Category Archives: Editorial Reviews

Learning from Taiwan about responding to Covid-19 – Summary

Author’s note: The complete article is titled:

Learning from Taiwan about responding to Covid-19 — and using electronic health records By Ezekiel J. Emanuel, Cathy Zhang, And Aaron Glickman JUNE 30, 2020

and can be found at:

SUMMARY:

Who beat the Covid Pandemic? If one measures success as fewest coffins per 100k or sustained economy, Taiwan kills the U.S.  

On a per 100k basis, the U.S. has 1,200 times as many new Covid-19 graves as Taiwan. The U.S. issued, begrudgingly, stimulus checks to idle workers and ailing enterprises. Taiwan? Not(). By containing the virus, Taiwan prevented deaths and sustained its economy. What are some obvious differences in the two countries? Taiwan is an island. Taiwan is less populous than the U.S. What else?

Doesn’t being an island and having less people automatically give Taiwan an advantage over the U.S. in the fight against Covid? Other factors counter these advantages. Compare population density per square mile in Taiwan (tái)(wān)= 1,680 vs continental United States = 103. Oh, and did I forget to mention her closest (81 miles) neigbor?

So, Taiwan’s successful response to Covid-19 was luck …NOT()!. Taiwan’s proximity to China abides. Since more than 1 million Taiwanese work in China, those workers carry home more than a paycheck. Having nationals working in the country where the pandemic originated and returning home posed danger but that danger never ensued. Why (was this so)?

Culture plus vigilance plus information equals power to the populous.

Taiwan has generated a culture of taking infections from China seriously. For example, Taiwan’s innovative electronic health records system made possible the country’s swift, targeted response to Covid-19. The health card gives the ministry regular, nearly real-time data. The availability of almost immediate data on patient visits allowed the country to efficiently identify, test, trace, and isolate cases. Therefore private patient data provides public populous good. But information potential does not always serve its many possibilities…

Having electronic health records solves nothing but the abstracts of time and space – unless innovatively utilized. The U.S. has come a long with its use of electronic records, thanks in part to the financial incentives built into the Health Information Technology for Economic and Clinical Health Act of 2009. What’s the next step for electronic records?

Size and site things. But the Republic of China and the “Land of the Free.” Differ in other and invisible ways.

Taiwan shows that data sharing is a challenge of policy, not technology. Americans’ health records privacy policy trumps technological solutions to national health care concerns. Americans seem reluctant to allow the Department of Health and Human Services to monitor patient encounters. Taiwan solves the riddle while the U.S. burns. When freedom prevents liberty, people die.

Putting privacy policy aside for popular good allows lifesaving innovations. Medicare and Medicaid could adopt something similar to the Taiwanese health card. Why haven’t they? Insurers already get data based on hospital and physician claims, albeit only weeks or months after encounters, making the information less useful for tracking infectious outbreaks. Adapting U.S. electronic health records to an expanded role would be work but not hard work because…

Accepting that hindsight may not always be 20/20, past experience should be the future starting point for developing a Taiwan like system. The U.S. has the benefit of hindsight for what went well and what went wrong with electronic health records development. Hindsight smooths the path (dào)to take the next step – health record utilization for public good. The U.S. needs a faster, more serious response to public health emergencies. When will this happen? Can it happen without serious revision of the privacy accord?

Shoring up the U.S.’s digital health infrastructure will help improve routine care in the long run while empowering us to better respond to future infectious disease outbreaks.

Albert Speer Jr. dies at 83

Albert Speer Jr., the architect who tried to overcome his father’s Nazi legacy, dies at 83

The son of Hitler’s architect and armaments minister died recently, click the article below and also read my summary and analysis.

Albert Speer Jr. Dies at 83

Albert Speer Jr. sought to differentiate himself from his father, Hitler’s architect and armaments minister (aka the devil’s architect) in order to overcome his father’s legacy.

Architects glorify regimes and heroes through monuments and so this proclivity exhibited itself from Nazi Germany forward into today’s Communist China. The Dictator of the Elder frightened the world; the father of the Younger frightened his children. Hitler’s demeanor enchanted both father and son; the former seeing Adolf as a hero and friend while the latter saw the leader of the Third Reich as a kindly uncle with dogs and sweets.

Albert Speer Jr. sought to disassemble his legacy and it became manifested in the innovative stadiums he designed which when disassembled, found resurrection from one regime to the next.

Reflections: From Prison to Ph.D.

New York Times, Eli Hager September 13, 2017

From Prison to Ph.D.: The Redemption and Rejection of Michelle Jones

My reflections on this article.

The leaves of the trees fall and whither and die.  Not so with fallen people.  Some people fall and whither but fight not to die.  Without assistance and little sustenance, one can rise by will from the ashes.  A public past refuses to be forgotten, but a fortified will must needs overcome that refusal and that past.  While belief in redemption needs each us to participate, belief in oneself to redeem thyself remains the most important factor.  Perfect fruit can die on the vine if caretakers neglect it.  That fruit may serve its purpose if responsible people simply serve their calling.  The fruit serves only then its purpose.  If fate somehow provides manna for the fallen in the form of abundant grace, then sweet be the results.  One who has fallen can never satisfy the relentless critiques.  Fear of being associated with controversy lurks enough to dampen soft support.

Early crimes against the fallen hardly count for anything.  Incessant abuse further corrupts the tender corrupted.  That horror begets horror should not horrify those who witness.  Where do the sentiments which raise the living dead to life originate?  Where does commitment to right wrongs which can never be righted seed and grow?  Where those sentiments come from remains a mystery, but the steps to achievement are simple.  One step then another, and endless and eternal and undeterred.  Examine where one is presently.  Find others who have been there and what happened to them.  Accept that what is present is also past.  Express it.  Rewards sit invisible at the end of blind journeys in faith.  The alone find company and competition.  One adjusts solely by self and will.  Judgements remain, but they must remain in the past.  Punishment, it its purest form, lies in itself.  If publicly served, guilt already recorded must be let go by all.

A fresh start.  Courage.  A second chance.  Each of these may manifest in supporters, but must emerge from the fallen.  None deserve anything from life, yet life serves pain and its opposite to each every day.  Let past pain be future strength.  Being an eyewitness to life’s pitfalls provides a foot path out of them.  Honest and full narration means much to investors, but most to the scrutinized.  Others may hijack a career, but they cannot derail the dream.  Don’t make a crime a focus, make it a fulcrum.  Realize the dark place people place the fallen and don’t forget it either.  Stay interest in the world and be cosmically connected.  Coming to means awakening to a world that was always there but that has changed its accoutrements.  Adapt and take the steps.  Expect curiosity.  Expect to have to prove.  Teach them resourcefulness is strength and nothing will ever be taken for granted.  Presumptions and underestimates lay before.  Experience and exceptional await.

Analysis: My Party Is in Denial About Donald Trump by Jeff Flake

Analysis

My Party Is in Denial About Donald Trump

How did we ensure the rise of Donald Trump?  Conservatives mocked Obama’s pledge to change even as we worked to assist with that failure.  Conservatives were silent when marginal figures attacked Obama’s legitimacy.  Depicting current happenings as normalcy requires a determined suspension of critical faculties.  This amounts to the conservative mind being diseased and abandons the normal constraints of reason and compassion.  The bitter pill to cure the diseased mind of the conservative is to acknowledge the accumulation of damage raining down from the president and act before the deluge rather than ignoring the obvious, forming a disaster.

Responding with silence to the erratic presidency abdicates responsibility.  Congress must be unified in defense of its prerogatives regardless of presidential affiliation.  When principles become malleable to the heat of power, they soon deform into something of no consequence and are no longer principles.  When a foreign power’s attack on our democracy results in a rejection by the presidency of his own intelligence, there is something rotten in the state of Denmark.

Despotic men are deposed but their ambition resurrects in others who have learned from the departed. Here now, our forebears cry out from their graves, warning us of the foreign transgressors now at the gates of our Republic.  Republicans win bigly when they shortsightedly play to populism and prefer protectionist policy, while handicapping the country without a long view, long term.  The ruling party engages in reckless politics and reenacts history to the detriment of the people that they are here to serve.

After the Ice by Paul Crenshaw – a review

There are few days in each of our lives that would be clearly remembered if it weren’t for the startling events of that day.  Ice, bright sun, dirty rivulets washing across the road would all blend with another day such as it, except for an event that will never leave one’s mind’s eye.

Paul Crenshaw tells the story of a family tragedy.  A little boy murdered by his step-father.  An endless personal journey for him, where emotions and sentiments speed up at times with rage and at other times slow to allow a glimpse of compassion or forgiveness but without stopping to let them into the mental mirage.  The author collected newspaper articles and microfilm reels in an attempt to review and understand what happened in those haunting days many years ago.  With courage that was suppressed for sometime by trepidation, Paul let the information sit for a long while before opening up the cans.

The little boy, a nephew of 18 months, died from child abuse.  The step-father was convicted of first-degree murder.  The author speaks of having a place within himself deeper than sadness as he reviews the material, it seems he is talking about some kind of wished for mental mechanism that allows him to remember and evaluate but that holds his simple sentiments in check, keeping them from careening to a place where there will be a loss of emotional control.  Images of the murderer and the murdered do not go away.  Images, detailed images, remain and emote and haunt and never quite leave one’s mind’s eye.

The memory of the day of the funeral once again introduced the existence and metaphor of ice.  A bleary memory of the funeral, an eager escape from a stifling house where men spoke of violence, and the writer’s aimless walk away into the woods, away from the sounds that accompany death, into the soothing cold.  Freezing air, a fickle air confused of its role of either rain or snow, and the early dark that served as a companion to thoughts which required no light.  His reluctant return was respected by solemn silence, except for the ice on the leaves which seemed to accompany him to the misted glow of his grandmother’s house porch light.

Memories of the nephew’s life before death are filled with snippets of the real and fill in the blank imaginaries which help to carve continuity for Paul’s imaginings.  Having never been in the house where the boy was murdered, a detailed layout of the inside of the house is imagined.   Not knowing the precise details of what happened on that fateful day, a scenario is painted with precision.  Images of overgrown, neglected, and empty pepper the section where the imagination takes over for the missing bits.

The most poignant piece for me is when the author tells of his own remarkable family event of consequence.  His young daughter is thought to have a deformed skull.  Panic and fear set in for both parents.  Tests are done and trepidation rises.  However, as it is for so many soap-operatic occurrences in today’s modern medicine, this was a false alarm.   Their daughter’s skull was normal.  The doctor’s skull is the one that needed examining.   The point he makes here is that after this near tragic event, which turned out OK, he has no memory of what kind of day it was, how bright the snow was, how the mud mingled with the rivulets.

Memories and imaginings both strain to have another constraint added.  Why couldn’t there be a way for fond memories of both the murdered and murderer be kept separate from the events that came after?  Why can’t forgiveness intervene and allow for peaceful remembering and silent forgetting?  Why can’t sense be made out of the senseless as opposed to murder invading the laughter of a Thanksgiving day?  The events watched and waved at fail to foretell the future.

The author’s father has not spoken his grandson’s name since.  Sometimes the two of them would stand together late at night in silence, staring into their thoughts, into whatever dreams they could not handle.  The family does not mention the grandson’s name.  The grave site is unknown to Paul.  He would visit that place but he fears it would be for his own comfort and that saddens him about himself.  The haunting continues in his own life with his own daughters.  He stands in silence in their bedrooms as they sleep.  He is there in the morning when his wife gets up.  He cannot explain.

His imagination returns to the step-father.  How did they pick him up and put him in prison?  How did the arrival and days after go?  Sometimes the thoughts are tinged with sympathy if not forgiveness.  Other times they are painted red, with vengeance in mind, and the possibilities of being incarcerated with violent men.  Each frame of this mind clip takes place on a cold day.

He contrasts his dour imaginings with those brighter as he writes about his adult family life.  The closeness of his parents to them emotionally and the love for their own daughters.  As he starts to flick through a box of photos, it’s not clear, at first, whether they are of the lost nephew.  It turns out to be of his own young girls and his reflections.  Somehow he concludes that he is less wise as the years go past.

The author Paul Crenshaw closes with foreboding moments.  First the imagined crying of the nephew in the house where he was to die.  Then a real life moment in a grocery store where Paul worked and the step-father and nephew came in.  The little boy was crying until Paul picked him up.  He returned to crying when handed back to the step-father.  The young man, though not expressing it, indicates that he may feel guilty that he did not foresee the events that would take place a few months hence.

Auscultation by Steven Church – a review

Auscultation, the meaning of the title only approximates the meaning of this editorial’s content.  Listening to the sounds of the body – serves as a definition for the title word, but listening FOR the sounds of life better serve this fine piece and might serve as a subtitle.  The editorial is divided into four sections, each numbered as Chamber #, which brings to mind the components of the heart, the ultimate indicator of body life via body sound.  Though the protagonist here is the ear, the heroine is the heart and the vignettes to be described can be ranged from heart-wrenching to endearing.

Chamber 1:  Six miners are buried alive far below.  Without sight or direct communication, electronic ears are erected and seismic sounds are listened for – in vain.  The search for life is ceremonially begun with three small explosions at the surface which serve to communicate to the miners to make noise which will indicate their health to those above.  All listeners heard no sound and the rescue was abandoned with little ceremony except the sealing of the tomb of the silent six.

Chamber 2: You are brought back in time to your first doctor’s exam using a stethoscope.  The feelings of the device on your body.  The gentle instructions issued by the doctor and followed by you.  The silence, except for breath, as your body sang its tune of condition into the black flexible tubes, giving clues to the ear, and a diagnosis to only a skilled doctor.  What your body told the listener and what the listener told you would be the legacy of your visit and the path of your health.

Chamber 3: The stethoscope is a product of centuries of medicine’s quest to extract sounds from deep within the body where prying eyes cannot see.  From rudimentary to refined, the listening device has progressed from a monaural horn, to a bin aural listening device, to an electronic noise translator.  Still less than perfect, doctors train their ears on classical music – learning to discern the individual instruments.  Further, a doctor’s emblem is his stethoscope, and the sight of it serves as his good word.

The author tells of doctor and parents gathered around a fetal heart monitor awaiting the news of life.  The doctor acknowledging the noise as normal.  The author accepting that “It begins” with those first sounds.  He did not feel like a father until the heart noises registered in his ear.  That tap-tap-tap signal of life we cannot see and can in no other way sense.

Chamber 4: Nine miners are buried alive far below.  Without sight or direct communication, the trapped men listen for sounds from the surface – the ceremonial three small explosions at the surface – but don’t hear anything.  The trapped men continue to pound on the roof bolts but they get no response.  At the surface the drill operator finally punches through into the cavity and then quiets the gathered crowd.  He feels or hears the rhythmic sound of the trapped men hammering at the steel.  Life is detected and lives are saved from a place not seen but heard.

Port-au-Prince: The Moment by Mischa Berlinski – editorial review

Disaster knocks softly on one’s door before breaking it down.  This is how Mischa Berlinski introduces us to the horrific earthquake in Haiti, 2010.  Frightening sounds without source.  The foundations of the elite and the impoverished at once blended in a swirl of nature’s chaos.  Secret gardens exposed to everyone still standing…but only for the moment.  The author spinning, dizzied, seeing horror in rapid flashes as if seated in a slideshow.  Rushing in controlled panic (the author coining the term “reptilian optimism”) to his family at home, the young husband and father found his wife in mixed but joyful tears and his baby well and collected, calm.  As if in Jericho, a modern day Joshua blew his trumpet, and the high walls of P-a-P came tumbling down – all of them.  Though the situation was dire, as survivors gathered near the residence of the prime minister, the closeness emitted the contrary sounds of fragile gaiety in the moody air.  Stoic men vanished from the scene as the colorful emotions of the women dominated the sights and sounds and scenes of loss.

Communication ranged from none to spotty.  A cell phone might be found that connected but it might not have any prepaid minutes remaining.  Between the mundane programming, foreign radio stations reported, over seemingly long intervals, the quake in Haiti, first the occurrence, upgrading the adjective later to massive, and finally, hopefully, to the penultimate adjective: catastrophic.  This assessment being trumped by the declaration of a local priest – “fin des temps“.  Waiting for international response, the masses swayed on this island earth between the jolts of aftershocks.  Sounds lacking for this monumental tragedy included the absence of sirens coming to aid, the hissing of helicopters wishing to rescue.  Sounds tracking the night were those of prayer.  The darkness seemed to covet the mourning until dawn when the sun alerted those still murmuring on their knees that their struggle was to begin again and that each was exhausted.

Ruination dominated the hysterical hearsay, facts probably embedded.  What was left standing?  Curiosity out paced good sense to the hopeful skeptic.  The author ventured out to gather his own evidence at his own peril.  Sensed along his path to knowing, Mischa noticed that the odor of mass decomposition could not compete with that of massive human waste.   Sight awed at the collapse of all man’s structures thus burying the individual demise of many men,women, and children.  However, unavoidably, a mangled corpse struggled and emerged to be viewed.  Eyes wide.  Guts displayed.  Face powdered with the offal of the aforementioned collapses.  The green lawns of luxury hotels held the wounded in lawn chairs.  Foreigners, who had made contact with their country of origin and whose country cared about that individual, might be rescued by helicopter.  Elites reestablishing themselves atop the ruin as soon as conditions permitted.

With Mother Nature chortling in the background at the commencing nonsense, the blame game began to play out.  Aristide, his enemies, the elites…  The much maligned UN was there from the prior man-made disaster with its guns to contain perpetual chaos.  Nature was there to impose her enduring order.   Mr. Berlinski found his way to an impasse, within the impasse sat collapse, under the impasse lay Haiti’s destiny.  Dying but not dead.  Choking but still breathing.  Hopeless but still praying.