Monday, May 26, 2014

Memorial Day Mass Killing -- A Facebook Colloquy

I posted this on Facebook as a graphic and it triggered the following exchange.

HP  oh my gosh...i actually think i agree w/something this guy said....end times

JB  This case has all the makings of a "smoking gun", if you'll excuse the reverse analogy, implicating NRA complicity. All the parts of their perfect avoidance were there -- therapist and parents both in the loop, therapist alerted parents in a timely manner and they, in turn, alerted the police, police did as much as they were legally permitted to do (no "grounds" for a search warrant), and finally the words of the perpetrator in his manifesto "if they had looked in the other room it would all be over" or something to that effect. 
The NRA has put into place all the ways that everyone who could have intervened was blocked from doing so.
If this doesn't crack the blind indifference of the Second Amendment extremists, nothing will.

HP  what's the solution?

JB  There is no one solution that will protect against all avoidable firearms killings. There are just too many open pathways and too much political opposition to even the slightest adjustments, but a partial list would include...

**  responsible study by the CDC and NHS to find out what safety and statistical analysts recommend, much as they study the drugs, toys, cars and trucks, hazardous materials, mine safety and other matters of life and safety. (The NRA has successfully blocked any Congressional funding for both of those agencies -- and brags about it in their official statements.)
**  legislation limiting the number and availability of military grade weapons for non-military use (including "collecting" which is often used as a cover for bulk straw purchases at "gun shows"
**  A national database of who owns what. And why. And what they aim to do with them.
This is the most hated of all suggestions, it being the first step in "the government taking away our guns." Of course the phrase "background check" is only that -- a phrase. There is no way that any meaningful background check for firearms danger signals can be done if there are holes in the database big enough to drive a truckload of weapons on the way to Mexico through.
**  HIPAA privacy rules have made eveybody in healthcare and law enforcement paranoid about discussing anything with anybody unless they have a signed document from that person giving them permission to do so. It's so bad that I was taught at Wellstar not to even discuss anything about a resident with another member of the staff, even in the bathroom, on the chance that somebody not authorized might overhear. 

This is totally nutty. I understand privileged conversations between lawyers and clients, clergy and laity with an expectation of privacy, doctors and patients, etc.
But when a mental health professional suspects that someone is about to act out on violent fantasies, the least that should happen is surveillance of that person's access to the means of carrying out those fantasies. 

I could go on, but you see where this is going. We don't let children have dangerous toys. We now see auto companies recalling millions of cars because of the statistical possibility of injury or fatality which is minuscule compared with the almost certain expectation that a similar number of firearms will result in far greater numbers of death and injury. (Fatalities, of course, will outnumber injuries, thanks to the purpose of guns compared with that of cars. And since any comparitive studies are forbidden -- see the first item about CDC abd NIH -- we can't go there until other things are in place.
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Nope. No simple single solution.
Again, to excuse the analogy, no silver bullet.
But if we don't take the first steps we well never go down that much safer path.

HP   i don't see the point in assault firearms, at all. don't like guns to begin with and don't like even killing chickens. That being said, we actually, believe it or not, really HAVE to hunt to have meat on the table at times...  
two deer saved our butts last year. And if I heard about some patient that i thought was going to be dangerous, I'd sure as heck tell somebody who could do something. It makes me nervous to think that the government knows exactly what hunting rifles I have at my house, but i thought that was what happened when we registered. So none of what you're suggesting scares me to death. Glad to hear that you're not suggesting we turn in our hunting rifles....guess we'd have to learn use a hunting bow.
JB  Sensible firearms safety is light years away from hunting and self-defense. America is one of the most heavily armed populations on the earth.

HP  i honestly think that that poor kid in california would probably have found a knife or concocted a bomb if he didn't have a gun...but i know what you're saying, too.

JB  You haven't been following the story closely. He began with a kinfe. They pulled his first three victims out this morning from the place where he lived -- three Asian dudes with whom he lived. They were all stabbed to death. My guess is that he planned that part as well, knowing that the noise of a gun would have alerted authorities too soon for him to get a head start. His victims then were scattered among half a dozen more separate crime scenes as he went from place to place at random, shooting some here, more there, as he went randomly through the residential streets. The police responded quickly, but he was a moving target. Even at the end he was using the car as a destructive device, crashing it into bikes and people. And he was in possession of three Glock semi-automatic handguns, all legally registered to him. Something is very wrong with this picture.

BO  It was reported that the same law enforcement agency came in contact with him recently on a request for a welfare check, but he smooth talked the officer's and convinced them that he was doing great and the concerns were without merit. He wrote is his manifesto that had they entered his home to investigate further, they would've found his guns and his writings about what he intended to do.
JB  Exactly. This is an example of the authorities "need to know" in the interest of public safety and common sense exceeds the rules of HIPAA and whatever other obstructive tactics have been crafted by otherwise well-meaning people more paranoid than the sickos they need to be concerned about.

Saturday, May 24, 2014

Palestinian Chef Joseph Asfour

Pope Francis makes a three-day visit to the Middle East. But this pope is doing more than going through the motions of the usual papal visit. I will leave the symbolic analysis to others but this Tweet and story caught my eye just now. The chef is identified as Palestinian. That is important, especially because a large number of people argue that there is no such country as Palestine and no people with such an identity. This is what I found with a quick search:

A December issue of This Week in Palestine featured sketches of eleven Palestinian chefs, of which Chef Joseph Asfour was one.
Chef Joseph Asfour 
 Chef Asfour spoons out dollops of humus.
Born, raised, and educated in the Golden City, Jerusalem, Chef Joseph comes with a packed bag, just like Saint Nicholas on Christmas Eve, yet Chef Joseph’s bag is packed with expertise in the theory and practice of food, beverage, and condiments processes. His education and knowledge, which started back in 1983, come from countless training courses in quality management for hotels and restaurants, marketing management, and human resources development, in addition to courses in food and beverages, where he developed a unique style among other chefs. His presentations are fashionable and eloquent. It is as if he communicates his love of food from his heart to yours. His outstanding knowledge of French, Italian, Irish, Palestinian, and other cuisines makes Chef Joseph a highly qualified artist. 
He is the founder of one of the most elaborate settings in Ramallah, Darna Restaurant. His work at Angelo’s Restaurant, the Red Crescent in Ramallah, and other localities, here and overseas, has provided Chef Joseph with the knowledge he needs to present food of exquisite quality. Chef Joseph believes in quality rather than quantity on the plate.

Chef Joseph has had the opportunity to serve his delicious creations to many presidents and dignitaries, such as the late President Yasser Arafat of the PLO, Mr. Mahmoud Abbas, the current head of the PNA, Russian President, Mr. Putin, US Secretary of State, Ms. Rice, former British prime minister, Mr. Tony Blair, the late Pope John Paul II, the former UN general secretary, Mr. Kofi Anan, Mr. Javier Solana, the famous American actor Mr. Richard Gere, and many others.

Sunday, March 30, 2014

World Migration Chart

I'm blogging this link in order to see a larger image. 
Where everyone in the world is migrating—in one gorgeous chart



It’s not the poorest who migrate the most

While the results of the migration study aren’t particularly groundbreaking, there are two interesting insights:
1) Adjusted for population growth, the global migration rate has stayed roughly the same since around since 1995 (it was higher from 1990-1995).

2) It’s not the poorest countries sending people to the richest countries, it’s countries in transition—still poor, but with some education and mobility—that are the highest migratory contributors.
“One of the conclusions they make in the paper, is the idea as countries develop, they continue to send more migrants, and at some point they become migrant-receiving regions themselves,” says Fernando Riosmena, a geographer from the University of Colorado, who did not contribute to this research, but is collaborating with one of the authors on a future paper.

A few other noteworthy results:
1) The largest regional migration is from Southeast Asia to the Middle East. This is largely driven by the huge, oil-driven, construction booms happening on the Arabian Peninsula

2) The biggest flow between individual countries is the steady stream from Mexico to the US. (In fact, the US is the largest single migrant destination)

3) There’s a huge circulation of migrants among sub-Saharan African countries. This migration dwarfs the number leaving Africa, but the media pay more attention the latter because of the austerity-driven immigration debates in Europe.

Tuesday, March 25, 2014

Fragile Diplomacy

Tuesday, March 18, 2014

HCR -- Patient-Centered or Profit-Centered?

Two recommended readings this morning were brought to my attention by a comment left at The Health Care Blog yesterday. What the Work of the Inspector General Tells Us about Patient Safety… by Dr. Ashish Jha is the first reading. 

The second is the comments thread, focuses on the connection between what professionals euphemistically call "sentinel events" (another way of referring to often preventable circumstances leading to often fatal results) and how they are paid for (or not).

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A couple weeks ago while waiting for my wife to undergo a hospital procedure I read an unsettling link about (you guessed it) patient safety in hospitals. It was not a pretty picture and I urge others to check it out.
>> The OIG looked at care for a national sample of Medicare beneficiaries and what it found was unexpected: 13.5% of Medicare beneficiaries suffered an injury in the hospital that prolonged their hospital stay, caused permanent harm, or even death. 
An additional 13.5% of Medicare patients suffered “temporary” harm – such as an allergic reaction or hypoglycemia – things that are reversible and treatable, but quite problematic nonetheless. Taken together, these data suggest that 27% of older Americans suffer some sort of injury during their hospitalization – much higher than previous numbers. 
There are three more statistics from the OIG report that should give us all pause: First, they estimate that unsafe care contributes to 180,000 deaths of Medicare beneficiaries each year. This is a stunningly high number. Second, Medicare pays at least an additional $4.4 billion to cover the costs of caring for these injuries. And finally, about half of these events are preventable based on today’s technology and know-how. 
I suspect that if we actually make safety a priority, many more events would become preventable over time. And yet, although hospitals are supposed to identify, study, and track adverse events, the OIG says it mostly isn’t happening. At least not in any systematic way. <<
That should be enough to whet your appetite. But a comment left yesterday about the connection between the PRICE of medical care (I refuse to say "cost" which is quite different from "price") and outcome statistics reminded me of Dr. Jha's post, which I would rather forget.
>> What is really disgusting is that these errors, i.e. “adverse events” are NOT reimbursed by CMS or GAP and Advantage Insurers. Medicare/Medicaid patients (most prone to suffer from adverse events) who pay Medicare and Social Security taxes their whole working lives have NO IDEA that they are the victims of errors and “charity” patients for the hospitals —and that they may be hastened unto death for fiscal expediency and to hide the errors. 
Disgracefully, our Congress, HHS, CMS and Big Insurance, when they developed the policy to NOT reimburse hospitals/physicians for adverse events, made no law that protects the patients and that requires hospitals, physicians, or Medicare to notify patients that they are the victims of errors and “charity” patients for the hospital. Often, these elderly/disabled Medicare/Medicaid patients are hastened unto death with covert/overt (default DNR Code Status) for the fiscal expedience of Big Insurance and the hospitals. 
This is what happens when you have “profit-centered” health care and not patient-centered healthcare. The epidemic of unilateral covert/overt(default DNR Code Status) that is extrapolated into the hospital charts of elderly/disabled Medicare/Medicaid patients to limit/withhold life-saving and life-extending treatments that won’t be reimbursed is a national disgrace. <<
There is more at the link. Much more, including a raft of supportive outlinks as well. I trust the reader to follow the trail, drill into the links and in the end, as they say, follow the money.