Archive for October 2014

The Council Has Spoken: October 31, 2014

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Council Submissions: October 29, 2014

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A Stay at the Grove Park Inn – Asheville NC

Originally posted at TripAdvisor.

Let me begin by saying I wanted to like this hotel. If the names Stickley and Roycroft and the term “Arts & Crafts movement” mean something to you as it does to me, then you really have no choice but to stay and appreciate the artistry of the wood and stonework the hotel is famous for. But if you are looking for a relaxing stay where you are pampered by staff, or want a base from which to explore the area, forget it. There are other hotels in the area that can accommodate you better.

Asheville is one of our favorite cities and since we are Arts & Crafts aficionados, we had visited the hotel several times but had no reason to stay there. A medical conference being held there last weekend changed that, so we stayed. Our problems started immediately upon arrival. Because the conference started before checkout we arrived before our room was ready and had to park.

Why does parking have to be gated and controlled if everything in the complex is owned by the hotel? It’s not like people would park at the hotel for free and go elsewhere, and the gates were new since our last visit there in the Spring. Our room wasn’t ready until the afternoon so we had to leave the facility for a trip downtown. To leave the gated parking you have to present your room key, but since our room wasn’t ready we didn’t have a key. We were told to press the button for assistance at the gate, but several attempts to do so went unanswered. We ended up paying the $10 to leave.

Which brings up another point. $15 for parking? We’ve stayed in hotels in downtown areas of Dublin, New York City, and Chicago and parking was included with the room. Why the additional charge? Valet is $22 + tip for those who like paying a stranger to drive their cars and I can understand that. But $15 for general overnight parking struck me as cheap and didn’t match my expectation for this hotel.

Nowadays WiFi is almost as important as a private bath while traveling, and at least it’s free here unlike other high-end hotels. But to access it you have to login with your last name and room number. Since we didn’t have these at the time we arrived we couldn’t use them, so I had to use my smartphone to create a hotspot so that I could use my laptop.

These are minor issues but they do suggest a broader problem I have with the hotel: The Grove Park Inn having the same policies applied to it by the OMNI chain that it applies to its other properties right down to the branding “OMNI Grove Park.” It seems to me that it is a corporate directive to play down the Grove Park Inn name in favor of the OMNI brand, making it impossible to find a coffee mug the Wife wanted with the name “Grove Park Inn” on it instead of OMNI Hotels & Resorts.

If the brand OMNI Hotels & Resorts means something to you then perhaps that’s a good thing, but for those of us who appreciate the hotel for what it has been and where it is, then who owns it today is meaningless. The hotel has changed hands numerous times through its history and will know doubt do so again. In fact it has had 3 owners in just the past 3 years and the only constant has been the Grove Park Inn name.

This thoughtless and heavy-handed approach to the hotel by its corporate owners betrays an ignorance and lack of appreciation for this hotel. To its owners its just another property, not a 100 year old historical icon in Asheville. I don’t see how they will be able to succeed at keeping the hotel profitable over the long term without appreciating the hotel’s distinct and unique character and charm and maintaining those into the future.

We stayed in one of the old parts of the hotel and the room was small but acceptable. If you want a palatial suite either pay for one of the newer rooms or don’t stay in a hotel designed when people didn’t require rooms as big as their bedroom suites in their mcmansions. The woods in the room were amazing, and the unassuming Roycroft desk was a marvel of craftsmanship. Although the floor carpet was worn, the bed was comfortable and we had no trouble with the room.

A lot of the directions and advice we received (e.g. leaving the parking area, logging into Wifi) was wrong. They were also overwhelmed the first night of our stay and attitudes struck me as patronizing or snotty. Later in the weekend we had better interactions as the crowd thinned but it was still hit or miss.

An example of this was entering the new Edison restaurant Friday night and seating ourselves at one of the many open tables after standing around for several minutes trying to catch the eye of a waiter or hostess. Although there were numerous empty tables and had been ignored for several minutes, a hostess approached us and said the table was reserved and told us to sit at the bar, which we did. We were then ignored there too. I guess we weren’t young enough to grab the attention of the staff unless we were breaking the rules. We finally got the attention of a bartender and the Wife asked if he could recommend a dry house red wine. He passed her the menu, said “See page 3” and disappeared. We took it all in stride of course but it was amazing to be treated so poorly at the price we paid to stay.

One final recommendation. Because the hotel is at the edge of the city, if you are staying there intending to spend a lot of time downtown there are much better options closer to the heart of the city.

Like I said, I wanted to like this hotel more than I actually did, and I do hope it improves. But Life is short and there are plenty of other options in the area.

Ebola in America: How to Fund Research

This article in the New York Times points out a problem in medicine and the pharmaceutical industry: how to support research and development of treatments and vaccines for rarely occurring diseases or conditions that only affect the poor. As Ebola shows today these diseases have a habit of becoming egalitarian real quickly, citing the Ebola virus and the discovery of a vaccine 5 years ago.

 

Its development stalled in part because Ebola is rare, and until now, outbreaks had infected only a few hundred people at a time. But experts also acknowledge that the absence of follow-up on such a promising candidate reflects a broader failure to produce medicines and vaccines for diseases that afflict poor countries. Most drug companies have resisted spending the enormous sums needed to develop products useful mostly to countries with little ability to pay.

 
Instead pharmaceutical companies chase after profits,  meaning that in the US tens of billions of dollars are spent on new erectile dysfunction drugs and cosmetic treatments such as botox injections, yet treatments for diseases that kill in poor countries such as malaria and chikungunya, or those that only affect a few in wealthy countries have to rely upon charity to fund their research.

Diseases don’t check your bank account before they infect you. Sure some diseases are more prone to the poor than wealthy due to sanitary conditions and other factors, but not all. A disease that strikes the poor abroad can easily take up residence among the wealthy at home, as the spread of HIV proved in the late 1970’s through early 1980’s, moving from Haiti to wealthy enclaves in the US.

So the question arises: How do we develop treatments for diseases that are uncommon and/or appear only in poor countries? Providing money to prevent an Ebola vaccine from being shelved is not a completely altruistic act given the reality of how contagious the disease is. The dollars spent today will not only save lives over there, they will also save our lives here.  But how do we fund it?

Although I hate taxes in principle, why not levy a 5% tax on all elective surgeries and lifestyle drugs? That money could be placed into a pool and used to provide grants for the research and development of treatments for diseases that are too rare to justify researching, or to subsidize treatments of diseases like malaria, Guinea worm, and drug resistant TB. Alternately the corporate tax laws could be amended to deduct the costs spent on these diseases on a 1-1 basis: for each dollar spent a firm’s tax burden is reduced by a dollar. Neither is a perfect solution and both are prone to avoidance, abuse and the usual “unintended consequences” which are inevitable in any public policy change, but the Ebola scare in the US should serve as a wake up call.

Almost a hundred years ago the Spanish Flu influenza virus swept through the country, killing millions of Americans in their primes. It touched every family, rich and poor, black and white, immigrant and native born. In my own family it killed a great-aunt and a young cousin and left two other cousins orphans. A few decades later Jonas Salk tamed the beast of polio which had been the dread of all families that came with the approach of the cool autumn. For the past half-century only HIV has risen to the level of concern, but that virus is actually quite hard to catch. It doesn’t survive outside the body of its host for long and cannot penetrate the skin. Besides we have tamed that with anti-virals, turning what had once been a death sentence into a chronic condition.

Ebola has more in common with the Spanish Flu than it does HIV. It can survive for lengthy periods on surfaces outside of the body. It can penetrate the skin. There is evidence that it can be transmitted through the air. And besides Ebola there are other viruses lurking abroad just a flight away from our borders such as MERS and SARS. Each plane arriving here is a dice throw, and eventually we are going to be on the losing end of the odds.

The recent Ebola scare in the US has shown the authorities are not prepared for another pandemic. It has also showed us the limits of our health care system. We need to take these lessons and learn from them to prepare ourselves and our society for the  next thing Mother Nature is going to throw our way. But America has a wonderful habit of hitting the snooze alarm until the very last minute. Hopefully it will awaken before more die here and millions die there.

The Council Has Spoken: October 24, 2014

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Council Submissions: October 22, 2014

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The Council Has Spoken: October 17, 2014

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The Council Has Spoken: October 17, 2014

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Kick Turkey Out of NATO

Lord Palmerstone once noted that nations do not have permanent allies, only permanent interests. This statement assumes that a nation always acts in its own best interest, and this assumption is the basis for the realist school of international relations. Realists always expect national actors to do what is best for themselves. If an action does not benefit the nation in any particular way, or worse threatens it, then one cannot reasonably expect it to act even though one might think and others might agree that it is the right course of action. In international relations at least according to the realist school, there are no completely altruistic acts by nations or their actors.

I’ve been rooted in the realist school of international relations well before I got my degree in political science, having grown up while Henry Kissinger acted as Nixon’s national security advisor and later secretary of state under him and his successor Gerald Ford.Realists not only expect nations to act in their best interests, but regimes and the organizations constituting them to do the same. In statecraft realists aren’t surprised when regimes do what’s best for them even when it might compromise or damage others, but are willing to act in their own best interest when the opposite party acts in theirs.

Case in point: Turkey. Under the regime of Recep Erdogan for the past 12 years Turkey has been acting in the best interest of Erdogan and his ruling party the AKP. Erdogan is an Islamist in a nation where political Islam had been banned for decades after its re-founding under Kamal Ataturk. While Ataturk and the secularists saw Europe as a useful ally that would strengthen Turkey and their regime in the Middle East, Erdogan has instead positioned Turkey as the next Islamic Caliphate more in line with the Ottoman Empire of the 17th century rather than secular and Democratic Western Europe.

Perhaps the biggest interest Erdogan has besides the desire to remain in power is to avoid empowering the Kurdish minority within Turkey. Unlike the Palestinians, the Kurds  have a much longer claim to their land stretching from northern Syria across southeastern Turkey, northern Iraq to Iran. One commonality between Erdogan and his secular predecessors has been the oppression of the Kurds in Turkey and their nationalist aims. The no-fly zone established in northern Iraq after the first Gulf War led to autonomy under Saddam and later the post-Saddam Iraqi government. Iraqi Kurds are as close to independent as Kurds have ever been, and their Syrian, Iranian and Turkish cousins recognize this.

From Erdogan’s perspective the decimation of the Syrian Kurds by the Islamic State (IS) is welcome. It weakens the Kurdish cause by reducing the number of Kurds in the region. Plus the Syrian Kurds were also strong supporters of the PKK, Turkey’s al-Qaida. From the realist perspective Erdogan will not act against IS on behalf of the Kurds unless there is an even greater, more pressing interest to do so.

And that’s the problem. Current American and European leadership is run by idealists not by realists. American and Europeans leaders simply do not understand why Erdogan  and to more worrying degree Vladimir Putin  act the way they do. To them bombing Kurds in Turkey instead of IS in Syria makes absolutely no sense just as annexing Crimea and dismembering Ukraine. They do not see the world the way Erdogan and Putin do, but realists do. Realists recognize that Putin and Erdogan will only act when the pressure applied to them is real and painful.

For Erdogan that pressure should include Turkey’s rejection from NATO and any possible future admittance to the EU under his regime. If Turkey acts in its own interests, so should the EU and the United States. The truth is that instead of being a beacon of secular Islam as Turkey once was, Turkey under Erdogan has become just another corrupt, Islamic Middle Eastern dictatorship with caliphate dreams. Turkey has condoned the rise of IS as well as backed  other terrorist groups such as Hamas. It has kept a tight leash on the American base in Incirlik, preventing it from participating in the second Gulf War and in attacks on IS.

Switching from Erdogan’s perspective, what is in America’s best interest? The dream for a secular Islamic state isn’t dead, it’s just moved to the southeast. As Iraq and Syria fall apart, the US should throw their backing behind the Kurds. The Kurds are not infected with the anti-western, anti-Semitic and anti-American ideology of Shi’a Iraq and Iran, or Erdogan’s Turkey. They are our only natural allies in the region besides the Israelis and should be supported not just with rhetoric, which the current administration excels at, but with military and logistical support against IS as well as diplomatic backing for an independent Kurdish state.

Doing this would pretty much end the alliance with Turkey, but the alliance is pretty much all but dead. Would the US actually send troops to Turkey if it invoked Article V? What if it invoked it against Israel, as some had suggested when the Israelis raided a Turkish ship attempting to break the embargo of Gaza?

What would the consequences be? Turkey would likely ally with Russia, but this is happening anyway as the Europe of the early 21st century looks increasingly like the Europe of the early 2oth century. After all, what’s the point of having a military base in a country if you can’t use it? Let the Turks and Russians try to get along on their own as they did in the 19th century.

For more on the subject read Michael Totten’s latest which inspired this post. Bernard-Henri Levy also states that should Kobani fall, Turkey should be kicked out of NATO.

 

 

 

Council Submissions: October 15, 2014

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Ebola in America: 2 Weeks In

Two days ago a 26 year old nurse in Dallas, Nina Pham, tested positive to the virus. She was one of Thomas Duncan’s seventy caregivers. Her diagnosis puts a pretty smiling petite face on a horrendous disease, and one can only hope that by discovering the disease early she will be luckier than the man she treated at Texas Presbyterian hospital.

 

We don’t know exactly how she caught the virus from Duncan. She wasn’t one of the responders who came into contact with him during his first visit to the hospital, after which he was sent home with antibiotics and Tylenol. Evidently she had worn the gear dictated by the CDC, “gown, glove, mask and shield,” yet still got sick. The CDC stated there must have been a “breach in protocol” but Ms. Pham doesn’t recall when it may have happened and neither do the investigators who have interviewed her. The CNN article notes “Or the problem could have been something else entirely.”

“Something else entirely” means maybe we don’t know this disease as much as we think we do, and after 40 years of research that isn’t very much.

Take for example the question of whether the virus is spread through the air. The CDC states unequivocally “Ebola is not spread through the air or by water,” but others aren’t so sure. “We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks,” writes Lisa M Brosseau, ScD, and Rachael Jones, PhD in commentary published by the Center for Infectious Disease and Research Policy (CIDRAP). According to CIDRAP Brosseau and Jones are nationally recognized experts on infectious diseases, not tin-foil hat posters from ZeroHedge.

Here’s the distinction between an airborne infectious disease and one spread through aerosoles. The common cold is considered to be an airborne virus, potentially spread from one person to another without landing on any surface. An aerosolized one is defined by Brousseau in a 2011 research paper as one where disease is spread through the air between people, or as Brousseau writes, “defined as person-to-person transmission of pathogens through the air by means of inhalation of infectious particles. Particles up to 100 μm in size are considered inhalable (inspirable). These aerosolized particles are small enough to be inhaled into the oronasopharynx, with the smaller, respirable size ranges (eg, < 10 μm) penetrating deeper into the trachea and lung.”

Notice any difference? Let me know if you do because I don’t.

I would expect that scientists would disagree about how a relatively new disease like Ebola spreads, but the CDC needs to be honest and it needs to assume the worst. The medical workers currently treating Ms. Pham need to assume the virus can be spread through the air and a 10 micron virus will spread through a facemask or around a plastic shield as if it weren’t there. They should wear respirators.

Americans need the Truth. Truth will deter panic more than empty assurances from pseudo-politicians in the CDC.

Update: A second hospital worker has tested positive to the disease, and it’s increasingly likely that Ms. Pham didn’t make a mistake removing her protective gear. Instead it’s looking like the CDC protocol for handling this disease is wrong and needs to be changed.

Since the advent of antibiotics and common vaccines we have been spared the pandemics that raged through our history like Bubonic Plague, Smallpox and Spanish Flu. These diseases not only killed millions, they changed our history countless times. Since these were tamed, however, the only large outbreak has been HIV so most of the experience of public health professionals has been with this virus. Unfortunately HIV and Ebola are very different viruses. HIV is quite weak outside the body. It breaks down quickly on surfaces and can only penetrate the skin through a wound. Ebola on the other hand is much stronger. It can remain virulent on surfaces for long periods. It easily passes through the skin and doesn’t need to gain entry to the body through a cut the way HIV does. Worse, the those infected shed much more of the virus through diarrhea, uncontrolled bleeding and vomiting. HIV doesn’t cause such symptoms making it much harder to transmit.

My guess is that the CDC’s protocols are based on HIV and if so, they are inadequate and must be changed. “(CDC director Dr. Tom Frieden) outlined new steps this week designed to stop the spread of the disease, including the creation of an Ebola response team, increased training for health care workers nationwide and changes at the Texas hospital to minimize the risk of more infections.”

Mistakes are going to be made, and demanding perfection is unrealistic. As long as we learn from the mistakes and deal honestly with their consequences we will eventually control the advance of this disease. Am I scared? Of course I am. This is a nasty disease but what other choices do we have?

Update 2: It gets worse. The second hospital worker, a nurse named Amber Joy Vinson, flew from Cleveland back to Dallas just 12 hours before she came down with a fever. The plane stayed in Dallas overnight and then was used for several flights the following day before being taken out of service today.

The likelihood of a passenger on any of those flights catching the disease from Ms. Vinson is low but it is not zero, and given the failures so far to stop the spread in Dallas I’m wondering whether it would have been too much to ask for hospital management and the CDC to make the following rule:

If you are being actively monitored for potential exposure to the virus (as Ms. Vinson was), don’t fly.

It seems like common sense to me.

One other note: We will soon be entering cold/flu season and millions will be developing fevers that are not caused by Ebola, providing a perfect screen for the disease to spread in. While perfection from the CDC may be too much to ask, we should expect them to at least up their game.

Update 3: Ms. Vinson knowingly boarded the plane with a temperature of 99.5 degrees. This is below the threshold of 100.4, but what the heck…

Update 4: March 1, 2015 – Pham survived the disease and is now suing the Texas Health Presbyterian Hospital for failing to protect her and the other caregivers.

 

The Council Has Spoken: October 10, 2014

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Noteworthy Article on the American Health System

This is one of the best articles I’ve read on the subject of American health care and medical insurance. It pretty much explains that the system is so bad that it is well beyond partisan bickering. Here’s a taste.

 

We all instantly recognize that it would be a disaster if we collectively decided that the way all cars should be purchased would be by having a job with a company that will provide you a car (with a tax break, and if you lose your job, you lose your car), and an insurer that will pay for gas and oil. Should you not be able to get a car that way, the government will buy you a car. We can easily imagine that, because the choices in the car sector would no longer be made by individual consumers but by powerful entities—the government, large companies, insurers—almost every car would be a hideous, hideously expensive, comically ill-designed clunker akin to the ones that became the butt of “Lada” jokes in the Soviet Union. Or consider what would happen if housing were provided the way we “provide” health care; the mere thought should send chills down one’s spine. But whenever we talk about health care, that part of our brain seemingly shuts off, and these simple truths become about as intelligible as an angry Klingon warrior.

 

+1 for Klingon warrior reference, but seriously, if you care about the shambles our medical system has become, read this article.

Council Submissions: October 8, 2014

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Stinkbug War: 2014

Just a note for you Internet denizens who are plagued by stinkbugs.

The infestation began about around Sept. 11 with the stinkbugs crawling on our screens, windows and siding. We set up indoor traps (lamps above pans of water with detergent in it) and I dedicated a shop vac to sucking them off the outside of the house. I put a small amount of water with non-t0xic detergent in the shop vac, and when it became full I dumped it into the mulch pile and turned the pile.

Current body-count so far: 3,000 estimated but they didn’t go down without a fight. They broke the shop-vac so I’m using an old handheld Shark from my workroom, and if that breaks I’ve got a new 6 gallon one in a box in my truck.

I just spent 15 minutes and sucked up 242. They absolutely love getting between the plastic dog houses and the deck. I scored about a third of the count there.

The horror… The horror…