The pitfalls of ‘big’ medicine

This is the problem with ‘scaling up’:  something necessarily gets lost in the process.

I recall when the Canadian government was ‘standardizing’ their IM/IT infrastructure, implementings seamless inter-operability and portability and other optimization measures:  the result was that the whole system was now monolithic, with the necessary loss of flexibility and adaptability to specific, perhaps non-typical applications.

But it gets worse:  the only vendors who could service this behemoth were those who were bundling and re-selling ‘the one big solution’.  No independant little companies with clever, efficient and cost-effective solutions for particular applications could possibly penetrate this marketplace.

It got even worse:  when employees, burdened by the monolithic ‘optimized’ system would write their own bits of code to add back the functionality their specific little segment needed, but which was lost due to this stadardization, they were not celebrated as innovators – they were punished as rogues and ‘not team players’ and, eventually, this sort of innovative initiative had been completely stamped out of our Federal civil service.

This predictably depressing – but important to read nonetheless – article in Washington Monthly shows how this process had occurred in the US, as hospitals strove to optimize their purchasing practices:  they had ‘optimized’ them to such a level that now, highly superior products that would save lives – but which come from small innovators – have little or no chance to even enter the market, much less succeed in it.

‘ …  Edward Goodman, the hospital’s director of infection control, wrote a letter to the purchasing department, saying Shaw’s product was “essential to the safety and health of our employees, staff and patients.” But Shaw soon learned that the enthusiasm of health care workers was not enough to gain him entrée; the hospital initially promised him a contract, only to back out three months later. Though he didn’t realize it at the time, Shaw had just stumbled into the path of a juggernaut. ‘

‘… One of the first witnesses was California entrepreneur Joe Kiani, who had invented a machine to monitor blood-oxygen levels. Unlike other similar devices, Kiani’s worked even when patients moved around or had little blood flowing to their extremities, a crucial innovation for treating sickly, premature infants, who tend to squirm and need to be monitored constantly for oxygen saturation—too little and they suffocate, too much and they go blind. But most hospitals couldn’t buy Kiani’s product because his larger rival, Nellcor, had cut a deal with the GPOs. ‘  (Note:  GPO’s are the ‘purchasing optimization’ which has now gridlocked the hospitals, preventing them from purchasing better, safer and cheaper equipment.)

It also highlights something that ought to be a ‘no-brainer’, but that seems to be a mystery to our law-makers:  exempting anyone – ANYONE – from anti-trust, anti-racketeering and similar legislation is destructive and will end badly, no matter how noble the motivations may be.

‘Then, in 1986 Congress passed a bill exempting GPOs from the anti-kickback provisions embedded in Medicare law. This meant that instead of collecting membership dues, GPOs could collect “fees”—in other industries they might be called kickbacks or bribes—from suppliers in the form of a share of sales revenue.’

‘…But, as with many well-intended laws, the shift had some ground-shaking unintended consequences. Most importantly, it turned the incentives for GPOs upside down. Instead of being tied to the dues paid by members, GPOs’ revenues were now tied to the profits of the suppliers they were supposed to be pressing for lower prices. This created an incentive to cater to the sellers rather than to the buyers—to big companies like Becton Dickinson rather than to member hospitals.’

The article is long – but important and we should heed its message!

 

Destroying Latin America: Journalist Mary O’Grady on Populism, Protectionism, and Prohibition

From ReasonTV:

 

Ottawa Protocol on Combatting Anti-Semitism

A friend called my attention to this:  The Ottawa Protocol on Combatting Anti-Semitism, produced by the Inter-Parliamentary Coalition for Combatting Anti-Semitism (ICCA) and just signed by the Harper Administration.  Perhaps it is important that I reproduce it in its entirety:

The Ottawa Protocol on Combating Antisemitism

Preamble

We, Representatives of our respective Parliaments from across the world, convening in Ottawa for the second Conference and Summit of the Inter-parliamentary Coalition for Combating Antisemitism, note and reaffirm the London Declaration on Combating Antisemitism as a template document for the fight against antisemitism.

We are concerned that, since the London Conference in February 2009, there continues to be a dramatic increase in recorded antisemitic hate crimes and attacks targeting Jewish persons and property, and Jewish religious, educational and communal institutions.

We remain alarmed by ongoing state-sanctioned genocidal antisemitism and related extremist ideologies. If antisemitism is the most enduring of hatreds, and genocide is the most horrific of crimes, then the convergence of the genocidal intent embodied in antisemitic ideology is the most toxic of combinations.

We are appalled by the resurgence of the classic anti-Jewish libels, including:

–       The Blood Libel (that Jews use the blood of children for ritual sacrifice)

–       The Jews as “Poisoners of the Wells” – responsible for all evils in the world

–       The myth of the “new Protocols of the Elders of Zion” – the tsarist forgery that proclaimed an international Jewish conspiracy bent on world domination – and accuses the Jews of controlling government, the economy, media and public institutions.

–       The double entendre of denying the Holocaust – accusing the Jews of fabricating the Holocaust as a hoax – and the nazification of the Jew and the Jewish people.

We are alarmed by the explosion of antisemitism and hate on the Internet, a medium crucial for the promotion and protection of freedom of expression, freedom of information, and the participation of civil society.

We are concerned over the failure of most OSCE participating states to fully implement provisions of the 2004 Berlin Declaration, including the commitment to:

“Collect and maintain reliable information and statistics about antisemitic crimes, and other hate crimes, committed within their territory, report such information periodically to the OSCE Office for Democratic Institutions and Human Rights (ODIHR), and make this information available to the public.”

We are concerned by the reported incidents of antisemitism on campuses, such as acts of violence, verbal abuse, rank intolerance, and assaults on those committed to free inquiry, while undermining fundamental academic values.

We renew our call for national Governments, Parliaments, international institutions, political and civic leaders, NGOs, and civil society to affirm democratic and human values, build societies based on respect and citizenship and combat any manifestations of antisemitism and all forms of discrimination.

We reaffirm the EUMC – now Fundamental Rights Agency (FRA) – working definition of antisemitism, which sets forth that:

“Contemporary examples of antisemitism in public life, the media, schools, the workplace, and in the religious sphere could, taking into account the overall context, include, but are not limited to:

  • Calling for, aiding, or justifying the killing or harming of Jews in the name of radical ideology or an extremist view of religion.
  • Making mendacious, dehumanizing, demonizing, or stereotypical allegations about Jews as such or the power of Jews as collective – such as, especially but not exclusively – the myth about a world Jewish conspiracy, or of Jews controlling the media, economy, government or other societal institutions.
  • Accusing Jews as a people of being responsible for real or imagined wrongdoing committed by a single Jewish person or group, or even for acts committed by non-Jews.
  • Denying the fact, scope, mechanisms (e.g. gas chambers) or intentionality of the genocide of the Jewish people at the hands of National Socialist Germany and its supporters and accomplices during World War II (the Holocaust).
  • Accusing the Jews as a people, or Israel as a state, of inventing or exaggerating the Holocaust.
  • Accusing Jewish citizens of being more loyal to Israel, or to the alleged priorities of Jews worldwide, than to the interests of their own nations.

Examples of the ways in which antisemitism manifests itself with regard to the State of Israel taking into account the overall context could include:

  • Denying the Jewish people their right to self-determination, e.g., by claiming that the existence of a State of Israel is a racist endeavour.
  • Applying double standards by requiring of it behaviour not expected or demanded of any other democratic nation.
  • Using the symbols and images associated with classic antisemitism (e.g. claims of Jews killing Jesus or blood libel) to characterize Israel or Israelis.
  • Drawing comparisons of contemporary Israeli policy to that of the Nazis.
  • Holding Jews collectively responsible for actions of the State of Israel.

However, criticism of Israel similar to that levelled against any other country cannot be regarded as antisemitic.

Let it be clear: Criticism of Israel is not antisemitic, and saying so is wrong. But singling Israel out for selective condemnation and opprobrium – let alone denying its right to exist or seeking its destruction – is discriminatory and hateful, and not saying so is dishonest.

Members of Parliament meeting in Ottawa commit to:

  1. Calling on our Governments to uphold international commitments on combating antisemitism – such as the OSCE Berlin Principles – and to engage with the United Nations for that purpose. In the words of former U.N. Secretary-General Kofi Annan, “It is […] rightly said that the United Nations emerged from the ashes of the Holocaust. And a Human Rights agenda that fails to address antisemitism denies its own history”;
  2. Calling on Parliaments and Governments to adopt the EUMC Working Definition of Antisemitism and anchor its enforcement in existing law;
  3. Encouraging countries throughout the world to establish mechanisms for reporting and monitoring on domestic and international antisemitism, along the lines of the “Combating Antisemitism Act of 2010” recently introduced in the United States Congress;
  4. Encouraging the leaders of all religious faiths – represented also at this Conference – to use all means possible to combat antisemitism and all forms of hatred and discrimination;
  5. Calling on the Parliamentary Forum of the Community of Democracies to make the combating of hatred and antisemitism a priority in their work;
  6. Calling on Governments and Parliamentarians to reaffirm and implement the Genocide Convention, recognising that where there is incitement to genocide, State parties have an obligation to act;
  7. Working with universities to encourage them to combat antisemitism with the same seriousness with which they confront other forms of hate.  Specifically, universities should be invited to define antisemitism clearly, provide specific examples, and enforce conduct codes firmly, while ensuring compliance with freedom of speech and the principle of academic freedom.  Universities should use the EUMC Working Definition of Antisemitism as a basis for education, training and orientation. Indeed, there should be zero tolerance for discrimination of any kind against anyone in the university community on the basis of race, gender, religion, ethnic origin, sexual orientation or political position;
  8. We encourage the European Union to promote civic education and open society in its European Neighbourhood Policy (ENP) and to link funding to democratic development and respect for Human Rights in ENP partner countries;
  9. Establishing an International Task Force of Internet specialists comprised of parliamentarians and experts to create common indicators to identify and monitor antisemitism and other manifestations of hate online and to develop policy recommendations for Governments and international frameworks to address these problems;
  10. Building on the African representation at this Conference, to develop increased working relationships with parliamentarians in Africa for the combating of racism and antisemitism;
  11. We urge the incoming OSCE Chair, Lithuania, to make implementation of these commitments a priority during 2011 and call for the reappointment of the Special Representatives to assist in this work.

 

There is little to disagree with here – except, of course, the encroachment on the freedom of speech and the freedom of the internet, which must both remain above limitation, even in worthy causes such as this. 

We know perfectly well from history, from our own experience, that laws limiting freedom of speech specifically intended to stamp out anti-Semitism have, in the past, been used to stifle opposition to the genocide of the very Jews they were intended to protect.  So, let’s begin to learn from our mistakes!

H/T:  Andy

Sudanese Writer Al Haj Waraq says very important things

This Sudanese writer, Al Haj Waraq, is an amazingly clear-headed thinker.

He says what so many of us fail to grasp:  that you cannot possibly have equality of citizens in any state based on one religion.

He explains what had happened to the Arab Spring with such clarity and insight that I was quite surprised, watching this video, that he is not better known world-wide!  Yet, I could not even find a Wikipedia page on him…

Daniel Hannan: honest words about Turkey’s EU chances

 

These Are the Bastards Who Passed CISPA

Simon Deng speaks at “Islamic Apartheid” event at Temple University

 

What is ‘GlobaLeaks’?

Just came accross this:  I wonder what it’ll become.

‘GlobaLeaks is the first open-source whistleblowing framework. It empowers anyone to easily set up and maintain a whistleblowing platform. GlobaLeaks can help many different types of users: media organizations, activist groups, corporations and public agencies.’

A quick guide to current online privacy threats

Europe’s Last Dictator

From the Free Thinking Film Society:

You won’t want to miss our event this week – the Canadian premiere of the film, “Europe’s Last Dictator”.

April 25, 2012, 7:00 PM
Library & Archives Canada
395 Wellington
Admission $15 ($10 for students).Tickets available at the door or at selected retailers (Compact Music, 190 Bank, 785 Bank; Collected Works, 1242 Wellington; Ottawa Festivals, 47 William)

Irina is the sister of imprisoned Belarusian presidential candidate Andrei Sannikov. Through her eyes this doc charts the violent crackdown that followed the 2010 rigged elections and its dreadful aftermath. Powerful, award-winning photography captures Orwellian images of brute force used against unarmed men and women. We see the state-sponsored torture, murder and kidnap that defines Belarus today. A rare glimpse into Europe’s most repressive state.

“We formed a group to lead negotiations with the government, but the troops were called”, Iryna Khalip, journalist and wife of presidential candidate Andrei Sannikov, says over the phone. “My husband was badly beaten, we’re on the way to the hospital.” Suddenly her voice becomes raised with panic. “Looks like we’re being arrested. We’re on the ground…They’re hitting my face!” She screams and then the phone cuts out. This episode is part of Lukashenko’s promise to “wring the necks” of all those who joined the opposition during the elections.

Iryna Khalip and Andrei Sannikov were imprisoned after this arrest. Irina Bogdanova, Andrei’s sister, has lived in England for 18 years. The other side of Europe, she has turned her house into a refugee camp for all those who have escaped Lukashenko’s violent crackdown that night. A crackdown that it appears Lukashenko may have premeditated. Staggering images of the protest show riot police beating their shields in unison, and bloodied, disorientated protestors. “There was no resistance, people were not armed. It’s just despicable what happened.” Police charged the crowds with their batons striking the defenseless protestors repeatedly. “Human beings don’t behave like that, animals don’t behave like that”, Irina says, her voice tremulous with emotion.

Hundreds of others like Sannikov, including the other presidential candidate Alexander Neklayev, were also brutally beaten and imprisoned that night. With virtually the entire opposition behind bars, it fell to family members to campaign for their release. So Irina and Eva, the daugther of Alexander Neklayev, have now taken to the road to meet world leaders in an attempt to secure the release of their loved ones. While they lobby world politicians to put pressure on Belarus their relatives are brutally tortured. “If I think about how he is doing I just fall apart.” In fact, as Lukashenko’s popularity wains his violence against the opposition has increased.

From Irina’s defiant perpective this doc gets right inside the prison that Lukashenko has turned Belarus into, exposing the true extent of the crisis. “People are so isolated in terms of information in Belarus, especially now that 10 million people live in jail”. As the opposition continues to languish in custody, how long will the people of Belarus have to wait before they are set free?

I hope to see everybody at this important event.  David Kilgour will be on hand to say a few words as well as Ivonka J. Survilla President , Rada of the Belarusian Democratic Republic in Exile.On May 28th, we’ll be showing a film, “When China Met Africa” which we will follow with a panel discussion on China in Canada with Terry Glavin, David Kilgour, David Harris and Scott Simon.

And, on June 18th, we will be bringing in Irish Filmmaker Nicky Larkin to show his new film on the Middle East, “Forty Shades of Grey.”

Sincerely,
Frederick Litwin
Free Thinking Film Society