Who Has The Top Schools? The Best Students? The Most Prestige?

I started to setup a testing environment for development of web code using the AngularJS library. As a Python programmer, I have gotten used to using the interpreter to develop in a more-or-less test driven fashion, using REPL (Read, Evaluate, Print, and Loop). Mozilla's C++ based open source JavaScript environment, Spider Monkey, has an interactive JavaScript shell, as well as full source for the whole environment.

I was curious about the implementation and started reading through the source. This is the complete JavaScript environment that supports all of the platforms that Firefox runs on, including Linux, Mac, Windows, Intel ARM, MIPS, Sparc, the whole Universe. (Well, the whole planet, anyway. Maybe that's why the fox is embracing the entire globe.) Major subdirectories in the SRC tree include ASSEMBLER, BUILD, CTYPES, DEVTOOLS, JIT, JIT-TEST, PYTHON, SHELL, TESTING, TESTS, V8, VM, and a few others. SRC.ASSEMBLER.ASSEMBLER includes C++ code for ARMAssembler, MacroAssemblerARM and MacroAssemblerX86.

Looking at the (C) Directives in the comment blocks, it was interesting the different companies and schools that had contributed "chunks" of knowledge towards definition of this JavaScript cross-assembler. The Sparc code was from (C) Mozilla, while the MIPS code was (C) Apple (no surprise!). The biggest surprise to me was the (C) for ARM assemblers - University of Szeged. It is a large research university in Hungary which is located in Hungary's third-largest city, Szeged. According to the Academic Ranking of World Universities by Shanghai Jiao Tong University (2003, 2004, 2005), the University of Szeged was ranked 80-123rd in European Universities and first in Hungarian Universities.

I shouldn't have been surprised. John von Neumann, a Hungarian mathematician demonstrated in 1945 the concept of the stored-program technique of computer architecture which allows computers to execute different programs without hardware modification. He demonstrated the use of a main routine calling subroutines stored in libraries. While Edward Teller (another Hungarian!) is generally regarded as the father of the H-Bomb, it was von Neumann that "proved" through modeling that Deuterium, Tritium and Lithium Deuteride would burnwhen ignited by an atomic bomb. In 1946 von Neumann collaborated with Klaus Fuchs on further designs of atmic weapons, and in late 1946 von Neumann and Fuchs filed a secret Patent on Improvement in Methods and for Utilizing Nuclear Energy which used radiation implosion to compress Deuterium and Tritium for burning.

He became a member of the Atomic Energy Commission and participated in targeting studies for ICBMs, and helped develop the concept of MAD, Mutually Assured Destruction, as a method of stability.

When I took my first two courses in Computer Science some 25+ years ago, the Computer Science professor that made the greatest impression on me was Donald Knuth, and his three volumes on Computer Science. Donald Knuth cites John von Neumann as the most influential Computer Science professor.

Would You Go To This Doctor?

Healthcare, like government, is something that we could do better in America. American car companies learned to innovate after Japanese car companies surpassed them in cost and quality. Sweden has an aging population, just like the US (indeed like every other country), but it has reformed its state pension system, from projected insolvency (Social Security) to solvency. The overall labor productivity in America has increased by 1.6% per year over the last two decades, while the productivity for health care in America has gone down by 0.6% per year over the same period. One place the AMA could look is India, but would they buy it? Would you?

Devi Shetty is an Indian heart surgeon, trained at Guy's Hospital in London (quite prestigious). He performed the first neonatal heart procedure in India, and took care of Mother Teresa. He has taken the assembly line to health care. His flagship Narayana Hrudayalaya Hospital in Bangalore has 1,000 cardiac beds, compared to an average of 160 in American cardiac hospitals. He and his team of 40 cardiologists perform about 600 procedures a week in truly assembly line style. The sheer number of procedures allow his surgeons to acquire world-class expertise and specialize, and the hospital has true economies of scale in purchasing power. Individual surgeons perform 4-6 times as many procedures as American cardiologists. Richer patients pay more so that poor patients get free, but because of the economies of scale, the hospital can perform open heart surgery for about $2,000 versus about $100,00 in the US (cost; never mind the insurance issues here). Their success rate is as good as the best American cardiac hospitals. He has established a health-insurance program with local self-help groups that covers 2.5 million people for a premium of $0.11 (yes, 11 cents!) a month that provides one-third of his patients.

His group has built three other hospitals adjacent to his cardiac hospital in Bangalore; a trauma center, a 1,400 bed cancer center and a 300 bed eye hospital. They share common labs, blood banks, radiology centers, etc. and save from a common economy of scale. Shetty plans on increasing the number of beds in his practice to 30,000 over the next five years, which would make his the largest practice in the world. His hospitals have video and internet links with hospitals in India, Africa and Malaysia, so his staff can practice tele-medicine.

Finally, he is building a 2,000 bed hospital in the Cayman Islands that will offer Americans heart operations for less than half of what they pay in the US. Would you go to this Doctor?

Lest you worry over assembly line surgery, there was (I am not sure if he is still in practice now) a plastic surgeon that did breast implants in Houston, who had an operating room that featured four beds in a cross-shape that rotated. As soon as he finished with a patient, the next would rotate into position, while at stations 3 and 4, patients were loaded and unloaded.

America's Not So Best Healthcare System

After reading about Sweden's hospital system, where statistics about length of stay by disease (a direct indicator of health and recovery) by hospital are available to the people, I decided to try to find the same statistics for US Hospitals. Zip, zilch, nada. Oh, you can find averages for the US, averages for community hospitals, averages for non-federal hospitals, averages by year from 1950-1968, etc. etc. But try to find them for the hospitals in your city, so you can pick the best. No way.

Here is how it works: the longer you stay in a hospital for a given disease, the more likely you will either a. get another disease (generally a hospital-acquired infection) or b. die. Now, granted, individual cases of pneumonia or pancreatitis or liver transplant or whatever will vary by individual. But averaged over a patient population, the hospital that fixes 'em quicker will have better outcomes. So in Sweden, people can find out how their hospitals perform. And, not surprisingly, length of stay has gone down as the difference between the best and worst has decreased. Making the information available seems to stimulate improvement.

However, my goal of finding the corresponding statistics for US Hospitals was sidetracked by my investigation of the kinds of "improvements" that the US Hospitals/US Insurance companies/Health and Human Services are working on. America's not so best Healthcare System (#1 Switzerland, #8 Sweden, #24 USA; see is really a triumvirate, with the Medical Community saying what we need, the Insurance Companies saying what we can pay for and H&HS trying to regulate the other two. Our Healthcare System is sidetracked on trying to make sure that when we are struck by a turtle (either the initial encounter W59.21XA or subsequent encounters W59.21XD) or are burned due to water skis on fire (again, either the initial encounter V91.07XA or subsequent encounters V91.07XD) both the hospitals can properly code it (using the new ICD-10) so that the Insurance Companies will pay for it. And here's an interview, from PBS News Hour, with a consultant who can explain why that's a good thing.

Seriously, for the very small number of people who get bitten by a Diamondback and suffer tissue necrosis, it is very important that their medical records can distinguish them from the (equally) small number that get bitten by a Coral snake. And with the adoption of electronic medical records, it is no longer sufficient to rely on the physicians description of the disease. But having read Wendell Potter's Deadly Spin about the American medical insurance industry and its PR campaigns, I have to believe that some of the new codes were reactive to past payment fights, rather than attempts to improve patient care.

In today's information age, with the Internet providing us with so much of the information in the world, isn't it time that we get some information about how well our hospitals and doctors treat us? The American parents now know that American children perform about equally in math to Slovakian students at more than twice the cost. Naming and shaming needs to come to health care the way it has to education. And just like in education, with teacher's unions complaining about the comparison, hospitals and doctors will tell us that comparisons are "unhealthy". But it is not unreasonable for us consumers of health care to know how much a hospital costs, how quickly it heals, and what are the chances of surviving. Swedish health registries (open statistics) are no joke.

Figuring Out the Economy

I bought a loaf of bread yesterday at the local grocery chain here in Austin. It was a loaf of Pepperidge Farms Whole Wheat, weighing in at 24 ounces. I didn't notice the price in the store, not at the shelf when I picked the loaf, nor at the register when I paid. Today, as I was making a sandwich, I noticed the price on the closure tag: $4.29. Whenever I see the (escalating) price of a loaf of bread, I remember back to my Junior year in high school and my Latin teacher, who one day predicted that when the price of a loaf of bread rose past $1.00 there would be rioting in the streets.

Now this was back in 1974, and fortunately, his prediction has not come to pass, although there has been rioting in other countries when bread and other staples became more expensive. Who hasn't heard (mostly in history class) of bread riots in France (1725), Russia (Petrograd - 1917) or Richmond (1863). Revolutions and Civil Wars have accompanied (correlation, not causation) bread riots. Yet today, with bread having more than quadrupled (OK, expensive bread, not white) over 40 years, (10% per year) we accept it. I guess it's the old story of "How do you boil a frog?" The price increases, year by year, perhaps haven't seemed so much.

In comparison, my wages have gone up, on average, about 8% per year. Unfortunately, due to various events like an auto accident and rehab, changing jobs, changing home towns, recessions, I haven't earned those wages every day of every year since I entered the work force. I am fortunate to have skills (software engineering) that are in demand. Unfortunately, quite a number of Americans in the middle class have seen their wages stagnate and/or their jobs eliminated by globalization. To them, $4.29/loaf bread probably feels like something to cause a bread riot.

Over the past several years there has been an outcry against over-paid government workers. Scott Walker, governor of Wisconsin, broke the government worker's union over pay issues. However, I know of government workers here in Austin, doing valuable work for society, who make 1/3 of what I do. Take away their function, and the people of the community would be up in arms over their loss. Yet their pay scale forces real hardship on them.

I studied chemistry and medicine, yet despite attending a liberal-arts university, I never took a class in economics. Since the Great Recession, I have been reading a number of books on economics, trying to figure what happened. I was lucky (I guess) to have been in an auto accident in January 2008 and to have spent the year concentrating on my rehab, and not on the economy. So I didn't experience it firsthand, really. Instead, I got the effects throughout the "recovery". I wasn't willing to accept what I heard from Geithner or Greenspan or Obama or Santelli.

So far, the best book I have read for explaining the Great Recession is House of Debt, by Atif Mian and Amir Sufi. While both economists, this is one of the few books on economics that I have read that backs up each conclusion with data. So many of the economics books attempting to explain the Great Recession seem to limit themselves to logic arguments or word games, rather than any approach examining real data. Or else the authors work hard at proving their conclusions by eliminating the observations that don't fit their assumptions.

House of Data lays the case for the cause of the Great Recession on the huge increase in household debt that lead up to the 2007 crash. The authors present many previous financial crises that arose from the same cause. Never mind whether the debt expansion came from eased lending restrictions to poor (quality) borrowers or from predatory load behavior chasing origination fees or big banks harvesting securitization fees or politicians seeking higher home ownership statistics or a president intent on waging two wars without economizing (and household saving). Or all of the above.

Where do we go from here? Will continued globalization result in the decline of America? Or can more American companies do what Apple has done - redefine the state of the art. Will capitalism continue to dominate the world's economies in its current form? Or will the free flow of information and technological innovation produce the Zero Marginal Cost Society that some believe will provide greater equality through cheaper production? Will bread top $5.00 a loaf and bring about the second American revolution?