Cowboys and Pit Crews: Atul Gawande's 2011 Commencement Address to Harvard Medical School.

Dirty Medicine: Infuriating account of stifled innovation, waste, and corruption. Incidentally, I did not know this little factoid about bloodstream infections: "while most people rarely think about them, these are the most dangerous of the hospital-acquired bugs that afflict one in ten patients in the United States. Their spread has helped to make contact with our health care system the fifth leading cause of death in this country."

Christopher Hitchens: “In whatever kind of a ‘race’ life may be, I have very abruptly become a finalist.”

Really interesting article on Steve Jobs’ liver transplant and subsequent push to pass a law in California that will require the DMV to ask you if you’d like to become an organ donor (which may double the number of transplant organs available there):

But something about his whole experience still bothered Steve.

What bothered him was that while he, a very wealthy man, was surviving his liver’s failure, others were not so lucky. Specifically, he was upset because, while he was able to afford the costs of multiple-listing and a private jet that could ferry him to any hospital in the country at a moment’s notice, others in California could not; they had to stay in California and hope. He knew that 400 people died hoping.

And so, in a departure from a largely apolitical career, Steve decided to do something about it.

Great stuff from Roger Ebert that’s not a movie review: The Gathering Storm.

This one might be the graphic of the year for me. National Geographic has a brilliant visualization of healthcare spending, life expectancy, and doctor visits per country. Here’s a taste, but you gotta click through to the full version to find the US on there (the red line below should give you some idea):

Sigh!

Update: Here’s Andrew Gelman’s version.

How cool is it that Wired has stories up on Archimedes and Eureqa [sic]. That can’t be a coincidence, can it?

The former is a sophisticated computer model that simulates human drug trails with uncanny accuracy. In 2004 they ran it and compared it against the actual human trials for the same drug and were remarkably (but not perfectly) accurate. How? It is a…

soup-to-nuts model that captures everything known by modern medicine, from the evolution of disease in different people — as shaped by factors like race, genetic risk, and number of hours spent doing yoga — to specific physiological details, such as the amount of heart muscle that dies in the hours after a heart attack and the degree to which medications like aspirin can limit that damage.

Eureqa sounds even cooler: it is a program that takes in raw data, and proposes scientific laws to explain said data. For example, it can extrapolate the laws of motion from data representing a pendulum’s swing. It took hours for it to discover what took Newton years (not to mention everybody who came before him). Oh, and it’s a free download if there’s a scientific law you’ve been struggling to discover. Be prepared, though:

“We’ve seen this in the lab. Eureqa finds a new relationship. It’s predictive, it’s elegant, it has to be true. But we have no idea what it means.”

Always drop what you’re doing when a new Atul Gawande piece comes down the pike, this time for his take on the wide range of health care costs across the country, what factors influence that, and what a huge problem it is:

Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. It’s also devouring our government. “The greatest threat to America’s fiscal health is not Social Security,” President Barack Obama said in a March speech at the White House. “It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”

Atul Gawande is always worth reading. Here he makes the case for building on what we have in reforming health care rather than a complete tear-down and rebuild, which would kill people:

Yes, American health care is an appallingly patched-together ship, with rotting timbers, water leaking in, mercenaries on board, and fifteen per cent of the passengers thrown over the rails just to keep it afloat. But hundreds of millions of people depend on it. The system provides more than thirty-five million hospital stays a year, sixty-four million surgical procedures, nine hundred million office visits, three and a half billion prescriptions. It represents a sixth of our economy. There is no dry-docking health care for a few months, or even for an afternoon, while we rebuild it. Grand plans admit no possibility of mistakes or failures, or the chance to learn from them. If we get things wrong, people will die. This doesn’t mean that ambitious reform is beyond us. But we have to start with what we have.

He then proceeded to teach me about the phone system by way of analogy:

The P.S.T.N. [Public Switched Telephone Network] is probably the shaggiest, most convoluted system around; it contains tens of millions of lines of software code. Given a chance for a do-over, no self-respecting engineer would create anything remotely like it. Yet this jerry-rigged system has provided us with 911 emergency service, voice mail, instant global connectivity, mobile-phone lines, and the transformation from analog to digital communication. It has also been fantastically reliable, designed to have as little as two hours of total downtime every forty years. As a system that can’t be turned off, the P.S.T.N. may be the ultimate in path-dependence. But that hasn’t prevented dramatic change. The structure may not have undergone revolution; the way it functions has. The P.S.T.N. has made the twenty-first century possible.

Two hours of downtime every 40 years!

Wow, this is a shockingly bad logo:

As a friend noted, do I really want the new direction for my health care to be backwards? And doesn't it look more like CJIIP rather than CDHP?

On the other hand, maybe the backwards bit is appropriate.

From the paying through the nose for a whole lotta nuthin' department:

The point was to compare the health of the United States and the United Kingdom. It's an interesting question for a number of reasons, but principally because the United States spends $5274 per person, per year, on health care and the United Kingdom spends $2164, or substantially less than half as much. The question is—what do we get, in terms of health, that for extra $3100 a year?

The one line answer: "The first conclusion is that Americans are really, really sick compared to the British."

I'd say "I could fall over and die from that surprise," but living where I do I just might!