So, You Have a Headache?

On Executions

I live in the state of Texas. The state executes more individuals than any other state in America. The fact that I have not thought a great deal about this is related more to the fact that I try to live my life so that the ultimate penalty is not a factor in my life, rather than my not thinking much about it. However, with the number of executions in America being performed with differing and alternate drug cocktails, and the number of people commenting on the length and apparent 'painfulness' of the death of inmates, I thought to make a few comments. While I have not observed any such executions, the description of inmates 'gasping' for minutes to hours after receiving the 'lethal' injection sounds like agonal breathing. Agonal breathing occurs when an unconscious person suffers ischemia or hypoxia, and is the last stage of respiration before apnea, or complete lack of breathing. The method that executioners use to kill someone is to stop the executioners breathing, so that the body dies of lack of oxygen. The fact that these 'alternative' cocktails seem to take so long is a testament to their inefficiency, not their methodology. My understanding is that physicians (ie MDs and DOs) will not participate in an execution, due to their oaths to protect life. So you have individuals with less than complete medical training and understanding planning and performing the execution on behalf of the state. Then there is the issue of obtaining the specific drugs that would perform the most 'efficient' execution, where execution is measured, I guess, by the duration from injection to death. The published story of the latest execution in Arizona indicated the inmate was injected with a mixture of a benzodiazepine to cause unconsciousness, followed by an opiate to induce respiratory depression. The inmate took more that several hours to die, and exhibited 'gasping' breath types. While the choice of the two medications might have been made strictly by the availability, it is a reflection of the lack of medical knowledge by those individuals to try to execute someone with that drug combination. Opiates, while causing respiratory depression, are a poor choice for a drug to cause apnea and brain (and therefore body) death. While many people die of opiate overdose, it has rarely been proven that the opiate was the cause of death. Many times, the death is a result of other drugs taken with the opiate, such as alcohol. Opiates are a poor choice to kill someone. As I mentioned earlier, I have not pondered deeply the right of the state to execute an individual. When I was practicing medicine, which I did only for a short time, there where procedures I would not have participated in due to personal beliefs, one being performing an execution. However, if the state is going to insist on performing an execution, I think that it should at least learn how to do in the "best" way possible, if such a thing exists. When a patient is undergoing a surgical procedure, say for thoracic surgery, the anesthesiologist induces deep unconsciousness and then paralyzes the skeletal muscle system. This renders the patient unable to breathe on their own, and the anesthesiologist places the patient on a respirator to breathe for the patient. Without the respirator, the patient will die within 4-7 minutes from anoxia. This is exactly the method that the state should use to execute an inmate, if they wish to be "efficient" and merciful. (If you can call executing someone merciful.) These drugs are used in hospitals daily. There are alternative drugs for causing muscular paralysis. There are alternative drugs for inducing unconsciousness. I have to ask, if the state is so powerful that it can take the life of one of their members, is it so weak that it can't procure the necessary drugs to so in a proper fashion? Or are its workers so incompetent or lazy that they can't execute the power of the state properly? This article in the Royal Society of Chemistry, outlines the triple drug cocktail that mimics surgical anesthesia for inducing unconsciousness, muscle paralysis, and heart stoppage. It notes that as far back as 2007, executions by this method caused external signs, such as 'gasping', that caused observers to question the method of execution. Here's another article, an interview with an anesthesiologist. Now, with states deviating from the most ideal drug combination, is it any wonder that people question the methods being used? Also, in a Florida cases, the executioners couldn't even place the catheter properly into a vein, so that the drugs could speed directly to the heart and brain, the site of their action. Surely this is a sign of true incompetence of the state to perform its function. I have had trouble placing a needle into a vein in patients, but I never injected a drug without first drawing back and ensuring the needle was in a vein and had free flow of blood. If an airline pilot could't land a plane, he wouldn't be allowed to fly. If bus driver couldn't keep his bus on the road, he would lose his license. The state is responsible to see that individuals that can hazard life by their performance due so properly. Likewise, the state is responsible for seeing that the executioner, even when taking a life, does so properly. Inmates scheduled to die have the right to a merciful death. Otherwise is cruel and unusual punishment, outlawed by the Constitution. One thing that is interesting is that here in Texas, dogs and cats can't be executed except by sodium pentobarbital. Furthermore, there are mandatory training programs that are required for individuals euthenising a dog or cat in Texas (Sec. 821.055). Could it be that we have better standards of care for our animals then our inmates?

The Rule of Law

I've been reading several books recently trying to figure out why America is, ahem, "slowing down". Two that shed some light on the mystery include Niall Ferguson's The Great Degeneration and Philip K. Howard's The Rule of Nobody. I haven't finished Ferguson's book, but his examination of "The (English) Rule of Law" seemed a perfect tie-in to Howard's entire book. Howard's thesis is that America used to function according to the Rule of Law, but that, starting in the 1980's, the flexibility and efficiency with government and courts had operated were taken away by the over-specification of laws. Ferguson contrasts the economic development of countries under common law, like England, and civil law, like France. Common law countries:

1. have stronger investor protections and provide companies with better access to equity financing than civil law countries, as manifested in larger stock markets, more numerous firms, and more initial public offering;
2. have better protections of outside investors relative to 'insiders', whereas French civil law countries have poorer protections;
3. make it easier for new firms to enter the market, as manifested in the number of procedures, number of days and costs of setting up a new business;
4. have more efficient (because less formalistic) courts, as measured by the time it takes to evict non-paying tenants and to collect a debt after a cheque has bounced;
5. regulate their labor markets less and therefore have a higher labor participation and lower unemployment rates than civil law countries;
6. have more extensive mandatory disclosure requirements, which again encourages investors; and
7. have more efficient procedures in cases of insolvency, such as a hypothetical hotel bankruptcy.

You can purchase his book to get the footnotes; each point is footnoted with a study.

He goes on to quote:Legal investor protection is a strong predictor of financial development...[as well as] government ownership of banks, the burden of entry regulations, regulation of labor markets, incidence of military conscription, and government ownership of the media...In all these spheres, civil law is associated with a heavier hand of government ownership and regulation than common law...Civil law is 'policy implementing', while common law is 'dispute resolving'.And this is the tie to Howard. America, inheriting a common law tradition from England, used to implement the Rule of Law much more in a fashion of resolving disputes. However, can anyone look at America's modern mode of law and government and claim that we have not strayed into the policy implementing arena? And why? According to Howard, it was a reaction to the 1960's, where America was forced to look at it's shortcomings. Looking at Jim Crow and a corrupt ('I am not a crook') president and no longer trusting the ability of government and judges to have any flexibility or interpretation of the law, the individuals that wrote the laws started writing law in such detail and minutiae to prevent any interpretation or flexibility. And we, Americans, wanted that, because we no longer trusted our judges to interpret the laws or trusted government workers to implement or interpret a law. But by taking away the flexibility we deviated from the common law heritage, and would up with something far worse: an ungovernable system.

Our tax code is so complicated that no one can possibly understand it, except those who specialize in it. Dodd-Frank, the 2010 law that is supposed to prevent another financial melt down is so complicated it is still not implemented. Section 342 requires the regulatory bodies that are to "promote the financial stability of the US" to establish "An Office of Women and Minority Inclusion". My point is not that we don't have problems with too few women and minorities in our workplaces and in the regulatory bodies. My point is that we are developing a morass of laws and regulations and guidelines and findings and "stuff" that is impossible to perform under. Certainly impossible to achieve within.

The 1946 Academy Award Best Film was "The Best Years of Our Lives". The movie is about three WWII vets who ride home in the same B-17 to Boon City. Fredrick March is the banker who is thrust into the spot of evaluating Vets requesting GI-Bill loans. His board is giving him pressure to "be responsible", "look at collateral", be a banker. At a dinner celebrating his promotion, he get's drunk and tells the other bankers a story, about when he was ordered to take a hill. He says: "So I told them, but sir, I don't have any collateral. So we didn't take that hill, and we lost the war." He then tells them that the bank is going to trust the Vets, give them the loans, because their war accomplishments and their character is their collateral. And, of course, those Vets did prove their collateral. That movie was in 1946, and America did very well over the next several decades. Of course, the rest of the world was in ruins. And not everything America did over the next few decades was right or just or noble. But Americans trusted each other, its government and its courts. It lived by the Rule of Law.

America lost that trust, and tried to replace it with a rule for every situation. Don't trust a judge; codify the sentences. Don't listen to a bureaucrat, spell everything out in the rules. Until there are now just too many rules, too many laws. Any more, and America will sink under all the laws.

"HOUSE PASSES BILL TO AVERT 'CONSTRUCTION SHUTDOWN' " and Illustrates all that is wrong in Washington.

The House passed some short term funding to keep the Highway Trust Fund solvent until next May, thereby kicking the can down the road just a little bit, and doing nothing to solve the real problem. Until Congress stops using stopgap funding and putting bandaids on top of bandaids, so long as hearings about Bengazi replace entitlement reform, as long as members of Congress are more interested in trashing each other and raising re-election fund than they are in working together: Congress will continue to be irrelevant to the rest of the country.

It's Time We Did a Little Comparison Shopping.

Hey, psst! You know that colonoscopy your doctor insisted you have last month? Did you know your doctor charges more than any other doctor in the city? Yeah, you want to know how much more? Well, I can't tell you. You can look it up. Any one can. But you can't publish the numbers. You can't set up an app so that the next guy who needs a colonoscopy can do a little comparison shopping. Even though you and I are paying the bill, either through insurance, or medicare, or through reduced salaries every paycheck. Why can't anyone publish the numbers? Because medicare says so. Even though we, as taxpayers, pay the bill. As part of the Obama Administration's efforts to make our healthcare system more transparent, the Centers for Medicare & Medicaid Services (CMS) prepared and released a data set that lists the numbers and costs of all the services provided by physicians and paid for by Medicare in 2012. You can get the data set here. For every different procedure performed by each doctor, the data set lists the number of times the doctor performed the service (delivering a baby, replacing a hip, giving a facet-block injection), the average amount (s)he billed for the service, the average amount allowed for the procedure, and the average amount paid to the doctor. Great stuff, right? Time to do a little comparison shopping, right? It would make a great app! Put in your city, the operation you need, and see which doctor is the most expensive, which is cheapest, maybe select one in the middle? Or that great surgeon your neighbor loves, maybe rule him out 'cause he's twice as expensive as anyone else. Any other business in the market, but not healthcare. The data set has a very restrictive license.

"You, your employees and agents are authorized to use CPT only as contained in the following authorized materials of Centers for Medicare and Medicaid Services (CMS) internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid or other programs administered by CMS." "Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza, 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885. Applications are available at the AMA Web site, http://www.ama-assn.org/go/cpt."

That's the good old American Medical Association, arm-in-arm with the Centers for Medicare & Medicaid Services that want to make all that cost data "more transparent". Maybe they just want to keep the good old over-priced system running, where the insurance companies and the hospitals and the doctors divide up the pie, and keep the customer, the patient, in mushroom mode. Of course, all this medical information is too important to allow the patient to see it; they might get confused, might not understand just exactly why they need to be charged so much. Even though that poor patient pays more than twice the average amount as patients in any other industrial country, and get results that put that poor patient out of the top 20 in terms of results. Seems to me it's time we demanded that we be given the data we have paid for, to do what we wish with it. It's time we be allowed to do some comparison shopping. It's time the patients were treated like consumers, to be given a service, and treated, rather than a condition to be billed. Hospitals and physicians in Sweden and India are getting better, and cheaper, results, better outcomes, and costing less, by improving their care. Our system is working hard to preserver the status quo, and outcome we can't live with.

Man's Footprint on the Earth

Have you ever pulled up Satellite view in Google Maps and looked down on the Earth, as if you were in a plane gazing out and down through the window? If Google has given us nothing else than the ability to virtually "fly" across the Earth, looking down at wherever we wish we could be, this is the best for me. I have spent many a time, using Google maps to try to find a place to live or my next vacation trip, or just looking at a place that I wish I could go to live. I expect to be moving soon, and I was looking at some of the smaller communities around where I expect to be soon. I was looking at the area south-west of Dallas-Fort Worth, and I noticed a huge number of pale tan "spots" fairly uniformly scattered around.

Zooming in a bit, I could see them all over, but I couldn't figure out what they could be, to be so common in North-Central Texas. Wind turbines? No, lots of them in West Texas, or along the coast. Not Minuteman ICBMs, they are all in the Dakotas. I was stumped.

Each seemed to have its own small driveway in, with a wide dirt area, and close to the roads. I was still stumped.

Zooming in all the way, it finally hit me. Oil! Good old Texas oil and gas wells, and the associated storage tanks. Oil, petroleum, has become controversial. The industrial revolution would never has gone as far as it did, and our civilization would never have grown as large as it has and become as technologically complex as it is on coal alone. And the climate change and sea-level rise and the other impacts we are seeing would not have occurred if we had never discovered oil. You could say that we owe almost everything we have now because of oil. Yet it is so easy to forget our footprint on the Earth, the impacts of our technologically complex, oil-fed society. We need to be reminded of it by looking at the Earth. I can almost understand how the climate-change deniers can deny the changes that are occurring. Sitting inside your air-conditioned office or riding in your air-conditioned limousine to the next campaign stop doesn't expose you to the real world. And that is a problem, because we can't begin to take on all those big problems our country faces when we don't even see them, don't want to see them, and (maybe) are paid not to see them.

How Spoiled We Are!

Today we live like kings and don't realize it. How spoiled we are! Let's compare our lives to the those of the ancient Romans. Tonight when you sit down to dinner, look up at the light that lights your table. That 100-watt bulb or 18-watt CFL is the equivalent of a slave on a pedal powered generator pedaling away to illuminate your table. How many cords of wood would you need to burn to cook your meals or heat your home this winter? How much work is done when you burn one gallon of gasoline in your car? What is the value of that energy? Sure, about $4, right? Crank up your car and drive from home until that gallon runs out. Now, push your car back home. How much was that gallon worth? $4? How much would it cost you to cover the same distance in a wagon pulled by 200-400 horses? How much would all that hay cost? The petroleum we are using was assembled by millions of years of sunlight, harvested by plants and then crushed and baked by the weight of rocks and sediments over millions more years. We are about halfway through burning all the oil we have ever used, just in about 150 years. In much less than the next 150 years, we are going to need alternatives. We simply can't burn the remaining the same way as the first half. We need to start now on the alternatives, as well as save as much as possible of the remaining as a feedstock for the synthesis of products like pharmaceuticals and dies that only come from oil. We need programs in America like the Germans instituted to put solar cells on homes to generate electricity from sunlight. We need better batteries to store wind- and solar-generated power to feed back into the grid when the sun isn't shining and the wind isn't blowing. Finally, we need to value our remaining oil realistically to match the elevated lifestyle it gives us. We live like rulers, like kings of old, through the application of cheap oil. We should become good stewards of our energy resources, so that our grandchildren and their grandchildren won't have to live like slaves.