Surgeons surger

A friend who’s son just completed a wonderful, non-invasive treatment for club foot posted a link to this great NPR story that is a depressing tale of modern medicine.  Basically, there’s been a method around since the 1950’s to correct clubfoot (1 in 1000 births) through a series of casts, braces, etc.  It works, there’s few side effects, and there’s no repeated painful surgeries– the traditional treatment.  Well, when your baby is born with a clubfoot where do you but an orthopedic surgeon.  And what do surgeons like to do?  Cut.  Thus, a non-surgical treatment that is superior in pretty much every way was ignored for about half a century.  Until finally enough parents found out about it on the internet.  It’s a pretty amazing story.  Here’s a bit:

Just a decade ago, up to 90 percent of babies like Snyder’s daughter Alice were treated with surgery that usually had to be repeated several times. That created a buildup of scar tissue that often left patients with a lifetime of chronic pain, stiffness, arthritis and medical bills. But with the help of a simple, noninvasive solution and an Internet campaign led by parents, the course of treatment and likely outcomes have changed completely…

Instead, Herzenberg used what’s called the Ponseti Method. Doctors begin by applying a series of full-leg casts to slowly turn out the infant’s flexible feet. Casts are changed weekly for three to eight weeks…

Unlike the traditional surgical method, the Ponseti method is pretty much painless, and patients who receive it usually have a complete recovery, with no long-term discomfort. It also costs less. Ponseti spent the next 50 years tirelessly trying to get other doctors to accept it, but with little success.

“People were falling over themselves to do fancy invasive surgery, and this one strange old guy who speaks softly with a Spanish accent in Iowa was getting sort of ignored by the drumbeat of people who were in favor of surgery,” says Herzenberg, who is one of the foremost practitioners of the Ponseti method today.

Surgeons are trained to operate, explains Herzenberg, and usually that’s the way they make money. The Ponseti method brings in a lot less for orthopedists. For about 50 years, the technique mostly stayed in Iowa.

But then something new came along: the Internet…

Today, the Ponseti method is now almost always the treatment of choice for clubfoot and is recommended by the American Academy of Orthopaedic Surgeons. When it is done correctly, 97 percent of children born with clubfoot never need invasive surgery.

Orthopedic surgeons should be absolutely ashamed of themselves for causing their patients needless suffering while they were getting needless enriched (I know they weren’t doing this for the money, but it doesn’t hurt to step back and question one’s assumptions– especially when practicing medicine).

I’m not a big fan of alternative medicine– I’m basically for any medicine that’s evidence-based– but with stories like this you cannot help but wonder what great treatments are out there that may simply be getting ignored by the medical establishment.  Also, chalk one more up for the internet.

Photo of the day

Discovery channel gallery of best ocean animal photos of 2013:

Blacktip sharks are active at dusk, as you can see in this shot of a shark near KwaZulu Natal, a province of South Africa.


How to fix voting

Jeffrey Toobin with a nice summary of the recommendations of a bipartisan commission to fix voting (hours long lines, anybody) problems in the US:

The world’s greatest democracy is not so great at running elections, as we all saw in 2012. There were, among other things, long lines at polling places, botched registrations, and mysterious rules on absentee ballots. As President Obama declared victory on election night, he wanted to do something about these problems. He appointed a (very) bipartisan commission, chaired by two self-described “partisan hacks”: Robert Bauer (Obama’s personal lawyer and his one-time White House counsel) and Benjamin Ginsberg (the national counsel to the Romney campaign and many other Republican causes). Wednesday, after six months of work, the “lines commission,” as it’s known, released a hundred-page report. Notwithstanding the strong party affiliations of its leaders, the group was unanimous in its recommendations…

The key recommendations come in four areas:

• More early voting. More mail and Internet voting would take care of the biggest problem in 2012, long lines. This is a clear embrace of a Democratic priority.

• Easier voter registration, including online. Again, this is a top Democratic priority, though the commission also gives a nod to technologies that compare databases and allow purges of ineligible voters, which have been a Republican cause.

• Improved voting technology. After the 2000 fiasco in Florida, the federal government subsidized the purchase of many new voting machines, but these are now approaching the end of their useful lives. The commission recommends ending the hegemony of the specialized voting machine and allowing voters to use their own computers to print out their ballots at home, like they do with boarding passes. With the right security in place, this makes all the sense in the world.

• The legacy of Newtown. The commission learned, surprisingly, that in the wake of school massacres, many schools are determined to keep strangers off the premises at all times—and that includes voters. Schools represent about twenty per cent of all polling places, and the commission proposed putting even more to use, so this creates a serious problem. The report recommends “taking all the steps necessary to address these legitimate security concerns,” as well as trying to arrange days when children aren’t present—ones set aside for teacher training, for example—to coincide with elections. (Election Day is only a holiday in some states.) Again, early voting and improved technology can address these issues…

Democrats are likely to greet the recommendations with some enthusiasm, though many will regret the absence of proposals on photo identification and the Voting Rights Act…

The recommendations will test Republicans. If, as many Democrats believe, they simply want to reduce turnout because they have a tendency to win low-turnout elections and lose high-turnout contests, Republicans can ignore or nitpick the recommendations, despite Ginsberg’s impeccable partisan credentials. (I first met both Ginsberg and Bauer when they were on opposite sides of the Florida recount, in 2000.) Or the commission’s work could serve as a model of bipartisan coöperation, with the two sides putting aside their differences in the interest of setting up fairer fights in the future. That, in any event, is today’s fond hope.

I’m going to go out on a limb here and suggest that the majority of Republican legislators are far more interested in doing whatever they think keeps themselves in power (lower turnout) than in taking obvious steps that even very partisan non-elected Republicans can conclude are good for our democracy.  I’d love to be proven wrong.

Can any Democrat beat Hillary in 2016?

Probably not.  There’s some really nice Political Science work that emphasizes that, although it may not appear that way, the institutional political parties are still the key players in determining the presidential nominees.  A nice CJR interview with Hand Noel lays this out:

The key insight of the book is to look at presidential nominations not from the point of the view of the people trying to get the nomination, but from the point of view of the party that’s trying to bestow it. There are only a handful of people in the party that are running for office. Most of the people in the party are not running for office, but they really care about who wins the nomination and who wins the general election. And so we should tell the story from the point of view of the players in the party who have an opinion about who the nominee should be and can do something about it.

I think that’s the big difference. We generally talk about individual candidates building a campaign, hiring people, doing the strategy, and all of these things. And they are doing that, but they’re doing it in the context where there’s a bunch of other people who are very, very important, who have a lot of influence, and can kind of decide, “Look, you can build all the campaigns you want, but if you’re Pat Robertson, you’re not going to be taken seriously, no matter how much money you’ve earned.”

Anyway, with that it mind, John Cassidy runs down the situation for Democrats in 2016 and barring some unexpected developments (always possible, of course) it’s hard to see somebody else getting the nomination:

Right now, twenty-four months before the Iowa primary, and at a point when not a single serious candidate has declared that she or he is running for President, Priorities USA, the Democratic Super PAC that raised and spent wads of cash in support of President Obama’s 2012 reëlection campaign, is putting its money and expertise behind—you guessed it—Hillary Clinton.

We shouldn’t be too surprised at this journalistic onslaught, and you can’t blame it all on political reporters desperately looking for something to write about. In the post-Citizens United world, Presidential campaigns are big business, and they never take a break. As the Times story indicates, decisions are being made today that will determine who runs the country—or, at least, the White House—for four years after President Obama leaves. So, suck it up and keep reading!

The most immediate implications of the decision by Priorities USA, which was founded by two former Obama-campaign officials, Bill Burton and Sean Sweeney, are for anybody who is thinking of challenging Clinton for the Democratic nomination.

Imagine for a moment that you were one of these hopeful souls. Here’s what you’ve just been told: don’t bother! This thing is already sewn up. If you go ahead with your foolhardy pursuit, you’ll be crushed. Not only will you be confronting the candidate with the most experience and strongest poll numbers, you will also be going up against practically the entire Democratic establishment: [emphasis mine] the best campaign managers, the wiliest spinmeisters, the biggest of big-name endorsers, the most modern technology, and the deepest pockets. Forget about it. There’s always 2024, or 2020 if Hillary loses.

Yep.  Sure, it’s early, but this does seem to be a big step in the party deciding and it is deciding on Hillary.  Click the link for Cassidy’s take on all the other possibilities.

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