Iatrogenic Risks of Risk Management

Managing the Iatrogenic Risks of Risk Management
Jonathan Baert Wiener
9 Risk: Health, Safety & Environment 39 [Winter 1998]

http://www.fplc.edu/RISK/vol9/winter/Wiener.pdf

“…Empirical study of the modern medical system suggests that
iatrogenesis is serious. In the most thorough analysis to date, the
Harvard Medical Practice Study Group studied a representative sample
of over 30,000 hospital records from over 50 hospitals in New York
State. Using carefully developed protocols and trained reviewers, it
found that 3.7% of all hospitalizations induced iatrogenic health events,
of which just more than one in eight (14% of all iatrogenic injuries, and
about 0.5% of all hospitalizations) were iatrogenic fatalities. 2 9

Extrapolating this data to the full U.S. population, suggests a national
annual total of over 1.2 million iatrogenic injuries and over 150,000
iatrogenic deaths from hospitalization amounting to 7.5% of all
deaths in the nation each year, more fatalities than are caused each year
by, e.g., auto (40,000 to 50,000) and occupational accidents (about
6,000) combined.30…”

Terrorism and You — The Real Odds

Via Alex Taborrok of the Armchair Economist list. An illustration of the dangers of misjudging risks.

http://www.washingtonpost.com/ac2/wp-dyn/A7812-2001Nov23?language=printer

Terrorism and You — The Real Odds

By Michael L. Rothschild

Sunday, November 25, 2001; Page B07

The odds of dying in an automobile accident each year are about one in 7,000, yet we continue to drive. The odds of dying from heart disease in
any given year are one in 400 and of dying from cancer one in 600, yet many of us fail to exercise or maintain a healthy diet. We have learned
to live with these common threats to our health. Yet we have been afraid to return to the malls and the skies.

What are the odds of dying on our next flight or next trip to a shopping mall? There are more than 40,000 malls in this country, and each is
open about 75 hours per week. If a person shopped for two hours each week and terrorists were able to destroy one mall per week, the odds of
being at the wrong place at the wrong time would be approximately 1.5 million to 1. If terrorists destroyed one mall each month, the odds
would climb to one in 6 million. This assumes the total destruction of the entire mall; if that unlikely event didn't occur, the odds would
become even more favorable.

In another hypothetical but horrible scenario, let us assume that each week one commercial aircraft were hijacked and crashed. What are the
odds that a person who goes on one trip per month would be in that plane? There are currently about 18,000 commercial flights a day, and if
that person's trip has four flights associated with it, the odds against that person's being on a crashed plane are about 135,000 to 1. If there
were only one hijacked plane per month, the odds would be about 540,000 to 1.

Stories in the news media have begun to consider the virtue of a public relations campaign in Muslim nations to bring our side of the war to
the populations of these countries. While this can be an important strategy, I would like to suggest that we need an information campaign in
this country as well, because a key element of life after Sept. 11 has not been well presented to the public: Our leaders and media have not done
a good job of discussing the risks that citizens need to consider when making choices in their daily lives.

We are presented with a continuous stream of stories telling us about the most recent horrible incident and the possibilities of future terrors.
Frequent repetition of these stories may lead people to overestimate the likelihood of future dire events. While we need to be made aware of
potential dangers, we also need to understand the true probabilities of these risks. In the above examples, the scenarios were pretty extreme;
the odds of any one of us being directly affected by a lesser event would be even more remote.

People tend to underestimate the probability of a common event's occurring but overestimate the probability of a rare event. These findings
may be due in part to the frequency with which we are exposed to news stories about the remote versus the common event. Anthrax, which
has so far claimed five lives out of a population of 275 million, is a continuous story, while smoking-related illnesses, which claim about
400,000 lives per year, are not a news story at all.

Anthrax is a big story and is worthy of media attention, but people may be overreacting in changing their personal behavior because of this
remote event. Perhaps they overestimate the potential probabilities that an anthrax-related incident could happen to them because of the
frequency with which they see anthrax-related news stories. In Madison, Wis., it was reported that in some neighborhoods parents didn't
allow their children to go trick-or-treating at Halloween because of the heightened risks of terrorism. What are the odds that any single child
would be affected by terrorists on that one night?

We need to separate the probability that an event may occur in our country and the probability that it will occur to us as individuals. In making
an informed decision about my own behavior, I need to know the probability that I will be personally affected by a terrorist act, not what the
probability is that such an act may occur at some place and some time.

We each have many opportunities to take various actions each day. Each opportunity has multiple choices and multiple outcomes. Each of us
must independently make our own decisions, but we are being given incomplete information on which to base these decisions. As a result we
may have been unnecessarily cautious.

The economic cost to our nation in lost expenditures, resulting in lost jobs and lost businesses, has been enormous. While the impact of any
potential event on any one of us is slight, the impact of the sum of our individual behaviors is great. There is a key question that we need to
consider: What are the odds that I, myself, will be at the exact wrong place at the exact wrong time?

While any terrorist event is horrible, if I act with respect to my own real risk and the probability that I, personally, will be affected, then I can
return to a more normal life. If I act as if each terrorist act will be directed specifically at me, then I will hide, and collectively we will all hide.

The writer is an emeritus professor at the University of Wisconsin's business school.

� 2001 The Washington Post Company

Backwoods Home, Lehman's, Mother Earth News, Real Goods, Whole Earth Catalog

A potpourri of off the grid resources:

http://www.backwoodshome.com/

Back Woods Home Magazine
Off the grid howto articles plus libertarian propaganda.

http://www.lehmans.com/

Lehman's Catalog
For all your Amish tool needs.

http://www.motherearthnews.com/

Mother Earth News
Off the grid living. My parents have subscribed since the '70's.

http://www.realgoods.com/renew/index.cfm

Real Goods Catalog
More off the grid/solar living.

Whole Earth Catalog

https://www.wholeearthmag.com/market/index.cfm?FuseAction=dspMillCat

http://www.amazon.com/exec/obidos/ASIN/0062514148/qid=1007028441/sr=1-2/ref=sr_1_10_2/102-5660625-9651327

Dated, and I don't agree with the motivation for much of it, but still great source of cool weird stuff.

Anyone who thinks money can't buy happiness doesn't know where to shop.

Does Money Buy Happiness? A Longitudinal Study Using Data on Windfalls
March 2001

Jonathan Gardner
Department of Economics
Warwick University CV4 7AL
[email protected]

Andrew Oswald
Department of Economics Warwick
University CV4 7AL
[email protected]

http://www.warwick.ac.uk/fac/soc/Economics/oswald/marchwindfallsGO.pdf

Abstract

The most fundamental idea in economics is that money makes people happy. This paper constructs a test. It studies longitudinal information on the psychological health and reported happiness of approximately 9,000 randomly chosen people. In the spirit of a natural experiment, the paper shows that those in the panel who receive windfalls — by winning lottery money or receiving an inheritance — have higher mental wellbeing in the following year. A windfall of 50,000 pounds (approximately 75,000 US dollars) is associated with a rise in wellbeing of between 0.1 and 0.3 standard deviations. Approximately one million pounds (1.5 million dollars), therefore, would be needed to move someone from close to the bottom of a happiness frequency distribution to close to the top. Whether these happiness gains wear off over time remains an open question.

Lot's of fascinating stuff on Oswald's site: http://www.warwick.ac.uk/fac/soc/Economics/oswald/

The Keeper

Introducing: The Keeper

The Keeper, tampon alternative

Wonderwash

I'm a sucker for hand-operated gadgets. According to the manufactures specs, the Wonderwash measures 12″x12″x15″ (LxWxH) and can hold 5 lbs of clothing:

* 7-8 dress shirts or
* 10 T-shirts or
* 30 pairs of socks or
* 3 pairs of blue jeans

How does it work? According to the FAQ:

“…When you put warm or hot water into the drum, fit the lid in place and
seal the machine,the air inside the drum will absorb the heat of the
water and expand (i.e., just like a hot air balloon). When the air
expands it creates pressure inside the drum. The pressure forces the
detergent (which is diluted into the water) into & through the fabric
(which is porous) about 100 times faster than you could by hand or
machine….”

It costs ~$40.

Wonderwash, hand operated washing machine

This seems like it would be useful for an RVer or single apartment dweller. Anybody use it?

For $300, they also offer an automatic mini washer-dryer. If I had access to electricity and $1100 bucks to spare, I'd probably go for the Thor, though. CompactAppliance has some more cool gadgets.

Baltasare Forestiere: The Mole Man of Fresno

http://www.retroactive.com/south/moleman.html

Retro, July/August, 1996

Forestiere's patio

“The Mole Man of Fresno”

WHAT STRANGE drive possesses a man to
toil for thirty-eight years alone, in the middle of nowhere, on an
elaborate labyrinth of underground rooms and gardens? Was it madness,
a broken heart, or something else?

Early this century, a young man returned
home to Italy to claim his childhood sweetheart as his bride. Proudly
and excitedly, he told her of a comfortable home he'd designed and
built for the two of them in America, ideally suited for the desert
climate of California. He asked that she return with him as his wife,
and share in this good fortune.

Baltasare Forestiere, the Mole Man of Fresno

Her response was to ridicule and shame
him. How could she have waited so long only to learn of the outlandish
way that he proposed they live? She refused his offer. Heartbroken,
the man returned to California alone, and vowed that he would continue
building his home until he'd created an estate like no other; a
spectacle that would bring, instead of mockery, public wonderment and
fame.

This was the pledge of Baldasare
Forestiere. The home he had built for himself and his childhood
sweetheart — the home she had rejected — was located completely
underground.

Forestiere was born in 1879 near Messina,
Sicily, the son of a prosperous fruit rancher. He'd emigrated to
America at the age of 21 to work as a laborer on several large
projects: the Croton Aqueduct, a subway under the city of Boston, and
a tunnel connecting New York City with New Jersey. In 1908, Forestiere
decided to move west, and with his life savings and a small
inheritance, bought 200 acres of mostly barren land near Fresno,
California.

In the summertime, Forestiere found that
the temperature on his new land would soar to 120 degrees or more. He
remembered how cool and comfortable the subways he'd worked on had
been, even when the temperature on the surface had been oppressively
hot. Inspired, the little man started to dig, and soon he had
burrowed out a spacious four-room apartment under his land. On the
hottest days, his home was a refreshing seventy degrees, and in
winter, it was several degrees warmer than the surface, since the
temperature below ground varies only a few degrees throughout the
year.

Forestiere built his home to allow in
plenty of light, while keeping out the elements. Each room fronted a
patio; one on the east caught the early morning sun, and one to the
west captured the light during the rest of the day. The indoors
blended gracefully with the outdoors through the use of arches and
columns. Broad verandas, functioning like deep overhangs, kept
sunlight from directly entering the rooms. He built sliding windows in
the kitchen, and half of one wall in his summer bedroom had a large
window overlooking the sunset patio. Light was further controlled by
glass-covered skylights; rain, dust storms and winds passed harmlessly
overhead. Grapevines planted around the rims of the rooms filtered
the summer sun, and as the days shortened into fall and winter, the
leaves gradually fell away to admit more light.

As the son of a fruit rancher, he'd
learned a lot about gardening, so it was natural that an elaborate
garden was part of the plan. Grafting was a special hobby, and one
tree was modified to offer seven different kinds of fruit: navel and
valencia oranges, sweet and sour lemons, tangerines, grapefruit and
cheedro. To promote the growth of his garden and trees, Forestiere
made countless trips in his Model T pickup to dig and haul truckloads
of rich soil from ancient lake beds some 75 miles away.

After returning from his ill-fated trip
to Italy, Forestiere began enlarging his underground home with a
vengeance. First he dug a tunnel, then a room, then a passageway, then
a patio, a giant automobile tunnel, more rooms, gardens, grottos, more
passageways — until he'd developed a system of rooms that honeycombed
nearly seven acres. His work began to pique the curiosity of the
locals. A reporter once described him this way: “Forestiere has dug a
veritable Tutankhamen tomb, a catacomb such as afforded the early
Christians refuge from the persecutions of the Roman Caesars.” No one
could determine, however, what, if anything, Forestiere was seeking
refuge from, other than the oppressive heat above ground.

Forestiere at work (center) in 1923
(age 44), laying up a pillar of rock strata called hardpan. For this
room, the entire surface was dug away, columns built, roof reinforcing
laid, and the opening re-covered.

His work was not finished when he passed
away in 1946, at the age of sixty seven. After Forestiere's death, his
older brother, Joseph, added a 3500 square foot ballroom to the
home. Baldasare Forestiere's home and gardens were opened to the
general public on April 18, 1954. Visitors are constantly amazed at
the amount of work accomplished in forty years by this one tiny man,
standing all of five feet, four inches tall. Though he never learned
to read or write and spoke only halting English, Forestiere evidently
learned much from his experience working on the subways. Engineers who
have inspected the labyrinth of rooms have marveled at his self-taught
genius. It's difficult to imagine how dirt and rocks were shoveled out
of a hole more than three times the height of a man's head, or slabs
of hardpan weighing hundreds if not thousands of pounds were moved and
fitted by only Forestiere working alone. Millions of his pick marks
are still visible, fossil-like details of his day to day work.

Just what was he creating? Some locals
claimed that Forestiere said he was making an underground resort,
where people would enjoy fine Italian food, drink and dancing. The
tunnel was made so that people could drive their cars into the cool
depths, alight at a restaurant, and a valet would drive through to a
parking lot at the other end. In typical cold-war fashion, a 1959
tourist brochure called “The Secret World of the Human Mole”
hypothesized that Forestiere may have had prescient knowledge of the
nuclear age, and was thus building a bomb shelter. More likely, it was
a simple obsessive vision of a lone soul to escape from the harshness
of the elements, as well as what he felt were the harsh realities of
modern civilization. And perhaps, a broken heart.

Contact: Fresno Convention and Visitors
Bureau, 808 M St., Fresno, CA 93721; telephone (209)233-0836; fax
(209) 445-0122.

Arming America data spurious

Arming America by Emory University history professor Michael Bellesiles was hailed by pro-gun control advocates because his work suggested that guns were rare and heavily regulated in colonial America. His book won widespread acclaim and publicity, winning positive reviews in the New York times, as well as the Bancroft prize, the most prestigious award for American history writing.

However, it appears that much of the data upon which Bellesiles based his claims cannot be independently verified.

Airstream

If I ever buy an RV, it would be an Airstream.

Alfred Letournear (France) towed this 22' Liner in the late 1940's as an Airstream publicity stunt

Alfred Letournear (France) towed this 22' Liner in the late 1940's as an Airstream publicity stunt. From the Vintage Airstream owner's club.

2002 Index of Economic Freedom

The Heritage Foundation's 2002 Index of Economic Freedom is out. Hong Kong scored the highest, followed by Singapore, New Zealand. Estonia, Ireland, The Netherlands, and the U.S. tied for fourth.

Estonia? What's happening there?

Also, small island nations seem to be disproportionately represented…

Here's the Wall Street Journal's coverage:

http://opinionjournal.com/editorial/feature.html?id=95001454

Repression Breeds Terrorism
Who's free? Who's not?

BY GERALD O'DRISCOLL JR., KIM R. HOLMES AND MARY ANASTASIA O'GRADY
Monday, November 12, 2001 12:01 a.m.

The 2002 Index of Economic Freedom, released today by the Heritage Foundation and The Wall Street Journal, might just as easily have been titled “A
Guide to the Sources of Peace and Prosperity.” Or, as a primer for terrorism's Western apologists, it could be called “Civilization for Dummies.”

The findings of this study, now in its eighth year, have always been straightforward: Countries with the most economic freedom also have higher rates of
long-term economic growth. But this year, another pattern also jumps out at the reader. Economically free countries exhibit greater tolerance and
civility than economically repressed ones, where hopelessness and isolation foment fanaticism and terrorism.

The world's largest concentration of economic repression–Iran, Iraq, Syria and Libya–is also a primitive hotbed of terrorism. Egypt and Yemen are
“mostly unfree,” while Afghanistan, Sudan, the Democratic Republic of Congo, Angola and Somalia are all so void of a rule of law that they are
impossible to analyze.

Yet, on balance, the world is growing freer. For the eighth straight year, economic liberty has expanded. World-wide, 73 countries received better
scores than last year, 53 received worse scores, and 27 remain unchanged. Of the 156 countries numerically graded in the 2002 Index, 71 are either
“free” or “mostly free,” while 85 are “mostly unfree” or “repressed.” (To see the rankings, click here.)


The Index grades countries on such questions as the liberality of trade policy, how much citizens are burdened by taxes and regulation, the soundness of
monetary policy, whether property rights are protected, and the size of the black market, a good indicator of the degree of repression. Data from the past
eight years are now online at www.index.heritage.org.

Here, region by region, are the principal findings of the latest Index.

* North America and Europe: This remains the world's most economically free region, with six of the top 10 freest countries in the world, one more than
last year. The reforms in Ireland, Estonia, the United Kingdom, Spain and the Nordic countries are on the whole similar to those launched years ago by
Ronald Reagan and Margaret Thatcher. By contrast, France's economic freedom score is worse this year precisely because of further government
economic intervention.

Former Soviet republics account for three of the 10 countries that have shown the greatest overall improvement over the eight-year history of the Index.
Estonia has become one of the freest economies in the world.

* Latin America and the Caribbean: This is a region suffering from stalled reforms. Of 26 countries that are graded this year, 11 have improved in overall
economic freedom and 11 are worse. It is the only region in the world that did not experience a net gain in economic freedom this year.

Chile is for the first time classified as a “free” country. But El Salvador, which was ranked as the freest country in the region last year, has been
downgraded to “mostly free” because of an expanded fiscal burden and black market. Argentina's current economic tribulations could plunge it into
further disarray if economic reform is not implemented soon. Argentina's trade policy, regulatory burden and black market scores are all worse this year.

* North Africa and the Mideast: The scores of nine countries have improved this year, while eight are worse, giving this region a net gain in economic
freedom of only one country.

Bahrain remains the most economically free country in the region, and the 15th freest economy in the world. But its wages-and-prices scores worsened
this year, and it fell to the category of “mostly free.” The United Arab Emirates has the second freest economy in the Middle East, led by the economic
policies of the emirates of Dubai and Abu Dhabi (such as openness to foreign investment). It is followed by Israel, Jordan and Kuwait.

* Sub-Saharan Africa: Overall, economic freedom improved in 2001. The scores of 17 countries rose, while those of 12 declined. This makes the region
the second most improved on net.

None of the countries received a rating of “free.” However, for the first time, five sub-Saharan African countries are designated as having “mostly free”
economies: Botswana, Ivory Coast, Mali, Namibia and South Africa. Mauritius and Uganda miss this designation by a whisker.

* Asia-Pacific: With 17 Asian countries improved in the rankings and only seven worsened, the Asia-Pacific region experienced the greatest overall
gain. Though Hong Kong's score is a bit lower this year due to increased black market activity, it is once again ranked as the world's freest economy.
For the region overall, the black market factor was the most problematic, with six countries earning worse scores in that category. Better monetary
policy accounts for the greatest gains, with 11 countries improving. Hong Kong, Singapore and New Zealand are classified as the three freest countries
in the world this year.