On the last week of April earlier this year, a small committee of doctors met quietly in a midsized ballroom at the Renaissance Hotel in Chicago. There was an anesthesiologist, an ophthalmologist, a radiologist, and so on—thirty-one in all, each representing their own medical specialty society, each a heavy hitter in his or her own field.
The meeting was convened, as always, by the American Medical Association. Since 1992, the AMA has summoned this same committee three times a year. It’s called the Specialty Society Relative Value Scale Update Committee (or RUC, pronounced “ruck”), and it’s probably one of the most powerful committees in America that you’ve never heard of.
The purpose of each of these triannual RUC meetings is always the same: it’s the committee members’ job to decide what Medicare should pay them and their colleagues for the medical procedures they perform. How much should radiologists get for administering an MRI? How much should cardiologists be paid for inserting a heart stent?
While these doctors always discuss the “value” of each procedure in terms of the amount of time, work, and overhead required of them to perform it, the implication of that “value” is not lost on anyone in the room: they are, essentially, haggling over what their own salaries should be. “No one ever says the word ‘price,’ ” a doctor on the committee told me after the April meeting. “But yeah, everyone knows we’re talking about money.”
That doctor spoke to me on condition of anonymity in part because all the committee members, as well as more than a hundred or so of their advisers and consultants, are required before each meeting to sign what was described to me as a “draconian” nondisclosure agreement. They are not allowed to talk about the specifics of what is discussed, and they are not allowed to remove any of the literature handed out behind those double doors. Neither the minutes nor the surveys they use to arrive at their decisions are ever published, and the meetings, which last about five days each time, are always closed to both the public and the press. After that meeting in April, there was not so much as a single headline, not in any major newspaper, not even on the wonkiest of the TV shows, announcing that it had taken place at all.
Monthly Archives: July 2013
‘United Stasi of America’ Light Artist Wanted by Berlin Police
Berlin police believe that this message, projected onto the wall of the US Embassy in Berlin on Sunday night, could be a violation of laws against insulting representatives of foreign states.
Berlin police are investigating a light artist for projecting the phrase “United Stasi of America” onto the the US Embassy in Berlin. The phrase refers to the former East German secret police and was meant as a protest against American spying. But can the artist really be prosecuted?
It was meant to be a publicity stunt — a political prank aimed at voicing displeasure over vast US Internet surveillance and spying activities. But Oliver Bienkowski, the light artist who projected the words “United Stasi of America” onto the US Embassy late Sunday night now finds himself in hot water with the Berlin police after authorities opened an investigation.
America against democracy
That would have been some real democracy-promotion, right here in the homeland. What happened? Is it naive to think Mr Obama really believed this stuff? I’ll admit, with some embarrassment, that I’d thought he did believe it. But this “commitment” has been so thoroughly forsaken one is forced to consider whether it was ever sincere. It has been so thoroughly forsaken one wonders whether to laugh or cry. What kind of message are we sending about the viability these democratic ideals—about openness, transparency, public participation, public collaboration? How hollow must American exhortations to democracy sound to foreign ears? Mr Snowden may be responsible for having exposed this hypocrisy, for having betrayed the thug omertà at the heart of America’s domestic democracy-suppression programme, but the hypocrisy is America’s. I’d very much like to know what led Mr Obama to change his mind, to conclude that America is not after all safe for democracy, though I know he’s not about to tell us. The matter is settled. It has been decided, and not by us. We can’t handle the truth.
Circumventing Invasive Internet Surveillance with Carrier Pigeons
Recent disclosures have revealed the extreme level of surveillance of telephone and internet communications, as discussed separately with respect to the US National Security Agency, the UK GCHQ, and other members of the Five Eyes Anglosphere agreement (Vigorous Application of Derivative Thinking to Derivative Problems, 2013). There is therefore a case for exploring how such surveillance can be avoided, if that is considered desirable. The situation can be compared to that in any wilderness where predators deliberately create zones of fear through the manner of their engagement with potential prey — prior to any attack, as recently noted (Scared to death: how predators really kill, New Scientist, 5 June 2013, pp. 36-39).
Extensive use has been made in the past of carrier pigeons for secure communications, notably in arenas of threat, and most notably in World War I, continuing into World War II, but to a lesser degree. The founder of the news agency Reuters made use of carrier pigeons for the delivery of vital financial data in parallel with introduction of the telegraph. Other little-known examples are cited in what follows.
With the current development in the insecurity of computer and internet technology, there is a case for exploring alternative possibilities in the light of the threat of internet surveillance and the need for secure communications. Security agencies are effectively framing the “war on terrorism” as a global war in which independent governments and institutions are a source of potential security threat — as well as the world population at large.
It is to be expected that active consideration will be given to possibilities of secure communications by diplomatic services following the Wikileaks disclosures (Alleged Breach of UN Treaty Obligations by US, 2010). It is also to be expected that governments with any interest in preserving the confidentiality of their own communications, including developing countries and delegations to international conferences, will want to consider their need for such facilities — especially in the light of the recent disclosures regarding communications in such contexts (Ewen MacAskill, et al., GCHQ intercepted foreign politicians’ communications at G20 summits, The Guardian, 17 June 2013; GCHQ taps fibre-optic cables for secret access to world’s communications, The Guardian, 21 June 2013). Clearly use of internet facilities has become increasingly untrustworthy.
NSA scandal delivers record numbers of internet users to DuckDuckGo
. Taking a class in stained-glass making, he discovered that the teacher’s handout with “useful web links” didn’t tally with Google’s results at all. “I realised that there were millions of people who knew the right list of search terms and would make a better engine than Google.”
Then he noticed growing amounts of junk sites in Google results – pushed there by experts who had gamed the giant’s algorithms. He decided that by hooking into web services such as Wikipedia, Yelp and Qype, he could get focused answers cheaply. By using a combination of those services and crowdsourced links, he built the site’s first search index.
Of the privacy angle, he says: “I kind of backed into that.” It wasn’t a political decision, but a personal one. “It’s hard to define my politics. I take every issue seriously and come to my own conclusion. I don’t really feel like I belong to any political party in the US … I guess I’m more on the liberal side.”
The reason he decided not to store search data was because it reveals so much about us. In 2005, AOL accidentally released details of searches made by 650,000 of its users via Google; reporters from the New York Times were able to use the information to identify one of the users: a 62-year-old woman in Georgia. Nowadays Google would also have your IP address (indicating your ISP and perhaps precise location) and, if you were logged in, all your previous search history. If you logged in to use Google on your mobile, it would have your location history too.
Having decided that searching is intimately personal, he deduced that governments would want to get hold of search data. “I looked at the search fiascos such as the AOL data release, and decided that government requests were real and would be inevitable, and that search engines and content companies would be handing over that data [to government] in increasing amounts.”
BMW i3 drive review
The new i3 is also the first road-going BMW model to be based around an all-carbon-fiber body. For development, BMW forged a working relationship with SGL Carbon and established a state-of-the-art carbon-fiber weaving and curing facility at its Landshut factory in Germany, where the new car’s structure is made.
BMW says using carbon fiber has helped achieve a low (for an electric car) 2,635-pound curb weight. This helps the car’s performance potential because BMW could use a smaller-capacity battery than would have been possible with a more conventional steel monocoque construction.
Stylistically, the production i3 differs little from the most-recent concept. It is a modern-looking car boasting proportions like those of the Mercedes-Benz B-class but with a more contemporary look. With no B-pillars, the car uses front-hinged suicide doors, allowing excellent access to the rear seat.
Power comes from an electric motor mounted low in the rear axle — a position allowing BMW to devote the space under the hood to improved crashworthiness. The synchronous motor is produced in-house at BMW’s Munich engine plant; the company says it weighs just 287 pounds and produces 168 hp. As with all electric cars, the torque is what counts, and the motor’s 184 lb-ft is 5 lb-ft more than what the Mini Cooper S’ 1.6-liter four-cylinder turbo produces. The i3 is rear-wheel drive with a single-ratio gearbox offering three driving modes: comfort, ECO-PRO and ECO-PRO+.
The End of Car Culture?
But America’s love affair with its vehicles seems to be cooling. When adjusted for population growth, the number of miles driven in the United States peaked in 2005 and dropped steadily thereafter, according to an analysis by Doug Short of Advisor Perspectives, an investment research company. As of April 2013, the number of miles driven per person was nearly 9 percent below the peak and equal to where the country was in January 1995. Part of the explanation certainly lies in the recession, because cash-strapped Americans could not afford new cars, and the unemployed weren’t going to work anyway. But by many measures the decrease in driving preceded the downturn and appears to be persisting now that recovery is under way. The next few years will be telling.
“What most intrigues me is that rates of car ownership per household and per person started to come down two to three years before the downturn,” said Michael Sivak, who studies the trend and who is a research professor at the University of Michigan’s Transportation Research Institute. “I think that means something more fundamental is going on.”
If the pattern persists — and many sociologists believe it will — it will have beneficial implications for carbon emissions and the environment, since transportation is the second largest source of America’s emissions, just behind power plants. But it could have negative implications for the car industry. Indeed, companies like Ford and Mercedes are already rebranding themselves “mobility” companies with a broader product range beyond the personal vehicle.
“Different things are converging which suggest that we are witnessing a long-term cultural shift,” said Mimi Sheller, a sociology professor at Drexel University and director of its Mobilities Research and Policy Center. She cites various factors: the Internet makes telecommuting possible and allows people to feel more connected without driving to meet friends. The renewal of center cities has made the suburbs less appealing and has drawn empty nesters back in. Likewise the rise in cellphones and car-pooling apps has facilitated more flexible commuting arrangements, including the evolution of shared van services for getting to work.
With all these changes, people who stopped car commuting as a result of the recession may find less reason to resume the habit.
Related: Federation of State PIRGS:
From World War II until just a few years ago, the number of miles driven annually on America’s roads steadily increased. Then, at the turn of the century, something changed: Americans began driving less. By 2011, the average American was driving 6 percent fewer miles per year than in 2004.
The trend away from driving has been led by young people. From 2001 and 2009, the average annual number of vehicle-miles traveled by young people (16 to 34-year-olds) decreased from 10,300 miles to 7,900 miles per capita – a drop of 23 percent. The trend away from steady growth in driving is likely to be long-lasting – even once the economy recovers. Young people are driving less for a host of reasons – higher gas prices, new licensing laws, improvements in technology that support alternative transportation, and changes in Generation Y’s values and preferences – all factors that are likely to have an impact for years to come.
Doctors perform thousands of unnecessary surgeries
Peter Eisler and Barbara Hansen:
“If we ever learn about it at all, it’s only after the fact, if something goes wrong and the patient sees another doctor, or if Medicare or someone else comes in retroactively and does an audit,” says Rosemary Gibson, an authority on patient safety and author of The Treatment Trap, a book on unnecessary care. “The system, in my opinion, doesn’t want to know about this problem.”
Academic studies have discovered high rates of unnecessary surgery, particularly in spinal and cardiac operations.
A 2011 study in the Journal of the American Medical Association reviewed records for 112,000 patients who had an implantable cardioverter-defibrillator (ICD), a pacemaker-like device that corrects heartbeat irregularities. In 22.5% of the cases, researchers found no medical evidence to support installing the devices.
Another 2011 study, in the journal Surgical Neurology International, evaluated 274 patients with neck and back complaints over a one-year period: More than 17% had been told they needed surgery but had no neurological or radiographic findings that indicated an operation was necessary.
“I am seeing more and more patients who are told to have operations they don’t need,” says the spinal study’s author, Nancy Epstein, a neurosurgeon and chief of Neurosurgical Spine and Education at Winthrop University Hospital in Mineola, N.Y.
Who is deciding what spying projects matter most and why?
The most likely explanation is that President Obama never carefully discussed or specifically approved the E.U. bugging, and that no cabinet-level body ever reviewed, on the President’s behalf, the operation’s potential costs in the event of exposure. America’s post-September 11th national-security state has become so well financed, so divided into secret compartments, so technically capable, so self-perpetuating, and so captured by profit-seeking contractors bidding on the next big idea about big-data mining that intelligence leaders seem to have lost their facility to think independently. Who is deciding what spying projects matter most and why?
Designing Dashboards With Fewer Distractions
The engineers working on Honda’s new Acura MDX luxury sport utility vehicle were obsessed with giving customers more — more space in the rear seat, more fuel economy from a high-tech engine, and above, all, more apps, maps and connectivity.
But there was one feature they wanted less of: buttons.
In an effort to simplify the newest Honda vehicle, which went on sale in June, the product team was determined to streamline the instrument panel. For the new MDX model, more than 30 buttons have been eliminated. The change was emblematic of the challenge confronting automakers in the age of the connected car. How does a car company give customers the technology they crave without overwhelming them with complicated controls that can impair their ability to drive safely?
“We are trying to give our customers what they want in a way that’s going to be safe and make sense,” said Steven Feit, a senior Honda engineer on the project. “That’s the balance we are trying to get to.”