Wednesday, May 20, 2015

A Painful Endorsement of Mrs. Clinton


It was painful to watch this focus group, Iowa Democrats: Flawed Hillary Clinton Our Only Hope, particularly the response to the question of Mrs. Clinton's accomplishments as Sec. of State.

I suppose the most reasonable argument came from the young man who stated better Mrs. Clinton than Scott Walker, who will destroy unions. I guess he hasn't noticed unions have been dying since 1945.

I still believe the Democrats will choose someone else.


Monday, May 18, 2015

What Is It With Surgeons Who Think They Should Be President?


From the beginning of medical school I never understood the lure of surgery. It always seemed to me an occupation relatively devoid of thinking. My mentor during my medicine rotation, a brilliant kidney specialist, used to say that the most gifted surgeon he had ever known was his lab assistant George, a man with an 8th grade education who could dissect out an intact, perfectly functioning kidney from a rat in 30 seconds.

To their credit, surgeons generally are hard working, focused, dedicated individuals. They accept challenges that most of us would never consider. When successful, they relieve suffering to a degree that is hard to overstate.

But the operating room is not the ideal location to learn the kind of compromise and interpersonal skills that are classically described as essential to process of effective governing. It certainly isn't a hotbed of democracy. Within its cloistered confines, the surgeon usually gets what he (and it is still by far mostly he) wants. Woe to the nurse, or anesthesiologist who gets in his way.

Maybe that's why Dr Ben Carson, arguably the greatest pediatric neurosurgeon of his generation, thinks he qualifies for a job for which surgery provides absolutely no experiences, or Dr Rand Paul, an elite trained eye surgeon, treats every challenging interrogation from the media as a personal affront.


Saturday, May 16, 2015

Monitoring the Food Supply


I saw this chart at Mark Perry's Carpe Diem blog and thought back to your listeria letter of a few days ago.

The US food market is at least $100 billion per year, based on this chart. The food part of the FDA budget is about $1 billion per year. Is it reasonable to think the FDA can adequately supervise the $100 billion food industry on $1 billion a year? I think the answer is: sort of.

I think there has to be a cop, but the cop doesn't have to be everywhere nor inspecting at all times. We see this every  day in many aspects of our life. So maybe $1 billion is enough. But also, maybe $1 billion is enough because the players in the space know they can get caught and fined even if the police aren't around constantly AND they know if they mess up they will face an even stiffer penalty from their customers AND most of the men and women who run these business are decent people just like you and me and they do their best to to do the right thing. What we really want the FDA, or any police force, to guard against are the criminal and the incompetent. Personally, without any supporting evidence, I believe the incompetent are much more prevalent than the criminal.

I don't think a large and ever-growing police state is necessary to keep the public safe, and as we've seen with the War on Drugs, the War on Poverty, the War on Crime, and the War on Terrorism, the police state can move from protecting the public to making war on the public.


Friday, May 15, 2015

Rubio Might Be My Man.


What little I know of Rubio, I like, but I know very little. I used to like Scott Walker until he came out in favor of greater restrictions on immigration, support of ethanol subsidies and his answer to the all important would you attend a gay marriage question. For Walker: Reception, Yes. Wedding, no comment. I liked Rubio's response, “If it’s somebody in my life that I care for, of course I would." I think Jorge Ramos was so surprised by the answer, he asked it again.

I simplify everything down to free trade. The more in favor of free trade, the more I like the candidate. Free trade for me includes free trade domestically, not just internationally. Anyone that supports renewable portfolio standards, ethanol, wind, solar subsides, minimum wage, the Ex-Im Bank,  and many other programs is anti free trade and won't get my vote. Free trade includes social issues as well. Gay marriage and marijuana legalization are free trade issues to me.

When Walker turned anti-free trade I turned anti-Walker. I'll see where Rubio lands.


More U.S. Grant.


A few more examples of Grant's humor and tenacity from his Memoirs:

Grant's Vicksburg campaign culminates in the siege of Vicksburg. Pemberton, the commander of the Confederate forces  asks for terms of surrender. Grant's reply:

Your note of this data is just received, proposing an armistice for several hours, for the purpose of arranging terms of capitulation through commissioners, to be appointed, etc. The useless effusion of blood you propose stopping by this course can be ended at any time you may choose, by the unconditional surrender of the city and garrison. Men who have shown so much endurance and courage as those now in Vicksburg, will always challenge the respect of an adversary, and I can assure you will be treated with all the respect due to prisoners of war. I do not favor the proposition of appointing commissioners to arrange the terms of capitulation, because I have no terms other than those indicated above.
 It is similar to the response Grant gave to General Buckner on the surrender of Ft. Donelson a year earlier.

Buckner: “I propose to the commanding officer of the Federal forces the appointment of Commissioners to agree upon terms of capitulation of the forces at this post under my command.”

Grant: “No terms except unconditional and immediate surrender can be accepted. I propose to move immediately on your works.”

Buckner: “the overwhelming force under your command compels me, notwithstanding the brilliant success of the Confederate arms, to accept the ungenerous and unchivalrous terms which you propose.”
Buckner's pique is classic. And characterizing the brilliant success of the Confederate arms while on the cusp of surrendering and then insulting the man who is responsible is hilarious.

Back to Vicksburg. Grant meets Pemberton outside Vicksburg:

Our place of meeting was on a hillside within a few hundred feet of the rebel lines. Near by stood a stunted oak-tree, which was made historical by the event. It was but a short time before the last vestige of its body, root and limb had disappeared, the fragments taken as trophies. Since then the same tree has furnished as many cords of wood, in the shape of trophies, as “The True Cross.”
No time to celebrate however.  Lincoln begged his Eastern generals to continue moving forward after a victory. He never had to ask Grant. Grant is always moving forward.

On the third, as soon as negotiations were commenced, I notified Sherman and directed him to be ready to take the offensive against Johnston, drive him out of the State and destroy his army if he could.


U.S. Grant


I just finished Volume I of U.S. Grant's Personal Memoirs and loved it. He is a clear writer, has an unassuming attitude and a marvelous dry sense of humor.

He describes an encounter with Mexican forces during the Mexican American War.

At last I got pretty close up without knowing it. The balls commenced to whistle very thick overhead, cutting the limbs of the chaparral right and left. We could not see the enemy, so I ordered my men to lie down, an order that did not have to be enforced.
He charges the Mexican line and discovers

the ground had been charged over before. My exploit was equal to that of the soldier who boasted that he had cut off the leg of one of the enemy. When asked why he did not cut off his head, he replied: "Some one had done that before." This left no doubt in my mind but that the battle of Resaca de la Palma would have been won, just at it was, if I had not been there.
During the Vicksburg campaign Grant captures Jackson, Mississippi, capital of the state.

I sent for the corps commanders and directed the dispositions to be made of their troops. Sherman was to remain in Jackson until he destroyed that place as a railroad centre, and manufacturing city of military supplies. He did the work most effectually.
I can only imagine the effectiveness of Sherman destroying the place as a railroad center.

He continues:

Sherman and I went together into a manufactory which had not ceased work on account of the battle nor for the entrance of Yankee troops. Our presence did not seem to attract the attention of either the manager of the operatives, most of whom were girls. We looked on for a while to see the tent cloth which they were making roll out of the looms, with “C. S. A.” woven in each bolt. There was an immense amount of cotton, in bales, stacked outside. Finally I told Sherman I thought they had done work enough. The operatives were told they could leave and take with them what cloth they could carry. In a few minutes cotton and factory were in a blaze. The proprietor visited Washington while I was President to get his pay for this property, claiming that it was private. H asked me to give him a statement of the fact that his property had been destroyed by National troops, so that he might use it with with Congress where he was pressing, or proposed to press, his claim. I declined.

He is tough, and persistent. The Vicksburg campaign occurred as it did partially because Grant didn't want to retreat to Memphis. He recognized retreating would have been the correct strategic move, and Sherman argued for retreat, but Grant thought the Union needed a victory, not another retreat.

The most amazing thing to me is the rapidity of Grant's movements; he's always moving forward. It is a stark contrast with the lassitude of the Eastern commanders.


Rubio Is Your Man


Doing my morning cardio before work I had the chance to watch Charlie Rose interview Marco Rubio at the Counsel Of Foreign Relations. He's impressive. Smart, articulate but not glib, his responses are well reasoned and carefully constructed. His view of the world and the United States place in it is coherent and flows naturally from his upbringing and life's experience. He has the exuberance and glamour  that raise frequent comparisons to Jack Kennedy. And he doesn't seen motivated by the same nativist animus that propels so many of his competitors. Nor does he appear to believe that he has a direct line to what God thinks.

He would be a formidable candidate in general election.


Friday, May 8, 2015

Your Listeria Hysteria

I haven't paid attention to the Blue Bell listeria story. Your letter was the first I heard of it.

You imagine my response that the "whole affair proves the the incompetence of the FDA for its failure to intervene sooner." There's no reason for me to say that when you have proved it yourself.

You suggest the reason the FDA has been incompetent because "Of course the relentless downward pressure on the FDA's budget might have something to do with that." I love the "of course." Unfortunately for your argument the FDA budget has gone up, substantially, over the past 15 years.

This from the FY2000 budget submission:

That's about a 9% compound annual growth rate through Republican and Democratic administrations and congresses. (The FDA gets user fees. Program level funds reflects the amounts approved by Congress plus the user fees).  It's also the wrong line item to look at since the FDA includes the drug approval process which is substantial. But you chose the metric, not me.

There's no reason for you to get snarky imaging what I'm going to say. I still believe the markets punish companies for their misbehavior. I still believe that punishment is probably more effective than the FDA. So maybe you should tell the families why quadrupling the FDA budget didn't help.

But let's be serious for a second. No system will be 100%. Even if the FDA budget quadrupled again there would be unfortunate incidents like this and even if all companies were run by saints with unlimited safety budgets, there would still be incidents like this. The paucity of listeria is testament to the effectiveness of the FDA and market policing mechanisms. 


Just Trust Us


The Times today provides an update of the ongoing Blue Bell listeria scandal. The toll so far; 10 cases, 3 deaths,. The FDA reports that 1) Blue Bell knew of listeria infection as far back as 2013, 2) did not adequately assess (indeed did not assess at all) the effectiveness  of its cleaning procedures, 3) more or less consistently denied that listeria, a bug that loves cold and damp and is notoriously difficult to eradicate was a problem at all.

Now I imagine you may reply that the whole affair proves the the incompetence of the FDA for its failure to intervene sooner.  Of course the relentless downward pressure on the FDA's budget might have something to do with that. You might also argue that this unhappy episode is a good example of the power of the market to regulate itself, as Blue Bell has paid a heavy price for its incompetence, with the complete shutdown of its operations indefinitely. To which I would not be able to avoid the snarky reply; "tell that to the families of the dead


Speaking Their Language


As a student I lived in what might be described as a tough area. My roommate and I were the the only Anglos in a long block of row houses lining Racine Avenue. I walked to school along Taylor St.  past a series of low rise housing projects. On the other side of South Loomis, a working class Italian American neighborhood held its ground. Black folks from the projects, it was said, knew better than to be caught on the other side of Loomis after nightfall.

When the weather warmed I would join our neighbors on the stoop, sit and chat, drink beer and watch the world go by. One of the neighborhood kids, Mario I'll call him, would sit and talk about his plans. "I'm going to be a doctor like you" he would say. Skeptical, I would ask "Are you doing your math? And how about your chemistry?" "Hard at work Doc" he would reassure me with a grin that suggested otherwise. When his pals came by he would whisper, "Doc let that school talk go now. Can't have my boys think I'm into that."

One day a cruiser car came by and pulled up alongside the curb beside us. The cop in the passenger seat gave us a long look. Something was up. The guys around me started to rise. The cop's face darkened. "Easy guys" I said. I turned my back to them and walked over to the cruiser. "Good afternoon Officer. What can I do for you?"

"Cover your containers," directed the cop. Our beer cans were open and visible, a minor but unequivocal violation of Chicago's public drinking law. I nodded my head, mumbled "yes sir" and went into the apartment to grab paper bags. The car took off without waiting to see if I would comply. They knew, of course, that I would.
"You stared him down!" Mario exclaimed. "No no I didn't, " I answered. "I just spoke his language." I was respectful as a matter of course. I had nothing at stake except our safety. I knew that if we complied it would all end well. There would be no being thrown against the car, no epithets, no search, no beating, no being hauled off in cuffs. My skin color and my deference to his authority would ensure that.

This was of course, before the Drug War, before the the number of African Americans incarcerated (most for non violent offenses) quadrupled, before Tamir Rice, Eric Garner, Walter Scott and Freddy Grey, before smartphones ended police impunity. The outcome of such an encounter today between a neat, polite, white boy and a city cop would likely be the same. The viral videos tell us that the outcome for many others is very different.

Now once again race and class, blame and responsibility,  hope for justice and fear of change, step out together, partners on the dance floor of the nation's consciousness. We have been here before. I wish I could say that now will be the last time, but I doubt it.