craschworks

I'm going to enter my books into the Distributed Library Project, but I have a lot of books, so I'd like to enter in those that people want most. What are the top five books or movies you want to read/see?

Via Kevin Kelly's always enlightening Cool Tools:

A decade ago some community librarians in California initiated a great idea: why not lend tools as well as books? The idea slowly spread to a couple of dozen other US towns, but the most active and well-stocked tool libraries are still in the Bay Area — one in Berkeley, Oakland and San Francisco. The typical tool lending library offers basic hand tools, and a selection of garden, landscaping and construction tools. The hot items with waiting lists at the San Francisco Tool Lending Library (now in the middle of a move to a new location on Howard Street) are heavy duty power tools. The top four borrowings are: an electric jack hammer, a drain snake for clearing sewage lines, an electric weed wacker (the library only deals with electrical tools, no gas), and rotary impact drills. There are racks of shovels, rakes, stampers, crow bars, pliers, and the usual shop tools, but the Saws-alls, belt sanders, wet tile saws, and other not-so-often needed tools get the most rotation. Many of these occasional tools are what you might find at a tool rental shop; indeed anyone with a city library card — including contractors — can, and do, borrow tools for the maximum 3 days.

Lending tools, like planting trees, is unalloyed goodness. Tool Lending Libraries are a great idea that should be duplicated everywhere. The biggest cost is not the tools but the liability insurance for the power tools. Patrons are pretty good at returning things in good order — they want to be able to use 'em again.

A very nifty idea. There are nodes for other areas, that will eventually be connected together.

http://triangle.communitybooks.org/

What is the DLP?

The Distributed Library Project is an experiment in sharing information and building community in the Triangle Area.

Unfortunately, the traditional library system doesn't do much to foster community. Patrons come and go, but there is very little opportunity to establish relationships with people or groups of people. In fact, if you try to talk with someone holding a book you like – you'll probably get shushed. The Distributed Library Project works in exactly the opposite way, where the very function of the library depends on interaction.

How does it work?

Create an account, then list the books and videos that you own.  You will then have access to the multitude of books and videos available in other people's collections.  You can search for specific authors or titles, browse individual collections, find nearby users, or find people who like books in common with yours. You will have access to user-written reviews and have the opportunity to write your own.

If the owner of a book or video you're interested in has time for you to pick it up, you can check out items for a 2, 7, 14, or 30 day period (at the owner's discretion). Returning books late will get you negative feedback, while returning books promptly will get you positive feedback. You are never under any obligation to lend an item if you don't feel comfortable doing so.

How do you manage trust?

While this is a community site based on good will, we have an ebay-style feedback system for managing trust. Lenders have the opportunity to leave positive or negative feedback for borrowers when an item is returned. These positive or negative points contribute to an overall “score” which lenders can use to gauge the trustworthiness or responsibility of a borrower. Lenders can also leave comments along with the points to be more specific.

Give your kids a birthday party they will never forget.

'Vengeance' swipes cake, eats it, too

August 30, 2004

A 6-foot-tall, 275-pound bearded man crashed a children's birthday party in Oak Forest, identified himself as “vengeance,” then helped himself to a piece of cake, police said.

The incident occurred earlier this month at a home in the 14800 block of South Landings Lane in the south suburb, Deputy Police Chief Nick Sparacino said.

When the owner of the home asked the man who he was, the intruder replied, “I am vengeance. I am the knight. I am Batman.” Then the man went into the kitchen, cut a piece of birthday cake, took it into the living room and ate it.

After continued questioning by the homeowner, the man left the house and drove off in a red 1988 Cadillac.

Police haven't found the man yet and want to charge him with criminal trespass.

“I've been on the job 31 years and I've seen a lot of weird stuff, but nothing like this,” Sparacino said.

Art Golab

My friend Jon pointed out that part of the reason that celebrities seem to have drug or alcohol problems more than most is that lot's of people want to sleep with them. And one way to get somebody to sleep with you is to get them stoned or drunk. So celebrities are offered drugs and alcohol much more often than most people. [1]

[1] There are probably lot's of other reasons celebrities become addicts. This is offered as only part of the explanation.

Via :

Garrison Keillor writes in (We’re Not in Lake Wobegon Anymore):

How did the Party of Lincoln and Liberty transmogrify into the party of Newt Gingrich’s evil spawn and their Etch-A-Sketch president, a dull and rigid man, whose philosophy is a jumble of badly sutured body parts trying to walk?
…

The concentration of wealth and power in the hands of the few is the death knell of democracy. No republic in the history of humanity has survived this. The election of 2004 will say something about what happens to ours. The omens are not good.

Lincoln was no friend of liberty:

My paramount object in this struggle is to save the Union, and it is not either to save or destroy slavery. If I could save the Union without freeing any slave, I would do it; and if I could save it by freeing some and leaving others alone I would also do that. What I do about slavery, and the colored race, I do because I believe it helps to save the Union.

– Abraham Lincoln

In other words, Lincoln didn't particularly care about slavery one way or the other — he was simply using the slavery issue as a way to maintain power by preventing the Southern states from seceding.

I would argue that the Republicans are returning to the policies of Lincoln–strong centralized government– and abandoning their more recent support for decentralized power. They've also adopted Lincoln's disrespect for constitutional safeguards:

“…[Lincoln] suspended the writ of Habeas Corpus, the only personal liberty law in the Constitution, and ordered the military to arrest tens of thousands of Northern citizens for merely voicing opposition to his administration. This number included hundreds of Northern newspaper editors and owners who criticized the Lincoln administration. None of these individuals was ever served a warrant and some spent four years in military prison without any due process. …”

Sound familiar?

The concentration of wealth and power in the hands of the few is the death knell of democracy. No republic in the history of humanity has survived this. The election of 2004 will say something about what happens to ours. The omens are not good

If the concentration of wealth and power worries you, then you should be just as concerned with a win by John Kerry. Kerry's net worth is 20 times more than George Bush's net worth. All of the top 10 donors out of the top 100 individual contributors in this election are Democrats. As Common Dreams, a liberal advocacy group notes:

The GOP can solicit a greater number of $2,000 donations as a result of wide support in a corporate community…Democrats, in contrast, have depended on trial lawyers and wealthy liberals who do not have large constituencies to draw on.

In other words, Bush has a much broader base of financial support — Democrat John Kerry depends much more heavily on donations from a small number of wealthy individuals.

Methinks Keillor doesn't really mind the concentration of wealth and power — he's just upset that the power isn't being concentrated in the hands he favors.

If Keillor were really concerned about the concentration of power, he would be advocating downsizing government, and returning money and power to individuals and local level goverments. In fact, Keillor's candidtate Kerry wants to expand Federal power as much or more than Bush does, albeit in slightly different areas.

Note that I'm voting for Kerry. However, I don't think he's a better candidate than Bush. His policy proposals are as bad or worse than Bush's. However, as a Democratic president, he won't be able to easily press his agenda through a Republican controlled congress or judiciary. Unlike Bush, who has only too easily been able to expand the size and scope of the Federal government.

http://techcentralstation.com/082704D.html

“…A few years ago, Stephen F. Venti and David Wise examined the relationship between income and wealth for people nearing retirement age. If everyone had approximately the same savings behavior, then you would expect that most of the variation in wealth would be due to variation in lifetime income. High earners would have accumulated much more wealth than low earners, but within an income group the differences would be small.

What Venti and Wise found instead was that much of the variation was within an income group. You could find high-income people who had managed to accumulate very little wealth, and vice-versa. As Hal Varian noted, “Mr. Venti and Mr. Wise started their analysis by estimating the lifetime income of each household, then sorted the households into 10 equal-sized groups based on their estimate. Their most striking observation was the extreme variation in total asset accumulation within each income group. For example, the wealth held by the top 10 percent of households in the group just below the median was 35 times the wealth held by the bottom 10 percent of that same income group.” To understand this observation, imagine two families with virtually identical incomes annual incomes of $40,000. After several decades one family has accumulated $700,000 in savings for retirement and the other winds up with just $20,000 in savings for retirement….”

—

“…There is a parallel between the problems of middle-class squeeze and obesity. Self-control is required in order to live within one's means financially and in order to maintain a low body weight.

…. did you know that the entire increase [in American obesity[ can be explained by three Oreo cookies a day? The trouble is that calories accumulate so holding caloric expenditures constant even a small permanent increase in calories consumed can lead to serious weight gain over long periods of time.”

Small changes in lifestyle can have large cumulative effects. A family that spends 92 percent of its after-tax income will accumulate substantial savings, while a family that spends 98 percent of its disposable income will not. On the surface, their lifestyles might not seem to differ, but eventually they will end up in very different circumstances.

Similarly, someone may consume 99 percent of the calories that her body needs each day, and someone else may consume 102 percent of the necessary calories. While they appear to be eating almost identical amounts, those two people will end up with very different body masses after several years…”

Understanding 'Middle-Class Squeeze'

By Arnold Kling
 Published 
 08/27/2004 

“The 445,000 second homes sold in 2003 represent a 7 percent increase from 2001 and a 33 percent increase from 1995, the Realtors group said.

According to the study, the typical second-home owner is 61, has owned property for nine years and earns a household income of $76,900.”
– Newsday, August 6, 2004

 

On our family's annual beach vacation this year, I could not get away from thinking about economic issues, such as the well-documented boom in second homes. It led me to ponder the phenomena of “middle-class squeeze,” obesity, and the question of where personal responsibility ends and government obligation begins.

 

More Middle-Class Squeeze

 

I think of Bethany, Delaware, as a middle-class family resort. My best guess would be that the typical vacationer is in the 80th percentile of the income distribution, meaning someone who is in the top 20 percent. If John Kerry were sincere in targeting the top 2 percent of incomes for tax increases, then most visitors to Bethany would have little to fear. It is certainly several notches below the vacation spot that a ketchup heiress would select.

 

According to left-wing politicians and the media, the latest economic crisis is “middle-class squeeze,” which is the pressure on family budgets caused by government's failure to spend more on education, health care and other middle-class needs. At Bethany, however, we saw a different type of middle-class squeeze. We had to squeeze our way onto the beach, amidst the crowd of umbrellas and chairs. We had to squeeze our way into restaurants, with lines of people waiting outside. We had to squeeze our way through traffic jams any time we got into our car.

 

But by far the biggest indicator that middle-class squeeze is not quite what is portrayed in the media was the volume of construction and the prices of homes. Since our first vacation there almost twenty years ago, thousands of housing units have been built in Bethany, with much of the building taking place within the past five years. This expansion in supply has done nothing to hold down prices, however. We passed a development, located across a four-lane highway from the ocean, offering “luxury townhomes from the $700,000's.” It seemed incredible to us that you could sell a townhome in a second-rate location in a middle-class resort for that much money. Each time we passed another new home site, I would mutter “looks like more middle-class squeeze going up.”

 

The Single Mom

 

A friend of ours, who I will call Marie, joins us every year when we vacation in Bethany. A while back, Marie told us that she was having trouble making ends meet. We agreed to “lend” her some money (we do not expect to get it back).

 

Marie was not ostentatious. She did not drive a fancy car or wear designer dresses. She engaged in much quieter forms of extravagance. Buying a cup of coffee every morning instead of making it at home. Subscribing to premium cable channels, even though almost all the movies that her family watched at home were rentals. Spending more on a cell-phone plan for three people than we spend for five. The total picture consisted of items that, individually, do not amount to much, but collectively are more than what can be afforded on a middle-class income.

 

One evening, when we called Marie to discuss the possible loan, no one was home. It turned out that she had taken her two children to see Indigo Girls in concert. I thought, “We're giving her money, and that is how she spends it?”

 

What going to the concert illustrates is what I call cause-effect disconnect. Marie simply did not see the connection between her behavior and her financial situation. Ever since she and her husband separated a few years ago, Marie had been telling herself — and all of her friends — that her financial problems are due to her ex-husband's stinginess. She believed that more alimony would be the solution. Most of Marie's friends have fallen for her “single mom” shtick.

 

I am sure that there are divorced women out there who are not receiving money that they need and are supposed to get. However, that was not Marie's problem. Her total income was more than that of a typical Bethany beach vacationer. Her income seemed inadequate only because she was in the 99th percentile for spending, meaning that probably only one percent of families in America spends more than hers each year.

 

As my wife and I began to grasp Marie's situation, we realized that more important than giving her money was getting her to understand cause and effect. We told Marie to focus less on her dissatisfaction with her divorce settlement and instead to pay attention to her own behavior. We tried to get her to appreciate that rock concerts and other small extravagances played a causal role in her financial straits.

 

No Typical Middle Class Family

 

Economists have found that people with identical incomes can wind up in very different places financially. A few years ago, Stephen F. Venti and David Wise examined the relationship between income and wealth for people nearing retirement age. If everyone had approximately the same savings behavior, then you would expect that most of the variation in wealth would be due to variation in lifetime income. High earners would have accumulated much more wealth than low earners, but within an income group the differences would be small.

 

What Venti and Wise found instead was that much of the variation was within an income group. You could find high-income people who had managed to accumulate very little wealth, and vice-versa. As Hal Varian noted, “Mr. Venti and Mr. Wise started their analysis by estimating the lifetime income of each household, then sorted the households into 10 equal-sized groups based on their estimate. Their most striking observation was the extreme variation in total asset accumulation within each income group. For example, the wealth held by the top 10 percent of households in the group just below the median was 35 times the wealth held by the bottom 10 percent of that same income group.” To understand this observation, imagine two families with virtually identical incomes annual incomes of $40,000. After several decades one family has accumulated $700,000 in savings for retirement and the other winds up with just $20,000 in savings for retirement.

 

Another way to look at the data is that there is no such thing as a “typical middle-class family,” because lifestyles vary more within income classes than across them. People with middle-class incomes are all over the map when it comes to spending vs. saving. At one extreme are people like Marie, who spend all of their income and more. At the other extreme is what Thomas Stanley and William Danko call The Millionaire Next Door, a coupon-clipping, used-car driving saver who manages to accumulate a seven-figure nest egg on a five-figure salary. The in-between includes people who can afford to buy second homes in Bethany and, on the other hand, people who report that they are suffering from middle-class “squeeze.”

 

Obesity and Squeeze

 

There is a parallel between the problems of middle-class squeeze and obesity. Self-control is required in order to live within one's means financially and in order to maintain a low body weight.

 

Another parallel is that you do not have to consume ostentatiously in order to become obese. As Alex Tabarrok put it, “Obesity rates in the United States have increased dramatically in the past two decades — so much so that manufacturers of everything from clothes to coffins are now super-sizing. But did you know that the entire increase can be explained by three Oreo cookies a day? The trouble is that calories accumulate so holding caloric expenditures constant even a small permanent increase in calories consumed can lead to serious weight gain over long periods of time.”

 

Small changes in lifestyle can have large cumulative effects. A family that spends 92 percent of its after-tax income will accumulate substantial savings, while a family that spends 98 percent of its disposable income will not. On the surface, their lifestyles might not seem to differ, but eventually they will end up in very different circumstances.

 

Similarly, someone may consume 99 percent of the calories that her body needs each day, and someone else may consume 102 percent of the necessary calories. While they appear to be eating almost identical amounts, those two people will end up with very different body masses after several years.

 

What the Wise-Venti analysis of saving suggests is that wealth is determined less by earnings capacity and more by lifestyle choice. Thus, even if you believe that earnings capacity is given by luck or fixed by educational background, people within the middle class still have considerable leeway in determining their long-term financial status. The spenders will wind up with little wealth, and the savers will wind up with a lot.

 

For obesity, studies of identical twins demonstrate that there are genetic differences in our ability to burn calories. Nonetheless, for most people, the range of feasible lifestyle choices includes calorie consumption a little below or a little above that needed to maintain body weight, with the former leading to weight loss and the latter leading to weight gain. In other words, genetics notwithstanding, our choices do matter.

 

Cause, Effect and Government

 

I am no psychologist, but my amateur opinion is that in order to lose weight or save money you have to understand the cause-and-effect relationship between the choices you make and the outcomes that result. You are unlikely to change your lifestyle if you deny personal responsibility.

 

If Marie continues to believe that her weak financial position is because of her status as a single mom, then she will not make the decisions necessary to control her family budget. Only when she can face the connection between the daily extravagances in her spending and her need to ask friends for money will she be able to get her finances in order.

 

If you believe that your obesity is caused by corporate America or some other external force, then you probably will be less motivated to control your weight. Only if you are conscious of the connection between the small excess of calorie intake and weight gain are you likely to make the lifestyle changes needed to shed excess pounds.

 

Under these circumstances, politicians who take on middle-class squeeze or obesity as public policy issues may be causing harm. Sending out a message that government is the solution may serve to weaken the cause-effect connections that people need to make in order to solve what are fundamentally personal problems. The damage caused by exacerbating the cause-effect disconnect that weakens personal willpower may far exceed the benefits of whatever actual remedy the government is able to deliver.

http://www.mises.org/fullstory.aspx?control=1547&id=71

100 Years of Medical Robbery

by Dale Steinreich

Our mentor has always been Hippocrates, not Adam Smith –President of a County Medical Society at an AMA meeting quoted in the February 16, 1981 issue of the New York Times.

This weekend (June 11-13, 2004), the American Medical Association (AMA) will celebrate the 100th anniversary of its Council on Medical Education. The medical establishment understandably sees the formation of the Council as a good thing. However, some patients aren't ready to celebrate yet, and their instincts may be good.

History

The American Medical Association (AMA) was founded in 1847 around two propositions: one, all doctors should have a “suitable education” and two, a “uniform elevated standard of requirements for the degree of M.D. should be adopted by all medical schools in the U.S.” [1] In the days of its founding AMA was much more open–at its conferences and in its publications–about its real goal: building a government-enforced monopoly for the purpose of dramatically increasing physician incomes. It eventually succeeded, becoming the most formidable labor union on the face of the earth.

AMA's initial drive to increase physician incomes was motivated by increasing competition from homeopaths (AMA allopaths use treatments–usually synthetic–that produce effects different from the diseases being treated while homeopaths use treatments–usually natural–that produce effects similar to those of the disease being treated). This competition did serious damage to the incomes of AMA allopaths. In the year before AMA's founding, the New York Journal of Medicine stated that competition with homeopathy caused “a large pecuniary loss” to allopaths. [2] In the same issue, the dean of the school of medicine at the University of Michigan railed against competition because it made treating sickness “arduous and un-remunerative.” [3]

Apart from reversing rapidly declining incomes, allopaths also wanted to rescue their public reputations, which quite reasonably suffered given their proficiency in killing patients through such crude practices as bloodletting (“exsanguination”) or mercury injections (poisoning). A few allopaths desired adulation normally reserved for star athletes and actors. The Massachusetts Medical Society opined in 1848 that physicians should be “looked upon by the mass of mankind with a veneration almost superstitious.” [4]

Shut 'em Down

The curse of medical education is the excessive number of schools–Abraham Flexner, 1910.

To accomplish the twin goals of artificially elevated incomes and worship by patients, AMA formulated a two-pronged strategy for the labor market for physicians. First, use the coercive power of the state to limit the practices of physician competitors such as homeopaths, pharmacists, midwives, nurses, and later, chiropractors. [5] [6] Second, significantly restrict entrance to the profession by restricting the number of approved medical schools in operation and thus the number of students admitted to those approved schools yearly. [7]

AMA created its Council on Medical Education in 1904 with the goal of shutting down more than half of all medical schools in existence. (This is the Council having its 100th anniversary celebrated in Chicago this weekend.) In six years the Council managed to close down 35 schools and its secretary N.P. Colwell engineered what came to be known as the Flexner Report of 1910. The Report was supposedly written by Abraham Flexner, the former owner of a bankrupt prep school who was neither a doctor nor a recognized authority on medical education. Years later Flexner admitted that he knew little about medicine or how to differentiate between different qualities of medical education. Regardless, state medical boards used the Report as a basis for closing 25 medical schools in three years and reducing the number of students by 50% at remaining schools.

Since AMA's creation of the Council a century ago, the U.S. population (75 million in 1900, 288 million in 2002) has increased in size by 284%, yet the number of medical schools has declined by 26% to 123.[8] [9] In terms of admissions limits, the peak year for applicants at U.S. schools was 1996 at 47,000 applications with a limit of 16,500 accepted. [10] This works out to roughly 64% of applications rejected. [11] On a micro level, for the last six years the University of Alabama (hardly a beacon of prestige in the medical discipline) has averaged about 1,498 applicants per year with an average of about 194 accepted. This is about an 87% rejection rate. The sizes of the entering classes have been of course even smaller, averaging about 161.

AMA would likely argue that there's nothing necessarily wrong with very high rejection rates. This is correct, except for the fact that these rates are being applied to pools of candidates who are cream-of-the-crop in quality and have put themselves through a very costly admissions process. [12] Current admissions practices could still be justified by what Milton Friedman (1982, p. 153) refers to as a “Cadillac standard.” (Getting away from the pop-culture anachronisms of the 1960s, let's say “Lexus standard” a la the government decides that every driver today deserves nothing less than Lexus quality.) Applied to health care, the benefits of a Lexus standard could supposedly offset the costs of rejecting many ostensibly qualified applicants.

Quality

The first problem with asserting the existence of a Lexus standard in health care from very stringent admissions policies are the contradictions introduced by current racial and sexual preferences. The Center for Equal Opportunity found that at a sample of six medical schools, more than 3,500 white and Asian candidates were not admitted in spite of having higher undergraduate grades and MCAT scores than Hispanic and African-American applicants who were admitted in their place. The Center's study didn't touch on sex discrimination but undergraduate science professors indicate that it clearly exists as well. [13]

The second blowout on our shiny Lexus would be the number of unnecessary/questionable procedures performed on patients every year. Ex-surgeon Julian Whitaker (1995) tirelessly rails against the excesses of angioplasty (PTCA), atherectomy (directional and rotational), and coronary bypass. [14] Whitaker states that, with few exceptions, all three procedures for heart-disease patients have been empirically shown to be utter failures in terms of solving short-term problems without creating long-term problems which are much worse.

The first complete study of bypass effectiveness was the Veterans Administration Cooperative Study [15]. Between 286 patients who received bypass surgery and 310 who did not, the survival rate at the end of 3 years was 88% for the bypass group and 87% for the control group. In an 8-year follow-up to a second VACS study [16] among 181 low-risk patients, the bypass group had a much higher cumulative mortality rate (31.2%) compared to the non-surgery group (16.8%). This was among a group of low-risk patients to begin with.

A Rand study [17] revealed that nearly 50% of bypass operations are unnecessary. Whitaker [18] notes that the number of bypass surgeries since this Rand study, which should have plummeted, has increased by more than 50%. While the death rate from heart disease declined from 355 per 100,000 in 1950 to 289 per 100,000 in 1990, the amount of bypass operations jumped from 21,000 in 1971 to 407,000 in 1991, a increase of more than 1,838%. [19] Whitaker states that laypersons are quick to attribute increases in life expectancy to surgery, but the credit clearly belongs to greater exercise and healthier diets.

Other examples:

180 patients with osteoarthritis of the knee were given arthroscopic débridement, arthroscopic lavage, or placebo surgery (skin incisions and simulated débridement). In two years of follow-up the surgery group reported no less pain or impaired joint function than the placebo group. Six placebo patients liked their fake surgery so much they wanted it performed on their other knee.[20]  For other arthroscopies, knee surgeon Ronald Grelsamer, M.D., states that at some hospitals doctors are performing as many as “ten a week [where] nine are unnecessary.” [21]
Jens Ivar Brox, M.D., in a Norwegian study compared the effects of spinal fusion surgery with non-surgical therapy for 64 patients with chronic lower-back pain and disc degeneration. The non-surgical treatment was as effective as surgery, but at a fraction of the cost with no complications.[22] With regard to fusions for lower back pain, Nortin Halder M.D., stated, “If this were a pill and I used it, I would probably lose my license and go to jail.” Nevertheless, there are about 125,000 fusion surgeries a year at $30,000 each bringing back surgeons a hefty yearly median income of $545,000.[23] 

Stuart Spechler, M.D., studied 247 patients with severe acid reflux in the 1980s and found that surgery was significantly more effective in improving symptoms than lifestyle changes and drugs. [24] These results reversed in the 1990s after the introduction of proton pump inhibitors (today's Prevacid, Nexium). About 62% of surgery patients still needed drugs to control reflux and had no less incidences of esophageal cancer than non-surgery patients. [25] Mayo Clinic's Yvonne Romero, M.D., is even more pessimistic, pointing out that in countries where surgery has been performed longer than the U.S. (e.g., Brazil), as much as 85% of surgeries fail after 15 years. Says Spechler, “When you look at data it is hard not to be biased against surgery.” Nevertheless, about 65,000 Nissen fundoplications are performed each year at a price of $10,000 each. [26]

Hysterectomy (uterus removal) is the probably the best example of an often unnecessary surgery. While a necessity for uterine cancer patients, gynecologist Michael Broder, M.D., found that in a sample of about 500 women, about 70 shouldn't have received the surgery for any reason whatsoever and about 350 hysterectomies had been performed without any diagnostic tests to determine if the surgery was appropriate in the first place. About 70 women with benign fibroids had their uteruses removed without first trying drugs or other treatments that could have been effective. [27]

A final challenge to the Lexus standard is the number of accidental deaths occurring in U.S. hospitals every year. Harvard University's Lucian Leape estimated that there are approximately 120,000 accidental deaths and 1,000,000 injuries in U.S. hospitals every year. [28] To understand what staggering figures these are, imagine a Boeing 777-200 with its maximum of 328 passengers crashing every day for an entire year with no survivors. This would add up to 119,720 deaths, still not as many as are killed through medical error in hospitals every year. UCLA Professor of Medicine Robert Brook, M.D., told the Associated Press, “The bottom line is we have a system that is terribly out of control. It's really a joke to worry about the occasional plane that goes down when we have thousands of people who are killed in hospitals every year.” [29]

Certainly not all accidental hospital deaths can be attributed to institutionalized AMA mischief. Errors by nurses, pharmacists, and sleep-deprived residents play a role as well. However, there's also no doubt that AMA-backed restrictions against greater specialization have helped wreak their havoc over time as well. [30] A later study by Leape [31] showed that just the presence of a pharmacist on physician rounds reduced adverse drug reactions from prescribing errors by 66%. [32] [33] Despite some shortcomings, the U.S. system still has some of the finest physicians, surgeons, research, and facilities in the world. However, the best aspects of the system are due to whatever vestiges of market freedom still survive, not some illusory Lexus standard supposedly created by strict statist controls. [34]

The Exceptional World of the Modern Physician

AMA has built an impressive edifice, one that has completely insulated physicians from recessionary (“cyclical”) and until recently, technological (“structural”) unemployment. While decade in, decade out, recessions, depressions, consolidations, and (recently) outsourcing have dislocated millions of blue-collar, engineering, computer programming, and middle management employees from jobs and forced permanent career changes, physicians as a class have been almost completely immune. Unlike workers in most other industries, a competent, licensed physician with a clean record who remains unemployed despite months and months of search for work is unheard of in the U.S. [35]

Restricting labor supply has markedly boosted incomes. Median yearly salaries for primary-care physicians are $153,000, for specialists $275,000. [36] Another more recent survey across many specialties and 3+ years of experience makes hospitalists relative paupers of the profession at $172,000 and spine surgeons at the high end raking in $670,000.

Restricted supply aside, there's certainly nothing wrong with competent physicians becoming fabulously wealthy at their craft and nothing about a free market that would ever preclude such. Indeed one of the worst transgressions of current system is allowing the most rude, incompetent, and stupid physicians (e.g., Clinton Surgeon General Jocelyn Elders who wanted public schools to teach first graders how to masturbate) to earn incomes relatively close to competent ones.

Of course life is not a complete bowl of cherries for all physicians. Malpractice insurance premiums for some Ob/Gyns are now running as high as $160,000 per year. Some Ob/Gyns have been lucky to have their hospitals pick up the tab. Others have had to move to different states. No one would disagree with AMA that paying $160,000 in insurance premiums is outrageous.

The problem is that AMA's restriction of labor supply has made the problem worse at the margin than it otherwise would be. Plus, exactly how does a thoroughly rent-seeking organization such as AMA lecture malpractice attorneys on the adverse consequences of wealth redistribution? It can't with any convincing credibility, thus it has no effective answer to some in the far Left either, who want to conscript physicians to provide infinite “free” care to them because they claim they have a “right” to it.

Robots to the Rescue?

Two recent articles on the Web show two divergent paths the U.S. health care system can take. A recent story on MSNBC reflects the worsening status quo. It was a report on a new robot (“robo-doc”) that roams hospital halls visiting patients in place of a physician (see photos). The robot is controlled from remote location by a physician. The device is an obvious implicit attempt to cope with the artificial scarcity of physicians. Most of the patients, instead of laughing the pathetic robot out of their wing, thought the idea was jim dandy. Presumably they couldn't explain how the armless robot would resuscitate them if their conditions took a sudden turn for the worse.

On the other hand, the great Ron Paul, M.D., has recently discussed the trend of cash-only practices which reject all insurance as well as Medicaid and Medicare. He profiles a Robert Berry, M.D., who charges only $35 for routine visits. (This is about half to a third of what I'm typically charged–with insurance at that–and yet my current doctor, whose income in one year exceeds what I make in five, is moving to another practice because she wants more money.) Cash-only practices of course do nothing to address physician supply, but some relief is better than none, especially when living in a clueless American public that thinks robo-docs represent actual progress in medicine.

A happy 100th birthday to the Council on Medical Education…and for the sake of all our health, hopefully not too many more.

________________________

Dale Steinreich, Ph.D., is an adjunct scholar of the Mises Institute, and contributor to AgainstTheCrowd.com. The author is indebted to Llewellyn H. Rockwell, Jr., for his incisive synopsis of AMA history in the June 1994 issue of Chronicles. Comments by economists L. Aubrey Drewry, Jr., Ph.D., Paul A. Cleveland, Ph.D., and Richard O. Beil, Ph.D., were of great value. [email protected]. Comment on the Blog.

References
Friedman, Milton. Capitalism and Freedom. University of Chicago, 1982.
Langreth, Robert. “Is Elective Surgery Overdone?” Forbes. 27 Oct. 2003, 247+.
Rockwell, Llewellyn H., Jr. “Medical Control, Medical Corruption.” Chronicles. June 1994, p. 17-20.
Starr, Paul. The Social Transformation of American Medicine. Basic, 1982.
Tully, Shawn. “America's Painful Doctor Shortage.” Fortune 16 Nov. 1992, p. 104.
Whitaker, Julian. Is Heart Surgery Necessary? What Your Doctor Won't Tell You. Regnery, 1995.
Wolinsky, Howard and Tom Brune. The Serpent on the Staff: The Unhealthy Politics of the American Medical Association. Tarcher Putnam, 1994.

Notes
[1] Rockwell, p.17.
[2] ibid, p. 18.
[3] ibid, p. 18.
[4] ibid, p. 18.
[5] Chiropractors filed an antitrust suit against AMA and eventually won on August 24, 1987. AMA had dismissed chiropractic as quackery since at least 1925 and began an organized effort to shut it down in 1962. See Wolinsky and Brune, pp. 124, 139-40.
[6] Starr (1982) asserts that it is a myth that allopaths achieved dominance by crushing homeopaths and eclectics. He claims that once homeopaths and eclectics joined forces with allopaths for occupational licensing and thus began to blur their distinctions, public approval of homeopaths and eclectics died.
[7] Friedman (1982, p. 152): “To return to medicine, it is the provision about graduation from approved schools that is the most important source of professional control over entry. The profession has used this control to limit numbers.” Blocking entry is much more effective than just raising the real price of a medical license; the “far more important” measure is “establishing standards for admission and licensure that make entry so difficult as to discourage young people from ever trying to get admission” (p. 151).
[8] This actually understates continual declines. Starr (1982, p. 421) reports that in 1965 only 88 schools existed meaning that the Council almost reached its goal of a more than 50% closure of schools.
[9] The 123 AAMC listed schools include the newest at Florida State University, but not the three med schools in Puerto Rico. Unlike Puerto Rico, 19 states are limited to just one school.
[10] Assuming 125 schools at the time, including those in Puerto Rico. This works out to about 132 new admissions per school.
[11] Source: John Ross, President of Ross University Medical School in Domenica, 1997 interview on Westwood One's Jim Bohannon Show. Here for recent stats.
[12] The admissions process involves sizable application fees and the Medical College Admission Test (MCAT). MCAT can, with practically no exceptions, only be taken twice.
[13] One chemistry instructor at the University of Alabama told me strictly off the record, “If you're a white male who is 27 (not the usual 21-23), you're an old man as far as med-school admissions goes. They won't take you regardless of how good your GPA or MCAT looks. You have to go to a Caribbean school or forget medicine as a career. For white and especially black women, you can not only have mediocre grades and a mediocre MCAT, but be as old as 35 and still have a pretty good chance of getting into a U.S. school. I've seen it again and again.”
[14] Angioplasty involves inflating a small catheter balloon to clear blocked arteries, atherectomy clears blockages with blades or burr tips in lieu of a balloon.
[15] New England Journal of Medicine 311 (1984): 1333-1339.
[16] American Journal of Cardiology 74 (September 1, 1994): 454-58.
[17] Journal of the American Medical Association 260, no. 4 (July 22/29, 1988).
[18] p. 26.
[19] Whitaker, p. 71.
[20] New England Journal of Medicine, July 11, 2002
[21] Langreth, p. 248.
[22] Annual European Congress of Rheumatology, June 20, 2003
[23] Langreth, p. 248.
[24] New England Journal of Medicine, March 19, 1992
[25] Journal of the American Medical Association 2001; 285: 2331-2338.
[26] Langreth, p. 250, 254.
[27] Obstetrics and Gynecology 95:199, 2000.
[28] Leape's estimates are variously cited as running the gamut from 44,000 to 100,000 to 180,000.
[29] These estimates would ironically make hospitals America's deadliest industry. Imagine the government inquisition that would move against the airlines and Boeing if jet travel were as unsafe as hospitals.
[30] Nurses' duties are heavily restricted in many jurisdictions by state-level acts. By some estimates (Wolinsky, p. 142) nurses could provide up to 80% of the care now delivered by primary-care physicians at about 40% of the cost.
[31] Journal of the American Medical Association, July 1999
[32] Despite pharmacists being much more knowledgeable than M.D.s about drugs, AMA not only stands in the way of pharmacists prescribing drugs but destroyed their ability to write refills (Rockwell, p. 20).
[33] Another worthy topic for Leape might be a study of all the people who unnecessarily die because they don't get to the hospital in time. The estimates might dwarf Leape's alarming ones on errors. Severe restriction of the number of hospitals in the U.S. and the workings of the corrupt hospital cartel is material for another long and depressing article.
[34] One final possible nail in the allopathic coffin is a fascinating report in the U.K. Independent of the claims by Glaxo Smith Kline geneticist Alan Roses, M.D. that “most [prescription] drugs do not work for most patients.”
[35] Some frictional unemployment certainly exists (e.g., after med-school graduation). There has also been a bit of outsourcing in radiology, although that will come to a quick end if the American College of Radiology gets its way. What does not exist is a “shortage” of physicians despite ample assertions to the contrary (see Tully). A shortage exists in the case of a wage ceiling, where market wages are fixed at a below-equilibrium level. First, physician wages aren't fixed under equilibrium, and they're anything but too low.
[36] Langreth, p. 254.

fry: can't we just be together?
leela: listen – you are a man, I'm a woman. We're just too different.

Dodgeball was a blast last week. I'm going to go again tomorrow. You can still register if you want to join!.

Just a reminder that the second of ColtSport's Adult Dodgeball Association “Test Days” will be held this Saturday, starting at 11 a.m.  Our first round of testing has resulted in a few changes, such as:

 

– Increasing the number of games per weekly series from 5 to 7.

– Shortening game duration from the original 8 minutes down to 5 (most games were still over well before then).

– Increasing possible team size from 5 players up to 7.

 

We expect some additional refinements based on Saturdays games, so come on out and help us write the rules!

 

Saturday is also our registration deadline for teams and individual players.  Individual players will be grouped into teams as necessary to ensure as many folks get to participate as possible, though a team may end up being organized with slightly more or less than 7 players if needed to accommodate everyone.  Teams not organized by the league will not be asked to take on additional players however.  Team registration is $ 125.00 (up to 7 players) while individual registration is $ 25.00 per player.

 

We'll be releasing the league schedule early next week, with our regular season starting on Saturday, 11 September, weather permitting.  Our inaugural DODGEBOWL Championship Series will be scheduled for Saturday, October 23rd.  So bring some friends or co-workers out Saturday and have some fun throwing things at one another!  The site will be the multipurpose field at Marsh Creek Park in Raleigh.  If you need directions, PLEASE don't hesitate to e-mail me and ask!

 

D.P. McIntire
[email protected]