Dr. Robert Replogle's Weblog

The world is about to be treated to Al Gore's movie, "An Inconvenient Truth" which sensationalizes the causes and effects of global warming, Manhattan underwater, hundreds of millions of people homeless, etc, all after 2050. As Mr. Gore states, " the dabate ( on global warming secondary to human activity) is over in the scientific community." However, there is disagreement about this "consensus " from Richard S. Lindzen, the Alfred Pl. Sloan Professor of Atmospheric Science at MIT. This is a must read article. Al Gore's movie will get a ton of Academy and other Awards, so brace yourself. Some very thoughtful people do not believe the world is coming to an end. Don't build your Ark unless you hear the Lord salling.

Posted by Bob Replogle at 12:06 AM | Permalink

My blog has been without an entry for some time as I checked out the medical system in the US to see if it was as bad as the media portrays. I under went a left knee replacement in April, went home on the 3rd postoperative day, developed the classical signs of acute cholecystitis the day I got home, and wound up in the emergency room the next morning. I made the diagnosis clinically, any 3rd year medical student could have done it. The clinical diagnosis was confirmed by an MRI, a ventilation-perfusion scan ( to rule out a PE) an Doppler flow studies of the venous system, to further rule out a PE. Perhaps this was overkill, but it was reassuring to know that my clinical diagnosis was confirmed. Since the GB was acute, my surgeon wanted to wait for it to quiet down, so I had a cholecycstostomy tube placed percutaneously, the GB was drained for a couple of weeks, then the tube was plugged and 6 weeks later the gallbladder was removed laparoscopically. This time it was same day surgery, home by noon of the day of operation. Would I rather have had a lap cholecyctectomy than the rectus splitting incision I was trained to do" You bet! Now what is the point of sharing this rubbish with my unknown audience? Well I can tell you that my experience with the medical system in the US was sterling. The medical folks were on the ball, doctors, nurses technicians all. The hospital staff was unfailingly polite and competent, the facilities clean and convenient, and my treatment was superlative. Anyone who believes that we do not have great medical care in the US is either in the wrong place or not capable to judge. By the way, if you have a painful, arthritic knee, take it from me, get a new one.

Posted by Bob Replogle at 11:44 PM | Permalink

i promise this will be the last blog I do on climate change, unless something dramatic happens. However, once in a while one feels self-rightgeous about a position that one has taken that is shared by someone who is really knowlegeable about the subject. In today's Wall Street Journal, Richard Lindzen, the Alfred P. Sloan Professor of Atmospheric Science at MIT, had an article that clearly articulates the conspiracy that has thoroughly dominated the debate, if one is allowed, on "global warming", or climate change. Climate change has gone from being a scientific pursuit to a political one. Al Gore is specifically mentioned in Lingzen's piece as one who has tried, and succeeded, in stifling the honest scientific discussion on this important topic. I am reminded of the furor that occurred following the publication of the book "The Skeptical Environmentalist" by Bjorn Lomborg. Lomborg questioned common views on the environment, the global food situation, and strategies for development assistance to the poor. There was little , or no critique of the book, or its sources. Rather , the criticism was personsal, attacking Lomborg personally, just as Sloan documents the personal attacks on anyone who questions the relationship between human activity and climate change. I think this is the direct result of an educational system that has failed to teach analytic thinking. And so it goes.

Posted by Bob Replogle at 12:05 PM | Permalink

My wife and I returned a few weeks ago from a 5 week trip to Antarctica. We went the Southern route, to the Ross Sea, and visited all the original huts of the Antarctic explorers of the early 20th century, Scott,Shackleton and Carsten Borchgrevink. . We were on a Russian icebreaker, the Kaptain Klebnekov, which enable us to reach areas not open to standard cruise ships. I have attached a photo of Mt Erebus below, showing that despite the fact it is summer there, the snow and ice prevails. Several expert geologists, climatologists and historians were along to provide excellent lectures, and I tried to learn as much as possible about the effects of climate change ( noone used the phrase "global warming"). The Antarctic is divided by the Trans-Antarctic Mountains, into the Western Antarctic (about 1/3 of the continent) and that portion (about 2/3) which is located East of the Trans-Antarctic Range of mountains. The interesting point relative to "global warming" is that while the ice in the Western Antarctic is receding, that ice in the Eastern Antarctic is is on the increase. A couple of recent articles caught my eye and I wanted to share with this small audience, most of whom I suppose aren't as caught up in this as I am. One of the reasons I persist in trying to understand what is going on in climate change, is because I have become so cynical about the media, particularly the hysterical manner in which the presumed effects of climate change are going to change civilization. Of course , these changes are predictions based on modeling data, with huge assumptions. One of the favorite references that define the urgency of the dangers that face us is the characteristic "hockey stick"shape of temperature change, showing a sharp increase in the late 20th century. Since the availability of actual temperature measurements are relatively recent, say the past 500 years, some climatologists use proxies (such as the width of tree rings) to develop models to simulate real date. This is the source of the widely publicized "hockey stick" phenomenon. Well a Canadian computer scientist and mathemetician, David Stockwell used a large collection of proxy data, applied the methods of the authors of the "hockey stick" phenomenon, and achieved the same "hockey stick" pattern. however the "proxy" data Stockwell used were a collection of random-numbers with similar bulk properties to those of the tree ring data. In other words, purely random numbers, which conditioned by the statistical methods of the "hockey stick" authors, still result in a hockey stick. George Will has written a common sense piece which puts this whole thing in perspective, in my opinion. Finally, the hysterical bloviators will somehow need to deal with the established fact that the temperature records of the Climate Research Unit at the Universit of East Anglis demonstrate , that for the years 1998-2005 global average temperature did not increase , ( actually there was a slight, but not significant decrease. This is an article you will want to read. And so it goes.

MT. EREBUS FROM SHACKLETON HUT, CAPE ROYDS

KAPTAIN KLEBNEKOV PARKED IN PACK ICE

MINKE WHALES, EMPEROR PENQUINS IN BAY OF WHALES

Posted by Bob Replogle at 09:26 PM | Permalink

I have often said that in my next life, in addition to training to be a cardiac surgeon ( yes, I certainly would do it all over again, gladly) I would also train to be a Certified Public Accountant and get a Ph.D in statistics. The accountant expertise would allow me to read a spreadsheet on budgets so I could figure out where all the money has gone, particularly in the hospitals I worked at, and the statistics angle would enable me to understand articles such as the one from the Economist that I have reprinted here.Since Britain has pumped more money into the Nstional Health Service in the past few years, the issue becomes whether the folks in the NHS wisely used the money to improve the productivity of the system. How to do that? Well, where there is an algoithm. there is a way. In fact several ways, depending on the algorithm. So you can wind up with a graph like this:

If you read the entire article, reprinted from the March 2nd, 2006 Economist, you will see how the Office for National Statistics are playing this one, something for everyone. What it does do is to point out the difficulties of assessing productivity in medicine, as oposed to doing it in industry, yet everyday we find some politician suggesting that medicine is a business, or a commodity, and shuld be treated as such. And so it goes.

Health-service productivity
Take your pick
Mar 2nd 2006
From The Economist print edition
New official estimates are confusing and misconceived

DURING the past seven years, public money has been poured into the
National Health Service. Whether or not the NHS has used the deluge
of cash productively is a politically charged question that matters
hugely to taxpayers and patients. People rightly expect the Office for
National Statistics (ONS) to provide a reliable and trustworthy answer.
On February 27th, the ONS served up not one but six answers (see
chart). For those of a sunny disposition, NHS productivity—the ratio of
health-service output to inputs—rose by 1.6% a year from 1999 to
2004. For those inclined to look on the dark side, it fell by 1.5% a
year over the same period. And for those who shun extremes, the
ONS had four other variants on offer: annual rises of 0.9% and 0.2%
and yearly falls of 0.5% and 0.9%.
As with music and love, so with official numbers and productivity: an
excess of them may cause the appetite to sicken and die. However,
the ONS says the surfeit of figures is needed after a report in 2005
on measuring public-service output and productivity. That review, in
which a team of government officials was led by Sir Tony Atkinson of
Oxford University, called for far-reaching changes in methods.
At present, the official measure of NHS output published in the national accounts is based on the number of treatment activities, with more expensive ones being given a higher weight than cheaper ones. It is this estimate that produces yearly declines of 0.9% or 1.5% in productivity, depending upon how inputs are calculated.
However, the Atkinson review said that output should take into account quality. If, say, the number of hospital operations is static but they are becoming clinically more effective, that quality gain should bhigher output. Incorporating a range of quality adjustments (all positive) suggested by the Department ofHealth, produces a 0.2% annual rise in productivity or a 0.5% yearly fall.
The Atkinson review also argued that the output of public services like health and education becomes more valuable as the economy grows. The worth of an educational grade and the value of health rise in line with real earnings, it suggested. Unsurprisingly, the department also advocates applying this principle. Since trend earnings growth is 1.5% a year, it results in the most upbeat of all the productivity figures. Together with the quality adjustments, it gives annual rises of 1.6% or 0.9%.
With its plethora of answers, the ONS report is certainly confusing. A further weakness is that it has accepted the department's output estimates without questioning them. Yet the department's tendentious methods are open to challenge. For example, the main source of the quality boost to productivity comes from statins, drugs used to lower cholesterol. The department calculates that their benefit to patients is much higher than their cost to the health service. This higher valuation is then used to re-weight statins' contribution to output, which in turn pushes up NHS productivity growth by 0.8 percentage points a year. But as the department itself acknowledges, arguably this gain should be credited to the pharmaceutical industry rather than the NHS. The notion that public-service output becomes more valuable in a growing economy is also contentious.

François Lequiller, head of national accounts at the OECD, says the principle is “new for national accountants”. He adds that the majority would prefer to keep it on the research agenda for the time being. Academic experts are blunter. Barbara Fraumeni, former chief economist at the Bureau of Economic Analysis (BEA), which draws up America's national accounts, says she doesn't think the principle is a good one. Jack Triplett, also a former BEA chief economist, says that it muddles up price and quantity. The trend increase in the value of health is being driven by rising demand. “The fact that people are willing to pay more for health care doesn't say anything about the quantity that is being provided,” he says.
The ONS is treading on dangerous ground. Britain's crime figures have lost credibility because of conflicting official numbers. Publishing confusing measures of NHS productivity, when there is grave doubt whether the underlying methods are sound, is likely to undermine public faith in official statistics still further.

Posted by Bob Replogle at 04:36 PM | Permalink

I have been in Antarctica for the past 5 weeks on a Russian icebreaker and have not blogged due to technical obstacles, not that anyone has probably noticed. I want to do a piece on Antarctica because this trip enabled us to visit the historical huts of of the great Antarctic explorers, Carsten Borchgrevink, Robert Falcon Scott and Ernest Shackleton. However I was motivated to do something else first by the marvelous blog by Tom Treasure, "Don’t like the evidence? Eminence strikes back" This piece struck a chord which I have been more or less pursuing with my blogs on climate change, regarding the failure of many scientists to permit debate on this most important topic simply because they are not open to diverse opinions because of their political positions. The debacle that followed the exposure of the fraudulent data of Korean scientist Hwang Woo-Suk has led to many interesting comments about the current state of scientific reliability, particularly now that many advocates of political policy are using scientific articles to support their position. I thought it wss particicularly revealing when the Editor of Lancet, Richard Horton, tried to pass off the cloning fraud case as a scientific success story. This from an editor who published an article , in Lancet, just before the US presidential election ( in an effort to influence the election outcome) on the number of civilian deaths in Iraq attributable to the US military, data which was subsequently shown to be grossly exaggerated. If there was any honor in this cloning story, it was not because of the scrutiny of the editors and reviewers at the journal Science, who could not wait to rush the cloning story into press, but it goes to Dr Hwang's laboratory associates who brought the attention of the scientific community to the fraud. Science should be science, and scientists should not temper their observations on the hot politically correct issue of the day.

Posted by Bob Replogle at 10:32 PM | Permalink

The impact of the avalanche of e-mail and the proliferation of blogs are changing the cultural dimensions of communication in ways not entirely anticipated at the onset of these electronic wonders. In the future we will not have the wonderful literature provided to us by the publication of thoughtful letters, such as those of John Adams to his wife on his experiences in Philadelphia during the formation of the US. E-mail has led to a to a primitive type of shorthand,which does not lend itself to literary reproduction. The ease and economy of sending e-mail has led to a crescendo of use that threatens to overwhelm recipients. More than one busy individual has stated that the better part of the day is spent answering their e-mail messages. It is even difficult to deny that you received the message because the successful transmission is also documented. Finally, those who wish to deny accountablility for some nefarious activity are often caught up by the evidence of participation provided by the permanence of e-mails. Those executives facing jail time resulting from the Enron scandal were nailed by their intra-office e-mails. At least when you write a letter, someone has to write it, then put it on paper, place it in an evelope and mail it. I often made a practice of sticking a particularly nasty letter to someone in a desk drawer over night just to see how it looked in the morning. That saved me a lot of trouble over the years. Furthermore, you can burn a letter, but noone has figured how to burn an e-mail. A proficient technical genius can even scrape all those deleted e-mails off your harddrive. The same message is true for bloggers, be careful of what you write, Those bloggers who take to cyberspace to tell the world what a lousy boss they have, or what a miserable company they work for, or how terrible their neighbors behave may find themselves embarrassed or worse. So be careful, all that stuff is floating around there is cyberspace somewhere, maybe forever.

Posted by Bob Replogle at 12:20 PM | Permalink

One of the great advantages of retiring from clinical practice is the opportunity it provides to read and explore outside our customary specialty material. It is still interesting to keep up with current cardiac surgical practices for me because it is fun to see how it all worked out. Having been there during the early days, when we were operating to a large extent on intuition, common sense and good judgement, finding out now if we were correct is interesting. I read a lot, and I have just finished a book by a British physician, Theodore Dalrymple, entitled "Our Culture, What's Left Of It". Dalrymple is an interesting guy .He spent time in various locations in developing countries around the world, finally being a physician in a British prison for the last 15 years of his career. Very observant, one of the reviewers on the jacket cover commented " why is it that a medical training- Somerset Maugham, Celine, Bulgakov ,Chekhov at once come to mind- has been such a fertile background for literature at the highest level?" Dallrymple's book, a collection of essays written over the past few years, exposes the foolishness that has been foisted upon athe public, using incremental changes in cultural values, perpetrated by a bored intellectual elite,to construct a society that would be unrecognizable to our civilized and cultured ancestors. For example, Dalrymple has a chapter on"Trash, Violence and Versace: But Is It Art?" It describes the trends in modern art over the last 40 years, as more and more rubbish is pawned off as art. One striking example is the critically acclaimed "artistic" representation of Myra Hindley, which was displayed at last fall at an exhibition of modern British art at the Royal Academy of Art in London entitled "Sensation". Most of us have never heard of Myra Hindley, although those in the UK probably have. In collaboration with her lover, Ian Brady, she was convicted in 1965 of the murder of several small children. Not only were these children murdered, but they were tortured in a particularly horrific way, and these criminals made tape recordings of the children's screams while they were being tortured. The customary left wing activists have called for her release after serving many years of a life sentence. Now that is the background for the "artistic" creation: The artist, Marcus Harvey, took the image of Hindley from a police mug shot taken at the time of her arrest, and enlarged it to 13 by 10 feet. However, the the artist used a clever method to amplify the horror of the image, to make the painting particularly appealing to the intellectual elites who thrive on sensation. What was this clever ploy? Harvey used the handprints of a small child in the painting to build up the image instead of the dots traditionally used by newspapers in their reproductions, that is to say the image of Hindley was constructed of hundreds of tiny children's handprints. Needless to say, the parents of the murdered children were devastated by the exploitation of these heinous crimes for "Sensation", since Harvey would never have used Hindley for the painting if she had not murdered and tortured their children. Dalrymple asked the Royal Academy's chief of exhibitions why he would desplay such a horrific reminder of this crime. The answer? " All art is moral. anything that is immoral is not art--this piece raises a question about the exploitation of children" Good grief ! There is another great book I would recemmend, one by Roger Kimball entitled " The Rape of the Masters". Kimball writes well, is refreshing, outspoken and his book is filled with wonderful illustrations.read these two, when you retire, and it will enlighten your outlook on life.

Posted by Bob Replogle at 08:32 PM | Permalink

When Hurricane Katrina devastated the Gulf Coast, the US government went all out to aid the helpless victims. Amidst the protracted efforts of politicians to take political advantage of the situation, vast amounts of money were shipped to the affected areas and people. The Red Cross gave a $2000 debit card to most anyone with a plausible story of disruption, and a total of $265 billion was approved for the relief effort. Expediency was deemed more important than care in the distribution of funds. Well, surprise,surprise, widespread evedence of fraud was discovered, and now more than a thousand investigations are underway to sort out the mess. A recent article about fraud in France indicates that skillful fraud artists are not confined to the US. But lest you think that governments are the only ones capable of making big time mistakes, take a look at what some that Captains of Industry have made.

Origins: In September 2005, the Agence France Presse (AFP) news agency distributed a series of photographs showing Hurricane Katrina evacuee Latesha Vinnett and her daughter, Mychal Boykins, at the Reliant Center in Houston, Texas. Ms. Vinnett had just received one of the many $2000 debit cards issued to Katrina evacuees by the Red Cross, which she happily displayed for the camera — providing a full view of the debit card's number and expiration date. The photos were carried by a number of news outlets (such as Yahoo! News) or published as an accompaniment to news articles about Hurricane Katrina, thereby broadcasting a supposedly valid debit card number to millions of viewers.

A number of Internet-distributed rumors and spoofs have chided the participants (i.e., the cardholder, the photographer, AFP's photo editors) for all failing to realize they should have obscured at least a few numbers on the displayed card, and have posited wild spending sprees by hundreds of identity thieves that drove the debit card's balance to zero mere minutes after the photos were published. Although events may not have transpired in quite that spectacularly rapid a fashion, apparently the card number displayed was indeed used by fraudsters:

Posted by Bob Replogle at 04:03 PM | Permalink

There are a number of places in the US that wonder where is global warming when we need it.

Record Low Temperatures in Parts of U.S.
By CATHERINE TSAI
Associated Press Writer
Dec 07 10:56 AM US/Eastern
DENVER - Bitterly cold air poured southward across the nation's midsection Wednesday, dropping temperatures below zero to record lows from Montana to Illinois. The cold even extended south to the Texas Panhandle, where Lubbock shivered at 9 above zero, toppling a record for Dec. 7 that had stood since 1942, the National Weather Service said.
A winter storm warning was issued Wednesday for counties in and around the Dallas-Fort Worth area, where the temperature fell from the low 40s before sunrise to the upper 20s by the end of the morning rush hour. Freezing rain and up to 2 inches of snow is predicted by Thursday morning.
Elsewhere Wednesday, the weather service said record lows included 28 below zero at Drummond, Mont., where the date's previous record was 21 below in 1971; 26 below at Seeley Lake, Mont.; 25 below at Laramie, Wyo., tying a 1978 reading; 17 below at Alliance, Neb.; 19 below at Cedar Rapids, Iowa; and 3 below at Lincoln, Ill."

Posted by Bob Replogle at 12:17 PM | Permalink