On Medical Errors in Hospitals

This is a terrifying read from Marty Makary, a surgeon at Johns Hopkins Hospital, in The Wall Street Journal. Medical errors kill enough people to fill four jumbo jets a week:

I encountered the disturbing closed-door culture of American medicine on my very first day as a student at one of Harvard Medical School’s prestigious affiliated teaching hospitals. Wearing a new white medical coat that was still creased from its packaging, I walked the halls marveling at the portraits of doctors past and present. On rounds that day, members of my resident team repeatedly referred to one well-known surgeon as “Dr. Hodad.” I hadn’t heard of a surgeon by that name. Finally, I inquired. “Hodad,” it turned out, was a nickname. A fellow student whispered: “It stands for Hands of Death and Destruction.”

He then offers five suggestions for improvements, including the use of video recording of surgeries:

Cameras are already being used in health care, but usually no video is made. Reviewing tapes of cardiac catheterizations, arthroscopic surgery and other procedures could be used for peer-based quality improvement. Video would also serve as a more substantive record for future doctors. The notes in a patient’s chart are often short, and they can’t capture a procedure the way a video can.

Shaking the Hand of a Troll

Leo  Traynor recounts a frightening story of how he came face-to-face with a troll:

It started in July 2009. I’d been on Twitter for over 2 years at that point having joined in May 2007, and I’d never had a problem. My account was followed by a fairly innocuous looking one which I followed back and within 10 minutes I had received a Direct Message (DM) calling me a ‘Dirty f*cking Jewish scumbag’. I blocked the account and reported it as spam. The following week it happened again in an identical manner. A new follower, I followed back, received a string of abusive DM’s, blocked and reported for spam. Two or three times a week. Sometimes two or three times a day. An almost daily cycle of blocking and reporting and intense verbal abuse. So I made my account private and the problem went away for a short while. There were no problems on Twitter but my Facebook account was hacked, my blog was spammed and my email address was flooded with foulmouthed and disgusting comments & images. Images of corpses and concentration camps and dismembered bodies.

Again, it eased off for a couple of weeks. I relaxed. Thought they’d finally tired of failing to get a reaction from me. Boy, was I wrong.

I didn’t mention it to my wife. Didn’t see the point of worrying her. But then she joined Twitter to see what it was like and grew to enjoy it. It wouldn’t have been immediately obvious to outsiders that we were man and wife. She made the mistake though of changing her profile to state that she was ‘The long suffering wife of @LeoTraynor’. Not a good idea. She received a DM stating ‘Your husband is scum. A rotten b*stard and you’re a wh*re.’ She laughed it off. Blocked and reported and then the pattern started again. We got to the point of not accepting new followers at all and then one day my wife received a torrent of abuse via DM and on the timeline that was so vile she’s never been on Twitter since – which is a real shame as she has so much to share and is far more interesting than I am.

People kept asking me ‘Why you? Why would these guys want to have a go at you?’ I couldn’t answer them other than it was a couple of random nutters who didn’t appreciate my political views or ethnic origins. Or even someone who couldn’t solve my cryptic crosswords!

The whole thing escalated in June, July and August this year. I received more and more abuse on the timeline and via DMs. A crossword clue account I’d started (@Leo’sClue) was inundated with abuse too.

Then one day something happened that truly frightened me. I don’t scare easily but this was vile.

Click through to read the entire account. The resolution was amicable, but it’s disconcerting to think people like this exist on the Internet.

Who Invented the Internet, Anyway?

Steven Johnson, author of Future Perfect: The Case For Progress In A Networked Age, reminds us that the Internet wasn’t created by the government (and certainly not by Al Gore):

Like many of the bedrock technologies that have come to define the digital age, the Internet was created by — and continues to be shaped by — decentralized groups of scientists and programmers and hobbyists (and more than a few entrepreneurs) freely sharing the fruits of their intellectual labor with the entire world. Yes, government financing supported much of the early research, and private corporations enhanced and commercialized the platforms. But the institutions responsible for the technology itself were neither governments nor private start-ups. They were much closer to the loose, collaborative organizations of academic research. They were networks of peers.

Peer networks break from the conventions of states and corporations in several crucial respects. They lack the traditional economic incentives of the private sector: almost all of the key technology standards are not owned by any one individual or organization, and a vast majority of contributors to open-source projects do not receive direct compensation for their work. (The Harvard legal scholar Yochai Benkler has called this phenomenon “commons-based peer production.”) And yet because peer networks are decentralized, they don’t suffer from the sclerosis of government bureaucracies. Peer networks are great innovators, not because they’re driven by the promise of commercial reward but rather because their open architecture allows others to build more easily on top of existing ideas, just as Berners-Lee built the Web on top of the Internet, and a host of subsequent contributors improved on Berners-Lee’s vision of the Web.

If you like how Steven Johnson writes, I highly recommend his other book published in 2005: Mind Wide Open.

The Evolution of the Soda Can Tab

Tom Vanderbilt, writing for Slate, traces the very interesting history of soda tab design. The modern incarnation of the ubiquitous feature has only been in existence for less than 40 years:

The solution came from Daniel F. Cudzik, an engineer with Reynolds Metals, who for years had been toiling away on what would what become known as the “Sta-Tab.” As Cudzik told Studio 360, his search for a “convenience top” that was “more practical and less prone to litter” came to fruition one night when he was in living room, “half watching a movie.” While the idea might seem simple to a consumer raised on nothing but stay-on tabs, the design required some elegant engineering (and some subsequent legal battles over alleged patent infringements).

As Cudzik described the problem in his 1975 patent application: “The opening construction of the invention requires a tab which must be stiff against transverse bending and yet flexible enough and tough enough at the connection between the tab end wall to permit lifting and retracting the tab without causing a fatigue crack at the connection.” As elegantly explained in this video, the design operates both as a “second class” and as a “first class lever” at different points in the can-opening process—redirecting loads and shifting the fulcrum—using the inherent pressure from the carbonated beverage in its favor.

Apparently the new invention caused some concern, as people were used to opening cans with this device.

On Success as a Travel Blogger

Chris Guillebeau, whose World Domination Summit I attended earlier this summer, gave a closing keynote at this year’s #TBEX conference in Girona, Spain. I didn’t attend the conference, but I appreciate his message about becoming successful at what you do. It’s not about followers, but becoming better at your craft:

I hear from a lot of people who want to “get noticed.” They write in to ask, “How can I become more known?” Whenever I hear this question, I’m reminded of something that John Mayer said in a talk at the Berklee College of Music. As best as I recall, the quote was:

“The world doesn’t need more mediocre musicians who are really good at Twitter.”

His point was that musicians should focus on honing their craft instead of working on getting followers or mastering social media. I’d say something similar: the world doesn’t need more mediocre bloggers or writers who are really good at Twitter. 

What the world does need is storytellers. We need people to challenge us. We need people to explain how travel can be a force for good. 

Chris’s point about skepticism on the Internet resonates:

Don’t tell a story that isn’t yours. You have to remember that we live in a world of skepticism, so our task is to be authentic and congruous. There are blogs about making money online from people who have never made money online. There are blogs about being “location independent” from people who live in their parents’ basement.

You should read the entire post here.

 

Writing Rules and Advice from the New York Times Features

In this meta post, the writers of New York Times distill the writing advice they’ve offered or featured in various recent columns:

Rule 8: Nobody’s Perfect

Yes, Times writers and editors do make mistakes and the in-house feature “After Deadline,” which the public can view, too, takes them to task by highlighting and correcting errors in grammar, usage and style that appear in print.

Use this blog to understand grammatical points, like subject verb agreement. Then, become a better editor of your own work by taking the After Deadline Quiz.

Rule 9: Fail

Learn from your mistakes and failures, a topic Augusten Burroughs tackles in How to Write How-To”:

… to pass along the knowledge of how to succeed, first you must know how to fail. A great deal, if possible. This is essential because it’s far more common (and easier) to make mistakes than to enjoy success. Being aware of potential points of derailment helps to better and more accurately navigate your readers past your own missteps so they can succeed where perhaps you first failed quite miserably.

The post is a great place to start if you’re looking to improve your writing. Still curious? Continue here.

A Violin Once Owned by Goebbels Keeps Its Secrets

The setting was Berlin; the gift an 18th-century instrument said to be from the hands of a master luthier whose works mark the apex of three centuries of violin making. The ceremony a chance to cement an alliance and to thank the violinist for playing for Germans wounded in World War II.

Much is documented — if little remembered — about Goebbels’s gift on Feb. 22, 1943. But the origins of the violin itself remain a mystery. Was it confiscated property, one of thousands of musical instruments plundered by the Nazis, or otherwise obtained under duress from those persecuted during the Nazi era?

When Ms. Suwa and her violin returned to Japan, the whispers followed. They have trailed the instrument for nearly 70 years.

That’s from this fascinating piece in The New York Times, penned by Carla Shapreau, a violin maker and lawyer, who writes that she is:

conducting a project on musical losses, file by file, name by name. The analysis of authenticity and the history of ownership and possession, the provenance, are essential to the mission. 

The lady that’s the subject of the piece is Nejiko Suwa. Born in 1920, she was a prodigy by 10 and studying with the Russian violinist Anna Bubnova-Ono, Yoko Ono’s aunt by marriage. She risked her life to protect the Stradivarius violin, eventually making it back to Japan.

Mark Cuban on the Business of Wall Street

Mark Cuban dishes out a lot of questions in his latest blog post:

The important issue is recognizing that Wall Street is no longer serving the purpose  what it was designed to. Wall Street was designed to be a market to which companies provide securities (stocks/bonds), from which they received capital that would help them start/grow/sell businesses. Investors made their money by recognizing value where others did not, or by simply committing to a company and growing with it as a shareholder, receiving dividends or appreciation in their holdings.  What percentage of the market is driven by investors these days ?

I started actively trading stocks in 1992. I traded a lot. Over the years I’ve written quite a bit about the market. I have always thought I had a good handle on the market. Until recently.

Over just the past 5 years, the market has changed. It is getting increasingly difficult to just invest in companies you believe in. Discussion in the market place is not about the performance of specific companies and their returns. Discussion is about macro issues that impact all stocks. And those macro issues impact automated trading decisions, which impact any and every stock that is part of any and every index or ETF.  Combine that with the leverage of derivatives tracking companies,  indexes and other packages or the leveraged ETFs, and individual stocks become pawns in a much bigger game than I feel increasingly less  comfortable playing. It is a game fraught with ever increasing risk.

This was the most important reasoning from Cuban, I thought:

My 2 cents is that it is important for this country to push Wall Street back to the business of creating capital for business.  Whether its through a use of taxes on trades (hit every trade on a stock held less than 1 hour with a 10c tax and all these problems go away), or changing the capital gains tax structure so that there is no capital gains tax on any shares of stock (private or public company) held for 1 year or more, and no tax on dividends paid to shareholders who have held stock in the company for more than 5 years. 

Full post here.

On Another Type of Tournament, Magic: The Gathering

Noah Davis has a long feature about the three day Magic: The Gathering tournament in Seattle. As he recounts, it’s not just the nerds who enter this event:

The tournament at Showbox is both unusually intense and unusually laid back for a high-level Magic event. The pressure comes from the cash at hand and the extremely high quality of play, while the intimate feeling stems from the small group involved. Normal Pro Tour events — there are three every year — feature upwards of 400 players. The Grand Prix, tournaments that anyone can pay to enter, routinely draw more than 1,500 contestants and are played in massive convention spaces. “The laid back feel is nice. It’s nice not to have to walk around a big event hall,” David Ochoa says of the Players Championship, although he and others will admit they miss being recognized by adoring fans.

After a photo op of the entire group, the day kicks off with a Cube draft, one of the many formats of the game. Individual players are better at different variations of Magic, so the tournament features three varieties: Cube draft, booster draft, and Modern constructed. For our purposes here, the specific details of each format are not really important. Basic ones include which cards are allowed to be chosen and whether the decks are constructed before the tournament or drafted in a fantasy football-esque manner the day of the event.

After drafting, the players get 30 minutes to build their decks, then the action begins. Except it doesn’t. There’s a problem with the audio on the Internet stream. The Players Championship is a spectator experience, but it’s an online spectator experience. Fans are welcome inside the Showbox, but there will only be a handful throughout the weekend. The event isn’t promoted as an in-person experience. There’s little room because the space is dedicated to creating the Internet experience. Seven thousand viewers consistently watch the stream at all times, peaking just below 9,000 on the final day. The stage holds three tables, while five tables sit stage right for the other games. Equipment for the broadcast takes up the entire left side of the venue. Staff responsible for getting the tournament online outnumber the players nearly two to one. Two announcers at a time — over the course of three days, six men total will offer play-by-play and color — provide commentary throughout the tournament, focusing on the on-stage “feature match.” A large boom camera on the floor and two other cameras offer the producers three different angles on the action, allowing commentators and the audience at home to see into the players’ hands. But the game cannot start until the audio is ready. Brian Kibler suggests the group “hurry up and wait.” An organizer responds, “That’s what an event like this is about.” Everyone laughs, then sits patiently at their tables while the techs scramble to fix the issue. Soon, they do. Game on.

A fascinating read, even if I’ve never played a full game of Magic in my entire life.

Hacking the Voters’ Brains

With the U.S. presidential election less than two months away, we are exposed to more and more political coverage day by day. Sasha Issenberg (author of The Victory Lab: The Secret Science of Winning Campaigns), reporting for The Wall Street Journal, pens an interesting post about hacking the voters’ brains:

4. Get them to confess (indirectly) to bias.

Throughout 2008, Barack Obama’s advisers never entirely trusted polls that showed their candidate to be ahead. There was, after all, a long history of white voters misleading pollsters about their willingness to vote for a black candidate. The phenomenon was known as “the Bradley effect,” after Los Angeles Mayor Tom Bradley, who did far worse at the polls in his 1982 gubernatorial race than polls had predicted. Obama’s advisers didn’t want to risk such an election-night surprise and used their statistical-modeling prowess to hedge against one.

The challenge was separating voters who were resisting Obama (or remained undecided) because of his race from those who were drawn toward John McCain for other reasons. Obama’s top microtargeting consultant, Ken Strasma, focused on a small group of white voters who reported themselves to be supporting John McCain at a much higher rate than the campaign’s scores predicted they should. Mr. Strasma looked for variables that defined this group and found one when he tried a new question in his surveys: “Do you think your neighbors would be willing to vote for an African-American for president?”

People who answered “no” were likely to be Mr. Strasma’s problem voters. Everything his databases signaled about their political attitudes—based on their partisanship, age or socioeconomic status—suggested they would be likely to support Mr. Obama, but they said they planned to vote for Mr. McCain. So Mr. Strasma created a new category in his microtargeting: a so-called “openness score,” measuring the likelihood that someone was open to voting for a black candidate.

The campaign could isolate those with low scores and deal with them in one of two ways. They could be ignored or, if they looked like habitual voters who were likely to turn out, the campaign could approach them with targeted communications that focused on urgent economic themes rather than on Obama’s charisma (“hope and change”) and the historic nature of his candidacy.

5. Let them know (gently) that they are being watched. Few campaigns want to be associated with tactics like Mark Grebner’s threat to expose nonvoters to their neighbors, because it looks a lot like blackmail. But campaigns have figured out how to soften such approaches. One version widely used today tells a voter “our records indicate that you voted in the 2008 election” and says that the sender hopes to be able to thank the recipient again after this election day for his or her “good citizenship.”It may fail to meet Mr. Grebner’s goal of shaming those who don’t go to the polls, but it still works. It’s been tested.

You should read items 1 to 3 here.