To catch a thief

Loved this first person story in Salon about a woman who used Craigslist and myspace to catch the guy who stole her belonging from her car.  I especially appreciated that the police followed up.  When Kim’s backpack with wallet was stolen in grad school, the police had no interest in learning the phone numbers that had been called with her calling card (back in the pre- cell phone days).  Anyway, a good read.  The key break: surveillance technology at McDonald’s.

Gender in Afghanistan

I don’t have any particularly interesting commentary on this NYT piece about the tradition of families with only daughters in Afghanistan raising one as a boy, but I think it speaks for itself about the problematic gender attitudes in the country and is well worth your time to read.  The basics:

There are no statistics about how many Afghan girls masquerade as boys. But when asked, Afghans of several generations can often tell a story of a female relative, friend, neighbor or co-worker who grew up disguised as a boy. To those who know, these children are often referred to as neither “daughter” nor “son” in conversation, but as “bacha posh,” which literally means “dressed up as a boy” in Dari.

Through dozens of interviews conducted over several months, where many people wanted to remain anonymous or to use only first names for fear of exposing their families, it was possible to trace a practice that has remained mostly obscured to outsiders. Yet it cuts across class, education, ethnicity and geography, and has endured even through Afghanistan’s many wars and governments.

Afghan families have many reasons for pretending their girls are boys, including economic need, social pressure to have sons, and in some cases, a superstition that doing so can lead to the birth of a real boy. Lacking a son, the parents decide to make one up, usually by cutting the hair of a daughter and dressing her in typical Afghan men’s clothing. There are no specific legal or religious proscriptions against the practice. In most cases, a return to womanhood takes place when the child enters puberty. The parents almost always make that decision.

Okay, a little commentary, now that I’ve finished reading the article.  Sometimes, I feel the need to be really judgmental.  Any culture that encourages this type of behavior because women are so oppressed and devalued is hopelessly backward and dysfunctional.  I’ve got no acceptance for cultural relativism– the attitudes towards gender roles in Afghanistan are simply appalling and inhumane.  There, that felt good.

Cutting costs by cutting doctors

Doctors are great.  Nothing like a well-trained physician.  I’m grateful for them– especially considering my son has a rare genetic disease.  That said, one way we waste a lot of money on medical care in this country is by having things done by doctors that could be done by well-trained nurses.  Excellent case in point– anesthesia during surgery.  Really interseting Op-Ed in the N&O today persuasively makes the case that here is an area where we could save tons in costs, without any reduction in care or health outcomes whatsoever.  What’s stopping us?  The political power of doctors, I presume.  The details:

Two groups of medical professionals are trained to administer anesthesia: nurses who have been specially trained as nurse anesthetists and physicians specially trained as anesthesiologists. Despite compelling evidence that both groups provide equally safe anesthesia care, the majority of states, including North Carolina, still adhere to a federal government rule requiring nurse anesthetists to be supervised by physician anesthesiologists when providing care to Medicare and Medicaid patients…

Today, postgraduate education and clinical training in the specialty of anesthesia is remarkably similar for both groups, occurring in the same settings. As a result, both groups can independently provide an equivalent level of safe and effective anesthesia care.

A recent analysis found that in states whose governors opted out of the Medicare and Medicaid requirements for physician supervision of nurse anesthetists, there was no increase in patient complications or deaths. The independent report by RTI International recommended that nurse anesthetists be allowed to practice without supervision in all states…

So how wasteful is a system in which we train physician anesthesiologists who will ultimately supervise nurse anesthetists? According to the Rand Corporation, it costs somewhat more than six times as much to train a physician anesthesiologist as to train a nurse anesthetist, and the anesthesiologist earns twice as much on average per year. Similarly, a 2010 study of anesthesia delivery models by The Lewin Group found the most cost-effective delivery model by far is nurse anesthetists working without supervision.

More importantly, both the Rand and Lewin Group studies found there is no significant difference in quality of care when a certified registered nurse anesthetist delivers anesthesia versus a physician anesthesiologist.

These compelling findings are not a recent revelation. In 1980, the Centers for Disease Control and Prevention said the frequency of adverse outcomes associated with anesthesia was so low that a full-scale study of the issue was unwarranted.

I think this might be an interesting test case to watch to see if we can truly begin to approach our health care costs in a more rational manner.  If we cannot take this obvious and completely warranted step to seriously reduce costs without at all affecting the quality of care, its hard to imagine taking more difficult steps.

Assessing the Tea Party impact

After giving a talk about the Tea Party last week, I’ve been doing a lot of thinking about what the ultimate impact of the Tea Party is.  Most notably here, but there’s really a lot to consider.   Nate Silver does a terrific job looking at the many facets of the costs and benefits of the Tea party to the Republican party and conservative politics.   The following is his contention I find the most interesting, perhaps because I’m just not sure how much I agree with it:

One reason may be, as I have argued several times, that the Tea Party has provided a vehicle by which fiscal conservatism, which has never gone out of style, has been liberated from the Republican brand. In addition, the Tea Party has probably contributed toward higher levels of enthusiasm among conservative-leaning voters. And it may have played a key role in souring public opinion on Democratic initiatives like health care and the stimulus.

One possible course for these midterms was a low-turnout election, with voter apathy toward both major parties. The Democrats might still have lost quite a few seats in Congress –- simply because they were the incumbent party and had more of them to lose — but the losses would probably not have been catastrophic. The Tea Party, however, has made some conservatives feel as though they have a real alternative -– something new and fresh and different — to Democratic governance. The impact of this is hard to evaluate, but it could easily outweigh the loss of a Senate seat or two in specific cases like Delaware.

I do think there’s something here, but on the other hand, in this era of Fox news, talk radio, and right-wing blogs, I have a hard time not imagining now out-of-power conservatives getting enthused about this election.  Maybe not to the degree that the Tea party has helped facilitate, but to a considerable degree nonetheless.

I’ve already argued that I think, long term, the Tea party hurts the Republican party.  This may even becoming more the case as  Tea Party candidates, like Christine O’Donnell, tarnish the Republican brand.   Silver disagrees, but he’s less persuasive when he doesn’t have data to back him up (for all his brilliance, he’s a baseball statistician by trade, not a political scientist).  Anyway, in full, its an analysis very well worth reading.

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