I hate Microsoft Windows with a passion. If Al Queda set off a nuclear weapon in Redmond I would clap and cheer along with Muslim terrorists. Okay, maybe not but I really, really hate Microsoft.
A while back I stumbled onto a ridiculous blog about how much Linux sucks written by an idiot. His basic idea was that because things were "easier" with Windows Windows was "better". What an idiot, If everyone thought the same way he does Microsoft wouldn't be losing market share.
My wife has a windows computer and I set up an old windows system to use as a phone server for Magic Jack. Microsoft is tool people who are into computers have to know how to use because most people use microsh*t.
My daughter's boy friend wanted to copy some CD's that a friend had made of their band. I figured I could just install some freeware burning software and he could copy the CD's using my phone server (400mhz, 327meg of ram, XP). Since I have a heart condition and since he is familiar with windows it seemed like it might be a stress free way to handle the situation. Besides, I didn't want him mucking around on my desktop.
Yeah. right.
Ooops, Windows XP does not close audio CD's using the default burning software.
So I hunted around in my old CD's and found an old copy of Nero 9 for Windows. I canceled the install a half an hour in because the install was at 26%.
Look up windows freeware that does CD burning. Install a recommended software and yep, you guessed it. No copy button. No copy function.
About now, an hour into this disaster, I was wishing I had just written a simple script in Linux and let the guy loose on my desktop. I wrote a quick script and I shoved one of the CD's in and copied it on my linux system. Essentially rip an audio CD to a temp file, burn the rip and then delete the temp files. Quick script. Thank God Linux still uses a DOS prompt or if you like the more linux name, bash shell or terminal window.
I downloaded another recommended freeware and installed it. Oops, it won't install without the .Net Framework. Lets install that garbage on my system. Swap out the CD's on my Linux system and start #2 copying.
Okay so now the .Net framework needs something called WIC before it will install. Download and install the WIC. Slap #3 in my Linux desktop and copy #3.
Start the .NET framework install. While I am waiting copy CD's #4, #5 and #6. For a garage band these guys write a lot of music. Way too much to be good at any of it I am sure. Play one of the tracks, yep, I am correct about that. Not awful, but nothing special and the bass loses sync with the drummer. Check the Windows box. Nope, the .NET install is not even halfway. Now I am remembering why I hate Microsoft products.
While I am waiting I might as well write a blog and copy the rest of the CD's since this f*cking piece of microsh*t software.... Wait a second. Time to chill out. Now I get it. I have spent 16 years using microsh*t products at work. No wonder I have a heart problem.
Now lets see, does this fuc*ed-up Windows freeware have DOS commands I can write into a script? No, can't find any. .NET install still at around 50% and when it is done I can't write a script to make my life easier.
What a pain in the A**. How can people even pretend Microsoft is a worthwhile and useful product? The GDP of the United States has been trending downward since 1984. When was Windows released? 1984. How Orwellian is that?
How many companies have had huge losses and gone out of business because Microsoft makes crappy closed source software? Install of .NET still around 50%. Where did I put that baseball bat?
What is even more ridiculous is I know microscrap is crap and I thought this would be a simple and easy solution. I can't believe I made that mistake.
Know how to keep a microsoft computer working? Don't use it. That's right. Don't use it. Just buy the damn thing and turn it on. Then re-boot it once a day. Don't surf the web or write up documents or spread sheets. Don't play games or anything else. Just leave it alone and it works fine. Don't use Windows as a file server. If you use a microcrap box as a file server some idiot will crash your box trying to hack in.
As far as I am concerned Windows sucks. This episode in futility is just another example of micro-crap incompetence. .NET install is still at 50%. I'm done burning copies on my linux box while waiting to install a simple CD copy program on my Windows box.
Time spent 2 hours. Linux is finished. Windows is still installing the CD copy software.
Addendum: I also had to use a special un-install tool from Nero to remove all of their files from when I canceled the install. When all the required installs finished the copy button in the CD recording software didn't work. I kept getting the message "Drive D is in use by another program. Please shut down all other programs." Yeah, shut Windows down. That is what needs to happen.
Monday, August 29, 2011
Friday, August 26, 2011
Getting back to the problems with GDP...
A lot of people think “steady growth” is “best”. Not with GDP. If you have steady growth all the time that would be fine. It won't ever happen. At the very least natural disasters will occur that will cause a reduction in GDP. Hurricane Katrina for example.
If we look at the GDP through the 1990's to about 2005 we have an average GDP growth of about 6.5%. Sounds good? Not really. In 2005 the United States experienced a tremendous natural disaster and a sharp decline in GDP growth.
If we look at the straight economic data from BEA.gov Louisiana didn't have a bad year in 2005. State GDP in 2004 was 171 billion and in 2005 the Louisiana state GDP was 197 billion. Great to know that the major urban area in a state can be wiped out and it won't have any influence on the state GDP, in fact, state GDP increased.
Yeah, like I believe that.
Surf into http://www.bea.gov/regional/index.htm
scroll down to “DATA”
Select “Gross Domestic Product by State”
As of August 26 2011, This will take you into a wizard that will display the desired data and allow you to download it in Excel, CVS or PDF format.
You can check the numbers yourself. I imagine the government in its never ending quest to reduce to increase openness in government and spend a lot of money on web design will change this around and make it impossible to follow the links and instructions I have provided. I have found that government agencies like to change rules in such a way that it “improves efficiency” and just by happenstance reduces accessibility until people figure it out and then it is time to change it again.
In my opinion the never ending “improving websites” is just a new millennium way to introduce bureaucratic red tape and cloud the doings of our government.
So we can believe our eyes or the economic data. I don't think we can believe both.
Looking at the drop in national GDP I can relate quite a bit of it to the destruction and rebuilding of Louisiana. If you check out Wikipedia the cost is about 82 billion. If you read http://www.cbo.gov/ftpdocs/85xx/doc8514/08-07-Hurricanes_Letter.pdf
the money spent by the US government as of 2007 was about 95 billion and that does not count the money spent by individuals and state governments. I think we can at least double the amount spent by the US government and still be way below the total cost.
I figure total spending to recover from Katrina will be around a trillion dollars and it will take 15-20 years to spend that. This is just an estimate I make based on my research.
The Oil Spill in the Gulf of Mexico by the Deep Water Horizon, an off-shore oil drilling platform owned and operated by Transocean under a leasing contract by BP.
Sound confusing? Yep, I'll leave it there. If you want you can study the complex business relationships in oil. So we have the South Eastern region of the United States undergoing two major disasters within 5 years.
We can include some other hurricanes, earthquakes, terrorist attacks, and other issues in this but I think people can figure out the problem here.
Suppose the GDP has very stable growth at 6% even and then the occasional national disaster the causes the GDP to drop. Lets imagine that we have one major national disaster which causes a national GDP issue every 10 years. The GDP average has to be less than 6% and depending on the number of times the GDP drops and how far the GDP drops the national economy average growth can even end up being negative.
The biggest problem with GDP in the United States is that since 1985 there have been no years where GDP growth has been over 10%. Between 1970 and 1985 there were 7 times when GDP growth was over 10%.
So what does this mean?
In statistical analysis a normal distribution is a curve. Pour out a bottle of salt or dump a pile of dirt out of a truck and you will get a pile. Take a two dimensional cross section through the center of that pile and you will have the outline of a normal curve.
Here is the kicker. Most people think “normal” is average, the stuff in the middle. That isn't true. “Normal” encompasses the entire curve, from one end to the other. You can't have a middle or average without having a high and a low.
The high is just as important as the low.
Between 1961 and 1985 the low GDP growth was 4.0% and the high was13.0%. Average was 8.7%.
Between 1986 and 2010 the low GDP growth was -1.8%, the high was 7.7%, the average was 5.1%.
The range between the high and the low shrank 1% which indicates a more tightly controlled economy. The standard deviation went from 2.3% to 2.0%.
So what happens if we “stabilize” the economy so that it is tightly controlled with a GDP growth of about 6%?
Eventually a disaster occurs, Katrina, the Deep Water Horizon spill or something else.
When the disaster occurs the economy is influenced and the GDP is reduced.
If only economic disasters occur and growth is otherwise stable the economy must eventually flounder.
In other words, to balance the normal curve you need economic triumphs to occur as well as economic disasters to balance out the curve. Without economic triumphs the disasters eventually destroy the economy.
In a world where unpredictable natural disasters influence the economy in a disastrous way those managing the economy must create economic triumphs which balance the unpredictable disasters.
Sorry, no economic triumphs since 1985. Hasn't happened. Won't happen unless economic management in the United States does something to address the issue.
People think consistency exists. It does, it is called stagnation.
In life you will always have big losses. If there are no big wins to balance the big losses you will ultimately stagnate and die.
If we look at the GDP through the 1990's to about 2005 we have an average GDP growth of about 6.5%. Sounds good? Not really. In 2005 the United States experienced a tremendous natural disaster and a sharp decline in GDP growth.
If we look at the straight economic data from BEA.gov Louisiana didn't have a bad year in 2005. State GDP in 2004 was 171 billion and in 2005 the Louisiana state GDP was 197 billion. Great to know that the major urban area in a state can be wiped out and it won't have any influence on the state GDP, in fact, state GDP increased.
Yeah, like I believe that.
Surf into http://www.bea.gov/regional/index.htm
scroll down to “DATA”
Select “Gross Domestic Product by State”
As of August 26 2011, This will take you into a wizard that will display the desired data and allow you to download it in Excel, CVS or PDF format.
You can check the numbers yourself. I imagine the government in its never ending quest to reduce to increase openness in government and spend a lot of money on web design will change this around and make it impossible to follow the links and instructions I have provided. I have found that government agencies like to change rules in such a way that it “improves efficiency” and just by happenstance reduces accessibility until people figure it out and then it is time to change it again.
In my opinion the never ending “improving websites” is just a new millennium way to introduce bureaucratic red tape and cloud the doings of our government.
So we can believe our eyes or the economic data. I don't think we can believe both.
Looking at the drop in national GDP I can relate quite a bit of it to the destruction and rebuilding of Louisiana. If you check out Wikipedia the cost is about 82 billion. If you read http://www.cbo.gov/ftpdocs/85xx/doc8514/08-07-Hurricanes_Letter.pdf
the money spent by the US government as of 2007 was about 95 billion and that does not count the money spent by individuals and state governments. I think we can at least double the amount spent by the US government and still be way below the total cost.
I figure total spending to recover from Katrina will be around a trillion dollars and it will take 15-20 years to spend that. This is just an estimate I make based on my research.
The Oil Spill in the Gulf of Mexico by the Deep Water Horizon, an off-shore oil drilling platform owned and operated by Transocean under a leasing contract by BP.
Sound confusing? Yep, I'll leave it there. If you want you can study the complex business relationships in oil. So we have the South Eastern region of the United States undergoing two major disasters within 5 years.
We can include some other hurricanes, earthquakes, terrorist attacks, and other issues in this but I think people can figure out the problem here.
Suppose the GDP has very stable growth at 6% even and then the occasional national disaster the causes the GDP to drop. Lets imagine that we have one major national disaster which causes a national GDP issue every 10 years. The GDP average has to be less than 6% and depending on the number of times the GDP drops and how far the GDP drops the national economy average growth can even end up being negative.
The biggest problem with GDP in the United States is that since 1985 there have been no years where GDP growth has been over 10%. Between 1970 and 1985 there were 7 times when GDP growth was over 10%.
So what does this mean?
In statistical analysis a normal distribution is a curve. Pour out a bottle of salt or dump a pile of dirt out of a truck and you will get a pile. Take a two dimensional cross section through the center of that pile and you will have the outline of a normal curve.
Here is the kicker. Most people think “normal” is average, the stuff in the middle. That isn't true. “Normal” encompasses the entire curve, from one end to the other. You can't have a middle or average without having a high and a low.
The high is just as important as the low.
Between 1961 and 1985 the low GDP growth was 4.0% and the high was13.0%. Average was 8.7%.
Between 1986 and 2010 the low GDP growth was -1.8%, the high was 7.7%, the average was 5.1%.
The range between the high and the low shrank 1% which indicates a more tightly controlled economy. The standard deviation went from 2.3% to 2.0%.
So what happens if we “stabilize” the economy so that it is tightly controlled with a GDP growth of about 6%?
Eventually a disaster occurs, Katrina, the Deep Water Horizon spill or something else.
When the disaster occurs the economy is influenced and the GDP is reduced.
If only economic disasters occur and growth is otherwise stable the economy must eventually flounder.
In other words, to balance the normal curve you need economic triumphs to occur as well as economic disasters to balance out the curve. Without economic triumphs the disasters eventually destroy the economy.
In a world where unpredictable natural disasters influence the economy in a disastrous way those managing the economy must create economic triumphs which balance the unpredictable disasters.
Sorry, no economic triumphs since 1985. Hasn't happened. Won't happen unless economic management in the United States does something to address the issue.
People think consistency exists. It does, it is called stagnation.
In life you will always have big losses. If there are no big wins to balance the big losses you will ultimately stagnate and die.
Thursday, August 25, 2011
Segregation, ranting once again
Martin Luther King Jr's father put together a gospel choir (with MLK) that performed at the premiere of "Gone with the Wind". The premiere was segregated and one of the women who won an academy award boycotted the premiere because she was not allowed to sit with the other actors. Today, the segregation of that premiere would be almost un-noticed except for MLK's segregated involvement.
A boycott usually results in an immediate news story, an issue of immediate concern. Very few boycotts result in something that is historically meaningful.
Look at the Detroit people Mover. When Detroit wanted to build a comprehensive mass transit system in partnership with the suburbs the suburbs refused to work with Detroit. "White Fright" of a "Black Invasion" caused Michigan to segregate it's largest urban area and primary industrial development.
In a different blog I talked about how industrialization always follows urbanization. Without a primary urban development there can not be a primary industrial development. This blog only mentions that issue in passing. This blog discusses the pure genius behind the People Mover.
Mayor Coleman Young was a segregationist and a realist. While Mayor Young believed that blacks were fully capable of educating themselves and managing the infrastructure of the city without any involvement from white people Mayor Young also knew that without industry the city of Detroit would have budget problems. I think Mayor Young was also a little naive. Mayor Young did not expect the state of Michigan to cut it's own economic throat to spite themselves.
When Mayor Young received federal funding to build a mass transit system in Detroit he tried to work out a plan with the suburbs. That didn't work. Too much "White Fright". Coleman Young sat down and planned out a small mass transit system, segregated from the surrounding suburbs, running around in a circle like a puppy chasing its tail.
For the rest of time, or at last as long as Detroit existed, the People Mover would be a monument of segregation. A lasting reminder that in the 1970's and 1980's the state of Michigan worked very hard to segregate the city of Detroit.
The lack of a mass transit system which incorporates the surrounding suburbs exemplifies the ongoing abomination that is northern segregation.
This is 2011. Detroit is a decaying, segregated city. Unfortunately for the politicians in the State of Michigan, Detroit is a city of people.
The people are not stupid, they are well aware that the condition of the city of Detroit is caused by segregationist politics. Sure, there are bigots who will say something like "they did it to themselves", just as people walking past a lynched black man swinging from a lamp post in 1860's New York City might say the same thing.
People with any kind of empathy or understanding know that
A boycott usually results in an immediate news story, an issue of immediate concern. Very few boycotts result in something that is historically meaningful.
Look at the Detroit people Mover. When Detroit wanted to build a comprehensive mass transit system in partnership with the suburbs the suburbs refused to work with Detroit. "White Fright" of a "Black Invasion" caused Michigan to segregate it's largest urban area and primary industrial development.
In a different blog I talked about how industrialization always follows urbanization. Without a primary urban development there can not be a primary industrial development. This blog only mentions that issue in passing. This blog discusses the pure genius behind the People Mover.
Mayor Coleman Young was a segregationist and a realist. While Mayor Young believed that blacks were fully capable of educating themselves and managing the infrastructure of the city without any involvement from white people Mayor Young also knew that without industry the city of Detroit would have budget problems. I think Mayor Young was also a little naive. Mayor Young did not expect the state of Michigan to cut it's own economic throat to spite themselves.
When Mayor Young received federal funding to build a mass transit system in Detroit he tried to work out a plan with the suburbs. That didn't work. Too much "White Fright". Coleman Young sat down and planned out a small mass transit system, segregated from the surrounding suburbs, running around in a circle like a puppy chasing its tail.
For the rest of time, or at last as long as Detroit existed, the People Mover would be a monument of segregation. A lasting reminder that in the 1970's and 1980's the state of Michigan worked very hard to segregate the city of Detroit.
The lack of a mass transit system which incorporates the surrounding suburbs exemplifies the ongoing abomination that is northern segregation.
This is 2011. Detroit is a decaying, segregated city. Unfortunately for the politicians in the State of Michigan, Detroit is a city of people.
The people are not stupid, they are well aware that the condition of the city of Detroit is caused by segregationist politics. Sure, there are bigots who will say something like "they did it to themselves", just as people walking past a lynched black man swinging from a lamp post in 1860's New York City might say the same thing.
People with any kind of empathy or understanding know that
Monday, August 22, 2011
Everyone is terminal.
A few months ago I was diagnosed with a dilated cardiomyopathy having an ejection fraction of 20-25%. I weigh about 270 and at the time I went into the hospital. I was bloated with water because of congestive heart failure. I had been on Flurosimide for about six weeks and I had dropped about 30 pounds of water so far, but, I was still pretty squishy.
I was talking to the doctor about what was causing the CHF, congestive heart failure, and he started talking about eating better. I stood up with all the monitor crap and started pounding on my stomach.
Back in my early twenties I had once done 300 sit-ups using a roman chair, 6 sets of 50. You lay back flat with your hands crossed over your chest and come up to about a 45 degree angle. This works the hell out of your abs and it isn't as hard on your back as normal sit-ups. Back in April of 2010 I was working out in a hotel exercise room and some guy who was pretty well ripped was smirking at me as he did roman chair sit-ups. He did 25 or 30 so I knocked out 50. He did another 25 and I did another 50. It was the most I had worked my abs for years and they hurt for days, but, he wasn't smirking any more.
I have great quads, calves and abs. My leg-biceps, my lower back and my upper body are no where near as well developed. My best bench is 315. I worked my way back up to that back in 2006 and 2007, but, then I had to sell my weights so my workouts were limited to my recumbent bike and some dumb bells. I wasn't regular about it and then I tore my rotator cuff so for about a year I just did the recumbent, 30 to 45 minutes a day, moderate workout burning about 300 calories according to the computer.
While I was working at Oak Ridge National Laboratory they had a great employee gym. My bench was 3 sets of 10 using 160. I used the gym until December when I started feeling sick and fatigued. By February I had advanced CHF and that takes us to April when I was standing in the ER pounding my ab muscles telling the doctor that what we thought was a big gut was actually distended abdominal muscles combined with some visceral fat, but, not as much as they probably thought. I have about a 1/4” of fat over my upper abs and a pretty normal roll around my middle. When the doctor figured out I was in a lot better shape than he thought I was he ordered some other tests. Bingo, idiopathic dilated cardiomyopathy with an ejection fraction of 20-25%.
Treatment for that? Heart transplant. They can put in a pace maker. They can give you drugs. I can't do 30 minutes on an exercise bike any more. Ten minutes is about the most I can do and I can walk for a couple of hours if I get some resting in.
Median survival for someone with a pacemaker is about 8 years. They install pacemakers at below about 40% EF. Typical survival after a heart transplant is about 6 years. They do heart transplants for people with about 20% EF. Sixty percent of people with a cardiomyopathy having 20-25% EF without a transplant live longer than a year.
So right now my chances for survival beyond 5 years, with or without a pacemaker or transplant are pretty poor.
Http://cinc.mit.edu/archives/2005/pdf/0251.pdf Intelligent Analysis of Long-Term Patient Survival after Pacemaker Implantation
http://www.ncbi.nlm.nih.gov/pubmed/3314498 Poor survival of patients with idiopathic cardiomyopathy considered too well for transplantation.
If you want to review the chances for survival restrict the google search using the site:*.edu or site:*.gov so you get reliable data instead of all the new age mysticism BS out there.
As usual I don't plan on things working they way people tell me they should. After 30 years in manufacturing and engineering, 15 years in advanced situations where I am typically accomplishing something people tell me is impossible. I figure this is a similar situation, someone tells me what is possible and impossible and then I ignore them and make the impossible happen.
I couldn't count the number of times people with doctorates have argued really dumb positions. The older I get the less respect I have for formal education. All education is self education, the literacy rate of college graduates establishes this beyond a shadow of a doubt.
So what is causing my cardiomyopathy?
There isn't any specific diagnosis concerning the cause. This is typical and they have a name for it, idiopathic. It means the doctor knows the symptoms but does not know what the root cause is. Sometimes the doctor makes assumptions like the idiots who looked at my distended abdominals and bloated water retention deciding that my diet must be merde because I'm fat. Idiots, but, what can you do. Everyone stereotypes and makes stupid bigoted decisions based on their stereotypes. In medicne there are more stereotyped guesses than you would imagine.
If you want to know if a person is “profiling” or stereotyping ask about the standard deviation. A “profile” is a statistical analysis indicating probability. If someone does not know the numbers behind the probability they do not understand the probability and they are just stereotyping. For example, if someone tells you most drug dealers are young blacks ask them what percentage and what the standard deviation is. If they don't know the numbers they are spouting stereotypes, not profiling. Most young blacks are not drug dealers even if most drug dealers are young blacks. Get the idea?
Doctors depend a lot on test results because “patients lie”, or as Greg House explains it, “everyone lies”.
Lets look at a study about obese cardiomyopathy:
http://www.ncbi.nlm.nih.gov/pubmed/16880104 Obesity cardiomyopathy: is it a reality? An ultrasonic tissue characterization study.
We'll look at a a couple of numbers and the mean because the abstract does not give us median or curve modality. With a normal curve the mode, mean and median are all about the same number. “A slightly reduced LV diastolic function was demonstrated in obese patients (transmitral early to late peak diastolic transmitral flow velocities ratio = 1.1 +/- 0.7) as compared with control subjects (1.5 +/- 0.5, P < .02)”
So the range for obese patients is 0.4 to 1.8 with a mean of 1.1 and the range for control subjects is 1.0 to 2.0. The interesting thing here is that we can estimate the standard deviation from these numbers and the standard deviation is higher in obese patients.
About 33% of obese patients will have an LV diastolic function flow velocity between about 1.1 and 1.3. About 17% of non-obese patients will range between 1.0 and 1.35.
Hmmmm, so if someone has a flow velocity of 1.25 are they suffering from obesity related cardiomyopathy? About 20% of obese patients and about 20% of non-obese patients will test at this point. So the doctor looks at the person's weight and appearance and decides if the person is obese.
So what is the standard deviation and probability curve relating to weight? Yep, you guessed it the vast majority of doctors have no clue. What is the calorie requirement based on age, weight and height? Yep, you guessed it most doctors couldn't even tell you that there are two different formulas for this calculation and they really couldn't tell you what the standard deviation for caloric intake is.
Pretty scary since we all depend on these people to analyze probabilities as they pertain to ourselves as individuals and give us medical advice.
In reality doctors are not using probabilities, they are using stereotypes with minimal factual basis in probability.
You have to hope you have a good guesser, like “Greg House” and lets face it the probability is that your doctor is an average guesser. 66% of doctors will be average guessers. About 4% will be exceptional guessers. 4% will suck at guessing. About 13% will be above average guessers and 13% will be below average guessers. So you have about a 2/3 chance of having an average to good guesser who will guess right X% of the time, on average.
Now here is one of the issues, there are not a lot of real doctor guessing statistics, but, what there is indicates that the probability of incorrect guessing increases with the severity of the illness.
Yeah, I don't buy that. I figure that people are caught making bad guesses in serious situations more often then they are caught making bad guesses in non-serious situations.
Now there are a bunch of really bad numbers out there on diagnosis, some saying that 98.6% of doctors guessing is correct. This is using numbers similar to those we just reviewed where there is about a 20% overlap between normal and obese patients.
98.6% would mean subjective decisions made by doctors are more accurate than objective decisions made using a standardized test.
Yeah, I'll buy that for a dollar. If you have to ask what that means, don't bother.
In reality, after reviewing the data available I would guess the reported mean for average guessing is between 80% at the high and 70% at the low with a range of about plus or minus 20%. If we guess 75% then most doctors get 3 out of 4 right, which is actually pretty good for subjective interpretation. If stock brokers did this well we would all be billionaires.
So what is the probability those numbers are correct? What are the chances doctors are better at subjective analysis based on reviewing factual reports of objective statistical data than stock brokers? Interesting question. I would guess that the numbers are actually pretty close and the best stock brokers only guess right about 30% of the time (those numbers are easier to come by and objective since bad stock choices are objectively analyzed).
So, looking at the available data I figure the subjective analysis by a doctor is probably correct closer to about 1/3 of the time. In fact, subjective analysis by almost everyone is probably correct about 1/3 of the time. The most of the best are probably right about 45% of the time and guys like me (and I have tracked my subjective analysis stats) are correct about 60% of the time at my best in my area of expertise, between about 45 and 50 years old.
Okay, so doctors probably become better guessers as they age and have more experience and at the best are probably correct around 60% of the time. Statistics including all doctors are probably closer to 30% with, I would guess, a standard deviation of about 10% and these statistics can probably be further refined based on age, medical school and other variables.
Trouble is, we will never know if my analysis is accurate because medicine is no where near an objective science at this time which is why predictability on patient prognosis has so many anecdotal miracle and disaster stories. The prognosis stories are a result of the lack of objectivity and the over lapping data ranges in diagnosis.
Medicine will get better as research develops and data becomes more objective. For example, doctors may eventually have a method of objectively and easily measuring fat and muscle ratio. Maybe an office level scanner that reports muscle tone, water and fat percentages. Maybe brain computer interfaces will develop and doctors will have more confidence in the patients witness concerning their eating and exercise habits.
No way any doctor believed I once did 300 roman chair sit-ups in 6 sets of 50 until I began pounding on my abdominals. I can't blame them, I don't exactly walk around looking at fat guys and saying “I bet that guy has really solid abs”.
It's fun screwing with people though, like the time I was at REI and let the guy running the rock wall talk me into climbing because he thought it would be funny to watch me. After I hooked up he bent down to check his belay and I was already at the rafters. My wife laughed her butt off at the look on the guy's face. I swung over to an overhang and didn't do very well at that and that made the sales man feel better. It had been 15 years since I had done any rock climbing so I didn't feel bad and I didn't try very hard at the overhang. Overhangs were never a strong point for me because of my relative upper body strength. My strength is mostly in my lower body.
So I hope you take the knowledge that doctors are no better at guessing than anyone else is, when people are guessing in their area of expertise. Remember doctors go through a fairly difficult vetting procedure to determine if they are good guessers. Really bad guessers are weeded out and there could be a curve skewed to the above average guessing based on the vetting procedure. Of course charismatic people can be poor guessers and make it through the subjective vetting procedure and people who are un-charismatic and good guessers can be kicked out.
In the end you can only be the “best” person you can be for as long as you are around. In the end everyone is terminal, everyone dies, everyone mourns, everyone loves and everyone leaves love behind. Those of us who are religious have a lot of love to look forward to.
I was talking to the doctor about what was causing the CHF, congestive heart failure, and he started talking about eating better. I stood up with all the monitor crap and started pounding on my stomach.
Back in my early twenties I had once done 300 sit-ups using a roman chair, 6 sets of 50. You lay back flat with your hands crossed over your chest and come up to about a 45 degree angle. This works the hell out of your abs and it isn't as hard on your back as normal sit-ups. Back in April of 2010 I was working out in a hotel exercise room and some guy who was pretty well ripped was smirking at me as he did roman chair sit-ups. He did 25 or 30 so I knocked out 50. He did another 25 and I did another 50. It was the most I had worked my abs for years and they hurt for days, but, he wasn't smirking any more.
I have great quads, calves and abs. My leg-biceps, my lower back and my upper body are no where near as well developed. My best bench is 315. I worked my way back up to that back in 2006 and 2007, but, then I had to sell my weights so my workouts were limited to my recumbent bike and some dumb bells. I wasn't regular about it and then I tore my rotator cuff so for about a year I just did the recumbent, 30 to 45 minutes a day, moderate workout burning about 300 calories according to the computer.
While I was working at Oak Ridge National Laboratory they had a great employee gym. My bench was 3 sets of 10 using 160. I used the gym until December when I started feeling sick and fatigued. By February I had advanced CHF and that takes us to April when I was standing in the ER pounding my ab muscles telling the doctor that what we thought was a big gut was actually distended abdominal muscles combined with some visceral fat, but, not as much as they probably thought. I have about a 1/4” of fat over my upper abs and a pretty normal roll around my middle. When the doctor figured out I was in a lot better shape than he thought I was he ordered some other tests. Bingo, idiopathic dilated cardiomyopathy with an ejection fraction of 20-25%.
Treatment for that? Heart transplant. They can put in a pace maker. They can give you drugs. I can't do 30 minutes on an exercise bike any more. Ten minutes is about the most I can do and I can walk for a couple of hours if I get some resting in.
Median survival for someone with a pacemaker is about 8 years. They install pacemakers at below about 40% EF. Typical survival after a heart transplant is about 6 years. They do heart transplants for people with about 20% EF. Sixty percent of people with a cardiomyopathy having 20-25% EF without a transplant live longer than a year.
So right now my chances for survival beyond 5 years, with or without a pacemaker or transplant are pretty poor.
Http://cinc.mit.edu/archives/2005/pdf/0251.pdf Intelligent Analysis of Long-Term Patient Survival after Pacemaker Implantation
http://www.ncbi.nlm.nih.gov/pubmed/3314498 Poor survival of patients with idiopathic cardiomyopathy considered too well for transplantation.
If you want to review the chances for survival restrict the google search using the site:*.edu or site:*.gov so you get reliable data instead of all the new age mysticism BS out there.
As usual I don't plan on things working they way people tell me they should. After 30 years in manufacturing and engineering, 15 years in advanced situations where I am typically accomplishing something people tell me is impossible. I figure this is a similar situation, someone tells me what is possible and impossible and then I ignore them and make the impossible happen.
I couldn't count the number of times people with doctorates have argued really dumb positions. The older I get the less respect I have for formal education. All education is self education, the literacy rate of college graduates establishes this beyond a shadow of a doubt.
So what is causing my cardiomyopathy?
There isn't any specific diagnosis concerning the cause. This is typical and they have a name for it, idiopathic. It means the doctor knows the symptoms but does not know what the root cause is. Sometimes the doctor makes assumptions like the idiots who looked at my distended abdominals and bloated water retention deciding that my diet must be merde because I'm fat. Idiots, but, what can you do. Everyone stereotypes and makes stupid bigoted decisions based on their stereotypes. In medicne there are more stereotyped guesses than you would imagine.
If you want to know if a person is “profiling” or stereotyping ask about the standard deviation. A “profile” is a statistical analysis indicating probability. If someone does not know the numbers behind the probability they do not understand the probability and they are just stereotyping. For example, if someone tells you most drug dealers are young blacks ask them what percentage and what the standard deviation is. If they don't know the numbers they are spouting stereotypes, not profiling. Most young blacks are not drug dealers even if most drug dealers are young blacks. Get the idea?
Doctors depend a lot on test results because “patients lie”, or as Greg House explains it, “everyone lies”.
Lets look at a study about obese cardiomyopathy:
http://www.ncbi.nlm.nih.gov/pubmed/16880104 Obesity cardiomyopathy: is it a reality? An ultrasonic tissue characterization study.
We'll look at a a couple of numbers and the mean because the abstract does not give us median or curve modality. With a normal curve the mode, mean and median are all about the same number. “A slightly reduced LV diastolic function was demonstrated in obese patients (transmitral early to late peak diastolic transmitral flow velocities ratio = 1.1 +/- 0.7) as compared with control subjects (1.5 +/- 0.5, P < .02)”
So the range for obese patients is 0.4 to 1.8 with a mean of 1.1 and the range for control subjects is 1.0 to 2.0. The interesting thing here is that we can estimate the standard deviation from these numbers and the standard deviation is higher in obese patients.
About 33% of obese patients will have an LV diastolic function flow velocity between about 1.1 and 1.3. About 17% of non-obese patients will range between 1.0 and 1.35.
Hmmmm, so if someone has a flow velocity of 1.25 are they suffering from obesity related cardiomyopathy? About 20% of obese patients and about 20% of non-obese patients will test at this point. So the doctor looks at the person's weight and appearance and decides if the person is obese.
So what is the standard deviation and probability curve relating to weight? Yep, you guessed it the vast majority of doctors have no clue. What is the calorie requirement based on age, weight and height? Yep, you guessed it most doctors couldn't even tell you that there are two different formulas for this calculation and they really couldn't tell you what the standard deviation for caloric intake is.
Pretty scary since we all depend on these people to analyze probabilities as they pertain to ourselves as individuals and give us medical advice.
In reality doctors are not using probabilities, they are using stereotypes with minimal factual basis in probability.
You have to hope you have a good guesser, like “Greg House” and lets face it the probability is that your doctor is an average guesser. 66% of doctors will be average guessers. About 4% will be exceptional guessers. 4% will suck at guessing. About 13% will be above average guessers and 13% will be below average guessers. So you have about a 2/3 chance of having an average to good guesser who will guess right X% of the time, on average.
Now here is one of the issues, there are not a lot of real doctor guessing statistics, but, what there is indicates that the probability of incorrect guessing increases with the severity of the illness.
Yeah, I don't buy that. I figure that people are caught making bad guesses in serious situations more often then they are caught making bad guesses in non-serious situations.
Now there are a bunch of really bad numbers out there on diagnosis, some saying that 98.6% of doctors guessing is correct. This is using numbers similar to those we just reviewed where there is about a 20% overlap between normal and obese patients.
98.6% would mean subjective decisions made by doctors are more accurate than objective decisions made using a standardized test.
Yeah, I'll buy that for a dollar. If you have to ask what that means, don't bother.
In reality, after reviewing the data available I would guess the reported mean for average guessing is between 80% at the high and 70% at the low with a range of about plus or minus 20%. If we guess 75% then most doctors get 3 out of 4 right, which is actually pretty good for subjective interpretation. If stock brokers did this well we would all be billionaires.
So what is the probability those numbers are correct? What are the chances doctors are better at subjective analysis based on reviewing factual reports of objective statistical data than stock brokers? Interesting question. I would guess that the numbers are actually pretty close and the best stock brokers only guess right about 30% of the time (those numbers are easier to come by and objective since bad stock choices are objectively analyzed).
So, looking at the available data I figure the subjective analysis by a doctor is probably correct closer to about 1/3 of the time. In fact, subjective analysis by almost everyone is probably correct about 1/3 of the time. The most of the best are probably right about 45% of the time and guys like me (and I have tracked my subjective analysis stats) are correct about 60% of the time at my best in my area of expertise, between about 45 and 50 years old.
Okay, so doctors probably become better guessers as they age and have more experience and at the best are probably correct around 60% of the time. Statistics including all doctors are probably closer to 30% with, I would guess, a standard deviation of about 10% and these statistics can probably be further refined based on age, medical school and other variables.
Trouble is, we will never know if my analysis is accurate because medicine is no where near an objective science at this time which is why predictability on patient prognosis has so many anecdotal miracle and disaster stories. The prognosis stories are a result of the lack of objectivity and the over lapping data ranges in diagnosis.
Medicine will get better as research develops and data becomes more objective. For example, doctors may eventually have a method of objectively and easily measuring fat and muscle ratio. Maybe an office level scanner that reports muscle tone, water and fat percentages. Maybe brain computer interfaces will develop and doctors will have more confidence in the patients witness concerning their eating and exercise habits.
No way any doctor believed I once did 300 roman chair sit-ups in 6 sets of 50 until I began pounding on my abdominals. I can't blame them, I don't exactly walk around looking at fat guys and saying “I bet that guy has really solid abs”.
It's fun screwing with people though, like the time I was at REI and let the guy running the rock wall talk me into climbing because he thought it would be funny to watch me. After I hooked up he bent down to check his belay and I was already at the rafters. My wife laughed her butt off at the look on the guy's face. I swung over to an overhang and didn't do very well at that and that made the sales man feel better. It had been 15 years since I had done any rock climbing so I didn't feel bad and I didn't try very hard at the overhang. Overhangs were never a strong point for me because of my relative upper body strength. My strength is mostly in my lower body.
So I hope you take the knowledge that doctors are no better at guessing than anyone else is, when people are guessing in their area of expertise. Remember doctors go through a fairly difficult vetting procedure to determine if they are good guessers. Really bad guessers are weeded out and there could be a curve skewed to the above average guessing based on the vetting procedure. Of course charismatic people can be poor guessers and make it through the subjective vetting procedure and people who are un-charismatic and good guessers can be kicked out.
In the end you can only be the “best” person you can be for as long as you are around. In the end everyone is terminal, everyone dies, everyone mourns, everyone loves and everyone leaves love behind. Those of us who are religious have a lot of love to look forward to.
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