Wednesday, January 27, 2010

Obama State of The Union Address; Geitner and Summers should go

In his great, second State of The Union Address (SOTU), President Barack Obama kept his focus on creating new jobs, and called for a new sprit of bipartisanship, but without caving in on Heath Care Reform. But left out of the SOTU was what would have been his boldest stroke of all: firing Treasury Secretary Tim Geitner and Chief Economic Advisor (title: Director of the National Economic Council) Larry Summers.

Larry Summers

This blog post is more directed at Larry Summers than Tim Geitner, because according to The New Yorker's January 28th edition, Larry Summers failed to present the $1.2 trillion Economic Stimulus Plan Option to President Obama, even though his colleague, Berkeley Professor Christine Roemer said that all of the models she ran pointed to that size of stimulus as the best plan:

The most important question facing Obama that day was how large the stimulus should be. Since the election, as the economy continued to worsen, the consensus among economists kept rising. A hundred-billion-dollar stimulus had seemed prudent earlier in the year. Congress now appeared receptive to something on the order of five hundred billion. Joseph Stiglitz, the Nobel laureate, was calling for a trillion. Romer had run simulations of the effects of stimulus packages of varying sizes: six hundred billion dollars, eight hundred billion dollars, and $1.2 trillion. The best estimate for the output gap was some two trillion dollars over 2009 and 2010. Because of the multiplier effect, filling that gap didn’t require two trillion dollars of government spending, but Romer’s analysis, deeply informed by her work on the Depression, suggested that the package should probably be more than $1.2 trillion. The memo to Obama, however, detailed only two packages: a five-hundred-and-fifty-billion-dollar stimulus and an eight-hundred-and-ninety-billion-dollar stimulus. Summers did not include Romer’s $1.2-trillion projection. The memo argued that the stimulus should not be used to fill the entire output gap; rather, it was “an insurance package against catastrophic failure.” At the meeting, according to one participant, “there was no serious discussion to going above a trillion dollars.”

“There was no serious discussion to going above a trillion dollars," even as economists were talking about a stimulus package that had to be over $1 trillion. Dean Baker of the Center for Economic and Policy Research was quoted as saying "You're talking about a gap on the order of twelve-hundred-fifty billion dollars, and we're trying to plug that with four-hundred-something, so we've got a long way to go."

Paul Krugman said "I'd like to see it bigger." Krugman said. "I understand that there's difficulty in actually spending that much money, and I--they're also afraid of the--of the T word."

The "T" word is "Trillion" but with the economic stimulus package already close to that number, and the country in deep trouble, worrying about what Congress would think - rather than letting Congress deal with the truth - was a big mistake.

China's Economic Stimulus Package was 20 percent of GDP, and many eonomic observers used that as the benchmark for what the size of a U.S. Economic Stimulus Plan would be. Instead, it came in at just about 5 percent of U.S. GDP. The problem feared the most: of doing too little, too late is now facing America, just as it did Japan in the 90s.

Fears of the "T" word and the total U.S. Debt have backed us into this corner. The misunderstanding is that GDP growth guarantees a smaller percentage of GDP that is debt. The Economic Stimulus Package is supposed to jump-start growth. The fact that even the $800 billion version did is proof that the theory is sound, but it didn't boost American Economic Growth to levels that would reduce the record high unemployment rates around the country.

Larry Summers is to blame for this problem:

Summers brought a third argument to the debate, one that echoed his advice to Bill Clinton sixteen years earlier, when his Administration was facing persistent budget deficits that Summers believed were suppressing economic growth. He, like Romer, was guided by an understanding that in financial crises the risk of doing too little is greater than doing too much. He believed that filling the output gap through deficit spending was important, but that a package that was too large could potentially shift fears from the current crisis to the long-term budget deficit, which would have an unwelcome effect on the bond market. In the end, Summers made the case for the eight-hundred-and-ninety-billion-dollar option.

If Larry Summers had done the opposite: that is make an argument for the trillion-dollar option, there's clear evidence America's economic recovery would have been larger and more robust, as the extra $400 billion could have gone to a temporary injection of, say, $5,000 for every American taxpayer under $100,000, thus buying time for the other parts of the stimulus plan to take effect, and boosting consumption at the same time.

But that did not happen, and now America still has its employment problem and a Congress shy to spend more money, even though its badly needed. America has lost $976 billion in wealth due to jobs moving overseas over the last 30 years; over $400 billion just in the last eight years. Turning that problem around is going to take a lot of money.

Stay tuned.

Journey To Haiti With DocGurley!

14 days and counting. I got the message yesterday that a group would like me to go to Haiti. I'd already thrown my name in the hat in the beginning, but they all needed (appropriately) surgeons. Or nurses. But now the situation has morphed, and when the call came my insta-gut response was "yes." Afterward, a tiny flicker of stomach-butterflies set it. Maybe it was the fact that I don't (and maybe won't) have a confirmed return flight home. The estimated time for being there is a week (very do-able), but no guarantees on that estimate (um, less do-able?). Or maybe the butterflies were in part because of the way the lead doctor emphasized (three times!) the fact that we would always have Security with us (clearly said with a capital S). But I knew I wanted to go. When it comes to Haiti, so many of us want to do something. And so I thought you might like to go with me. Which is why I'm going to write about the trip, probably more openly and personally than anything I've written to you before. But first, just so we're all clear, here are the rules:

Doc Gurley's Haiti Manifesto

Rule #1: Why me? Altruism is a gift that benefits the giver. Never more so than when despair hovers. It is amazing how, when I told family, friends and co-workers that I was going to a life-threatening disaster zone, rife with disease and unspeakable deprivation, the uniform first response has been a blurted out: "You're so lucky!" followed a shocked moment of horror-filled realization as they heard their own words, then "Not lucky, I mean, it's going to be hard, really hard, it's just that I wish I could do something like that, well, you know what I mean..." Sometimes it's even difficult to verbalize exactly why we feel that spike of jealousy. I think it's because we all wish we could do something tangible. Something with our hands and our backs. Heavy lifting. Hey, we all know the checks are important (VERY important), but after a while they feel the same as handing your kid a twenty on her birthday. Like something crucial is missing in the act. Could that urge to do something, anything, be the reason I'm going? I've thought about it - am I taking the place of someone else who should go instead (keeping in mind that it can be too easy to think that maybe someone else ought to go, and, if we all do that - no one goes). But I don't think I am taking someone else's place. Here's why: a) I'm an internist, a grunt, a flea, a sickest-of-the-sick-adults'-doctor, one with extensive ER and hospitalist experience, the type of doctor (after the surgeons have left) that they need now, and b) I currently see patients in a homeless clinic with a strong culture of collaborative care so - while it's admittedly still not Haiti - I don't tend to have the typical easily-offended doctor amount of either ego or fastidiousness, and c) I speak good-enough French to have worked for three months in a monolingual medical environment, and d) I did those French-speaking healthcare months in a Third World country in Africa, a place somewhat like Haiti in that the generators turned off every night and mosquito netting and hungry bats were our major malaria interventions, and e) frankly I am lucky enough to have the job/benefits/luxury of being able to go on short notice while not paid to do so like a disaster team is, and f) while the fact is that I'm not a nurse (okay sure, I ran an IVAC once, but all I remember of the experience is a panic-filled blur of jabbing buttons while machines beeped at me in a decidedly contemptuous fashion), and would never claim to be a nurse, I can honestly say that if there's a bandaging, dosing, vital-sign-taking, bedpan-changing, spongebath giving, floor-mopping job to do, well, like most of us peri-menopausal moms, I'm your Gurley. All of which leads to Rule #1 - the better candidate goes. That means if someone more qualified or adept can take my slot, I step out. Even at the eleventh hour (that would be 4:30 am, February 15, in a United terminal at Chicago's O'Hare, in case anyone's keeping track).

Rule #2: We go there to work. There will be NO ethically weird moments when the camera swings, Gupta-like, in my direct and I orthodontially blind you while simultaneously performing surgery. I'm going there to work. As a doctor. I'll be sweaty, I won't waste suitcase space on make-up, and God knows what my hair will be doing. Sweaty doctor - that's it. There is no sub-clause, no asterisk, no employer, no other job title. There is no conflict-of-interest. The Chronicle/SFGate is not paying me anything, not transport, nada. Heck, I can't even get a satellite cell-phone out of them to make sure I can send and/or upload posts (but maybe! they're working on it!). Any sharing of the experience from me to you happens after the work is done. But as much as is humanly possible, we'll go together. Every step we can. Because whether you're frustrated, or despairing, or hungering to do something, or rage-filled about our own neglected problems at home, there are moments when it's best to share. And an epic disaster is one of them. Join me. We'll go together and do what we can to help.

Rule #3: HIPPA goes to Haiti. People the world over deserve their medical privacy. And no one - especially the very desperate - should have to wonder what their doctor's motivation really is. If I write/blog/video/audio record about a patient, or a situation, either that person will NOT be one of my patients, or their identity will be so changed that no one will ever be able to know exactly who that 12-year-old girl with a head injury really was.

Rule #4: It takes a village to help a village. It's been less than 24 hours since I found out I was going and friends have already stepped up. An Eagle Scout mom has an ultra-small sleeping bag for me (so I'll have more room for medical supplies in my luggage). Colleagues are pitching in to cover shifts they have NO obligation to work (thank you, Barry! thank you, Mary!). Churches - here and there - are helping with logistics and food. Total strangers are coming forward with airline miles for me to use, and a place for me to bunk in Chicago while I wait for my flight out. You too are welcome to go with me to Haiti in spirit. And if you would like to go with me in a more tangible way, I'll let you know of opportunities. But, when it comes to "stuff," I am limited to one 50-lb checked bag. In contrast, there is no limit on goodwill, or funds for those suffering there. I am not wasting time or energy picking apart anyone who wants to help - I don't care about your politics, religion or cash reserves. You want to roll up your sleeves too, well, you're my kind of Gurley...

So here we are, Day 14 and counting:

1) Told my kids I was going. Squeals, hand-flapping, "I'm so jealous," then silence while it sunk in. They're teens, they'll be fine. But I notice how the 15 year old wants to sit closer to me on the couch than she has in years, virtually sinking into my right side. I don't say anything about it, of course. I just let her sink into me too.
What is WRONG with these DPH Travel Clinic people? Don't they know medical visits aren't supposed to be (gasp) pleasant?

What is WRONG with these DPH Travel Clinic people? Don't they know medical visits aren't supposed to be (gasp) pleasant?

2) Shots today. I went to the phenomenal folks at the Traveler's Clinic at the Department of Public Health (conflict-of-interest disclosure: NONE. They don't pay me, I never saw them before today). Dropped in without an appointment at 12:45 pm, was asked by the receptionist in a stricken voice "Would 1:10 work?" After a stunned silence, I squeaked out a "You mean today?" and when she nodded (apologetically) "yes," I had to do a double-take to make sure I was actually standing in an American medical clinic. Who are these people? This is so NOT how medical care works. I got three shots - a hepatitis A, tetanus, and typhoid shot ("ooh, those are going to ache" the lovely NP said, as well as "too bad there's not time for the rabies series - you know it's rampant there, don't you? Just be sure and get airlifted out if anything furry breaks your skin"). The ooh-that's-going-to-hurt shots didn't seem to hurt at all. Being a macho internist, I nodded in agreement while thinking to myself good thing I'm stoic and not a big weeny like their other patients are. Three hours later, I promise you, I'm so sore I would not lift my arms up from my sides unless my hair caught fire. Even then I'd have to think about it. I'm getting a little panicky, in fact, about which side I'm going to sleep on - I'm imagining a night ahead of me composed of "ow" and then "ouch" muttered in the dark as I roll endlessly from side to side in my sleep.

3) Am now panicked about my "functional" French. I have been known on two prior occasions, when I spoke French in Paris, to provoke, from Gauloises-smoking, too-cool-to-sneer citoyens, a shocked guffaw of snorted laughter. One Parisienne laughed so hard she hiccuped. Apparently I tend to speak French with a thick West African accent. But see, French is the only foreign language it's almost impossible to use in the Bay Area (at least medically). Oh God, what if I've forgotten it all? So I ran to my town's fabulous library and checked out every single (non-beginner) French language item (yes, I am the pig who took them all, staggering out of the library under a teetering skyscraper of perilously stacked books): four textbooks - including one Haitian-Creole dictionary - and five massive boxed sets of CDs. Including one two-disc set from The Language Teacher To The Stars - Mel Gibson! Barbra Streisand! Woody Allen! Which makes me wonder what will happen if I visit Paris and speak french to sneering Gauloises-smokers in a thick Mel Gibson accent?

So, in the few moments while I'm not going ow and then ouch during the night tonight, I plan to be subliminally absorbing the nasal tones of a total 189 hours of French audio-lessons I checked out ("ne mange pas ce gateau"...).

But who am I kidding? Sleep is unlikely to occur. Because I've already started fretting over Ethical Haiti Dilemma #1. Let me lay it out for you:

Exhibit A: The supplies MOST in need in Haiti now are wound care, debridement/incision kits, rehydration and dressing supplies, as well as antibiotics and analgesics.

Exhibit B: Most of those supplies are too bulky for me to bring many of them in a suitcase. Except for pills (which are surprisingly heavy, but compact).

Exhibit C: Expiration dates on drugs are arbitrarily set by pharmaceutical companies (who have an obvious conflict of interest), and reliable sources have studied the issue and found that almost all pills and powders are still completely effective years after they "expire."

Exhibit D: I have a legion of eager-to-give-something neighbors, friends and acquaintances with bathroom medicine cabinets bulging with leftover pills.

Ergo: Should I take a half-suitcase of potentially expired, but still-effective antibiotics to Haiti? And...

Algebra Problem of the Day: If I board my connecting flight to Chicago, hurtling at 31,267 feet for 3.87 hours, while carrying a 4-liter grocery bag of donated 2 oz. pill-bottles labeled with 34 different individual names, and each bottle is 3/4 full of highly regulated narcotics, then please calculate how many DEA agents, on arrival at O'Hare, will force me to undergo how many body-cavity searches? Please express your answer in mucosal centimeters. Extra Credit: And, more importantly, given an estimated factor of X minutes per search will those body-cavity searches cause me to miss my Haiti flight? Hmm...

Should I "recycle" drugs for Haiti? Or is it ethically wrong to dump them on a people who have no choice? Share in the comments section - and tune in for the next in the series to get details about the Haiti trip - what will I panic about next? What DO they advise you to bring to a disaster? Keep up on the Haiti trip and the latest health issues in the news by signing up for a Doc Gurley RSS feed by clicking here. Look for future pics and other articles at Doc Gurley! Also check out Doc Gurley's joyhabit and iwellth twitter feeds - so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your wellth this coming year.

Megan A. Fox on Rush Limbaugh Haiti tampons comment

Since his insensitive comments on Haiti, including his blast on "April" a female caller who he told to take the tampon out of his ears, Rush Limbaugh has gained a firestorm of criticism and has been silent for a week (that is, no blasts). The Daily Beast commenters were all over Rush.

Amanda Terkel took up the Rush Limbaugh blast at Think Progress. Reid Report wondered what was wrong with Rush Limbaugh.

At, we wondered what Megan Fox would say about Rush Limbaugh's comments. To that end, Megan Avalon and this blogger came up with Megan A. Fox, a mix of a female bodybuilder and Megan Fox, who's middle name starts with a "D" and not an "A", but we're calling our hero Megan A. Fox.

Megan's a composite of the angry comments and emails and videos I've gotten from viewers, like this one sent to Zennie62 from a woman who actually put tampons in her ears!:

Megan A. Fox got rather heated about Rush Limbaugh's comments and took it out on the host, but given what Rush Limbaugh said, that's OK. Rush Limbaugh really should apologize for what he said as it offended women and good people everywhere. Of course, since that's one of the many ugly ways Rush Limbaugh justifies his $400 million contract, Megan A. Fox and others aren't holding their breath.

Stay tuned.

Apple iPad tablet called iTampon on Twitter; women tweet

The Apple iPad was introduced today at a presentation by Apple CEO Steve Jobs, and with a cost below $600, the iPad price is sure to move inventory. While the iPad's 9.7 inch ips display is certainly bright, and the iPad specs are attractive to all but video-bloggers, the one problem is a glaring one: it's name. The Apple iPad tablet is called "iTampon" on Twitter.

The name "Apple iPad" name was around even before today's announcement of the Apple iPad. In 2006, Mad TV created a satirical skit around the then-new iPhone, calling it "iPad" and advancing it as a clear replacement for the 'common tampon'.

Apparently that idea was fresh in the mind of women this week, because when the Apple Tablet's name was introduced as "iPad", almost immediate references to tampons sprouted up all over the Internet, especially on Twitter where the iPad has become the butt of tweet jokes calling it iTampon:

ChelleC79 RT @helenrazer: Can your docking bay accommodate an iPad, ladies? #iTampon #Apple
less than 10 seconds ago from Seesmic

michelleleung @sunvictoria oh look, itampon is actually a trending topic. lulz
less than 20 seconds ago from Digsby

xhelloxgoodbyex RT @DazzlinSN: itampon? really... did everyone on twitter take an immature pill this morning? such B.S.

Linda_Lum RT @WewillroastU: Steve, I'ma let you finish, but Moses had the greatest tablet announcement of all time #iPad #Apple #iTampon

Guroftw RT @bmxr761: Haha the iTampon trend is more popular then the iPad
less than 20 seconds ago from web

xddlovatoo Wtf is an itampon is that like a computer tampon? Eww maybe nerds could use them xD
half a minute ago from UberTwitter

cassiet1123 iPad = Fail. #iTampon
half a minute ago from web

fiosalvo Just in case you haven't already noticed, just wanted to point out that #iTampon is the top trending topic in the US haha
half a minute ago from web

And the vast majority of tweets referencing the iTampon are issued or retweeted by women. And adding Apple's self-inflicted insult to that injury is the Apple iPad video itself, presented by three white male Apple senior level employees and including no women, and one very provocative segment where a man is using the iPad, where it's placed between his legs and at his crouch, and the woman points to a feature on the iPad right near his crouch.

All of this leads women to wonder, as Boo Jarchow did at, if Apple Computer has any women in its marketing department. Well, the head of Apple Marketing is Phil Schiller, who's featured in Apple's iPad video, and there's no indication of a powerful female voice or staff in Apple's Marketing department.

Equally disturbing is the almost total lack of concern for the name of the device among the ranks of male bloggers and vloggers. Again, women are leading the charge here like Ann Althouse:

When you make something light, you should think about how important the product will be to women, who are touchy about carrying things. Anyway, for our light days, we have iPhones. For our heavy days, we have the iPad? The iMaxiPad? Come on, guys!

With all the attention Apple's getting from the name, and given Internet marketing tricks like the one used around Emma Watson's missing leg a while back, it's possible this was a deliberate trick.  If so, it was a very nasty one and could work against Apple's to-this-day all-accepting cultural image.

Stay tuned.

NY Newsday's pay for news fails: draws 35 people in 3 months

The idea of paysites - where subscribers has been touted as the model that would save Old Media. A recent study claimed that news consumers would spend $500 per year for online news. Tell that to New York Newsday.

Placed behind a pay wall last fall, New York only attracted 35 people at $5 per person. The reason for this awful performance, according to Newsday, is that the website's offered for free to "Millions of Cablevision customers in the New York tri-state area and 75 percent of Long Island households, including all Newsday home delivery subscribers, now have exclusive access to at no additional charge," Newsday said in a statement reported at Paid Content.

Watching the listed reasons why Newsday got only 35 people in three months is totally funny, and shows to what lengths people will go to protect a dumb idea. All of the points made miss a common fact of Internet life: people pay to be entertained, not informed. It's easy to click from one site to the other to get what the user considers is the same information. A report on the Iranian resistance in the New York Times is hampered by the free, and real-time reporting that Twitter offers.

Moreover, the next Twitter-level-impact social network is just around the corner. And that proves why the news organizations just don't get what's happening. Media is in a constant state of flux; to spend millions of dollars on new sites without some understanding of how technological change will impact them is a waste of money.

Pay walls do not work for news. But it will take more and more news organizations spending millions on new websites with pay walls that do not attract enough subscribers to pay for the site before they get it. By then it may be too late.

Stay tuned.