The Agony of Medical Bills

It shouldn’t take a Harvard expert in health policy to understand a doctor’s bill. But sometimes, it does. In August of last year, Liz was a medical student whose doctor found a lump on her tonsils. Her primary-care physician referred her to an in-network ear-nose-and-throat specialist.

Liz, who asked to go by her first name, expected the usual $20 copay. Instead, she was charged $219.90—wrongly, in her view—for separate physician and facility fees. Under the terms of her plan, Liz says, she should not have been responsible for those charges. After a polite letter to her (“Thank you for your recent grievance...”), Anthem Blue Cross upheld the charges.

A few months later, Liz convinced Anthem to wipe much of the bill. But here’s the thing: By that time, she was studying health policy as a master’s student at Harvard. “It took me hours of going over the insurance policy and hours of arguing with the insurance company over that insurance pamphlet,” she said. (Later, Liz realized she had been doubly insured that month—her Harvard insurance had already kicked in—and she got the other plan to take care of the remainder of the balance.)

“I’m in a privileged position, but the tides were very much against me,” she said. “Other people aren’t as privileged and don’t have as much time.”

Liz is, like the roughly half of Americans who have decent insurance through their jobs (or grad schools, in her case), comparatively fortunate. But her experience reveals the persistent frustration, for people with all types of insurance, of trying to avoid surprise medical bills. Even generous insurance plans don’t always shield patients from puzzling bills. A simple trip to an in-network facility—with a referral!—can combine all the mental anguish of tax season with all the physical anguish of, well, physical anguish. (...)

A major reason for medical sticker-shock is that many facilities bill patients separately for each service they provide. “Imagine going out to eat and receiving separate bills from the restaurant, host, waiter, cook, and busboy, some of whom were willing to negotiate discounts or accept coupons, while others were not,” wrote Stacey Pogue, from the Texas think-tank Center for Public Policy Priorities, in a September report on surprise medical billing. (...)

Even when a hospital is in-network for a given plan, one or more of the doctors whom a patient sees while there may not participate with that plan. Occasionally, this discrepancy results in balance billing, a situation in which a provider charges the patient for the portion of the bill the insurer didn’t pay. These bills can amount to thousands of dollars, especially for long or complicated hospital stays. (...)

In Dallas recently, I met a man whose personal account exemplifies how balance billing typically works. (He requested anonymity because of a legal case he says he is building, so I’ll call him Steve.) Three years ago, Steve had a stroke, and the paramedics who rushed to the house suggested they take him to Medical City Dallas Hospital, a top hospital for strokes in the area. At the hospital, he was given a clot-busting drug and spent the weekend in intensive care. He recovered and went home.“Our system is so convoluted that most providers don’t even know how patients are billed.”

Steve had an Aetna PPO plan, but he says that in the weeks to come, he received bills totaling several thousand dollars above what his insurance covered because of various diagnostics and providers that were billed out-of-network. Six months later, Steve had another stroke. He said the same thing happened with a different hospital, Methodist Richardson Medical Center, which was in-network for Aetna.

In separate statements, both hospitals said that while they encourage their doctors to accept the same insurance plans as the overall facility, the doctors do bill separately for their care. It’s conceivable, in other words, that these other providers did not accept Steve’s plan.

Steve told me he couldn’t find his bills, so I could not independently verify his account.

Which brings the total opacity of American health care full circle: Hospitals don’t tell patients how much they charge. Patients don’t know how much their insurers will pay until they get their bills. And the information in the bills isn’t publicly available, so there’s no way to know exactly how, why, or to whom frequently surprise billing is happening.

by Olga Khazan, The Atlantic |  Read more:

Image: Lauren Giordano

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Scientists Map 5,000 New Ocean Viruses

In March 2011, the Tara, a 36-meter schooner, sailed from Chile to Easter Island — a three-week leg of a five-year global scientific expedition. All but one of the seven scientists aboard the ship spent much of their time on the sun-drenched deck hauling up wondrous creatures such as luminous blue jellyfish and insects known as sea-skaters, which spend their entire lives skimming the surface of the ocean far from land.

At the stern of the Tara, a shipping container was bolted to the deck, with a door and a tiny window cut through the metal walls. One of the scientists, Melissa Duhaime, spent most of the voyage inside the dark, tiny cell, where she fought off an endless bout of seasickness.

“People would come in to see what I was doing and leave pretty quickly,” Duhaime said.

Inside her cell, Duhaime sat next to a hose as wide as an outstretched hand. A pump drew water through the hose from several meters below the boat and then pushed it through a series of filters. Each filter was finer than the last, blocking smaller and smaller life forms. The setup stopped animals first, then zooplankton and algae. The last filter in the hose, with pores just 220 nanometers wide, was fine enough to block bacteria. Scrubbed of all these living things, the water finally flowed into three 30-liter vats.

To the untrained eye, these vats might seem to be full of sterile water. But they were seething with ocean life — or life-like things, at the very least. The three vats held up to 1 trillion viruses.

The ocean contains many mysteries, but none so great as its viruses. Scientists estimate that there are 1,000,000,000,000,000,000,000,000,000,000 virus particles in all the world’s seas. They outnumber all cellular life forms by roughly a factor of 10. Scientists have been dimly aware of the staggering scale of the ocean’s virosphere since the late 1980s, but many of the simplest questions about it remained open for years. Scientists couldn’t even say how many species of viruses there were in the oceans. It’s as if zoologists were dimly aware that many places on Earth were home to things called mammals, but their knowledge was based only on a few squirrels in a cage.

Duhaime and her colleagues joined the Tara Oceans Expedition to change that, by collecting ocean viruses on a scale never attempted before. As they report in the May 22 issue of Science, they gathered enough samples to confidently estimate the total number of distinct populations of viruses in the sunlit upper reaches of the ocean. Out of the 5,476 populations they identified, only 39 were previously known to science.

The researchers have gone on to study where these species live and how they affect the ocean’s ecosystems. For years, scientists have suspected that viruses alter the very chemistry of the world’s oceans and may even influence the planet’s climate. Now, the data from the Tara are going to give researchers a much better handle on the full power of the ocean’s viruses.

by Carl Zimmer, Quanta | Read more:
Image: Jennifer Brum, Tucson Marine Phage Lab

Bred To Death

[ed. See also: Endangered Dog Breeds and The Market Forces Behind Them.]

Bred for looks, not health, many purebred dogs are drawn from a genetic wading pool that might have been designed by a cabal of Ralph Lauren, Dr. Frankenstein, Walt Disney and David Koch.

Even socially aware consumers who sneer at $5,000 designer purses, and animal defenders who deplore the cruelties of commercial livestock production, buy into trendy canines. Purebreds are commodities like any other luxury good, and breeding them is big business. Registered golden retrievers go for up to $3,000, English bulldogs for $9,000, and a Cavalier King Charles spaniel can cost $14,000, almost as much as a Honda Fit.

But neither price, pedigree nor being loved like a member of the family can shield a dog from the pain, breathing difficulties, cancer, panoply of debilitating genetic disorders, mental illness, crippling physiognomy and shortened life span that disproportionately plague purebreds.

The main U.S. arbiter of canine purity is the American Kennel Club. The first goal of its mission is “upholding the integrity of its Registry.” Pedigree, the AKC asserts, “creates a level of breed predictability” of “temperament and physical characteristics.” But the AKC is also a lead profiteer in an industry that Michael Brandow, author of A Matter of Breeding, decried as “a kind of long-term, institutionalized cruelty that makes vivisection look humane.”

“The demand for ever-more-perfect purebred dogs has concentrated bad recessive genes and turned many pets into medical nightmares,” Consumer Reports warned. Inbreeding for clonelike consistency ensures that genes for disease and deformity piggyback on those for a lush coat, appealing nose, witty wrinkles, quirky gait or endearingly protuberant eyes.

And often the deformity itself—like the crippling slope of German shepherds’ hindquarters—is the desired, indeed required, trait. In bulldogs, a “liver colored nose” is a deal breaker by AKC show standards, and a brachycephalic face that impairs breathing is essential. Both traits, however, can hasten death— one from breeders’ culling of irregular specimens, the other from disease.

Unlike some of its European counterparts, the AKC opposes mandatory genetic screening that weeds out heritable diseases. It rejects accepting healthier conformations or expanding the gene pool by outbreeding with non-registered dogs. Producers who want high-value animals eligible for competition must accede to insanely capricious, detailed and dangerous AKC standards set by its breed clubs.

Breeders are abetted by consumers, who—seeking fashion, predictability or the doppelganger of a beloved lost pet—disassociate breed flaws from their own cherished pet. Then, when faced with high vet bills for dogs that are disabled, ill or willfully deformed, they often offload the dogs within a year to shelters, where purebreds constitute 25 percent of canines.

The AKC keeps its registration fees. And they add up: The club’s 990 tax form for 2013 reported $60 million in total revenue, with more than half—$32 million—from registrations. Judging and pedigree dog shows (the AKC claims 3.2 million entries from 190 approved breeds), like Westminster, generated $12.6 million. The AKC allocated 1 percent of its revenue to its Canine Health Foundation. CEO Dennis Sprung’s 2013 compensation topped $567,000, while the club’s nine other top officers garnered $20.3 million.

While the club gets rich, the AKC abets or essentially mandates the genetic impoverishment of dogs through inbreeding, overbreeding and bizarre standards of beauty.

by Terry J. Allen, In These Times |  Read more:

Image: Gareth Cattermole / Getty Images

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The Enigma of “Blind Tom” Wiggins

[ed. The first African American musician to play in the White House, and probably an autistic savant, Blind Tom has been almost "completely written out of history". See also: Young, Gifted, and Black.]

"I am astounded. I cannot account for it, no one can. No one understands it," a St Louis man uttered after watching Blind Tom perform in concert in 1866. His mystification was by no means isolated. Few other performers on the nineteenth century stage aroused as much curiosity as "Blind Tom" Wiggins. Born a slave in Georgia in 1848, by the time he died Hoboken in 1908, he was an international celebrity and his name was a byword for inexplicable genius.

From an early age, it was clear that Blind Tom possessed extraordinary musical gifts. He could imitate, either vocally or musically, any sound he heard. This, coupled with an encyclopedic memory and all-encompassing passion for music, meant that by the age of sixteen, he hovered somewhere between a respected concert pianist and glorified sideshow freak. For the following forty years, he toured the length and breadth of North America, soaking up the sounds of the Civil War and Gilded Age, then baffling audiences with his astonishing gifts.

During the tumultuous election campaign of 1860, for instance, he was taken to a political rally in support of Democratic presidential candidate Senator Stephen Douglas of Illinois. Tom heard his speech and years after he would deliver this oration, capturing not only the senator's distinctive boom and mannerisms, but the crowd's heckles and cheers. Somehow he could recall the sensory snapshot of that moment with sparkling precision.

One of his music teachers described how Tom, now a man in his thirties, learned Beethoven's 3rd Concerto to perfection in the space of an afternoon. He then stunned her by capping off the lesson by turning his back to the piano and playing the bass with his right hand and the treble with his left hand. Somehow Tom could separate the treble from the bass as if they were detached, self-contained streams that were independent of one another. (...)

Yet today this remarkable pianist is virtually forgotten. His story comes as a surprise to many who consider themselves well versed in African American history. "How is it I've never heard of him before?" is a question often put to me.

The answer, I suspect, is that for all his genius, Blind Tom falls short on what an African American hero should be. After emancipation, he remained loyal to his master, electing to remain with him. Even at the height of his career, black newspaper editors kept him at arm's length, thinking him a buffoon who perpetuated negative stereotypes about the black race. Most damning of all, his most famous composition, The Battle of Manassas, tells the story of the great Confederate victory at Bull Run in April 1861. With a track record like this, little wonder some condemned Blind Tom to the ranks of Uncle Tom.

But was Blind Tom really a Confederate stooge or, like the St Louis man, was there something about him that American society did not understand? Drawing from the wealth of scientific research over the last fifty years, it is highly likely that "Blind Tom" Wiggins was a savant, most likely an autistic one. His brain was wired in a profoundly different way than most people.

by Deirdre O'Connell, BlackPast.org | Read more:
Image: Deirdre O'Connell

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Legacy Maker

That winter’s day, as she headed to the White House, Gina McCarthy undoubtedly steeled herself for a confrontation. It was 2014, and McCarthy, the head of the U.S. Environmental Protection Agency, was about to make her case for blocking the controversial Pebble gold mine planned for Alaska’s Bristol Bay watershed, home to one of the world’s most prolific salmon fisheries. But she knew that the lawyers, economists and political advisors assembled in the Roosevelt Room would make Swiss cheese out of her plan. The decision would inflame the Republican Congress, they’d say, hamper economic growth and likely provoke a lawsuit from industry. Then they’d send her on her way without an answer.

But McCarthy also knew there would be a new player in the room. Longtime Democratic operative John Podesta, Bill Clinton’s former chief of staff, had just returned to the White House as counselor to Barack Obama. And Podesta had a reputation for bold conservation policy.

Shortly before the meeting, in fact, Podesta pulled aside Mike Boots, the acting head of the White House’s Council on Environmental Quality. He said: “Maybe it’s time for me to show people it’s going to be different,” Boots recalled.

And 10 minutes into the conversation, Podesta broke in. He said that he and the president endorsed McCarthy’s plan, and then laid out exactly how the announcement would roll out. McCarthy left the room, dumbfounded and elated. “Was that the Roosevelt Room that I was just in?” she asked, according to a White House staffer, who asked to remain anonymous. “I’ve only ever been handed my ass in that room.”

The Pebble Mine decision was just the start of a yearlong presidential sprint to advance conservation and climate change goals. Podesta has been there every step of the way. Think of him as the Good Witch in The Wizard of Oz, telling Obama’s Dorothy that she always had the power to do what she wanted; she simply had to tap her heels together three times.

As the 66-year-old Podesta embarks on yet another adventure — this time 
as Hillary Clinton’s campaign manager for the 2016 election — he can list some remarkable achievements: He directly had a hand in six of 16 national monuments Obama
 has created or expanded so far by executive order, including New Mexico’s Organ Mountains-Desert Peaks, Colorado’s Browns Canyon, Southern California’s San Gabriel Mountains, and the country’s largest marine reserve, the Pacific Remote Islands National Monument; and steered a landmark climate deal with China to control greenhouse gas, as well as the first proposal to regulate climate emissions from U.S. coal-fired power plants.

Add in his record under Bill Clinton — the sweeping 2001 “Roadless Rule” protecting 58 million acres administered by the U.S. Forest Service, and the 19 national monuments and conservation areas, many in the West, that Clinton declared in his second term in office — and Podesta can claim a green legacy that even Teddy Roosevelt would be proud of.

“Nobody in the 21st century in U.S. government has had the influence that he has had on public lands and climate change,” says Douglas Brinkley, a Rice University professor of history.

Podesta rarely gets public credit, but those who do — from the presidents he has served to Cabinet members and agency heads — are quick to acknowledge his contributions.

by Elizabeth Shogren, High Country News |  Read more:

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Hans Jaenisch, Abstract No.10

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Other People

Once, when I was twenty-two and working in a liquor store, an old white woman came in and told me her son had died in the Vietnam war, and his body been flown home. She wanted badly to see him one last time, but though she begged and begged for a viewing she was told by military personnel that his face had mostly been destroyed, and she was not allowed to look. “They were trying to spare me,” she said, “against my will.” So during the service she tore down the aisle and ripped off the flag and pushed open the lid of his coffin, and inside was a dead Vietnamese child, not her son, his small corpse wrapped in a green wool blanket and his face perfectly intact. “They sent us hundreds of dead children,” she told me, “and none of them were ours.”

She was an alcoholic, one of many regulars who stood waiting outside our doors before we opened at nine a.m., their backs to the blood-freezing cold of the Minnesota wind, breathing into their hands and peering through the window at me as I counted the register. I’d started working at the liquor store as a direct result of being fired from a different job, a café in Uptown where I’d been late every single day of the three months I worked there. I’d caused a terrible scene in the office in front of my embarrassed managers; not an impressive you-can’t-fire-me-I-quit scene, but the kind with guttural sobs and mucus pooling first in my palms, then running silver down the cuffs of my sleeves. That evening my friend took me to the liquor store and I broke down again in the whiskey aisle. She led me to the counter by the wrist and presented me, deflated and soggy, to the guy at the register. “Do you have any specials for people who’ve just been fired?” she asked.

He gave me an airline serving of Jagermeister and a job application. Soon thereafter I began. My co-workers were all dark beards beneath woolen beanies, and one other woman who was twenty-eight and had recently lost her virginity. “Now I’m really trying to slut it up,” she said. Sometimes certain Somali men would ask us, “What do your husbands think of you working in a place like this?” and we would say, “Who’d be crazy enough to marry us?”

The store had recently been stung by undercover underagers and hit with a sixty thousand dollar fine, so we were now required to enter a birthday for each patron in order to unlock the computer and process the order. These men who asked about our husbands were often the same men who, when I said, “Date of birth?” would answer, “9/11,” and stare set-faced at me as if waiting for hysteria. I might have been nervous, except often enough their hijab’d wives came in with them and stood a pace behind their husbands’ shoulders and mouthed sorry to me, smiling, shrugging, rolling their eyes; what can you do?

“I thought Muslims didn’t drink,” I said to my co-worker.

“When has God ever stopped anyone from being an asshole?” she said, having her own conversation.

What can you do? My boss was miserable, and slunk into the basement to smoke weed when things were slow. He was the son of the owner, destined to inherit the beer dynasty, and when I had a headache he advised me to duck behind the counter and take a shot of sour-apple Pucker. “Go on,” he said, “I won’t tell.” He reported only to his sister, who came in every few weeks to walk the aisles with her lumpy long-haired dachshund, trailing judgmental fingers over dusty bottles of Boone’s Farm and telling my boss he was worthless; meanwhile the dachshund hunkered down to take a shit by the Captain Morgan’s. He’d glance at me mid-business, and then turn deliberately away, his little doggy face shamed but determined. This was how I felt the whole year.

by Emma Törzs, Okey Panky |  Read more:

Image: John Humble

The Death of Awe in the Age of Awesome

Travel writers like me spend a lot of time contemplating why people venture abroad. Not just the obvious enticements — relaxation, winter sun, cheap pilsner — but the emotional, soul-stirring stuff: the sustenance of the new. The awe. It has, I think, become one of the main incentives of our travelling lives. As spirituality wanes experience is the new faith, and we are refugees from the mundane.

But behind this quest for the big, beautiful and baffling is a disconcerting sense that wonder in the age of the bucket-list is under attack. From technology, from information overload, from the anti-spiritual cynicism of the post-hippy world. In an era where a child has only to hold a five-inch screen in front of their face to gorge themselves on the apparent miracle of a one-inch Dora the Explorer hatching from a two-tone chocolate shell, awe has started to feel increasingly elusive.

It doesn’t take a bona fide philosopher to understand that this diminution of the human experience is an inevitable price of social progress. Awe, after all, used to be much easier to come by. Imagine you’re a Stone-age hunter witnessing a solar eclipse (not like last month’s anticlimactic, cloud-snuffed eclipse. A proper one.). Suddenly, the sun is extinguished. You don’t know it’s a temporary phenomenon, an orbital idiosyncrasy. So you tremble, piss your mammoth-skin pants, invent Gods! That’s a great big uppercut of awe.

Travel, for many of us, has become a means of trying to resuscitate that sense of humbling incomprehension. Awesome places, whether natural or man-made — the sort that are endlessly catalogued in a thousand ‘things to do before you die’ books — have become lodestars for the restless mind, places to light out for. But it’s harder to feel awe when your eclipse is preceded by a 24-hour news preamble sucking every last grain of mystery out of the process.

The result is a uniquely modern malaise in which awe has become fugitive: desperately sought yet ever harder to wrest from the claustrophobic clamour of our overcrowded little planet. Our culture is all grown-up. And like the adult who realises that the illusionist is a con-man, not a conjurer, we’re becoming dulled by over-discovery and over-supply.

Real-life awe barely cuts it anymore; we have Photoshop and CGI outdoing the actual. In 1896, when the Lumière brothers premiered their 50-second movie in a Parisian theatre — of a flickering locomotive chugging towards the camera — people fled the auditorium. Now we watch The Hobbit, where 3D armies of orcs, trolls and warmongering dwarves appear utterly, compellingly alive, and shuffle out of the multiplex feeling lobotomized.

The city-dweller’s connection with nature — the most prolific wellspring of earthly wonder — is eroded, near-severed. Romanticising landscape is barely tolerated. Wordsworth would never get away with that lonely cloud shit now. People would just call him a self-regarding hipster wanker. Familiarity breeds contempt. Cynicism withers all. When was the last time you witnessed something special without seeing a photo of it first?

Perhaps the greatest problem, though, lies in the paradox that genuine wonder becomes more slippery the more you pursue it. You can have a bucket-list as long as your arm, but any inveterate awe-chaser will tell you that the carefully planned event, loaded with its adherent expectations, is too open to disappointment.

Say your great travelling aspiration is to witness the Northern Lights (and, let’s be honest, if you subscribe to bucket-lists, there’s an 80% chance it is). You’ve made it to the Arctic Circle, journeyed out to some gloaming Nordic fastness. And there! The ethereal vision of electric green ripples oscillating across space — curling, coalescing, painting great glyphs in the sky. Your imagination unfurls: one moment you see a charging horse, the next a crashing wave. What could it mean, this incandescent tumult, these billion motes of cosmic dust carried on the solar wind? You reach for your camera, then pause. No. You just want to breath this in (there are good photos available on Google images). Hair on end, eyes agog, soul vaulting, you shiver. But wait! What’s this? The couple from your group-tour have marched into your field of view. Backs turned to the light, they hold the phone aloft. Pout, snap; pout, snap. “This is so awesome,” the man breathes, returning to your side. And — POP! — your reverie is gone.

by Henry Wismayer, Medium | Read more:
Image: © Trond Kristiansen

N. Scott Trimble, Greenpeace - Kayaktivists
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Shawn Colvin

[ed. Talking Heads cover]

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The Insults of Age

I had known for years, of course, that beyond a certain age women become invisible in public spaces. The famous erotic gaze is withdrawn. You are no longer, in the eyes of the world, a sexual being. In my experience, though, this forlornness is a passing phase. The sadness of the loss fades and fades. You pass through loneliness and out into a balmy freedom from the heavy labour of self-presentation. Oh, the relief! You have nothing to prove. You can saunter about the world in overalls. Because a lifetime as a woman has taught you to listen, you know how to strike up long, meaty conversations with strangers on trams and trains.

But there is a downside, which, from my convalescent sofa, I dwelt upon with growing irritation. Hard-chargers in a hurry begin to patronise you. Your face is lined and your hair is grey, so they think you are weak, deaf, helpless, ignorant and stupid. When they address you they tilt their heads and bare their teeth and adopt a tuneful intonation. It is assumed that you have no opinions and no standards of behaviour, that nothing that happens in your vicinity is any of your business. By the time I had got bored with resting and returned to ordinary life, I found that the shield of feminine passivity I had been holding up against this routine peppering of affronts had splintered into shards.

One warm December evening, a friend and I were strolling along Swanston Street on our way out to dinner. The pavement was packed and our progress was slow. Ahead of us in the crowd we observed with nostalgic pleasure a trio of teenagers striding along, lanky white Australian schoolgirls in gingham dresses and blazers, their ponytails tied high with white ribbons.

One of the girls kept dropping behind her companions to dash about in the moving crowd, causing mysterious jolts and flurries. Parallel with my friend and me, an Asian woman of our age was walking by herself, composed and thoughtful. The revved-up schoolgirl came romping back against the flow of pedestrians and with a manic grimace thrust her face right into the older woman’s. The woman reared back in shock. The girl skipped nimbly across the stream of people and bounded towards her next mark, a woman sitting on a bench – also Asian, also alone and minding her own business. The schoolgirl stopped in front of her and did a little dance of derision, flapping both hands in mocking parody of greeting. I saw the Asian woman look up in fear, and something in me went berserk.

In two strides I was behind the schoolgirl. I reached up, seized her ponytail at the roots and gave it a sharp downward yank. Her head snapped back. In a voice I didn’t recognise I snarled, “Give it a rest, darling.” She twisted to look behind her. Her eyes were bulging, her mouth agape. I let go and she bolted away to her friends. The three of them set off at a run. Their white ribbons went bobbing through the crowd all the way along the City Square and up the steps of the Melbourne Town Hall, where a famous private school was holding its speech night. The whole thing happened so fast that when I fell into step beside my friend she hadn’t even noticed I was gone.

Everyone to whom I described the incident became convulsed with laughter, even lawyers, once they’d pointed out that technically I had assaulted the girl. Only my 14-year-old granddaughter was shocked. “Don’t you think you should have spoken to her? Explained why what she was doing was wrong?” As if. My only regret is that I couldn’t see the Asian woman’s face at the moment the schoolgirl’s head jerked back and her insolent grin turned into a rictus. Now that I would really, really like to have seen.

By now my blood was up. At Qantas I approached a check-in kiosk and examined the screen. A busybody in uniform barged up to me, one bossy forefinger extended. “Are you sure you’re flying Qantas and not Jetstar?” Once I would have bitten my lip and said politely, “Thanks. I’m OK, I think.” Now I turned and raked him with a glare. “Do I look like somebody who doesn’t know which airline they’re flying?”

A young publicist from a literary award phoned me to deliver tidings that her tragic tone indicated I would find devastating: alas, my book had not been short-listed. “Thanks for letting me know,” I said in the stoical voice writers have ready for these occasions. But to my astonishment she poured out a stream of the soft, tongue-clicking, cooing noises one makes to a howling toddler whose balloon has popped. I was obliged to cut across her: “And you can stop making those sounds.”

After these trivial but bracing exchanges, my pulse rate was normal, my cheeks were not red, I was not trembling. I hadn’t thought direct action would be so much fun. Habits of a lifetime peeled away. The world bristled with opportunities for a woman in her 70s to take a stand. I shouted on planes. I fought for my place in queues. I talked to myself out loud in public. I walked along the street singing a little song under my breath: “Back off. How dare you? Make my day.” I wouldn’t say I was on a hair-trigger. I was just primed for action.

by Helen Garner, The Monthly |  Read more:

Image: uncredited

Jonathon Gardner, Zig Zag 2014
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photo: markk

Host

Mr. John Ziegler, thirty-seven, late of Louisville's WHAS, is now on the air, "Live and Local," from 10:00 P.M. to 1:00 A.M. every weeknight on southern California's KFI, a 50,000-watt megastation whose hourly ID and Sweeper, designed by the station's Imaging department and featuring a gravelly basso whisper against licks from Ratt's 1984 metal classic "Round and Round," is "KFI AM-640, Los Angeles—More Stimulating Talk Radio." This is either the eighth or ninth host job that Mr. Ziegler's had in his talk-radio career, and far and away the biggest. He moved out here to LA over Christmas—alone, towing a U-Haul—and found an apartment not far from KFI's studios, which are in an old part of the Koreatown district, near Wilshire Center.

The John Ziegler Show is the first local, nonsyndicated late-night program that KFI has aired in a long time. It's something of a gamble for everyone involved. Ten o'clock to one qualifies as late at night in southern California, where hardly anything reputable's open after nine.

It is currently right near the end of the program's second segment on the evening of May 11, 2004, shortly after Nicholas Berg's taped beheading by an al-Qaeda splinter in Iraq. Dressed, as is his custom, for golf, and wearing a white-billed cap w/ corporate logo, Mr. Ziegler is seated by himself in the on-air studio, surrounded by monitors and sheaves of Internet downloads. He is trim, clean-shaven, and handsome in the somewhat bland way that top golfers and local TV newsmen tend to be. His eyes, which off-air are usually flat and unhappy, are alight now with passionate conviction. Only some of the studio's monitors concern Mr. Z.'s own program; the ones up near the ceiling take muted, closed-caption feeds from Fox News, MSNBC, and what might be C-SPAN. To his big desk's upper left is a wall-mounted digital clock that counts down seconds. His computer monitors' displays also show the exact time.

Across the soundproof glass of the opposite wall, another monitor in the Airmix room is running an episode of The Simpsons, also muted, which both the board op and the call screener are watching with half an eye.

Pendent in front of John Ziegler's face, attached to the same type of hinged, flexible stand as certain student desk lamps, is a Shure-brand broadcast microphone that is sheathed in a gray foam filtration sock to soften popped p's and hissed sibilants. It is into this microphone that the host speaks:

"And I'll tell you why—it's because we're better than they are."

A Georgetown B.A. in government and philosophy, scratch golfer, former TV sportscaster, possible world-class authority on the O.J. Simpson trial, and sometime contributor to MSNBC's Scarborough Country, Mr. Ziegler is referring here to America versus what he terms "the Arab world." It's near the end of his "churn," which is the industry term for a host's opening monologue, whose purpose is both to introduce a show's nightly topics and to get listeners emotionally stimulated enough that they're drawn into the program and don't switch away. More than any other mass medium, radio enjoys a captive audience—if only because so many of the listeners are driving—but in a major market there are dozens of AM stations to listen to, plus of course FM and satellite radio, and even a very seductive and successful station rarely gets more than a five or six percent audience share.

"We're not perfect, we suck a lot of the time, but we are better as a people, as a culture, and as a society than they are, and we need to recognize that, so that we can possibly even begin to deal with the evil that we are facing."

When Mr. Z.'s impassioned, his voice rises and his arms wave around (which obviously only those in the Airmix room can see). He also fidgets, bobs slightly up and down in his executive desk chair, and weaves. Although he must stay seated and can't pace around the room, the host does not have to keep his mouth any set distance from the microphone, since the board op, 'Mondo Hernandez, can adjust his levels on the mixing board's channel 7 so that Mr. Z.'s volume always stays in range and never peaks or fades. 'Mondo, whose price for letting outside parties hang around Airmix is one large bag of cool-ranch Doritos per evening, is an immense twenty-one-year-old man with a ponytail, stony Mesoamerican features, and the placid, grandmotherly eyes common to giant mammals everywhere. Keeping the studio signal from peaking is one of 'Mondo's prime directives, along with making sure that each of the program's scheduled commercial spots is loaded into Prophet and run at just the right time, whereupon he must confirm that the ad has run as scheduled in the special Airmix log he signs each page of, so that the station can bill advertisers for their spots. 'Mondo, who started out two years ago as an unpaid intern and now earns ten dollars an hour, works 7:00—1:00 on weeknights and also board-ops KFI's special cooking show on Sundays. As long as he's kept under forty hours a week, which he somehow always just barely is, the station is not obliged to provide 'Mondo with employee benefits.(...)

Whatever the social effects of talk radio or the partisan agendas of certain hosts, it is a fallacy that political talk radio is motivated by ideology. It is not. Political talk radio is a business, and it is motivated by revenue. The conservatism that dominates today's AM airwaves does so because it generates high Arbitron ratings, high ad rates, and maximum profits.

Radio has become a more lucrative business than most people know. Throughout most of the past decade, the industry's revenues have increased by more than 10 percent a year. The average cash-flow margin for major radio companies is 40 percent, compared with more like 15 percent for large TV networks; and the mean price paid for a radio station has gone from eight to more than thirteen times cash flow. Some of this extreme profitability, and thus the structure of the industry, is due to the 1996 Telecommunications Act, which allows radio companies to acquire up to eight stations in a given market and to control as much as 35 percent of a market's total ad revenues. The emergence of huge, dominant radio conglomerates like Clear Channel and Infinity is a direct consequence of the '96 Act (which the FCC, aided by the very conservative D.C. Court of Appeals, has lately tried to make even more permissive). And these radio conglomerates enjoy not just substantial economies of scale but almost unprecedented degrees of business integration.

by David Foster Wallace, The Atlantic |  Read more:

Image: Taylor Callery

What is Medicine’s 5 Sigma?

“A lot of what is published is incorrect.” I’m not allowed to say who made this remark because we were asked to observe Chatham House rules. We were also asked not to take photographs of slides. Those who worked for government agencies pleaded that their comments especially remain unquoted, since the forthcoming UK election meant they were living in “purdah”—a chilling state where severe restrictions on freedom of speech are placed on anyone on the government’s payroll. Why the paranoid concern for secrecy and non-attribution? Because this symposium—on the reproducibility and reliability of biomedical research, held at the Wellcome Trust in London last week—touched on one of the most sensitive issues in science today: the idea that something has gone fundamentally wrong with one of our greatest human creations.

The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness. As one participant put it, “poor methods get results”. The Academy of Medical Sciences, Medical Research Council, and Biotechnology and Biological Sciences Research Council have now put their reputational weight behind an investigation into these questionable research practices. The apparent endemicity of bad research behaviour is alarming. In their quest for telling a compelling story, scientists too often sculpt data to fit their preferred theory of the world. Or they retrofit hypotheses to fit their data. Journal editors deserve their fair share of criticism too. We aid and abet the worst behaviours. Our acquiescence to the impact factor fuels an unhealthy competition to win a place in a select few journals. Our love of “significance” pollutes the literature with many a statistical fairy-tale. We reject important confirmations. Journals are not the only miscreants. Universities are in a perpetual struggle for money and talent, endpoints that foster reductive metrics, such as high-impact publication. National assessment procedures, such as the Research Excellence Framework, incentivise bad practices. And individual scientists, including their most senior leaders, do little to alter a research culture that occasionally veers close to misconduct. 

Can bad scientific practices be fixed? Part of the problem is that no-one is incentivised to be right. Instead, scientists are incentivised to be productive and innovative.

by Richard Horton, The Lancet |  Read more (pdf):

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