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Dear Luc,

Just as I write this my old friend from Liverpool has rung me to say her son 
has just caught an MRSA  infection, she says, for the 5th time (he is a 
kidney patient on dialysis). In the UK despite ten years of reminders from 
the Parliamentary Health Committee NHS only started recording Hospital 
Acquired Infections at all four or five years ago and by type two or three 
years ago. Unbelievable but true.

Yes Pask would talk of discussing his symptoms with a General Physician as 
the right way with these things. That is if you can find a General 
Physician- they are very rare in London.  Most are specialists.

But there is a straight forward "decision making under uncertainty" 
solution. Say you have a diagnostic error rate of 25%. If you can have ten 
physicians agree the diagnosis independently (blind of previous findings) 
that will produce and error rate of 1 part per million. Accurate diagnosis 
would save a lot of time and money. But to the doctor a compliant agreeable 
patient is what is wanted.

However note  in UK 50% of death certificates are wrong so establishing a 
"Gold Standard" post mortem confirmation of diagnosis is elusive unless 
randomly selected patients (why not all? or a lot more than the 5% we get 
here rather than the 10% recommended) are subject to Post Mortem 
examination.  Heart disease and cancer, for example, are routinely over 
diagnosed. See http://jcp.bmj.com/cgi/content/full/55/7/499

There's a doctor and newspaper columnist called Ben Goldacre a self 
appointed Bad Science expert. I posted these error rates to his website. He 
went into total denial as my posting mysteriously disappeared. "Never 
happened before" he said then added "we though you were just knocking the 
NHS".  He doesn't know the bounds on his own discipline. Trouble is critics 
of science are rare I guess its one role for the cybernetician. But there 
are radical souls. In 2004 Richard Smith the editor of the British Medical 
Journal asked "Is surgery an anachronism in an evidence based age?" and 
complains that medical journals have become the creatures of the 
pharmacology industry "rife with fraudulent research". Then there's a GP, 
Vernon Coleman, who writes a book "How to stop your doctor killing you".

Best

N.
--------------------------------------------------
From: "Luc Hoebeke" <[log in to unmask]>
Sent: Sunday, November 29, 2009 3:48 PM
To: <[log in to unmask]>
Subject: Re: The Next 100 Years ($2.50 causes ***in hospitals***)

> Dear Nick,
>
> The medical ethos is the same as the "would be climate healers".  Medicine 
> as a science is a misnomer, it is still an art. Art is not  interested in 
> mastering or controlling "reality", but in interacting  with it and 
> continuously learning from successes and failures in those  interactions. 
> The expectation that MD's could be responsible for my  health, my life is 
> a way in which the patient also colludes with the  attributed power of the 
> medical profession. Patients also could  require from their nurses and 
> their doctors that at least they behave  as human beings relating to human 
> beings and not as mechanics dealing  with bladders, arteries, etc. But 
> again, shifting responsibility is  the name of the game. So eg., at once 
> euthanasy becomes a problem for  the doctors, the lawmakers and the 
> judges.
> Remember that our dear friend Arthur is the first one interested in 
> flight safety, because he is the pilot. Perhaps patients and their  family 
> should have a bigger say in hospital safety, because they are  the pilots 
> in that case. But I am sure that not many of them would  like to take up 
> that responsibility. Much easier is the blaming game.
>
> Kind regards,
>
> Luc
>
>
> Op 29-nov-09, om 16:10 heeft Nick Green het volgende geschreven:
>
>> Right yes, Luc, a rather poor joke by me. You can see Latour  modernity 
>> by-passed in, of all things, medicine.
>>
>> In UK news today there's a text book example of the irresponsible 
>> science- politics nexus from the basically unaccountable National  Health 
>> Service. Unaccountable because error rates have no formal  controls and 
>> were barely counted at all until recently. Reporting of  errors by 
>> anybody is resisted rather than welcomed as vital feedback.
>>
>> Some years ago Sir Brian Jarman (ex Chairman of British Medical 
>> Association- the Doctors trade union) realised that people die in 
>> hospital for the wrong reasons. His analysis of patient risk and 
>> viability bears some study. He addresses preventable errors (e.g.  Poor 
>> nursing care, misdiagnosis, filthy wards producing unnecessary  deaths) 
>> in UK hospitals. Learned references are given at the  Imperial College 
>> site.
>>
>> BBC Reports
>> http://www.guardian.co.uk/society/2009/nov/29/nhs-hospitals-safety-report
>> Dr Foster website
>> http://www.drfosterintelligence.co.uk/
>> University base
>> http://www1.imperial.ac.uk/medicine/about/divisions/ephpc/pcsm/research/drfosters/
>>
>> Usual story: ghastly bureaucrats with no incentive for quality doing 
>> fuck all or nothing as we say in polite society. Add in the elite: 
>> surgeons who by and large won't work at weekends,  on Fridays or 
>> Wednesday afternoons.
>>
>> The name Dr Foster ( a character who avoids unpleasantness) comes  from 
>> the children's nursery rhyme. As a word "foster" means nurture.
>> http://en.wikipedia.org/wiki/Doctor_Foster
>>
>> The NHS is basically a low pay uneducated culture: in hospitals  about 
>> 75,000 autopoietic and underworked doctors are supported by  more than 1 
>> million (mostly low pay) staff serving, at any one time  about, 185,000 
>> patients in a bed. That is an extraordinary variety  equation. Fewer 
>> staff getting in each others way and more hand  washing would be the 
>> "$2.50 relay" solution here. Far too much  statistically naive (false 
>> positive rates are largely unknown) time  wasting ritual bullshit that 
>> only the gullible can believe survives  in UK's NHS -and elsewhere I 
>> wouldn't doubt.
>>
>> Best
>>
>> N.
>>
>>
>> From: Luc Hoebeke
>> Sent: Sunday, November 29, 2009 8:23 AM
>> To: [log in to unmask]
>> Subject: Re: The Next 100 Years ($2.50 causes)
>>
>>
>> Dear Nick,
>>
>>
>> No missing vowel. In Serb and Croat languages this r is pronounced  er as 
>> in her.
>> Having followed this thread, I learn how the old responsibility  avoiding 
>> mechanism between Pope and Emperor has shifted towards  Science and 
>> Politics. We never have been modern as Bruno Latour  eloquently argues in 
>> his book with the same title.
>>
>>
>> Kind regards,
>>
>>
>> Luc
>>
>>
>>
>>
>> Op 29-nov-09, om 03:17 heeft Nick Green het volgende geschreven:
>>
>>
>>
>> Brklacic an imperfect clone of Stafford? The missing vowel in his  name 
>> surely proves this. Anyway New Scientist went with this saying  this week 
>> "Climate researchers have been inundated with what feels  like malicious 
>> demands for their data" Why aren't the data  downloadable and come to 
>> that how about a listing of their program -  like the Meadows etc did 
>> with Limits to Growth.
>>
>>
>> From: russell_c
>> Sent: Saturday, November 28, 2009 9:53 PM
>> To: [log in to unmask]
>> Subject: Re: The Next 100 Years ($2.50 causes)
>>
>>
>> And just when you thought is was safe to believe the simple story:
>>
>>
>> "Hacked climate change email furore" -- Hacked climate change emails  - a 
>> tempest in a teapot or a real storm? Paul Jay talks to Michael  Brklacic, 
>> November 28, 2009.
>>
>> http://therealnews.com/t2/index.php?option=com_content&task=view&id=31&Itemid=74&jumival=4533
>>
>>
>> Again, at the end, "... don't latch on to one or two pieces of  [$2.50] 
>> evidence ...", hmmmm?
>>
>> rc
>>
>>
>>
>>
>> On Sat, Nov 28, 2009 at 10:30 PM, Doug McDavid  <[log in to unmask]> 
>> wrote:
>>
>> This thread alone is worth the price of admission!  Great stuff!
>>
>>
>> On Sat, Nov 28, 2009 at 4:28 AM, Frank Wood <[log in to unmask]
>> > wrote:
>>> Ha ha, love the "marginal seat theory!" Where on earth did we get  the 
>>> idea
>>> that we humans are rational beings!
>>> Yeh, we're extremely rational in the context of greed and power and  the
>>> notion of power extends to the "I'm right and you're wrong"  attitude. 
>>> That
>>> is why your carefully balanced approach is the way to go.
>>> Regards
>>> Frank
>>> On 28 Nov 2009, at 12:12, russell_c wrote:
>>>
>>> Thanks Frank,
>>>
>>> ... and yes, there is that zeal is creeping in, and unfortunately,  many
>>> opportunists can smell a "win" ... and that will surely attract the 
>>> "lovers
>>> of winning" ... and so, off we go on another round of tail chasing. 
>>> It's not
>>> that they are completely wrong, just not completely right, and the
>>> simplicity of over self confidence is always a concern. One step  closer 
>>> to
>>> blind fundamentalism?
>>>
>>> Oh, and thanks for the agricultural angle. Guess what: not only is 
>>> Australia
>>> not responsible for the coal based greenhouse gasses that China 
>>> produces
>>> from burning the stuff we export to them; but also the farming  lobby 
>>> here
>>> has successfully managed to get exclusions from the emissions  trading 
>>> system
>>> being proposed! It is called "marginal seat theory" I think! (see:
>>> http://www.news.com.au/couriermail/story/ 0,23739,26350929-953,00.html )
>>>
>>> Now we know there are a lot of sheep (and cattle) down here, and  some 
>>> even
>>> have learned to walk on two legs, and vote, but this type of partial
>>> partisan response will just distort the whole by over weighting the 
>>> load on
>>> those other parts that cannot afford the right lobbyists.
>>>
>>> You have nailed it here imo -- "... develop sustainable societies  that
>>> effectively respond". Unfortunately, while economics theory and  praxis
>>> cannot operate outside/beyond the "Growth" paradigm, we will just  have 
>>> to
>>> communicate in that weird language that growing small is not  shrinking!
>>> Pulling out is not surrendering, stopping is not failing, etc...
>>>
>>> Mind numbing! So, surely, one of the functions of groups like this is
>>> ensuring that we can see more clearly through what is happening and
>>> communicate with others as Margaret Mead implied:
>>>
>>> I specifically want to consider the significance of the set of
>>> cross-disciplinary ideas which we first called 'feed-back' and then 
>>> called
>>> 'teleological mechanisms' and then called 'cybernetics' -- a form of
>>> cross-disciplinary thought which made it possible for members of many
>>> disciplines to communicate with each other easily in a language  which 
>>> all
>>> could understand. (cited in
>>> http://www.stanford.edu/group/SHR/4-2/text/foerster.html )
>>>
>>> Unfortunately reasonable climate science speculation (e.g. Lovelock  et 
>>> al)
>>> is being used for partisan corporate politics and unsustainable  policy
>>> implementation! BAU I'm afraid.
>>>
>>> Cheers
>>> Russell
>>>
>>> p.s.  Oh, BTW, the other $2.50 cause is the 80% of CO2 human activity
>>> systems living on less than $2.50 per day! And as mobile phone 
>>> penetration
>>> heads into the exponential in developing economies (e.g. see  various 
>>> World
>>> Bank reports) we will see more awareness of the differentials  between 
>>> rich
>>> and poor ... and we may start to hear echos of those famous 17th C 
>>> French
>>> words "Let them eat cake!".
>>>
>>> On Sat, Nov 28, 2009 at 7:19 PM, Frank Wood <[log in to unmask]
>>> >
>>> wrote:
>>>>
>>>> Great piece of writing Russell. The biting irony is that it is the
>>>> environmentalists that are the reductionists with their $2.50 relay
>>>> attitude.
>>>> There are so many vested interests on both sides of the debate  that 
>>>> any
>>>> genuine enquiry into what should be done gets lost.
>>>> To add to the complexity, I saw part of a TV programme a few days  ago 
>>>> (it
>>>> was to do with Obama's carbon reduction campaign) which said that  most 
>>>> of
>>>> the "greenhouse gas" was caused by food production.
>>>> Here is an article that lends support to this assertion.
>>>> Rearing cattle produces more greenhouse gases than driving cars,  UN 
>>>> report
>>>> warns
>>>> http://www.un.org/apps/news/story.asp?NewsID=20772&Cr=global&Cr1=warming
>>>> and another article on the proposed remedy.
>>>> 'Burpless' Grass Cuts Methane Gas From Cattle, May Help Reduce  Global
>>>> Warming
>>>> http://www.sciencedaily.com/releases/2008/05/080506120859.htm
>>>> but here again dear old complexity rears its head again. And of  course
>>>> there is the issue of gene modification. Oh dear.
>>>> We expect in our campaign to cut down CO2, that third world  countries 
>>>> to
>>>> cut down or cease logging. Of course these countries see through our
>>>> hypocrisy. Consider that the UK used to be almost covered in  forests 
>>>> and
>>>> now....
>>>> I still think that we must develop sustainable societies that 
>>>> effectively
>>>> respond to climate change (whether it be warming or cooling) and  worry 
>>>> less
>>>> about Gaia as that old girl is going to do her own sweet thing  anyway.
>>>> Frank
>>>>
>>>> On 28 Nov 2009, at 00:55, russell_c wrote:
>>>>
>>>> Hi Nick,
>>>>
>>>> Re: $2.50 causes
>>>>
>>>> Yes, I still don't know whether I fully 'get it' in respect to this
>>>> example either. I came to a similar conclusion as yourself about the
>>>> multiple causes -- with one additional aspect: it was also a  comment 
>>>> about
>>>> reductionist ways of thinking in respect to complex problems.
>>>>
>>>> I think the author was pointing to the phenomena of a whole 
>>>> organisational
>>>> system straining to get the simple answer as a cause. It (ie those  in 
>>>> it)
>>>> fears the looming circularity of deep systemic investigation.
>>>>
>>>> The $2.50 climate change cause 'issue' is said to be CO2, or  'carbon',
>>>> reflecting the escaping output sun rays/energy and thus bouncing  them 
>>>> back
>>>> to earth.
>>>>
>>>> And of course, as in all these things, the underlying assumptions  are 
>>>> not
>>>> often questioned. We assume that this heating phenomena is not the 
>>>> Gaia
>>>> system (of which we, by definition, must be a significant thinking 
>>>> part)
>>>> working in its own time scale to extend our happy modern existence 
>>>> between
>>>> the next pending 10,000 year interglacial cold cycle.
>>>>
>>>> One can take that 1974 Time article and replace a few key words  and we
>>>> have the same media-message being run today -- the sky will fall,  the 
>>>> crops
>>>> won't grow, the hens won't lay ... touching almost every deeply  held 
>>>> often
>>>> neurotic fear we have as a society, culture and empire. So how do  we 
>>>> know
>>>> the truth? We cannot, and so acting on the precautionary principle  is 
>>>> the
>>>> best defense. But again, what to do, or not do?
>>>>
>>>> What I'm really pointing to is the same phenomena that says bin  Laden
>>>> caused the Twin Towers attack and not the red flag of US foreign 
>>>> policy etc.
>>>> It is the cultural/systemic blindness to the bigger systemic 
>>>> picture.(*) I
>>>> saw it as a comment on the way 'the system' works -- i.e. who are  the 
>>>> 'they'
>>>> that will find the cause? IMO, they are the believers in their own
>>>> confidences -- whatever side they take in a situation of concern.  As 
>>>> Frank
>>>> said: we need more humility by scientists.
>>>>
>>>> But the rush is on. And so now it is not science and its quest for 
>>>> truth
>>>> and answers: it is politics and its power games. But what else can  be 
>>>> done?
>>>> Adaptation is the secondary theme in the climate change debate but  it 
>>>> is not
>>>> much focused on by the media. Why? Because it means operating  system 
>>>> change
>>>> (to use the computing analogy), not just program change. And can  we 
>>>> trust
>>>> systems programmers? Who are they working for? I think the elites  are 
>>>> not
>>>> yet certain of where they can stand safely in the wash up, and so 
>>>> things are
>>>> more complex than they need to be.
>>>>
>>>> Instead of CO2, why don't we start with population, blame the  medical
>>>> sciences for stopping malaria, polio, plague, etc without also 
>>>> implementing
>>>> birth control and sustainable socio-economic reform? What about  the 
>>>> other
>>>> 'club of rome' that will not support birth control etc? We will 
>>>> willingly
>>>> look at plant food (CO2) as the enemy, but not the local doctor  who is
>>>> working beyond his/her wellbeing limits, usually on a healthy  state 
>>>> subsidy,
>>>> to save CO2 producing humans (you & I) who should perhaps cease this
>>>> function permanently. Where do we stop? A $2.50 cause is all we  need 
>>>> to stop
>>>> the process of systemic change occurring naturally.
>>>>
>>>> One opportunity all this offers is a wide window on science studies.
>>>>
>>>> Russell
>>>>
>>>> (*) BTW, on my way out the door yesterday (c.o.b. Friday) a young  lady
>>>> came running past straight from a 1-day management guru seminar by 
>>>> some
>>>> professor x, and showed me a slide that said tomorrows leaders  will 
>>>> need,
>>>> guess what, yes, "systems thinking". Oh, dear, here we go again! I 
>>>> responded
>>>> that it will drive them mad if they try, and that imo leadership  is so
>>>> 'yesterday', as is management -- and that we are entering a heroic 
>>>> stage.
>>>> G-d help us!
>>>>
>>>>
>>>>
>>>> On Fri, Nov 27, 2009 at 11:39 PM, Nick Green 
>>>> <[log in to unmask]
>>>> >
>>>> wrote:
>>>>>
>>>>> Thanks Russell.
>>>>>
>>>>> Re your previous on the $2.50 relay.
>>>>>
>>>>> Both Stafford and Gordon emphasised multiple causes. So why did  the 
>>>>> relay
>>>>> fail etc.  I have to say I didn't really "get it" at first  because 
>>>>> like any
>>>>> other operational Joe I would go to stores and replace the relay  job 
>>>>> done.
>>>>> But Pask and Beer wanted to look at how the relay was designed, 
>>>>> managed etc
>>>>> I eventually concluded. One can be very thick sometimes.  Pask 
>>>>> preferred
>>>>> "produces" rather than "causes". It's that circular causality  problem 
>>>>> again,
>>>>> Does the spark cause the explosion or the presence of petrol  vapour. 
>>>>> We know
>>>>> the product of spark, petrol vapour and oxygen is an explosion  but 
>>>>> there is
>>>>> no single cause. Connect a bulb to a battery. Go away. Come back,  The 
>>>>> bulb
>>>>> is out. Why? There's no way of telling until each component is  tested 
>>>>> in
>>>>> another trusted circular system: the bulb, the 4 connections, the  2 
>>>>> leads,
>>>>> the battery. All this means something for Climate change etc- not 
>>>>> sure quite
>>>>> what-yet.
>>>>>
>>>>>
>>>>> From: russell_c
>>>>> Sent: Friday, November 27, 2009 10:25 AM
>>>>> To: [log in to unmask]
>>>>> Subject: Re: The Next 100 Years (CSIRAC)
>>>>> If anyone is interested in this CSIRO 'report card' released  today 
>>>>> (27th)
>>>>> then see:
>>>>> http://www.csiro.au/multimedia/Marine-report-card.html and
>>>>> http://www.oceanclimatechange.org.au/content/index.php/site/ welcome/
>>>>>
>>>>> On Wed, Nov 25, 2009 at 8:00 PM, russell_c <[log in to unmask]>  wrote:
>>>>>>
>>>>>> Nick
>>>>>>
>>>>>> I'm not sure this is on topic, but this CSIRAC story (below) came
>>>>>> through today and caused me to reflect on a comment (by Staford  I 
>>>>>> think?)
>>>>>> that "they will find the cause" to a major US power outage (a  $2.50 
>>>>>> relay?).
>>>>>>
>>>>>> Why are we blaming climate change causes on CO2 when the energy
>>>>>> increases have a lot to do with the complexities related to  power 
>>>>>> station
>>>>>> upgrades needed for PC proliferation, building air-conditioning 
>>>>>> capacity
>>>>>> increases, flat plasma screens and additional housing demand due  to 
>>>>>> family
>>>>>> break down etc.
>>>>>>
>>>>>> In respect to heat and power production -- are there any  estimates 
>>>>>> of
>>>>>> the energy generation involved in the growth of ICT and Internet 
>>>>>> over the 60
>>>>>> years from when this machine came to be? (there is a picture  with 
>>>>>> the story)
>>>>>>
>>>>>> Is this technology phenomena equally the cause of climate change  and 
>>>>>> can
>>>>>> it be somehow statistically correlated to CO2 increases?
>>>>>>
>>>>>> Russell
>>>>>>
>>>>>> Australia's first 'iPod' marks 60th birthday
>>>>>>
>>>>>> "The CSIRAC - Commonwealth Scientific and Industrial Research
>>>>>> organisation Automatic Computer - is housed in the state's  museum 
>>>>>> and has
>>>>>> today been granted heritage listing as part of its birthday 
>>>>>> celebrations.
>>>>>>
>>>>>> It is the first computer ever to be made in Australia; the fourth
>>>>>> computer ever to be made in the world; and the only first  generation
>>>>>> computer that remains intact. . . ."
>>>>>>
>>>>>> http://www.abc.net.au/news/stories/2009/11/25/2752781.htm
>>>>>>
>>>>>>
>>>>>> [snip]
>>>>>
>>>>>
>>>
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>>
>>
>>
>> --
>>
>> Doug McDavid
>> [log in to unmask]
>> 916-549-4600
>>
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