1.
Featured Article:
The Expert Mind, By Philip
E. Ross, Scientific American, August 2006
Studies of the
mental processes of chess grandmasters have revealed clues to how people become
experts in other fields as well
[During our
clinical clerkships as third year medical students, the Professor of Medicine,
leading a half dozen medical students on rounds, would ask the students as they
left the elevator with a patient on the gurney, or as a gurney passed by in the
hallways, what is that patient's diagnosis? We would start noticing the names
on the chart or the intern that was with the patient and after rounds would
hunt up that intern or rush to that nurses' station to check the chart. Invariably
the professor was correct. That patient did have cancer of the pancreas or the
gallbladder ducts, or that patient did had emphysema or interstitial fibrosis,
or that patient did have leukemia. How did the professor make the diagnosis and
never even talk with the patient? Dr. Ross gives us some clues as to how the
master's make augenblick diagnoses or decisions.]
A man walks along the inside of a circle
of chess tables, glancing at each for two or three seconds before making his
move. On the outer rim, dozens of amateurs sit pondering their replies until he
completes the circuit. The year is 1909, the man is José Raúl Capablanca of
How did he play so well, so quickly? And
how far ahead could he calculate under such constraints? "I see only one
move ahead," Capablanca is said to have answered, "but it is always
the correct one."
He thus put in a nutshell what a century
of psychological research has subsequently established: much of the chess
master's advantage over the novice derives from the first few seconds of
thought. This rapid, knowledge-guided perception, sometimes called
apperception, can be seen in experts in other fields as well. Just as a master
can recall all the moves in a game he has played, so can an accomplished
musician often reconstruct the score to a sonata heard just once. And just as
the chess master often finds the best move in a flash, an expert physician can
sometimes make an accurate diagnosis within moments of laying eyes on a
patient.
But how do the experts in these various
subjects acquire their extraordinary skills? How much can be credited to innate
talent and how much to intensive training? Psychologists have sought answers in
studies of chess masters. The collected results of a century of such research
have led to new theories explaining how the mind organizes and retrieves information.
What is more, this research may have important implications for educators.
Perhaps the same techniques used by chess players to hone their skills could be
applied in the classroom to teach reading, writing and arithmetic.
The Drosophila of Cognitive Science
The history of human expertise begins with hunting, a skill that was crucial to
the survival of our early ancestors. The mature hunter knows not only where the
lion has been; he can also infer where it will go. Tracking skill increases, as
repeated studies show, from childhood onward, rising in "a linear
relationship, all the way out to the mid-30s, when it tops out," says John
Bock, an anthropologist at
Without a demonstrably immense superiority
in skill over the novice, there can be no true experts, only laypeople with
imposing credentials. Such, alas, are all too common. Rigorous studies in the
past two decades have shown that professional stock pickers invest no more
successfully than amateurs, that noted connoisseurs distinguish wines hardly
better than yokels, and that highly credentialed psychiatric therapists help
patients no more than colleagues with less advanced degrees. And even when
expertise undoubtedly exists--as in, say, teaching or business management--it
is often hard to measure, let alone explain.
Skill at chess, however, can be measured,
broken into components, subjected to laboratory experiments and readily
observed in its natural environment, the tournament hall. It is for those
reasons that chess has served as the greatest single test bed for theories of
thinking--the "Drosophila of cognitive science," as it has
been called.
The measurement of chess skill has been taken further than similar
attempts with any other game, sport or competitive activity. Statistical
formulas weigh a player's recent results over older ones and discount successes
according to the strength of one's opponents. The results are ratings that
predict the outcomes of games with remarkable reliability. If player A outrates
player B by 200 points, then A will on average beat B 75 percent of the time.
This prediction holds true whether the players are top-ranked or merely
ordinary. Garry Kasparov, the Russian grandmaster who has a rating of 2812,
will win 75 percent of his games against the 100th-ranked grandmaster, Jan
Timman of the
Another reason why cognitive scientists
chose chess as their model--and not billiards, say, or bridge--is the game's
reputation as, in German poet Johann Wolfgang von Goethe's words, "the
touchstone of the intellect." The feats of chess masters have long been
ascribed to nearly magical mental powers. This magic shines brightest in the
so-called blindfold games in which the players are not allowed to see the
board. In 1894 French psychologist Alfred Binet, the co-inventor of the first
intelligence test, asked chess masters to describe how they played such games.
He began with the hypothesis that they achieved an almost photographic image of
the board, but he soon concluded that the visualization was much more abstract.
Rather than seeing the knight's mane or the grain of the wood from which it is
made, the master calls up only a general knowledge of where the piece stands in
relation to other elements of the position. It is the same kind of implicit
knowledge that the commuter has of the stops on a subway line. . .
A Proliferation of Prodigies
The one thing that all expertise theorists agree on is that it takes enormous
effort to build these structures in the mind. Simon coined a psychological law
of his own, the 10-year rule, which states that it takes approximately a decade
of heavy labor to master any field. Even child prodigies, such as Gauss in
mathematics, Mozart in music and Bobby Fischer in chess, must have made an
equivalent effort, perhaps by starting earlier and working harder than others.
According to this view, the
proliferation of chess prodigies in recent years merely reflects the advent of
computer-based training methods that let children study far more master games
and to play far more frequently against master-strength programs than their
forerunners could typically manage. Fischer made a sensation when he achieved
the grandmaster title at age 15, in 1958; today's record-holder, Sergey
Karjakin of Ukraine, earned it at 12 years, seven months. . . .
The preponderance of psychological
evidence indicates that experts are made, not born.
The preponderance of psychological
evidence indicates that experts are made, not born. What is more, the
demonstrated ability to turn a child quickly into an expert--in chess, music and
a host of other subjects--sets a clear challenge before the schools. Can
educators find ways to encourage students to engage in the kind of effortful
study that will improve their reading and math skills? Roland G. Fryer, Jr., an
economist at
Philip E. Ross, a contributing editor at Scientific
American is a chess player himself and father of Laura Ross, a master who
outranks him by 199 points.
To read the entire article (subscription required),
please go to
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2.
In the News:
Saying 'No' to Medical Treatment by Cal Thomas,
A
16-year-old
On July 21, juvenile court Judge Jesse E. Demps ruled that
the boy's parents, Jay and Rose Cherrix of Chincoteague, were neglectful and
that they must continue to share custody of their son, Starchild Abraham
Cherrix, with the Accomack County Department of Social Services.
I have heard Cherrix interviewed on the radio and he
sounds intelligent, articulate, reasonable and capable of making such a major
decision. Cherrix says three months of chemotherapy left him nauseous and weak,
and he prefers not to repeat that type of treatment. That a court would deny
Cherrix and his parents such a choice prompted the family attorney, John
Stepanovich, to say: "I want to caution all parents of Virginia: Look out,
because Social Services may be pounding on your door next when they disagree
with the decision you've made about the health care of your child."
In an age when we continue to debate "a woman's
right to choose" when it comes to a girl aborting her baby and we are told
that it is the girl's body and no one else should make decisions affecting it,
a boy has no such rights. A girl can be given birth control by the school nurse
and even abortion information without her parents' knowledge or consent, but a
boy can be prohibited from making decisions that affect his life and body. At
least the courts are consistent. They forbid parental involvement in either
case.
In some states, though, parents are held responsible
for their kids' illegal and antisocial behavior. Why is it that parents
supposedly have power to keep their kids from committing crimes, but can be
denied power when it comes to their child's health and welfare? If a young
child (say 10, or younger) is unduly influenced by parents who are members of a
religion that teaches that faith alone can heal or prohibits blood
transfusions, then the state has an interest in stepping in to protect the
child until he, or she, is old enough to make an informed choice.
But in this case, the informed one appears to be
Cherrix, who says he has studied his options, experienced the treatment given
by his doctors and doesn't want any more of it. He prefers "alternative
medicine." That should be his and his parents' right to determine, not a
social worker and a court.
The attitude of the state and culture toward the value
of human life is in constant flux. Like the Dow Jones Industrial Averages, it
is up one day and down the next. Some want to use embryonic stem cells for
research into all sorts of afflictions and diseases, though no clinical tests
have proved they are effective, and stem cells from placentas and other
sources, which cause no harm to human life, are available. Life in the womb --
indeed, life emerging from the womb -- may be destroyed at any time and for any
reason. There is pressure at the other end of life to euthanize the elderly and
handicapped when they become "burdensome" to family members or
"too costly" to the state.
Attorney Stepanovich says Cherrix's parents will
appeal the ruling this week. Absent any additional information that has not
been made public, which might prove neglectfulness and bad parenting, Cherrix
and his parents should decide what is best for them -- not the state of
About the writer: Cal Thomas writes for Tribune Media
Services, 2225 Kenmore Ave., Suite 114 , Buffalo ,
N.Y. 14207
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3.
International
Medicine: The
The 37th place ranking of the United
States' health care system by the World Health Organization (W.H.O.) is not an
assessment of the quality of American health care, but rather expresses the
organization's preference for public financing of health care, says Twila
Brase, president of the Citizens' Council on Health Care.
- The
W.H.O.'s June 2000 report, "The World Health Report 2000-Health
Systems: Improving Performance," finds the United States ranked
number one, out of 191 countries surveyed, in responsiveness to patient's
needs for choice of provider, dignity, autonomy, timely care and confidentiality.
- However,
the W.H.O. faulted the U.S. for not requiring mandatory health insurance
or offering social welfare programs to all citizens -- thereby failing to
meet the WHO's fairness and distribution goals relative to total
health-care resources.
- Fifty-six
percent of all American health care expenditures are privately financed --
whereas the majority of health care is government-financed in other
developed countries.
- The
W.H.O., which currently receives $96
million from American taxpayers -- roughly 25 percent of its general budget –
recommends explicit health care rationing policies, centralized prepayment
systems for health care based on household income after anticipated food
expenses are subtracted, the placement of health at the center of a worldwide
development agenda, and equitable development across and within countries.
Source: Twila Brase, R.N., P.H.N.
(president, Citizens' Council on Health Care), "WHO's Hidden Agenda,"
Ideas on Liberty, December 2000, The Foundation for Economic Education,
Inc., 30 South Broadway, Irvington-on-Hudson, N.Y. 10533, (914) 591-7230.
For more on CCHC, see www.cchc-mn.org.
For more on International Health Care www.ncpa.org/iss/hea/.
Canadian Medicare does not
give timely access to healthcare, it only gives access to a waiting list.
--
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4.
Medicare:
Single-Payer Health Care for the Elderly
The current system of health insurance
for America's elderly population forces seniors into a single-payer health care
system that restricts choice and freedom to choose one's own health care,
according to author Sue Blevins.
Medicare
is the single largest payer for health care in the
Blevins
says Medicare coverage is not as good as people think:
- Medicare's limited coverage doesn't protect
seniors against catastrophic medical costs.
- It also fails to cover many routine health
services outside the hospitals, such as, dental care, eye examinations,
and physical examinations.
- Seniors now pay about as large a share of their
income for out-of-pocket medical costs as they did before Medicare -- and
the percentage is projected to rise higher in coming years.
Seniors cannot refuse Medicare
hospital coverage without forfeiting all of their Social Security retirement
benefits, and there are no insurance products sold to seniors in lieu of
Medicare coverage. In addition, the federal government prevents Medicare
beneficiaries from paying physicians privately for Medicare-covered services.
Budget
analysts have been warning for years that Medicare's financial future is far
from secure. Medicare expenditures have grown much faster than originally
projected. Without meaningful Medicare reform, seniors will likely face fewer
choices and higher prices in the future.
Source:
Sue Blevins, Medicare's Midlife Crisis (
For
more on Midlife Crisis, visit www.cato.org/cgi-bin/Web_store/
web_store.cgi?page=midlife.html&cart_id=7866254.20002.
For
more on Medicare Services, see www.ncpa.org/pi/health/hedex3d.html.
Government is not the solution to our problems,
government is the problem.
- Ronald Reagan
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5.
Medical Gluttony: What Is
An Extra Year Of Life Worth?
DYING PATIENTS STRETCH FUNDS TO EXTEND LIVES www.ncpa.org/sub/dpd/index.php?page=article&Article_ID=10686
Is the chance for several more months of life -- maybe
a year or more, with luck -- precious enough to spend a small fortune?
Extraordinary care for dying patients can make for inspiring medicine, but its
extraordinary costs make it an increasingly debated choice in promoting public
health, say observers.
Faced with a lethal disease, more than a third of
Americans now would want everything possible done to save their lives, up from
just over a fifth in 1990, according to a poll by the Pew Research Center for
the People and the Press.
Yet this kind of care costs several times more than
the older treatments it supplements or replaces:
- A
mechanical heart pump can cost more than $200,000, with hospital care.
- A
last-resort cancer drug can cost up to $50,000 a year -- if patients survive
that long -- but insurance would typically pick up at least two-thirds.
Federal safety regulators evaluate only whether drugs
or devices work, not how well they work for their prices. And Medicare,
which insures about 80 percent of dying Americans, makes no acknowledged
evaluation of cost in deciding what to cover. Its coverage umbrella sets
a standard for private insurers, say observers.
- Some
insurers refuse to cover a treatment; doctors send patients home to die,
sometimes out of mercy, and some patients say enough is enough.
- One
common approach calculates the cost of a treatment for each year of life
it saves -- with an adjustment for suffering and side effects.
- Many
health economists view $50,000 to $100,000 as a reasonable upper limit.
- Many
hospitals also partner with drug companies to treat dying patients for
free, especially in the early stages of testing, but even some doctors
worry that too many patients merely spend, suffer and die.
Source: Jeff Donn, "Dying patients stretch funds
to extend lives; New drugs, treatments can buy a few months, but the prices are
steep," Associated Press/Kansas City Star,
For text (subscription required): www.kansascity.com/mld/kansascity/news/nation/15267477.htm
For more on Health Issues: www.ncpa.org/sub/dpd/index.php?Article_Category=16
So what is an extra year of
life worth? We will never know until patients determine its value based on what
they are willing to pay. Medicare, HMOs and Insurance carriers will never be
able to determine its value. As Medicare goes broke, the value of human life
will continue to decrease. And as it diminishes below what Medicare and others
are willing to spend, it will be extinguished to save funds.
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6.
Medical Myths:
The Uninsured Should Take the Money They're Saving and Buy Insurance.
The American Medical Association wants to require everyone who earns more than five times the poverty level to have health insurance. The thresholds are $49,000+ for individuals and $100,000+ for a family of four. Failure to comply would not earn jail time. It would result in higher taxes, however.
The AMA's mistake (quite common in health policy circles) is a failure to recognize that the uninsured already pay higher taxes because they are uninsured. At $49,000 income, an individual who gets a $6,000 health insurance plan from an employer avoids a 25% federal income tax, a 15.3% FICA tax and, say, a 4% state and local income tax. If he were uninsured, enjoying taxable wages instead of health insurance, the individual would pay $2,640 of extra taxes each year precisely because he is uninsured.
The problem is not the absence of financial penalties; we already have them. The problem is that the penalties primarily go to Washington, DC; whereas the free care (if needed) is delivered locally.
The solution is to coordinate tax and spending programs. There is no need for a mandate.
Go to this link to read the full article: www.ama-assn.org/ama/pub/category/16460.html.
John Goodman, President and CEO, National Center for Policy Analysis, 12770 Coit Rd., Suite 800
Dallas, Texas 75251 www.ncpa.org
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7.
Overheard in the
Medical Staff Lounge: Large Bequests Can't Keep Up with Law Suits.
Dr Sam noted
the settlement against
Sutter
Health, in a move that reflects a growing trend among hospital chains, agreed
Thursday to provide discounts and refunds to uninsured patients it was accused
of overcharging. Kelly Dermody, a lawyer for the patients, said the settlement
will be worth at least $275 million. In addition, Sutter agreed to keep its
current discount policies for the uninsured in place for three years, which
will add tens of millions more to the value of the settlement, she said. Sacramento-based
Sutter said it hasn't estimated the value of the settlement but indicated that
it believed very little money will actually change hands. Instead, Sutter will
likely write off significant sums owed by the patients. "The vast majority
of our uninsured patients, well over 90 percent, don't pay their bills,"
said Sutter spokesman Bill Gleeson. The Sutter settlement comes a few weeks
after Catholic Healthcare West, which includes the Mercy and Methodist
hospitals in the Sacramento area, made a similar settlement with patients
represented by Dermody's San Francisco firm.
Dale
Kasler, Sacramento Bee on Friday August 4, 2006: www.sacbee.com/content/news/story/14287355p-15107064c.html.
Dr Jay: If
the hospitals are writing off 90 percent of their overcharges of private-pay
patients, wouldn't the pursuit of these excessive bills for months and years by
the hospitals amount to mental cruelty and harassment? Where are the attorneys
that are interested in rectifying wrongs?
Dr Rosen noted
Charity hits new heights
as Sutter hails Oses' $10 million and other big gifts: The
family of a
Dr. Sam: Looks like Sutter will need 30
or 40 of these huge donations to cover one lawsuit. Donations will have to rise
to an astronomical level to cover their business misteps. Why do successful
people still feel that hospitals are Institutions of Mercy appropriate to leave
a lifetime of success?
Dr. Rosen: When hospitals become wards of the
state under single-payer government medicine, they will again become like our
old city or county hospitals and even some of our older VA Hospitals with 16
and 32 bed wards.
Dr. Milton: I was trained in a county
hospital with several semi-private four and five bed rooms and several 72 bed
wards. I was always amazed at the efficiency of nursing such a ward. The chief
nurse seemed to know just about every thing about each patient. It was such a
pleasure to ask her about any patient and she seemed to always have the answer.
Dr. Rosen: Several years ago when I was in
London, I walked into the Brompton, a world famous institution. I asked if I
could visit one of their wards and talk to a doctor or nurse. The person at the
front desk told me that would not be possible unless I had a specific
invitation or appointment with a specific doctor. I mentioned a couple of world
famous names. The "prison" guard eyed me suspisciously even after I
showed her my credentials. She asked if the doctor knew me. Obviously, he's the
one that is famous and known, not me.
Access Denied. I've Often
Wondered Why?
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8. Voices of Medicine: Humor
Can Be Good Medicine by Michelle B. Caughey, M.D., President,
There is some credible
evidence that laughter and therefore humor improves health care outcomes. The
laughter referred to is, of course, the patient's laughter. (For some excellent
references and a description of laughter as medical therapy, the Web site of
hoslisticonline.com has some interesting entries.) If that is true, then
perhaps the care provided by physicians is better when we're able to enjoy
those funny moments with a private or shared laugh. And the day does seem to be
less stressful and more rewarding.
A dermatologist
colleague of mine has said to me over and over, "We should write a
book." She has three children and I have four. At
Patients often tell us sad
and amusing stories, and with a little distance from the moment, the stories
can be funny. Humor and tragedy are so tightly linked.
And the stories they make
up! "By mistake I gave the insurance information of my wife to be used by
my current girlfriend, and I didn't realize that the medical information would
appear in my wife's chart." "The dog ate my homework and the
Vicodin." "The car wash employees took the Vicodin right out of the
glove compartment." The most common is, of course, "They fell into
the toilet." Does everyone keep his/her medicines on the toilet seat?
And what about all those
things our patients want to show us? I'm all for descriptions, but not all
patients will go that route. Various sputum specimens, urine, stool, and vomit
are of course the most common. Sometimes nasal discharge "snot" is
proudly presented. . .
To read the entire
President's message, please go to www.smcma.org/Bulletin/BulletinIssues/April06issue/President.html.
What's Your Humor Style? By Louise
Dobson, Psychology Today, August 2006
Are you a joker? A teaser? A clown? How you deploy your sense
of humor says a lot about how you relate to others and to yourself.
In today's personality stakes, nothing is more highly valued than a sense of humor. We seek it out in others and are proud to claim it in ourselves, perhaps even more than good looks or intelligence. If someone has a great sense of humor, we reason, it means that they are happy, socially confident and have a healthy perspective on life.
This attitude would have
surprised the ancient Greeks, who believed humor to be essentially aggressive.
And in fact, our admiration for the comedically gifted is relatively new, and
not very well-founded, says Rod Martin, a psychologist at the
Though humor is
essentially social, how you use it says a lot about your sense of self. Those
who use self-defeating humor, making fun of themselves for the enjoyment of
others, tend to maintain that hostility toward themselves even when alone.
Similarly, those who are able to view the world with amused tolerance are often
equally forgiving of their own shortcomings. . .
To read the entire
article, please go to www.psychologytoday.com/articles/index.php?term=pto-20060623-000001&print=1.
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9.
Book Review:
Understanding How Men and Women Think Differently
Memoir Vs Memoir By JEFFREY ZASLOW, The Wall
Street Journal
Married almost 60 years,
Harry and Naomi Zaslow each put their life stories on paper. But revisiting the
past, as families are discovering, can be a wrenching experience
My mother recently finished writing a book about her
life, and in it, she sums up her past three years with my father. "I
felt," she writes, "like I was living with his mistress."
The mistress is my father's 663-page memoir. It has
been an obsessive project for him, and my mother worries that he's stuck in the
years 1944 and 1945, when he was an American soldier in
She took to
writing her life story as a way to reconsider her reflections, as my father was
lost in his. They wrote their dueling memoirs on opposite sides of their house
in
Older people these days are often encouraged to put
their lives on paper. There's been a boom in adult-education classes on
autobiographical writing. Web sites and software programs are proliferating to
help people store their memories for posterity. And through advances in
print-on-demand publishing, people can now have their lives bound into books
without paying large fees.
Memoir writing is being celebrated as a cathartic,
enlightening, late-in-life exercise that leaves a precious legacy. That's all
true. Less talked about, however, are the risks: Memoirs can lead to
misunderstandings in marriages, and friction within families. While writing,
people need to be aware of the emotional land mines.
Yes, both my dad and mom, at ages 81 and 76,
respectively, have produced beautifully written, heartfelt documents that their
offspring will cherish. But the process took a toll on their marriage.
Memoir-writing experts say this is common.
"Women focus memoirs on their relationships and
families. Men focus on their careers or their military service," says
Paula Stahel, who teaches "life writing" to senior-citizen groups in
After hundreds of hours of writing, my parents, Harry
and Naomi Zaslow, eventually developed a measure of understanding about how
they each chose to chronicle their lives. My mother realized that my dad had
never completely come to grips with what he lived through during the war -- the
comrades he lost, the scenes he witnessed as a concentration-camp liberator. My
father, meanwhile, saw in my mother's book the courage and perseverance that
carried her through life: She grew up poor, lost her brother, a
Don't miss the rest of these charming life stories at
(subscription required) http://online.wsj.com/article_print/SB115083599209185483.html.
Mr. Zaslow is a senior
special writer in The Wall Street Journal's
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10. Hippocrates & His Kin: Is Medicine Going in the
Wrong Direction?
On a trip to
Many patients take their albuterol inhaler
ineffectively and frequently don't empty their lungs before taking a deep
breath of the medicated mist. So frequently, I ask patients to demonstrate how
they take it. In the majority of cases, the medication doesn't get to the voice
box, much less the lungs. The other day when I asked a patient to demonstrate
her technique, she aimed the mist upward in front of her and then put her nose
and mouth into the cloud, took a deep breath and held it. She was from
A 40-year-old woman asked for an air purifier. When she
was reminded that she was still smoking cigarettes, she said, "That's
true. But by cleaning up the air around me, surely the cigarettes wouldn't harm
me as much. I know MediCal pays for it."
The Dutch government expands its euthanasia policy to
allow doctors to end the lives of terminally ill newborns with parent's
consent. They are taking this killing of newborns very seriously according to
Annette Dijkstra, Dutch Health Ministry Spokeswoman: "The ending of a life
must occur with the utmost of caution." Hence, it must be premeditated.
What a contrast: Premeditated murder by doctors is
allowed but premeditated murder by the public is a felony. Why don't doctors
recognize the slippery slope of medicine? Isn't it obvious that when the state
takes over our lives and those of our patients, if we kill the wrong patient we
will be strung up for a felony? Maybe go to the prison? Or even to the gallows?
To read more on HHK vignettes, please go to www.healthcarecom.net/hhk1999.htm and scroll down to November.
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11. Physicians Restoring Accountability in Medical
Practice, Government and Society: