Pigou and Canada

The NY Times has a piece by some academic types regarding the use of a carbon tax, yes a Pigou type tax, in Canada. They write:

ON Sunday, the best climate policy in the world got even better: British Columbia’s carbon tax — a tax on the carbon content of all fossil fuels burned in the province — increased from $25 to $30 per metric ton of carbon dioxide, making it more expensive to pollute.

This was good news not only for the environment but for nearly everyone who pays taxes in British Columbia, because the carbon tax is used to reduce taxes for individuals and businesses. Thanks to this tax swap, British Columbia has lowered its corporate income tax rate to 10 percent from 12 percent, a rate that is among the lowest in the Group of 8 wealthy nations. Personal income taxes for people earning less than $119,000 per year are now the lowest in Canada, and there are targeted rebates for low-income and rural households.  

Well this is not what I thought Mankiw was pushing, and I suspect ultimately Romney. They, I believe, want to just add another tax, a tax which is highly regressive, on anyone using petrol fuel. If I read this article correctly this tax is in place of an income tax. It still is a highly regressive tax not withstanding. But who ever heard of any Government lowering taxes when they get permission to add a new one. Never happen, not in this country.

This Pigou tax is to disincent use, when there is no rational alternative. Taxing weight, carbs, whatever makes more sense and we can track the positive effects ounce by ounce.

Bad Cells Using Good Cells: Metastasis

In the Nature article by Straussman et al, they state (also see write up by Carpenter):

Drug resistance presents a challenge to the treatment of cancer patients. Many studies have focused on cell-autonomous mechanisms of drug resistance. By contrast, we proposed that the tumour micro-environment confers innate resistance to therapy. 

Carpenter states:

The presence of these cancer-assisting proteins in the stromal tissue that surrounds solid tumours could help to explain why targeted drug therapies rapidly lose their potency.

Targeted cancer therapies are a class of drugs tailored to a cancer's genetic make-up. They work by identifying mutations that accelerate the growth of cancer cells and selectively blocking copies of the mutated proteins. Although such treatments avoid the side effects associated with conventional chemotherapy, their effectiveness tends to be short-lived. For example, patients treated with the recently approved drug vemurafenib initially show dramatic recovery from advanced melanoma, but in most cases the cancer returns within a few months.

The Carpenter article concludes:

One of the most startling results of the teams’ experiments was the discovery that a protein called hepatocyte growth factor (HGF) boosts melanoma’s resistance to treatment with vemurafenib. Intrigued by this result, both teams looked at blood samples from people who had undergone treatment with vemurafenib, and found the higher a patient’s HGF levels, the less likely they were to remain in remission.

We propose an alternative but what we believe to be a consistent interpretation. Consider the example below. We have conjectured based upon modeling that cancer may act as a separate entity on the human host and further that it uses the human host not only for nutrients but for communications. In fact using the results from this paper one can construct a verifiable model of a bi-system distributed environment. Here the melanoma uses a stem cell to communicate at a distance.

 The above is a hypothetical example:

1. There exists a melanoma stem cell. It can produce ligands which manage to use the body's distribution system; blood or lymphatic.

2. The ligands use normal health cells which are to be activated and in turn produce at a distant site growth ligands at that site.

3.At the distant site we have Melanoma non stem cells which respond to this massive influx, an amplifier system if you will, to make the non stem melanoma cells to proliferate.

Just an interesting but possible physical interpretation.

Cancer Cells and the Environment

There is an interesting piece on Eureka talking about how researchers now believe the environment, micro environment, can be a controller to cancer cell.

They state:

The research team has found that normal cells that reside within the tumor, part of the tumor microenvironment, may supply factors that help cancer cells grow and survive despite the presence of anti-cancer drugs. These findings appear online this week in a paper published in Nature.

"Historically, researchers would go to great lengths to pluck out tumor cells from a sample and discard the rest of the tissue," said senior author Todd Golub director of the Broad's Cancer Program and Charles A. Dana Investigator in Human Cancer Genetics at the Dana-Farber Cancer Institute. Golub is also a professor at Harvard Medical School and an investigator at Howard Hughes Medical Institute. "But what we're finding now is that those non-tumor cells that make up the microenvironment may be an important source of drug resistance."

 We have argued likewise in one of our recent White Papers. We argued that such cancers as melanoma have a compelling model for metastasis which uses both short distance micro environment control as well as long distance macro environment signalling.

Namely we have modeled melanoma metastasis as a quasi distinct organism using the human as a host and specifically using the host extracellular signalling as a means for allowing the stem cell to effect metastasis at a distance.

This laboratory effort is truly worth following.

Something to Watch

PCORI is an off-shoot of the ACA. It states its mission as:

The Patient-Centered Outcomes Research Institute (PCORI) is authorized by Congress to conduct research to provide information about the best available evidence to help patients and their health care providers make more informed decisions. PCORI’s research is intended to give patients a better understanding of the prevention, treatment and care options available, and the science that supports those options.

 

The Patient-Centered Outcomes Research Institute (PCORI) helps people make informed health care decisions, and improves health care delivery and outcomes, by producing and promoting high integrity, evidence-based information that comes from research guided by patients, caregivers and the broader health care community.

Patients and the public have the information they need to make decisions that reflect their desired health outcomes.

Now this is one of the hundreds of Federal Government Agencies, off book if you will, which have no reporting requirement to Congress, which will mandate what health care we get. Yes, in my opinion, this is where the morbidly obese GS9s will find homes and deny folks care. You can lay bets on this one.

How is it funded:

PCORI is funded through the Patient-Centered Outcomes Research Trust Fund (PCORTF), which was authorized by Congress as part of the Patient Protection and Affordable Care Act of 2010 and receives income from two funding streams:  the general fund of the Treasury and a small fee assessed on Medicare, private health insurance and self-insured plans. PCORI is expected to receive an estimated $3.5 billion from the PCORTF to fund patient-centered outcomes research through September 30, 2019, the date through which the Act authorizes it to remain in operation.

Yes folks it is funded by us old folks with increased Medicare costs at in my opinion less coverage.
Its budget is as follows:

For FY 2010, $10 million
For FY 2011, $50 million
For FY 2012, $150 million
 

For FY 2013, the PCORTF will receive $150 million from the general fund in appropriation plus an annual $1 fee per individual assessed on Medicare and private health insurance and self-insured plans. The combined estimated total is $320 million.

For FYs 2014-2019, the PCORTF will receive $150 million from the general fund in appropriation plus an annual $2 fee per individual assessed on Medicare and private health insurance and self-insured plans and an adjustment for increase in healthcare spending. The combined estimated total averages $650 million per year.

 This will be an exploding costs base. The Government, rather than physicians and patients, will be telling us what is good for us, as I read the details. That is $650,000,000 per year as a starter for studies, yes studies. Not clinical studies, but Government funded, which in my experience means that someone has a conclusion and they seek some Beltway Bandit to confirm their view.

In Massachusetts alone the following have apparently been funded:

1. Influence & Evidence: Understanding Consumer Choices in Preventive Care
2. Developing and Testing a Decision Support Tool for Primary Medication Adherence
3. Direct Engagement of Stakeholders in Translating CER into Clinical Guidelines
4. Incorporating Parent Preferences in Decision Making about Childhood Vaccines
5. Assessing and Reporting Heterogeneity of Treatment Effect in Clinical Trials
6. Developing an Analytic Tool to Assess Patient Responses
7. Patient Experience Recommender System for Persuasive Communication Tailoring
8. Decision Support for Symptom and Quality of Life Management

 These are all somewhat questionable in my opinion. Take the CER conversion into clinical guidelines. Take specifically the elimination of PSA tests by the Task Force as an example. This means that the actual lives saved will no longer be considered. The Government is writing the medical books. It does not even have a license to practice but it it now controlling how we are treated. One must and should be concerned as to what use these "studies" will be put. This will also most likely change "peer review" so that in my opinion the Government "peer review" specialists will mandate what is truth. McLuhan would have had a field day with this construct.

This is truly worth watching. They have Pilot Projects shown and this may provide some insight. But one must keep in mind that this is just one of the hundreds set up under the ACA! Watch the Deficit explode! And the care implodes! Happy 4th.

Pools, Beaches and Swimming

The Times has an article regarding the opening of a public pool and its problems.

I started as a NYC lifeguard in 1959 and if I recall we had a beastly hot summer, 59 0r 60, at Coney Island. We had almost one million people at the beach. Yes we had some issues but lifeguards were typically 6' plus and near 200 pounds of muscle. Even more so we were the sons of Police Officers and even a few FBI agents. We all were on our way to college, had a smattering of Spanish, Puerto Rican dialects, and we walked alone down the beach watching the folks.

We never really had fights, there were no police on the beach but we walked with an oxygen tank, a heavy green thing, which I guess made us look a bit in control. We had orange and green bathing suits and tops with numbers.

The "better" life guards were assigned to the beach, second place went to pools. But we did have losses in life, some people drank a bit too much and then went in the water, then under. I recall possibly two or three losses each summer. On the other hand we had many rescues, cramps, poor swimmers, and the like.

Thus it is somewhat surprising to see these problems. We had a Chief Lifeguard, an older gentleman, Lou Lipke if I recall, who trained us on what to expect. But we had respect because we mingled with the people. One on the lifeguard chair looking an the rest of us walking amongst the crowds. It was as if we became "beat cops" knowing the people, week after week, and if I recall we never had a serious problem.

Perhaps the training has gone by the wayside, perhaps the lifeguards are different. But perhaps it is just the newness of the situation. Hopefully it will calm down again. The pools were as important as the beaches.

But looking back we had lifeguards from the community. We knew many of the folks, and yes there were trouble makers, but they could be controlled. There were lots of us, and yes the pay was not much. But the guys were a great team.

Happy 4th

Down the road a bit from my home is the path George Washington took many times to go back and forth with his troops.

In many ways the Declaration was as a product of Jefferson reflective of Rousseau and Montesquieu a French version of individualism, not the true thing. For when de Tocqueville wrote his observations it was American individualism that most impressed him.

Thus in today's Times we are confronted with an author who states:

But then came the late 1960s, and over the next two decades American individualism was fully unleashed. A kind of tacit grand bargain was forged between the counterculture and the establishment, between the forever-young and the moneyed. 

He continues:

People on the political right have blamed the late ’60s for what they loathe about contemporary life — anything-goes sexuality, cultural coarseness, multiculturalism. And people on the left buy into that, seeing only the ’60s legacies of freedom that they define as progress. But what the left and right respectively love and hate are mostly flip sides of the same libertarian coin minted around 1967. Thanks to the ’60s, we are all shamelessly selfish. 

 The ideas of individualism, libertarianism, hedonism, are all mixed up in this author's mind. The Scottish Enlightenment, Locke et al, are more a source and more on point. Jefferson was a Frenchman at heart, individualism was a clear evolution from the English desire to remove class. The Hippie world was a movement to remove responsibility. Individualism embodies duty, responsibility, while keeping that on the shoulders of the individual, not off-setting it upon the Government.

Having lived through the 60s, in Cambridge, what I saw was not individualism in any manner, but a Roman like break with that duty, by people and the Government, the Democrats in Washington especially.

Words do really mean something. The author seems in my opinion quite confused and uneducated. Words like citizen connote the meaning of being in a group. The French Revolution tried a level playing field euphemism of all being citizens. The Soviets used the term comrade. The in crowd in Rome were also citizens as were the crowd in Athens. The rights were group rights, not individual rights. Equality, level playing fields, fairness, all connote group think. The 60s was mass group think, not in any way individualism. True facilitators of mass group think.

The ultimate in individual rights was the construct of the right to be left alone, the famous paper by Warren and Brandies. It went beyond privacy, it went to the very heart of the individual and individualism. It was a right of anonymity.

The 60s were an "in your face" approach, as many of the same techniques are used today. It was Chicago politics, Saul Alinsky, and ever mayor of Chicago. These are NOT purveyors of individualism. They were destroyers of that very cherished idea.

The bottom line, what has become of our education system, our Press, with a paper of this type. Too bad we cannot wrap fish in it any longer!