Island Practice

The Book of the Week is “Island Practice” by Pam Belluck, published in 2012. This ebook discusses in detail, the life of a doctor who has been practicing general medicine and surgery on Nantucket for decades. He is a colorful character: having no qualms about cursing when providing psychotherapy (without a license); making house calls and treating patients at his own house; allowing patients to pay their bills through bartering; not charging indigent patients at all; treating animals as well; maintaining an extensive collection of operative firearms; occasionally allowing a needy person to live with him, his wife and three kids; and engaging in other offbeat pursuits.

Nantucket, a less-than-fifty-square-mile island in Massachusetts, is a socially isolated summer vacation destination for many wealthy celebrities. However, its year-round residents also need medical care, frequently for three serious tick-borne diseases, on which Dr. Lepore is an expert. When a patient has a life-threatening condition that requires immediate treatment, the doctor has them airlifted by helicopter to a hospital in the Boston area. In times of severe weather when aircraft are not flying, he must try to save the patient himself, by doing a Caesarian section or sewing up a hole in a duodenum in a case of pancreatitis.

The author portrays Dr. Lepore as similar to the fictional TV character Dr. Gregory House in that he is often diagnosing “zebras” (rare medical conditions) rather than “horses” (common ailments) through his intuition and then heroically curing the patient while bucking hospital rules.

Read the book to learn of the doctor’s highly irregular approach to practicing medicine, the difficulties and controversies he and his family have faced through the years, and the precarious future that medical professionals like him face, with the introduction of Obamacare.

As an aside, it appeared that this book’s thesis, stated toward the end, is that Obamacare would force doctors such as Lepore out of business. This blogger thinks that that will not occur. The wealthy will always seek out the best medical care, and pay such doctors under the table if necessary, to obtain it. They will find the loopholes in national healthcare to avoid a bad HMO. They would gladly pay the fine for not signing up for Obamacare because the fine will never be sufficiently high to be a deterrent for making their own private arrangements for medical treatment. A major argument some people– not just the wealthy– have against national healthcare– is that it is unfair to make the healthy people pay the high medical bills of the people who knowingly engage in risky, self-destructive behaviors (smoking; poor eating habits, lack of exercise) that result in preventable medical conditions or that exacerbate certain conditions (cancer, obesity, diabetes, etc.) that require expensive medical care. [By the way, this blogger’s medical bills were $0 last year and have been $0 so far this year (this includes out-of-pocket expenses)– for you curious readers.]

The Girl Who Fell to Earth

The Book of the Week is “The Girl to Fell to Earth” by Sophia Al-Maria, published in 2012. This is the autobiography of a member of Generation Y of mixed parentage. Her father was a Bedouin from Qatar; her mother, from the United States.

Al-Maria’s childhood began in America but her father’s job in the oil industry took him back to Qatar. She, her mother and younger sister then followed him. However, there occurred a serious rift in her parents’ relationship, due to the nature of his culture.

Read the book to see how the author learned to deal with switching between the two very different cultures while feeling a sense of belonging to both.

Super Crunchers

The Book of the Week is “Super Crunchers” by Ian Ayres, published in 2007. This is a book about how projections based on vast quantities of numerical data in various areas of life are spurring innovations and controversy.

Improvements have been made in health, education, welfare, politics, marketing and other aspects of the day-to-day existence of humans because technological advances have greatly facilitated large volumes of number-crunching; however, not without heated debates.

People who are “experts” in specific disciplines whose projections can be quantified, are being obsolesced by machines that make predictions better than they can. For instance, software has been created to project the duration of celebrity marriages. Such duration has been found to have an inverse relationship with Google web traffic. Horror.

When this ebook was published, Farecast.com (Now Bing Travel), a company known for its online airfare search engine– processed its information with a five-terabyte database– “… fifty billion prices that it purchased from ITA Software, a company that sells price data to travel agents, websites, and computer reservation services.” The sheer amount of data minimizes bias. Such “randomization” lets researchers “… run the equivalent of a controlled test without having to laboriously match up and control for dozens or hundreds of potentially confounding variables.”

A hue and cry was heard at teaching hospitals when internet users acquired the ability to diagnose themselves by Googling their symptoms. Around the same time, software was created by medical professionals concerned about the high percentage of misdiagnoses. Such software allowed medical-school students to make diagnoses with the use of a statistical algorithm in a database of diseases, syndromes, disorders, symptoms, causes, drug side effects, clinical findings, lab results and patient histories. The data consisted of “…word patterns in journal articles that were most likely to be associated with each disease.” The computer was more accurate than the medical school professors.

One profession in which jobs are not threatened by large-scale data processing, is psychoanalysis. It’s inferential and subjective– hard to quantify. In financial services, ego and feelings interfere with securities trading and the granting of loans. But computer programs’ regression equations are completely impartial. So they do better than humans at making predictions that make money. Even when a combination of a human and a machine are used to determine whether to grant parole to convicts (based on the probability they’ll go back to committing crimes after being released from prison), the machine alone makes better decisions in a larger percentage of cases.

Read the book to learn why number-crunching software is: inappropriate for making major one-time decisions; making some teachers into robots; good at predicting Supreme Court decisions; sometimes poorly understood by healthcare professionals; raising privacy concerns, and much more.

Bonus Post

This blogger skimmed the book “Law Man” by Shon Hopwood published in 2012. In this personal account, Hopwood details his actions as a bank robber, and their consequences, complete with the romantic subplot.

In May 1999, the author was permanently placed in prison in Peoria. He felt relief because “Mostly I wanted my hard time to begin so it would start to end.” He told the reader of the term “chester”– short for “child molester.” Luckily, early on, Hopwood found an inmate who became his mentor, who taught him how to fashion a wooden-handled steel rod; the best weapon in the prison– which housed a metal fabrication plant. “… you can run it straight through a man’s liver. But what’s better is a lot of friends.”

More than three quarters of the prisoners were wannabe rap stars. Hopwood wrote, “You must have a job in prison; it’s not supposed to be a vacation, after all.” Postage stamps were the major means of exchange. Whenever the post office raised the price of stamps, the prison economy was disrupted.

On one occasion there was a gang brawl in the exercise yard involving attempted murder, resulting in a four-day lockdown of the entire prison. “In a world of attention-craving narcissists, lockdowns border on cruel and unusual punishment.”

Read the book to learn how the author was responsible for a change in a major legal ruling, an occurrence whose odds were akin to winning the lottery.

The Astonishing Mr. Scripps

The Book of the Week is “The Astonishing Mr. Scripps” by Vance H. Trimble, published in 1992. This large volume documents the life, among other family members, of Edward Willis Scripps, born in June 1854, the 13th child of James and Julia Scripps. He became the head of the nation’s first newspaper chain by the end of the 19th century.

Prior to journalism, starting at twelve years of age, Scripps was required to assist his father at bookbinding, on the farm and at a sugar mill. He quit school at fifteen. In 1872, after dabbling in a few other ventures, at eighteen, he escaped a life of manual labor to help his 38-year old older brother in the print shop at the Detroit Tribune. The culture was such that journalists had to frequent a bar in order to get good assignments. There was peer pressure to drink.

About five years later, Scripps moved to Cleveland to start another newspaper there. He wanted to sell the paper on the streets, rather than through the customary routes with paperboys. “A newsboy could buy copies wholesale at the pressroom door for half a cent, thus earning fifty cents for each hundred sold.”

The composing room was where the ad and editorial departments had a conflict because advertising copy and news stories competed for space so the one that was typeset second got short shrift at deadline time. Scripps’ paper favored blue collar readers. Its rivals were read by wealthy, industrialist readers. Scripps supported trade unionism and opposed the capitalists. He tried to maximize revenue from subscribers rather than advertisers so he could write what he wanted; he thus didn’t have to print what advertisers told him to.

In 1880, Scripps started yet another newspaper in St. Louis– the Evening Chronicle. A competing paper, the Post Dispatch, was bribing the Chronicle carriers to transfer their route customers to the Post Dispatch. That same year, during the presidential election, the Chronicle’s circulation jumped to 13,000 and afterwards, fell back to 10,000.

In early 1881, when James Garfield was inaugurated U.S. President, Scripps wrote, “Hence we are writing the thing up from home [St. Louis], dating it from Washington and putting big headlines over it. Of course it is fraud, but there is no greater fraud than the doubt whether the country ever had a president with a title honestly acquired.”

The four newspapers were losing money, so in 1888, Scripps formed a “syndicate”– consolidated them– to achieve economies of scale and make them profitable. Nevertheless, he still imposed draconian, petty cost-cutting measures on his employees the following year, such as making reporters pay for work-related costs like transportation, pencils, business cards and promotional copies of the paper.

On the home front, Scripps’ wife had gotten pregnant seven times in twelve years. Four children lived to adulthood.

In 1904, Scripps knew it was a conflict to “… pollute its columns with noxious hucksterism. America’s press would never be truly free and honest until newspapers flatly refused to print any advertising matter at all.” Wealthy merchants could threaten to bankrupt a paper by not advertising. Scripps looked for a city where a paper could stay in business through circulation revenue alone. He thought the paper should be an instrument for fighting oppression and improving quality of life: “… better sanitation, better education, better and healthier and more moral amusements, better homes, better wages, better sermons in our churches, better accommodations on street cars.”

The two conditions required for success with an advertising-free paper are: it must be interesting and have prompt and dependable delivery. But for Scripps, the costs exceeded the profits because he had to pay printers, pressmen, reporters, circulators, rent, utilities, etc. This blogger believes that in the 21st century, many online publications have the aforementioned conditions; however, a third condition includes the fact that readers must be willing to pay for the product.

In 1915, Scripps invested in Max Eastman’s radical weekly “The Masses” – ironically named, because the weekly’s focus was not on the downtrodden, but America’s elite. Eastman’s 22 liberal contributors submitted articles for free. The paper still operated at a loss; circulation was stagnant. There is nothing new under the sun.

Scripps wanted his teenage son Bob to work, saying “I do not want to you to be a simple onlooker and student and critic of life…” Around 1913, Bob had an affair with the wife of his father’s business partner, just like in the movie “The Graduate” (1967). Only, Bob was under 18 years old. There is nothing new under the sun.

Unsurprisingly, Scripps was a cynic. He was “… convinced, rightly or wrongly, that altruism, which is almost universal, is still almost universally a minor motive in a man.”

Read the book to learn the history of the wire services, how the people at the Scripps newspapers coped with local political corruption, how they shaped policy in Washington, survived natural disasters and wars, company power struggles, and the consequences of the Scripps family’s alcoholism.