hardly a case for more storminess with global warming.
. . .
In Europe, Henk Tennekes was dismissed as research director of the Royal Dutch Meteorological Society after questioning the scientific underpinnings of global warming. Aksel Winn-Nielsen, former director of the U.N.’s World Meteorological Organization, was tarred by Bert Bolin, first head of the IPCC, as a tool of the coal industry for questioning climate alarmism. Respected Italian professors Alfonso Sutera and Antonio Speranza disappeared from the debate in 1991, apparently losing climate-research funding for raising questions.
And then there are the peculiar standards in place in scientific journals for articles submitted by those who raise questions about accepted climate wisdom. At Science and Nature, such papers are commonly refused without review as being without interest. However, even when such papers are published, standards shift. When I, with some colleagues at NASA, attempted to determine how clouds behave under varying temperatures, we discovered what we called an “Iris Effect,” wherein upper-level cirrus clouds contracted with increased temperature, providing a very strong negative climate feedback sufficient to greatly reduce the response to increasing CO2. Normally, criticism of papers appears in the form of letters to the journal to which the original authors can respond immediately. However, in this case (and others) a flurry of hastily prepared papers appeared, claiming errors in our study, with our responses delayed months and longer. The delay permitted our paper to be commonly referred to as “discredited.” Indeed, there is a strange reluctance to actually find out how climate really behaves. In 2003, when the draft of the U.S. National Climate Plan urged a high priority for improving our knowledge of climate sensitivity, the National Research Council instead urged support to look at the impacts of the warming — not whether it would actually happen.
Alarm rather than genuine scientific curiosity, it appears, is essential to maintaining funding. And only the most senior scientists today can stand up against this alarmist gale, and defy the iron triangle of climate scientists, advocates and policymakers.

For the full commentary, see:
RICHARD LINDZEN. “Climate of Fear.” The Wall Street Journal (Weds., April 12, 2006): A14.

United States Still Has Vitality in Research and Innovation

Has the United States lost its vitality? No. Americans remain the hardest working people on the face of the earth and the most productive. As William W. Lewis, the founding director of the McKinsey Global Institute, wrote, ”The United States is the productivity leader in virtually every industry.” And productivity rates are surging faster now than they did even in the 1990’s.
Has the United States stopped investing in the future? No. The U.S. accounts for roughly 40 percent of the world’s R. & D. spending. More money was invested in research and development in this country than in the other G-7 nations combined.
Is the United States becoming a less important player in the world economy? Not yet. In 1971, the U.S. economy accounted for 30.52 percent of the world’s G.D.P. Since then, we’ve seen the rise of Japan, China, India and the Asian tigers. The U.S. now accounts for 30.74 percent of world G.D.P., a slightly higher figure.
What about the shortage of scientists and engineers? Vastly overblown. According to Duke School of Engineering researchers, the U.S. produces more engineers per capita than China or India. According to The Wall Street Journal, firms with engineering openings find themselves flooded with résumés. Unemployment rates for scientists and engineers are no lower than for other professions, and in some specialties, such as electrical engineering, they are notably higher.
Michael Teitelbaum of the Alfred P. Sloan Foundation told The Wall Street Journal last November, ”No one I know who has looked at the data with an open mind has been able to find any sign of a current shortage.” The G.A.O., the RAND Corporation and many other researchers have picked apart the quickie studies that warn of a science and engineering gap. ”We did not find evidence that such shortages have existed at least since 1990, nor that they are on the horizon,” the RAND report concluded.
. . .
. . . , the American workplace is so competitive, companies are compelled to promote lifelong learning. A U.N. report this year ranked the U.S. third in the world in ease of doing business, after New Zealand and Singapore. The U.S. has the second most competitive economy on earth, after Finland, according the latest Global Competitiveness Report. As Michael Porter of Harvard told The National Journal, ”The U.S. is second to none in terms of innovation and an innovative environment.”

For the full commentary, see:
DAVID BROOKS. “The Nation of the Future.” The New York Times (Thursday, February 2, 2006): A23.

86% Agree that Government Should Ban Dihydrogen Monoxide

A junior high school student in Idaho, Nathan Zohner, demonstrated in a 1997 science fair project how easy it was to hoodwink a scientifically uninformed public. As described in “The Frankenfood Myth,” 86 percent of the 50 students he surveyed thought dihydrogen monoxide should be banned after they were told that prolonged exposure to its solid form caused severe tissue damage, that exposure to its gaseous form caused severe burns and that it had been found in tumors from terminal cancer patients. Only one student recognized the substance as water, H2O.

For the full commentary, see:
JANE E. BRODY. ” PERSONAL HEALTH; Facing Biotech Foods Without the Fear Factor.” The New York Times (Tues., January 11, 2005): D7.

Indiana Almost Legislated Wrong Value of Pi

Yesterday (3/14) was “Pi Day.” Source of image: http://www.mathwithmrherte.com/pi_day.htm
After school yesterday, my daughter Jenny told me that in her sixth grade class with Barbara Jens, they had celebrated “Pi Day.” I didn’t get it until Jen pointed out that the date was 3/14 and the first three digits of pi are 3.14.
Being a hoosier by birth and upbringing, Pi Day reminded me that in 1897 the Indiana House of Representatives unanimously passed a bill legislating the wrong value of pi. It would make a better story if the House had taken this action based on a literal interpretation of the bible, which gives the value of pi as an even 3. But apparently the House action was based on a mistaken “proof” offered by physician Edwin J. Goodwin. Fortunately for the reputation of Indiana government, a mathematician visiting the state capitol for other reasons, convinced Senators of the mistake, and consideration of the bill was postponed indefinitely in the Senate, before it could become law.
For my source, and more details, see Petr Beckmann’s wonderful book:
Beckmann, Petr. A History of Pi. New York: St. Martin’s Press, 1971.

Source of image: http://www.amazon.com/gp/product/0312381859/ref=ed_oe_p/104-6209536-4473568?%5Fencoding=UTF8