Saturday, September 24, 2005
Unfortunately, the US, nor any other nation, has met the promises made during the year 2000 which were aimed at reducing world poverty and outlined in the Millennium Development Goals. The G8 countries pledged 0.7% GDP annually to IMF/World Bank/UN programs aimed at reducing poverty (sustainable farming, infrastructure, education, and health initiatives). Yep, 7 cents of every 10 dollars is all it would take and during the Millennium conference the US promised to give just that. Last week at the World Bank meetings, those same countries looked at where they were 5 years later and realized that they were not on track to meet their 10 year goals and therefore, instead of ramping up efforts to follow through on previous commitments, simply SCALED BACK their earlier promises. However, at the same meeting Bush gave a speech citing the extreme burden of poverty on the future of global democracy, global trade, and economic sustainability, giving some hope that the administration at least understands why it is necessary to make serious commitments to future programs - such as Debt Cancellation.
Why is debt cancellation so important? If a country is trying to climb out of poverty, it needs to invest its money into infrastructure and new business. However, with a high debt, the financial price of servicing that debt is so high, that a country can never get ahead, no matter how innovative and successful its citizens, entrepreneurs, and businesses.
Tuesday, September 20, 2005
1. Dream State
2. The World Is Flat
5. Rise of the Creative Class
6. Flight of the Creative Class
7. When Germs Travel
8. Mountains Beyond Mountains
9. The End of Poverty
10. Pathologies of Power
11. Infections and Inequalities
12. Beating Back the Devil - a look at the Epidemiological Intelligence Service
13. Cost Effectiveness in Health Economics
14. The Economics and Health and Health Care
15. The Economist - weekly from May - August
16. The Commanding Heights (3 part DVD documentary)
It may not be evident from this list, but a central theme developed in my reading. That theme was focused on what I now see as an ongoing global revolution that I really have only begun to fully comprehend and articulate. That revolution is based in a liberal-capitalism with an inevitible breakdown of nationalistic geopolitical borders as an unstated future goal with the creation of a largely universal governing body arising out of the UN, WTO, World Bank, and other trade institutions. The goal of this revolution is set in technological/economic determinism as the ultimate salvation for an increasing burden of poverty and a rapidly shifting demographic/income distribution throughout the globe.
The major obstacles to these revolutionary ideas are religio-fascist governments/organizations, anti-capitalists, corruption, and, maybe MOST important, poor health and its relationship to poverty.
That's really where things got interesting for me. Its obvious to me and to most people that poor health and poverty go hand in hand - but I had never realized how unified the globalists are in thinking about this relationship and how significant that burden really has become. This allowed me to begin focusing on Health Economics in the latter portion of the summer, with the understanding that implementing global health programs - including treatment, education, prevention are critical to a revolution that will either bypass the many citizens of the world, or crush the coming changes due to an inevitible future resistance by a desperate poor majority - potentially leading to a defeat of this large scale wave of globalization such as was seen in the early 20th centrury with the onset of WWI.
Anyway, as Paul Farmer and others know all to well, the language of global health programs is cost-effectiveness and health economics. As a medical student and anthropologist, I feel that an ethical and critical responsibility lies at my feet in my coming career to craft policy and programs that seek to provide the greatest benefit to the greatest number during a period of rapid economic change by ensuring that people do not needlessly die or lose productive, quality years, from their lives due to easily prevented disease which sometimes have more to do with income distribution and geographic location than they have anything real to do with a person's current health profile.
Thursday, September 15, 2005
The article can be found at
Tuesday, September 13, 2005
Saturday, August 13, 2005
First of all, it is indeed clear that the number of motorcycle riders has increased. However, that is irrelevant for examining the relationship between head injuries and helmets. The report examines the incidence RATE and the percentage of accidents involving head injuries - both of these metrics control for increased ridership. Granted it is true that large sample size increases do yield a higher probability in achieving statistical signficance between two variables, I don't think that the sample size has increased that large here and I think the logical correlation between helmet use and head injuries rules out an odd statistical artifact as a possible explanation for the clear increase in head injuries assciated with motorcycle accidents.
I don't really think these "self interest" arguments are very appropriate - but even if that's the angle that can be used to convince someone that motorcylclists should be required to wear helmets - then just look at the associated medical costs. The amount of insurance required for a non-helmet rider is much lower then the average procedure cost involving a severe head injury. Thus, that creates an economic burden for the underinsured that you may pay for.
Tuesday, August 09, 2005
"Consider the study's results: In the three years before the helmet law was repealed on July 1, 2000, 9 percent of the 515 motorcyclists killed in crashes were not wearing a helmet.
In the three years after the repeal, 61 percent of the 933 fatally injured motorcyclists were not helmeted.
Of the 35 motorcyclists younger than 21 killed in crashes in the three years before the repeal, 26 percent were not wearing helmets.Of the 101 riders younger than 21 who were killed in the repeal, 45 percent were not wearing helmets.
Friday, July 29, 2005
Commission backs off Planned Parenthood
Led by Ronda Storms, the county cuts funding to a teen educational program.
Published July 29, 2005
TAMPA - The idea came from Hillsborough County Commissioner Ronda Storms: eliminate funding for a teen educational program sponsored by Planned Parenthood.
Commissioners went along with her Thursday, while expressing none of their personal feelings about the nonprofit group that supports women's reproductive rights.
But Storms had made her feelings clear in a conversation last week, said Barbara Zdravecky, who oversees Planned Parenthood in 15 counties, including the Tampa Bay area.
Storms supports life - Zdravecky remembers hearing her say - and Planned Parenthood supports death.
"I have to say I was pretty shaken," Zdravecky said. "I'm used to taking hits. But I was surprised at her lack of humanity."
Zdravecky, other nonprofit officials and proponents had just finished lobbying the commission the night of July 21 and were standing around after nearly three hours of budget discussion.
They wanted commissioners to give them $39,500 during the next two years for Source Teen Theater, a $130,000 program in which Tampa teens teach other kids about such topics as sexual activity, drugs, gangs and family violence.
Storms remembers the conversation, too.
She had called for Planned Parenthood's removal from the budget. Zdravecky asked her to reconsider. Surely, Zdravecky asked, the commissioner must support preventing teen pregnancy, even if she doesn't support Planned Parenthood.
"There is nothing you can say or do for me to support you," the commissioner said, according to Storms' version of the conversation. "Thank you very much for your comments."
But Zdravecky pressed on.
"I am prolife and you're not," Storms remembers saying.
Storms thanked them and told them she could not support the request. She even remembers that she smiled at them.
She told them that their organization is "prodeath from its founding." She told them how Planned Parenthood founder Margaret Sanger advocated eugenics - the study of improving hereditary qualities by controlling human reproduction - as her basis for supporting abortion.
In an interview with the St. Petersburg Times, Storms continued to make her case.
"Women are dying at the hands of Planned Parenthood today," she said, noting that the organization continues to promote the abortion pill RU-486. She pointed to a news account that questioned the drug's safety.
Those are the facts, Storms said. Lobbying, she added, "is not for the thin-skinned."
"She could have walked away and not had her feelings hurt," Storms said of Zdravecky.
Zdravecky remembers a more blunt conversation where Storms said, "I am prolife, you are prodeath" twice.
"I believe anyone who professes to be a proponent of Christianity would treat me with more dignity than the way I was treated," Zdravecky said.
Storms often takes controversial stands. On June 15, she led a commission vote to distance the county from gay pride events, a policy that has generated national attention.
Planned Parenthood of Southwestern Central Florida has been in Hillsborough for at least 25 years and operates a clinic in Temple Terrace. About 95 percent of the 65,000 clients Planned Parenthood sees annually in the region aren't coming for abortion services, Zdravecky said.
Last year, 1,700 did.
Hillsborough County has funded Source Teen Theater intermittedly during the past few years. It does not fund any other Planned Parenthood programs.
During the budget discussion that led to Thursday's 5-2 vote, Storms didn't comment other than to call for the elimination of the project's funding.
Commissioner Brian Blair spoke at length about how he favored the way the Pregnancy Center of Plant City operated. He said that its crisis pregnancy counselors encourage "the young women to choose life" and that its executive director raises money without asking for county help.
After the meeting, he said he voted against the program for fiscal reasons. He said his decisions are evenhanded, pointing to his rejection of a $250,000 request from Praise Cathedral and a $112,000 request from Redlands Christian Migrant Association. But Commissioner Kathy Castor, who voted against the motion with Commissioner Thomas Scott, said Planned Parenthood's program was the only project eliminated after a high rating from a county committee that reviews nonprofit funding requests.
Castor said that Hillsborough had $8-million to give to nonprofit groups.
"Their request," she said, "was one of the more modest."
Thursday, July 21, 2005
Tuesday, July 19, 2005
Saturday, July 09, 2005
Why are poor people more likely to contract HIV? Why are certain groups, such as racial minorities, in affluent societies, like the
It is not an accident of history that HIV/AIDS prevention messages and treatment programs have favored some individuals while skewing the vulnerability to the disease towards other individuals throughout the world. Instead a number of historical events generated the current distribution of HIV risk and account for the epidemiological profile of current HIV prevalence disparities.
In this manuscript, I examine the natural history of the AIDS epidemic in one community –
There are 3 goals that I hope to accomplish by writing this manuscript:
1. I hope to show ways in which we can erase health disparities that exist between socioeconomic and racial minority groups by illustrating the distribution of inequality in prevention policy that leads to a distribution of inequality in HIV prevalence and HIV outcomes. The goal of my dissertation work is to help focus future treatment efforts in order to serve all members of a HIV+ community equally, but we must also work on shifting the distribution of risk factors for HIV away from a skewed set of factors that target the poor.
2. By summarizing and documenting the official and cultural responses to an epidemic that arose and escalated rapidly, this manuscript can assist city planners and officials in coping with future epidemiological events.
3. The creation of an anthropological narrative of HIV/AIDs within a large metropolitan area provides a voice to those on the margins of this epidemic and those who have worked diligently as clinicians and observers of this disease during the past 25 years.
- The length of time from HIV infection to AIDS presentation varies among populations within
- Some populations utilize more or less medical resources for HIV/AIDS treatment due to social stigma in their culture and community.
- The incidence of acquired comorbidities (e.g. PCP and CMV) and the level of risk behaviors after diagnosis (e.g. IV drug use, unsafe sex, etc) varies in these groups.
The Healthy People 2010 initiative focuses on eliminating health disparities between populations. The incidence and prevalence of HIV infection between ethnic groups and socioeconomic levels within the state of
Previous studies have demonstrated variation in health outcomes among HIV+ individuals (Arno et al., 2004). Some populations experience higher incidence of comorbidity, such as PCP, and some populations may experience higher mortality rates both from AIDS and HIV-related illnesses. Furthermore, past work has shown that there are differences in health outcomes between populations, even after controlling for socioeconomic status and level of insurance. For example, black women are more likely to die of an acute MI than white women even after controlling for age, SES, and insurance (2003).
Diez-Roux et al., (2002) has also demonstrated that neighborhood resources are directly predictive of disease risk and play a significant role in changing health outcomes. The authors examined a number of neighborhood indicators and found it is possible to index neighborhoods into risk of acquiring chronic diseases and suffering from acute events such as myocardial infarction.
In this study, I will examine the health disparities present within the HIV+ community of the state of
Zip-codes will be used to define a population and census data will be used to characterize that population. Using the HARS data set, HIV information will be explored in order to examine the relationship between HIV outcomes and populations.
Diez-Roux, A.V. (2002). Investigating area and neighborhood effects on health. American Journal of Public Health. 91: 1783-89.
Tuesday, June 21, 2005
Anyway I feel rather strongly about this issue and am offended by the BOCC actions for three reasons:
1. The county should not mandate what a library can and can not display - from my perspective, this is a clear civil rights violation
2. The county is short sighted in making plans for the future of our community. Data has demonstrated that areas with a welcomed gay population also have a large creative class, driving a high innovation, high economic growth area. In other words, an anti-gay image threatens the future talent pool and economic growth of our area.
3. Gay Rights and Discrimination - it seems as though our society awards rights to one group only to find another group upon which to discriminate against. Seperate is not equal.
The meeting last night was VERY WELL attended - apparently some estimates are in the range of 700 people. I was in the main room which was was packed - forcing the church to set up numerous small rooms with audio to handle the hundreds of extra people. Not only was the meeting well attended in terms of sheer numbers, but also in terms of credible supporters. For instance, City Council women Linda Saul-Sena was there, as well as former county commision chairmen, Pat Frank. Furthermore, a representative of the ACLU was in attendance along with the attorney who handled the human rights ordinance in 1990. Other Tampa notables included Joe Redner.
Attendees were very enthusiastic - lots of applause and standing ovations for speakers. What was most impressive about the meeting though was the ORGANIZATION. Equity of Florida has thought this through - after a general short pep rally the moderator had the room divide into break-out groups including - Art, Business, Direct Action, Legal, Librarian/Education, and Meet-Up/Long Term.
I attended the Business group since I didn't really fit well anywhere else and feel that I understand the economic arguments of why the BOCC decision is wrong. Furthermore, I also feel strongly that the gay community must be careful in crafting their campaign to fight this - I have outlined three issues above and only one of those issues applies directly to the gay community. In other words, this is a chance for many people in the community to rally around a single issue but if the campaign is driven by a gay pride marketing strategy you stand to lose numerous would be supporters who might not get passionate about gay pride but would certainly be passionate about civil liberties or future economic impacts. You have to craft a campaign that markets to the non-gay community and keeps the focus on all three important issues. The economic impact arguement (articulated best by Richard Florida) is probably the easiest thing to get behind for most people. You don't have to be gay to be outraged.
Anyway, the business meeting went well with people offering suggestions including a buycott of gay and gay friendly businesses, a display of company non-discrimination statements that include sexual orientation, and contacting the NFL to discuss whether a superbowl should be played in a town so unfriendly to the gay community.
After the breakout sessions, the group came together again to share ideas. The art community will sponsor a number of gay readings and book discussions at the public library, as well as a gay family portrait studio with the prints to go on display at the public library. The librarian group supported these measures. Furthermore, the direct action group will be sponsoring a number of protests and also suggested contacting the Human Relations Board of Tampa and the Human Rights Board of Hillsborough County to lodge a complaint.
One of the most interesting aspects of all of this is that the city and the county do not agree. Pam Iorio and at least some members of the city council are supportive of the gay community and Iorio has come out against this initiative previously, while Saul-Sena spoke out last night. Therefore, it is important to seek positive resolve without punishing the city itself (e.g. losing the superbowl). In addition, this could make for some interesting political battles as we move on.
Finally, the Equality Florida group is interested in getting another Human Rights ammendment passed in the county that would inlude Sexual Orientation in non-discrimination policies.
To get a sense of how the creative class spans different fields but centers around basic types of people, author Richard Florida compares Andy Warhol to Thomas Edison, noting how similar their workstyles were and, possibly, their personalities. Both Warhol and Edison amassed a large amount of work and inspired others to create a number of items as well. Both Warhol and Edison designed large creative spaces - Warhol had the Factory and Edison had his New Jersey Labs. Both Warhol and Edison allowed people to work on their own projects, collaborate on their projects, and found time to indepently explore their creations as well.
In other words, "creative" is used here to refer to a unique way of organizing, synthesizing, and reorganizing patterns and data. Most importantly, the creative class flocks together. Dating back to the rise of Silicon Valley, Richard Florida details how creative groups come together and thrive off of each other in seeminly unrelated industries such as music and software design. The first example of this is the proximity and timing of the rise of Silicon Valley to not only Stanford University but also to the hippie districts of the late 60s. Gifted hippies (Jobs, Wozniak, the Homebrew Club) were able to find work and a creative outlet in the early computer companies, coexisting with the aging eccentric engineers. This pattern is repeated throughout the U.S. in Seattle (Nirvana/Microsoft), Austin (South by Southwest Festival/Linkletter/Dell), and other locations. The main point is that creativity breeds creativity and creativity attracts creativity, not because all the creative people are doing the same thing, but because all the creative people need the same type of environment and share similar life goals.
The rise of the creative class correlates with the decline of the working class and the rise of the service class (which provide many services to the creative class) creative class. This may sound elitist but Florida also argues that it is imperative to better train individuals to move into the economic creative class or to readily apply service skills to gain sucess.
Another major mark of the creative class is that growing numbers "front-load" their careers - long periods of education and hard work (post-docs, residincies, assistant professorships, numerous albums, constant touring) while deferring marriage and children. This has altered the traditional workplace and leads to the shift from the vertical corporate ladder to the horizontal division of labor (discussed below) and also allows an individual to establish early credibility allowing greater influence later in life with less work geared simply at getting your feet grounded and more on creating, flexibility, synthesizing, training/teaching others, and reflecting. (the tenured professor).
The idea of the creative class ties in perfectly with Leavitt's ideas of information leverage (the doctor and real estate agent in Freakonmics) and helps explain the technological advances discussed in Friedman's technodeterminist work, the World is Flat. Furthermore, Florida's Creative Class takes the much discussed knowledge/information based economy and posits that the creative class is what generates, drives, and manages the growing knowledge economy.
The Creative Class is also changing work environments (1. vertical division is replaced with horizontal division of labor, 2. people identify with their occupation/profession, not their company, and 3. greater assumed risk by the individual) and management styles (1. creative work is not repetitive, 2. it goes on inside people's head so a lot of it is not observable, 3. creative people tend to rebel at efforts to manage them systematically).
For these reasons, soft control has become a more common management tactic, marked by a system of peer recognition and competitive peer pressure. Certainly this is demonstrated in academia through the peer reviewed system and in music through magazines, blogs, club bookings, record contracts, and influential scenters - and of course market forces.
The divisions between work and life are dissovling for the creative class - creativity is not turned on at particular times or hours - the compartmentalization of labor has grown fuzzy. The potential downside to this is that we are becoming workaholics - but, as Florida points out, we are also saving ourselves from lives doomed at watching a clock, counting the seconds to clocking out.
Richard Florida's most important contributions may come in the 4th section of his manuscript in which he suggests that the cities that will thrive in the future will be those that maintain and nurture a creative class, becoming a Creative Center. He goes on to suggest that how we decide to live and work will be partly dictated by our desire to be in a Creative Center. Florida notes that the creative class are high salary earners and make significant economic contributions. Therefore, he observes, the creative centers are economic winners - with "high concentrations of Creative Class people, they have high concentrations of creative economic outcomes, in the form of innovations and high-tech industry growth. They also show strong signs of overall regional vitality such as increases in employment and population" (this goes well with Friedman's arguments concerning the shifting patterns in employment - new job titles created with job innovation). These Creative Centers, the author continues, are not thriving for traditional reasons - such as access to natural resources and transportation routes - instead they thrive from creative capital where artistic, cultural, technological, and economic creativity thrive. Over the 20th centruy, the cities that have grown the most economically have also had the highest density of human capital (as measured by education level) - corporations and firms come to these places to get access to the talent pool. In other words, economic growth is driven by where creative people choose to locate.
Furthermore, Florida goes on to note that creative people of all types flock to locations that breed further creativity. Many creative people, argues Florida, need an open environment that is tolerant of new ideas and maintains a social space for creativity to thrive. Therefore, many creative people may access how tolerant and diverse a location is before settling there. One proxy for this is the "gay index" - or how welcoming a particular community is to the gay population. As a matter of fact, economic growth and high density of high-tech/innovative fields orrelates very well with the gay index. It does not mean that most people in high tech are gay, it just means that high tech people are going to be more likely to settle in a place that is also attractive to members of the gay community. A similar correlation is demonstrated with the "bohemian index" - a measure of openenss to new ideas.
From these correlations, the author develops his three Ts of success for a region - technology, talent, and tolerance. Between 1990 and 2003, those regions with the highest ratings in each of those stats also had the highest economic growth.
In the final section of "The Creative Class" Richard Florida demonstrates how Austin, TX and Dublin, Ireland have sucessfully applied the three Ts to become leading areas of creativity and growth.
Richard Florida's Site
Buy it at Amazon
Saturday, June 18, 2005
This is from the seminole heights blog - I have just cut and pasted in order to spread the word
Emergency Town Hall MeetingI received this via email. An important event in Seminole Heights addressing an significant injustice countywide. See Ernest Hooper's article on the controversy.
Attend the Emergency Town Hall Meeting in Tampa - 6:30 PM Monday, June 20th. See below for directions and spread the word to others in Tampa. In an outrageous act of bigotry, the Hillsborough County Commission voted yesterday to bar county agencies from recognizing or participating in Gay Pride Month or any events that portray gay people in a positive light. Our help is needed!
Now we are hearing about similar censorship efforts being launched in other counties.
The policy is an attack on gay people, an insult to the entire community and a national embarrassment for our state. This policy is discriminatory and will must challenge it.
The commission’s actions came on the heels of a dispute regarding the removal of a display at the West Gate Regional Library highlighting gay and lesbian literature. The display was created in recognition of Gay Pride month.
Out of hundreds of library visitors, only three people complained about the content of the main-lobby display over the course of several days. The county’s chief librarian, Jean Peters, visited the library and demanded the display be removed. When the removal of the books sparked an outcry, the library allowed a much smaller display to be shown in the back of the library.
Commissioner Ronda Storms, a longtime anti-gay antagonist, introduced the policy. And despite the dozens of us who crowded the chambers in opposition, the Commission passed the proposal. It prevents Hillsborough county agencies from giving equal recognition to local events that present gay people in a positive light, including Gay Pride Month. To make things even worse, the commission went on to vote 6-1 to prevent the new policy from being repealed except by a super majority vote of the commission following a public hearing.
Before casting the only "No" vote, Commissioner Kathy Castor stated "Government should not be in the business of promoting discrimination."
An Emergency Town Hall Meeting will be held this Monday, June 20th at 6:30 PM. The location is the MCC Church at 408 E Cayuga Street in Tampa. Take I-275 to Dr. Martin Luther King Jr. exit and head west 1/10 mile. Turn right onto North Seminole Ave. and go 1/3 mile to E. Cayuga, MCC is on the right.
Thursday, June 16, 2005
Two recent amendments passed by
First, I will review two Amendments which allow these changes and second I will introduce a policy proposal that can be adopted using the current laws, infrastructure, and resources available to our state.
A panel was assembled in the winter and spring of 2005 that made recommendations to the state House of Representatives. Finally, the House followed many of these recommendations and a final Amendment was passed that modified the original legislation into a law that would not cause a significant burden on
These two Amendments should be welcomed by the both the legal and medical community, as well as by patients, and but not in the current way in which the Amendments are executed. If we do not continue pursuits of additional malpractice reform,
The major concern cited by opponents to the non-economic damages cap is that attorneys will be unable to take on malpractice cases due to the high cost by the law firm in gathering expert witnesses and investing the claim. Therefore, attorneys will be unable to take on the majority of liability claims due to the potential loss of their investment.
It is also important to note that only 2% of patients injured by negligent care ever file a malpractice claim and the current malpractice system only compensates 1 in 14 people. These low odds and the lack of precedent cause attorneys to adopt a strategy of swamping the courts with malpractice claims, 4 out of 5 of which are found to be invalid. A system of standards for awards and for care would greatly reduce frivolous suits and would allow attorneys, patients, and physicians to modify their practices and behavior accordingly.
There is a solution to these problems that would be in complete alignment with Amendment 3 and Amendment 8. The Progressive Policy Institute, among others, proposes a system of health courts for liability claims and written standards of liability settlement that would function similar to the workers compensation claims process operated by the Board of Labor.
The most striking and revolutionary changes that would follow the health court system would be a shift from designating blame to a particular physician into assigning a process of blame to a team, group, or institution. Furthermore, and maybe most controversial, the system would end jury awards for malpractice and would rely on written standards to dispense benefits.
The basic tenants of the Progressive Policy Institute proposed Health Court system include (1) replacing civil courts with health courts to hear liability claims (similar to specialized tax courts), (2)creating a written standard of accelerated compensation events (ACEs) of common medical mistakes and errors (e.g. bleeding after colon surgery requiring an additional surgery) that would detail a benefit schedule that could be included with lost wages and direct economic damages, (3) ability for patients to directly file liability claims with the health care provider or hospital, (4) a local board that would review injury claims and determine if they meet ACE designation or if they require further judafication, (5) a system of state and federal health care boards with mixed funding at each level, (6) the establishment of additional ACEs and benefit standards determined by written case law (7) experts will be paid and obtained by the court and board, not by the attorneys from either side, (8)the ability to monitor truly negligent hospitals and institutions over time and (9) use of evidence based medicine to establish a standards board for practicing physicians.
The benefits of this system are that physicians will have a clear idea of what constitutes malpractice and liable behavior because their will be a written set of standards developed from court rulings. This will decrease overall health care expenses by decreasing the practice of “defensive medicine” which is common among physicians (an over abundance of tests are ordered to cover liability). Furthermore, all patients will have access and ability to pursue injury claims in a similar manner in which they already pursue worker’s compensation claims. In addition, the hiring of experts by the court will reduce attorney fees significantly making it easier for low-income individuals to obtain representation. Also, juries should not be in the business of deciding law, they should be focused on deciding fact. However, the unclear precedents in current malpractice suits make it so that the jury focuses their efforts on deciding law since there are no clear standards of care. It is quite possible that two people suffering identical injuries will receive very different awards simply based on the jury they receive. A physician faces the same fate at the mercy of an assembled jury. Health Courts remove juries from these decisions and allow clear expectations and standards to develop over time.
The Progressive Policy Institute has also outlined a number of potential objections to this system. The objections will likely come from attorneys for two reasons – (1) citizens have the right to a jury trial and (2) malpractice attorneys could suffer decreased compensation and less demand for services. However, the workers compensation model is ideal for demonstrating that it is possible to settle liability claims without a jury. Furthermore, if only 2% of malpractice injury claims are pursued at present, and only 1 in 14 of those receive an award, attorneys may be able to find compensation simply by the increased frequency of malpractice cases they will be able to take on.
One other potential problem is that large jury awards have been significant for increasing reform in other industries. For example, tobacco lawsuits resulted in billions of dollars in jury awards that threatened tobacco companies and resulted in significant modifications within their industry and an increase in positive health outcomes among the community. However, the large jury awards are not useful in altering physician behavior or hospital practices. Since there are no clear standards in place, it is not possible that a systematic practice of negligent and liable behavior is occurring. In other words, there is no behavior to deter by these awards. As a matter of fact, the large awards are linked to increased health care costs due to the practice of defensive medicine and high insurance rates.
Tuesday, June 14, 2005
I was able to finish another book on my Summer Reading List (see below) over the weekend. This time it was Thomas Friedman’s work, the NY Times Bestseller – The World is Flat. In college I, as I’m sure many of you did, encountered Friedman on a number of occasions (Beirut to Jeruselum for example) and have continued to read his pieces in the Times. The book, as can be expected, was basically an articulated and comprehensive summary of many of the ideas expressed in his columns and previous books. However, in this manuscript, those ideas are unified to create a well formed argument concerning globalization, American economy, quality of life, and international relations. I’ve written a short review of the book below - but I suggest you buy it and read it, the anecdotes are entertaining and writing makes for easy and enjoyable reading.
In The World is Flat, Thomas Friedman argues that the rate of globalization has increased tremendously since the year 2000, fueled by technological advances and political reform. Furthermore, his major thesis is that the
First, Friedman outlines 3 major phases of Globalization both chronologically and methodologically. He suggests that the first phase of Globalization took place before the Industrial Revolution, during the period of exploration by
Early in the manuscript, Friedman outlines the 10 major innovations, inventions, or advances that have allowed the flattening of the world. These include: the fall of the Berlin Wall, the invention and public release of the Netscape browser, Open source software, the Windows operating system, outsourcing, offshoring, supply chaining, insourcing, and PDAs/cellphones.
Throughout the early portion of the book, the author makes his case for why each of these innovations was so significant. The Berlin Wall opened up a new market, a new community of hungry and ready workers and consumers. The release of Netscape allowed people to easily access data without understanding the nuances of computer technology and http file transfer. Open source software allows individuals to modify and change software to fit their needs and allows exponential and mass changes to take-hold and increase the efficacy of software programs. The Windows OS helped make computers easy to use for all populations and individuals. Outsourcing, and this is critical, reshapes the American economy, allowing American companies to invest more money in research and development, creating new jobs that did not previously exist in our country. Offshoring allows opportunities for people in India, South Korea, China and other locations and also provides low status American jobs to individuals in areas where the jobs are higher status – providing them with educational and advancement opportunities. Furthermore, offshoring changes the PATTERN of jobs (not the number) in all involved countries and in the country doing the offshoring requires upskilling or retraining of workers for new jobs that are created or not yet invented. Supply chaining allows goods to be moved rapidly and cheaply over large geographical distances and also may play a role in social interactions and cooperation between countries (discussed below). Insourcing generates new jobs that did not exist previously in established countries and allows organizations to increase their efficacy and redefine their role. UPS is the best example of this, argues Friedman, since they now come into a company and take over operation from warehousing to transport and ordering, allowing the company to focus on design, creation, research, and development. In-forming represents the easy access to information and knowledge via the internet and internet search engines such as Google. This makes all knowledge accessible to all people and goes hand in hand with the final significant innovation, the development and spread of PDAs and cellphones. These devices empower individuals to carry knowledge and to create media and act as journalists and archivers of their environment with relatively little expense.
Much of these changes, suggests Friedman were driven by the Dot-Com Boom of the mid to late 90s, most notably, the overinvestment in fiber optic cable which allows those in Bangalore to have high speed internet access and communicate and share data in real time all over the world.
The author also suggests that these technologies converged during the year 2000 to drive a global revolution in economics and market forces.
In the first half of his work, Friedman lays out and supports his case for rapid individual and technology driven globalization after the year 2000. In the second half of the book, Friedman suggests ways in which the
Overall, there is a bit of “the sky is falling” feel to the book, however, Friedman articulates something that everyone kinda knows already – the world changed a lot over the past few years the jobs of my generation and my kids generation won’t look anything like the jobs of our parents or their parents. I think Friedman has gotten it right – we are in the middle of an economic revolution that will change the world even more greatly than the Industrial Revolution and will allow the potential for corporation and innovation between countries or conflict and war for energy, resources, and jobs. American policy must be greatly altered to recognize our role in this global marketplace or our protectionist and isolationist past will lead to an economic downturn and decreased quality of life in the future.
The Creative TampaBay site has a study available online that assesses the views of 25-34 year olds regarding the city.
Creative TampaBay is in-tune with Richard Florida's ideas regarding the creative class and the future of a knowledge based economy. Therefore, they argue, it is important to attract educated 25-34 year olds to the city because it is during this period that these individuals will start a career and meet a mate (forminig roots) making it more likely that they will stay in that place for most of their adult life. The views expressed in Creative TampaBay's Young and Restless study are not encouraging regarding the present but are slightly encouraging regarding the potential of the future.
Out of the top 50 metropolitan areas, tampa is in the bottom 5 for educational attainment of the 25-34 year old group (25% with a 4 year degree) and and #47 in percent of population between 25-34 (12.7%). Charlotte, Raleigh-Durham, and Atlanta do much better than Tampa in almost every category regarding education and number of 25-34 year olds in the city or moving to the city and only Buffalo, Pittsburgh, and West Palm Beach-Boca Raton are ranked lower in percent of population between 25-34 among the largest 50 metro areas. Raleigh-Durham (45%), Atlanta (38%), Charlotte and Nashville (33%) boast a much higher proportion of college educated individuals compared to Tampa Bay's 25%. Furthermore, Tampa has only 0.022% of the total market share of college educated workers, while Atlanta ranks number 1 with 0.8%. Overall, Las Vegas and Austin, TX rank highest in almost every category concerning young adult growth (but Las Vegas ranks lowest in college education at 16% - however, it also had the greatest increase (101%) in college educated individuals between 1990 and 2000)
The 50 largest metropolitan areas account for 58% of the U.S. population, with 2.2 million residents of the Tampa Bay area (303,000 young adults between 25 and 34 years of age). The Tampa Bay area has 56,000 fewer young adults than it would have if it was in the middle of 50 largest metropolitan areas. THe population of young adults decreased across all of the US between 1990 and 2000 as the whole population aged. Slightly encouraging, the decline in population of young adults in the Tampa Bay area was less (-7.7%) than the national average (-8.3%), however, in absolute terms, the number declined from 328,000 to 303,000 25-34 year olds within the region and other Southern Regions, such as Atlanta and Raleigh Durham saw significant increases in their young adult populations during this period of over 20%. Overall population growth (16%) of the area was greater than the national average (14%) between 1990 adn 2000 but did not come close to other Southern metropolitan areas such as Atlanta (39%), Raleigh-Durham-Chapel Hill (39%), Charlotte (29%), Nashville (25%), and Jacksonville (21%).
Richard Florida also writes that increased tolerance is a key ingredient to attracting and competing for the creative class. One measure of tolerance is diversity, however, Tampa also ranks low in diversity with 80% of the 25-34 year olds labeled as "white" (national average is 70%). However, between 1990 and 2000 the number of African-Americans increased by 7%, the number of Asian Americans increased by 68% and the number of Hispanics increased by 101%. Currently, other Southern regions are made up by a more diverse group of 25-34 year olds, including Atlanta (60% white), Raleigh-Durham-Chapel Hill (67% white), H ouston (59%), New Orleans (58%), and Memphis (51%).
It isn't rocket science to figure out where our problems originate. First of all, you have to tolerate diversity to compete for the creative class. This does NOT just mean skin color and race - it means religious diversity, homosexual rights, tatoos, funny hair, and different styles of dress. While living in Ann Arbor, MI a few years back, a friend visiting from Tampa remarked to me how "everyone here looks like a scene kid" - what he was really saying was that a lot more people feel open to express themselves as individuals even while carrying $50K+ per year salaries. In addition, this area is not very inviting to outsiders - there is a strong good ole boy (and girl) network within the state and county (Palma Ceia CC, the Yacht Club, etc0 that still drives politics and change. If Tampa wants to attract innovative young minds and keep innovative young minds in the region, we have to allow INNOVATION and creativity. There needs to be a systamatic change in the way young people are treated in this region and a renewed respect for individuals with job titles and job training reflective of an oncoming knowledge economy driven by the creative class. Job titles are going to change drastically and what we do in our work is shifting as well - many of us produce and manage ideas now and it takes understanding from the community to allow room for these individuals and changes to take place. While I love living in a real city (Tampa) compared to Ann Arbor-Detroit, I must admit it was always easier to explain myself to the average person up north than it is here.
Next, as the Creative TampaBay report notes, we HAVE to improve downtown. While it is nice that the new Tampa Museum of Art is going to go into the existing old federal courthouse, we have to see the failures of this as well. Iorio's riverwalk plans were significant in that they allowed non-luxury, non-residential development to take place in an area overly focused on high-income POTENTIAL residents. We are setting ourselves up for another bust if we continue to push residential property growth without the necessary infrastructure and cultural resources there to support an influx of residents. If you have enough money to spend on a $300,000 plus condo in downtown you might also have enough disposable income to spend at coffee shops, movies, plays, shopping, etc - we have to ensure that those resources are in place in order to ensure that residents really do move in to these new homes. In other words, I feel that downtown must be developed but we can't simply force the issue by encouraging developers to make realestate investment (this is only part of the puzzle). We have to first change our approach and perspective on the creative class, then increase the resources for those individuals while also developing places to live and 'take root' as well.
This leads to my next point - we must focus the real estate development past the direct downtown area into places like Tampa Heights and Seminole Heights. There are existing beautiful neighborhoods within those regions that could be improved upon by focused efforts that have started and stalled on a number of occassions. However, we can't simply commit a blind gentrification. The creative class is sensitive to the residents of these areas who have owned and lived in their homes for many decades. It is NOT appropriate to force these residents to sell their home because the low price they would receive before redevelopment is unlikely to cover the price of a new home in another location. A similar tactic was undertaken, contrversially, by the former Mayor Dick Greco in the late 1990s and can not be tolerated in 2005.
Finally, the city must brand and market itself with greater exuberance. We need to specifically identify potential young adult migrants and migrant populations from national college areas and other metros with a high influx new residents (such as NYC). The image of Florida among many young adults in the North is of a backwards and socially unprogressive area, unwelcoming to new ideas and new people. What are we going to do in order to drive Tampa into the next phase of the knowledge based economy?
Thursday, June 09, 2005
"Mr. Bush values a frozen embryo. But he hasn't mustered much compassion for an entire population of terrorized widows and orphans. And he is cementing in place the very hopelessness he dreads, by continuing to avert his eyes from the first genocide of the 21st century."
The whole article can be found here...
Duane Hanson - Portraits from the Heartland is currently at Sarasota's Ringling Museum of Art.
Duane Hanson created life-like sculptures of ordinary people doing ordinary things but did so with amazing attention to detail, including the skin, clothes, and props. This exhibit is definitely worth checking out, especially if you haven't been down to Ringling previously.
The Ringling estate, which sits right on the water, is enormous and now contains his large Baroque art collection, a performing arts center, a rose garden, and an excellent circus museum with many original props, outfits, train cars, and memrobilia. Plus, its free for all Florida Students and Florida Teachers.
Anyway, if you are interested in Florida history the book is worth going through. The French, not Spanish influence on early America, the legacy of corruption, the stories of Confederate family members, the laregely Agricultural history of this state, and the persistance of the Democratic party to hold office (even after turn of the century changes in the democratic party) are all main points. While the voice of Roberts is likable in this book, she can also be a little frustrating at times in her lack of organized presentation (only roughly chronological) and overarching theme/backbone.
The book can best be described as a person who goes to an all you can eat buffet with really good food - they are bloated, full, and excited to tell you about this buffet but they simply vomit on the page spewing chunks of their meal everywhere. You are left to sift through the chunks and in the process find the remains of an excellent meal that you wouldn't mind consuming yourself.
Tuesday, June 07, 2005
Thursday, May 26, 2005
Wednesday, May 25, 2005
1) The VRACS dataset originally discussed is simply not going to work for my dissertation for a number of reasons - starting with the fact that it only kinda belongs to TGH and mostly belongs to some Indian researchers. Furthermore, the sample surveys were half-heartedly designed without adquete sampling theory applied and things are a bit slopply with the data itself. Finally, the sample size is only about 400 people - kinda small for a population based question. Anyway, I wanted things to be clean at every step along the way so that I didn't run into trouble somewhere deep down the line and deep in the summer, thus causing me to pull out and start over again (which is EXACTLY what happened last summer with the NHANES III and NHANES 1999-present series).
2) #1 is okay because things are coming together.
There are 2 models for writing a dissertation with the Michigan Anthro department. One models is traditional - you pick a topic, question, place - you go there, you do field work, you collect data, you come back, analyze data, and write it up. Another model is that you can throw together a string of 3 related published papers regarding some theme/question over a period of time.
Given my plans this summer, and the access I have to other data sets and populations, I believe that the latter may be the model I opt for in completing my dissertation.
3)Apparently the City of Tampa Department of Heath (DOH) is part of Tampa General Hospital and works closely with the Infectious Disease group - which I did not know but now makes total since because they are both public places and both deal with a lot of STD patients. Well, I was excited to learn that my summer contract with Infectious Disease allows me to also work with the DOH - therefore, I have some access to their data, clinic, and populations as well under the direction of Dr. H.
Yesterday, I met with the director, Dr. H and an epidemiologist Dr. G, to discuss the possibility of using an STD dataset collected in Tampa throughout the various DOH clinics. They were agreeble to this plan and had no problem checking this out a little bit. More specifically, we are having a meeting next week with some of the other epidemiologists at DOH regarding the data.
So why is an STD dataset so valuable to me?
4)I will also be working with the Hernando County Health Department with a group of HIV+ and at-risk for HIV adult men in Brooksville. The idea is to meet with social workers and public health officials to develop an education/policy initiative aimed at reducing HIV incidence amongst this population. See a theme developing? I do - and its quite appropriate for an anthropolgy dissertation using this population and the Tampa STD data.
HIV risk factors, socioeconomic status, population of people using Florida DOH clinicis.....its coming together - slowly.
The nice part about this is that a 3 paper model dissertation will allow a focus on the policy/prevention aspect, clinical aspect, and the data analysis of risk factors as well - getting at the problem from both ends (real people and real numbers, population and individual health care). Almost sounds like the kind of dissertation an MD-PhD student interested in population health and clinical care is supposed to be doing!
Saturday, May 21, 2005
Last week, I posted photos of Steven Lorenzo's home at 213 West Powhatten. If you remember, Lorenzo is the suspect in a series of kidnappings and murders of gay men. The police began searching the house again during the beginning of May but had been tight lipped about what they were looking for specfically and what they had found. However, in a St. Petersburg Times story today, Tampa Police elaborate on the case and the evidence recovered inside the home.
"They found rope, tape, plastic gloves and other "torture-type" items - along with printed pages about serial killers. They found an envelope containing newspaper articles about Galehouse, Wachholtz and "other missing or dead individuals."
They found pictures on Lorenzo's computer of a "lifeless" young man, blood on his face and on the floor beneath him, ligature marks on his wrists and ankles.
Tampa police and Hillsborough sheriff's detectives examined the pictures. So did two medical examiners and a DEA agent. They all agreed: The man was dead when the pictures were taken, in what appears to be Lorenzo's living room and bathroom."
It also looks like Lorenzo had an accomplice, Scott Schweickert, who helped plan and carry out the abductions and murders. Furthermore, there may have been previous attempts before the Galehouse/Wacholtz killings and there may have been victims after those two deaths.
Friday, May 20, 2005
Gary Payton, Shaquile O'Neal, and Grant Hill are the only remaining NBA players from the 1996 USA Men's Basketball Team, which lost another member to old age last night when Reggie Miller retired after the Pacer's game 6 loss to the Detroit Pistons - scoring 27 points on his way out the door while getting a chance to play one more time on his home court.
In the early 90s, Cliff Hall and I would have epic one-on-one battles in the backyard of his neighbor's home where there was a small, but well kept, basketball net, glass backboard and concrete drive. These battles usually took place during the spring and summer NBA playoffs - cliff was usually Michael Jordan or Scottie Pippen, but I was always Clyde Drexler, Patrick Ewing or Reggie Miller. Every shot was narrated by a pretend Marv Albert and scores were kept with great care in a never-ending Best of X series.
Thursday, May 19, 2005
Thanks to the help of readers, I have more information regarding the odd structure on Highland Avenue that was discussed last Tuesday.
Apparently, Bert Wahl owns this building and at one point ran a business "rescuing" and selling big cats, including lions, tigers, and cougars. However, in 1997 the business, Wildlife Rescue Inc., was cited for violating the Animal Welfare Act by the USDA. The inspectors claimed that Mr. Wahl was leaving his cats in poor conditions (which are obvious by the photos I posted previously). Since this was the first offense of Wildlife Rescue and Mr. Wahl, the USDA let him off relatively easy with a $1000 fine and a cease and desist order.
But this wasn't enough for the animal abuser. Bert Wahl continued running an illegal and unlicensed business while keeping his animals (merchandise) in poor conditions and in 2000 he was again cited for violations of the Animal Welfare act by the USDA.
While there are no longer any animals, at least in view, at the premises, Mr. Wahl may still be around the area. After looking his name up on the HC Property Appraiser website, 2 properties were found to belong to him - both in very close proximity.
I walked by the first of these properties and quickly realized that they weren't simply in close proximity - they were directly next to each other!
This is the view from the street in front of the second property -
And this is the view from the side of the house
You can clearly see from these photos that the structure I posted previously is directly behind the other home. Therefore, I assume that Mr. Wahl used (or uses) the yellow home as his residence and once used the brown home to keep the cats and supplies. Now that he can no longer do that, at least in plain view, the structure sits abandoned, dilapidated and falling apart.
An anonymous comment included these links:
Oddly enough, I still have fairly vivid memories of my preschool graduation - including the poems we read (polly, the doctor says), the songs we sung (my contry tis of thee was definitely one of them) and counting on stage with Mrs. Chambers. In some ways I have better memories of graduating preschool then high school and college...
Anyway, it has some fun color temperature/saturation settings as well that allow you to take horrible photos and at least turn them into odd visual experiences.
Here are just a few examples of some bad photos that I salvaged.
2. Kafka on the Shore. Haruki Murakami 2005
3. The World is Flat. Thomas Friedman 2005.
4. Freakonomics: A Rogue Economist Explores the Hidden Side of Everything. 2005.
5. The Ancestor's Tale: A Pilgramage to the Dawn of Evolution. Richard Dawins 2005.
6. Cigar City Mafia. Scott Deitche 2005. (tampa mobsters!)
7. Food Politics: How the Food Industry Influences Nutrition and Health. 2005.
8. Everything Bad is Good For You: How Today's Popular Culture is Actually Making Us Smarter. Steven Johnson 2005.
9. Foreign Babes in Beijing: Behind the Scenes of a New China. Rachel DeWoskin
10. Why Not? 2004
11. Mountains beyond Mountains
I try to squeeze a few non, or only tangentially, medicine and anthropology books in to the summer. This is my self-created list of choices - anyone else have any suggestions for must reads?
Tuesday, May 17, 2005
So I decided to head north, past Hanna (an unusual direction for our normal walk) to check out a building that caught my eye a few days ago. Unfortunately, I did not consider the fact that as we are getting later and later into May and with the progression into summer comes late afternoon thunderstorms.
Luckily, with the sky darkening, I reached the odd house at the corner of Sligh and Highland after almost turning back.
The house is obviously abandoned which is odd in and of itself - not so much because no one lives there, but because the real estate market is quite competitive in Seminole Heights and empty houses usually don't stay empty long and they stay relatively well-kept during their time on the market. But this place doesn't even boast a for-sale sign.
However, it wasn't the fact that this place was abandoned that caught my attention - instead it was the backyard.
The place is filled with cages - and these cages contain little plastic igloo shelters.
What kind of animals were in these cages? What was going on at this place? These people must have been breeders or some serious hobbyists of some sort. I seem to have this odd childhood memory large cats being located behind a place like this in Seminole Heights. Maybe this is the original location of Wildlife on Easy Street or something similar. Does anyone out there have any clues?
Unfortunately, I forgot to jot down the address to lookup the property on the Property Appraiser site because Sam's tugging alerted me to the presence of rain drops beginning to feel a little harder than a light sprinkle. So, I hurried away without thinking about getting more information to help solve the puzzle. I guess a trip back is in order.
Monday, May 16, 2005
Apparently, during the fall of 2003, Steven Lorenzo was committing some very serious crimes (drugging, kidnapping, and raping young men) at his home on 213 West Powhatten Avenue. On December 20, 2003 two young men left a gay bar and went missing. One of those men, Michael Wacholtz was found dead on January 6, 2004 - left wrapped in a blanket lying in his Jeep. Friends and bar-patrons remember the other man who went missing, Jason Galehouse, leaving the bar on December 20 with two other men, matching the description of Lorenzo and Wacholtz.
Galehouse is still considered missing since no body has been found and his mother, Pam Williams holds out hope (maybe delusional hope) that her son has amnesia from the drugs and is alive and well, shopping in the Ross in Sarasota (where he was supposedly sighted a few months back).
Steven Lorenzo has been in jail since December 2004 on federal drug charges. He is also a suspect in the kidnapping, drugging, and raping of 6 other men - however, he has not yet been charged in the case of Galehouse and Wachholtz.
Anyway, his empty house has been searched during recent weeks, bringing an influx of local news media into our neighborhood. If baynews9 was going to break the story, I figured it only appropriate that Hard Boiled Wonderland also get the "big scoop".
So, armed with SAM as my patsy, and camera in hand, I wandered over to 213 W. Powhatten yesterday afternoon to check things out for myself.
As you can see from this first photograph, the house has been kept up very well, considering that no one has lived there since November. Obviously, Mr. Lorenzo has arranged some type of landscaping/lawnmowing type service or a relative/friend is helping out in his absence.
There really isn't much to see from the street and this is clearly why the news outlets have resorted to using their helecopters for a better look at things behind the house. I have seen camera shots from the helecopters showing massive amounts of material being piled up and sorted through in the backyard of the home.
One of the main items of interest in news reports/rumors is the hot tub. I poked over to the side of the house, staying well within the public area of the sidewalk and observed that the hot tub had indeed been yanked out of the home or deck or wherever it normally goes and moved to an area for further investigation.
Oddly enough, there is no police presence/guard (at least in plain sight) and the house is not roped off with crime scene tape or a do not cross line. I would have thought that an empty house with an active search warrant might receive more protection.
If I here that the police are back to search the house again, I will take the ever-willing, crime-fighting companion, SAM, back for another walk on Powhatten and see if I can get a more interesting scoop while trying to stay relatively unnoticed and out of the way.