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December 31, 2004

Medical Kaizen
In response to the post below about Atul Gawande's article, several readers have sent links to these posts. Without any prompting from me, Professor Postrel emailed the following to Soxblogger James Frederick Dwight, thereby saving me the trouble of composing a response (and giving Dynamist readers the benefit of his statistical training and years of following the quality revolution in manufacturing):
Mr. Dwight: I have read with interest your posts on the New Yorker article by Dr. Gawande. It is undoubtedly correct that a rigorous analysis would require some sort of multiple regression approach to control for patient differences, assuming that genetic data at the patient level are available across the entire sample. Then coefficients on the dummy variables for each clinic would presumably capture the effect of each clinic (subject to the usual caveats about potential omitted variables).

The vehement tone of your criticism is, however, unwarranted, because it seems very unlikely that the superior performance of the clinic in Minneapolis is entirely or largely due to random assignment of genetic types. I conclude this on the basis of the following factors:

1) The types of CF that result in rapid death will constitute a vanishingly small percentage of the population at any one time, for the obvious reason that these unfortunate patients die off quicky. If, as I suspect from the crudity of measures that you highlight, the data have not been corrected for this bias, the hardest cases will have almost no effect on the performance differences found.

2) You provide no links or citations for your claims about genetic variants and their impact on longevity. Perusal of the CF Foundation website provides no such information. Taking your word for it, however, the key datum we need to evaluate Gawande's claim is NOT how many genetic variations there are but how big the range of severity is across those variants (weighted for their persistence in the clinic patient pools).

(Beyond evaluating Gawande's claims, it might be interesting to see if dummy variables on each genetic variation, both independently and in interaction with the clinic dummies, explain much of the variation. This would get at whether certain clinics were especially good at handling particular genetic variants. I don't know if we would have enough data points to do this though--degrees of freedom could be an issue.)

3) Your confidence about the low variance of performance among physicians is unwarranted. Even conditional upon being in the upper tail of a distribution of attribute X, there may still be substantial variation within that upper tail. More importantly, if attribute X is imperfectly correlated with what we really care about, attribute Y call it, then a group from the upper tail of the X distribution may well look like a bell curve in the Y dimension. Let X be the attributes that get people through medical licensing and let Y be proficiency in treating CF. It would not be shocking if professional training captured only some of the factors that ON THE MARGIN make one practitioner more effective than another.

4) It seems cosmically unlikely that the best clinic in the sample just happened to be the one run by the pioneer in comparative methods, the one who used demonstrably different techniques for treatment, quality assurance, and patient compliance. The idea that Minneapolis just happened to get a phenomenally favorable genetic draw AND was an innovator in treatment (doing things very differently) seems far-fetched.

5) The Gawande article claims that not only is there a bell curve in performance, but the leaders are IMPROVING faster than the average and below-average clinics. Unless patient turnover is negligible, that militates strongly against the suggestion that it is all the luck of the genetic draw. If patient turnover is negligible, then at best one could argue that there are genetic types that are not only easier to treat but that have initially hidden pathways to improvement not present in other types. This seems strained as well. More likely, we have an example of organizations exhibiting what the Japanese call "kaizen" or "continuous improvement through incremental refinement."

6) There is a vast body of empirical evidence in fields ranging from computer programming to automobile manufacturing that performance variations among similar units are large and persistent. To the extent that these are differences at the individual level (e.g. programming) no known intervention exist, to my knowledge. To the extent that they exist at the organizational level (e.g. auto factories), they can be addressed with a variety of management practices, many of which can help but none of which promise immediate performance convergence. For example, the Wall Street Journal [actually the NYT--vp] has just run an article on how getting hospitals to follow established standards of care in a few selected disease categories can have huge impacts on mortality. Failure to follow these standards of care is attributed primarily to physicians' inability to remember all the things that should be done given the stress and information overload they face and/or their cultural unwillingness to follow codified protocols consistently.

7) The CF Foundation website makes laudatory mention of the Gawande article and registers no objection whatsoever to its use of the data.

For all of these reasons, your tone of accusation and conclusive dismissal of Gawande's thesis is premature. Ideally, we would have peer-reviewed econometric studies to settle these matter conclusively. Absent those, however, your objections fall short of discrediting Gawande or the New Yorker.

Mr. Dwight has not had a chance to respond yet. I'm posting this because I thought readers would be interested in the counterargument.

Posted by Virginia at 07:07 PM


December 30, 2004

"Stingy" or Not? Drezner Weighs In
In response to my post below, Dan Drezner runs through the numbers on whether or not the U.S. is "stingy" with aid. He also catches the Washington Times with a misleading headline on a careful story. As anyone who writes for a newspaper can tell you, you can't trust headlines to be either interesting or accurate.
Posted by Virginia at 11:41 AM


Two Frustrated P.R. Departments
From Claudia Deutsch's NYT article on companies outsourcing their design, a significant trend but not as new as the article suggests:
"There's no question: the 2004 models of competitive cars look a lot more alike than the 1994 models did," said Sunil Chopra, a professor of operations management at the University of Chicago's Kellogg School of Management.

Kellogg, where Chopra works, is, of course, part of Northwestern University, which is in Evanston, just north of Chicago. The University of Chicago Graduate School of Business is called just that.

Posted by Virginia at 11:21 AM


December 29, 2004

What the Riots Wrought
Nostalgic pop culture recalls 1967 only as the Summer of Love, but it was also summer race riots burned through Detroit and Newark, to name only the deadliest incidents. Back in the '60s, inner-city property values were the last thing opinion elites were concerned with. But the riots of the 1960s had devastating long-term effects on the most significant assets owned by urban blacks: their homes. Those effects that may still exacerbate the so-called wealth gap between blacks and whites. My latest NYT column looks at research on the 1960s riots' long-term economic impacts:
As an economic historian, Robert A. Margo has long wanted to study the 1960's. But, he says, "for the longest time people would say, 'That's too close to the present.' "

Not so anymore. The 1960's are as distant from today as the Great Depression was from the 1960's, and economic historians, including Professor Margo, of Vanderbilt University, are examining the decade's long-term effects.

Consider the wave of race riots that swept the nation's cities. From 1964 to 1971, there were more than 750 riots, killing 228 people and injuring 12,741 others. After more than 15,000 separate incidents of arson, many black urban neighborhoods were in ruins.

As soon as the riots occurred, social scientists began collecting data and analyzing the possible causes. Until recently, however, few scholars looked at the riots' long-term economic consequences.

In two recent papers, Professor Margo and his Vanderbilt colleague, William J. Collins, do just that by estimating the impact on incomes and employment and on property values.

The riots not only destroyed many homes and businesses, resulting in about $50 million in property damage in Detroit alone, but far more significantly, they also depressed inner-city incomes and property values for decades.

Read the whole thing here, and check out the photo.

Posted by Virginia at 10:02 PM


Satellite Blogging on Tsunami Damage
My pal Charles Oliver points me to Chuck Watson's satellite blogging on the tsunami and its effects, with photos from low earth orbit. Based on what he sees from space, Chuck is estimating at least 128,000 deaths from the immediate impact of the tsunami, with more to come in the aftermath. In other news, he also has photos of fires in the Hamrin and Kirkuk oil fields.
Posted by Virginia at 09:39 PM


More on Medicine
Responding to the post below, my friend Jennifer George points me to this terrific Atul Gawande article in The New Yorker on the questions raised, for doctors and patients, by tracking and reporting the different outcomes from different medical centers. By definition, not everyone can be the best. What happens to doctors who are in the middle of the bell curve? How would their otherwise satisfied patients react to knowing their physicians' results are merely normal?The article focuses on cystic fibrosis treatments. Here are a few excerpts, but it deserves a full read:
Like most medical clinics, the Minnesota Cystic Fibrosis Center has several physicians and many more staff members. Warwick established a weekly meeting to review everyone's care for their patients, and he insists on a degree of uniformity that clinicians usually find intolerable. Some chafe. He can have, as one of the doctors put it, "somewhat of an absence of, um, collegial respect for different care plans." And although he stepped down as director of the center in 1999, to let a protege, Carlos Milla, take over, he remains its guiding spirit. He and his colleagues aren't content if their patients' lung function is eighty per cent of normal, or even ninety per cent. They aim for a hundred per cent--or better. Almost ten per cent of the children at his center get supplemental feedings through a latex tube surgically inserted into their stomachs, simply because, by Warwick's standards, they were not gaining enough weight. There's no published research showing that you need to do this. But not a single child or teen-ager at the center has died in years. Its oldest patient is now sixty-four....

We are used to thinking that a doctor's ability depends mainly on science and skill. The lesson from Minneapolis is that these may be the easiest parts of care. Even doctors with great knowledge and technical skill can have mediocre results; more nebulous factors like aggressiveness and consistency and ingenuity can matter enormously. In Cincinnati and in Minneapolis, the doctors are equally capable and well versed in the data on CF. But if Annie Page--who has had no breathing problems or major setbacks--were in Minneapolis she would almost certainly have had a feeding tube in her stomach and Warwick’s team hounding her to figure out ways to make her breathing even better than normal.

Don Berwick believes that the subtleties of medical decision-making can be identified and learned. The lessons are hidden. But if we open the book on physicians’ results, the lessons will be exposed. And if we are genuinely curious about how the best achieve their results, he believes they will spread.

The Cincinnati CF team has already begun tracking the nutrition and lung function of individual patients the way Warwick does, and is getting more aggressive in improving the results in these areas, too. Yet you have to wonder whether it is possible to replicate people like Warwick, with their intense drive and constant experimenting. In the two years since the Cystic Fibrosis Foundation began bringing together centers willing to share their data, certain patterns have begun to emerge, according to Bruce Marshall, the head of quality improvement for the foundation. All the centers appear to have made significant progress. None, however, have progressed more than centers like Fairview.

"You look at the rates of improvement in different quartiles, and it’s the centers in the top quartile that are improving fastest," Marshall says. "They are at risk of breaking away." What the best may have, above all, is a capacity to learn and adapt--and to do so faster than everyone else.

Once we acknowledge that, no matter how much we improve our average, the bell curve isn’t going away, we're left with all sorts of questions. Will being in the bottom half be used against doctors in lawsuits? Will we be expected to tell our patient how we score? Will our patients leave us? Will those at the bottom be paid less than those at the top? The answer to all these questions is likely yes....

The hardest question for anyone who takes responsibility for what he or she does is, What if I turn out to be average? If we took all the surgeons at my level of experience, compared our results, and found that I am one of the worst, the answer would be easy: I'd turn in my scalpel. But what if I were a C? Working as I do in a city that's mobbed with surgeons, how could I justify putting patients under the knife? I could tell myself, Someone's got to be average. If the bell curve is a fact, then so is the reality that most doctors are going to be average. There is no shame in being one of them, right?

Except, of course, there is. Somehow, what troubles people isn't so much being average as settling for it. Everyone knows that averageness is, for most of us, our fate. And in certain matters--looks, money, tennis--we would do well to accept this. But in your surgeon, your child's pediatrician, your police department, your local high school? When the stakes are our lives and the lives of our children, we expect averageness to be resisted. And so I push to make myself the best. If I'm not the best already, I believe wholeheartedly that I will be. And you expect that of me, too. Whatever the next round of numbers may say.

Read the whole article here.

Posted by Virginia at 09:33 PM


A Nagging Question about Susan Sontag
In my world, or perhaps my generation, Susan Sontag was mostly famous for being famous and having a skunk streak in her hair. I'll leave serious comment on her work to those who know it better than I do. (I've only read "Notes on Camp" and some selections on Cuban posters.) As a self-employed writer, however, I was struck by this passage in the NYT's long obit:
She found the form an agony: a long essay took from nine months to a year to complete, often requiring 20 or more drafts.

"I've had thousands of pages for a 30-page essay," she said in a 1992 interview. " 'On Photography,' which is six essays, took five years. And I mean working every single day."

How do you earn a living like that? The audience for intellectual essays is not big to begin with, and one book in five years, with no other career on the side, is hardly enough production to pay normal bills, let alone support a collection of 15,000 books and space to house them in Manhattan.

Professor Postrel, whose job conveniently provides health insurance for his self-employed spouse, suggests that the answer lies at the end of this less-than-favorable obit by Roger Kimball.

UPDATE: Christopher Hitchens, who most certainly does not take nine months to write an essay, sheds no light on the mysteries of Sontag's finances. But his appreciative obit does balance Kimball's jaundiced view.

Posted by Virginia at 03:12 PM


December 28, 2004

The Aid Debate
The tsunami has brought Dan Drezner back from his blogging hiatus. Since he's written on the topic before, I hope he'll join the debate over whether the U.S. is "stingy" with disaster aid.

Meanwhile, the Amazon Red Cross total has topped $834,000.

Posted by Virginia at 11:50 PM


Tsunami Aid
Reading down the entries on the newly created SouthEast Asia Earthquake and Tsunami blog, "the SEA-EAT blog for short," somehow brings home the magnitude of the disaster even more powerfully than the TV footage and growing casualty counts. All those little items, totalling such great tragedy, such great need, and so many efforts, small and large, to help...terribly sad and moving at the same time.

Amazon is collecting money for the Red Cross, charging no fees for the service. When I checked in and contributed, the total was more than $750,000 and rising rapidly. (Via InstaPundit.)

Posted by Virginia at 10:53 PM


December 27, 2004

"There's Something Strange Happening with the Sea."
WaPost reporter Michael Dobbs, vacationing with his family on an island his brother owns in Sri Lanka, was caught in the tsunami. He reports here.
Posted by Virginia at 11:16 AM


December 26, 2004

How to Help
Michele at Command Post has a fairly comprehensive list of how to donate to help victims of the South Asian tsunami.
Posted by Virginia at 11:57 PM


From War to Washing Machines
Here's an interesting A.P. article on how employers, notably Maytag, are snapping up people leaving the military:
DES MOINES, Iowa - Former soldiers, including those returning from Iraq or Afghanistan with disabilities, are finding that their military background can help them get jobs in civilian companies. Maytag Corp., for example, has an aggressive recruiting program turning recently discharged soldiers into repair technicians. Home Depot Inc. began Operation Career Front and Toyota North America started its Hire A Hero program in the past few years.

Companies say it's a win for them because they get high-quality workers.

“They have great discipline. They have great technical skills. They understand how to follow orders and follow procedures,” said Art Learmonth, president of Maytag Services.

One of the biggest advantages of former soldiers is that they're used to learning fast.

Posted by Virginia at 11:42 PM


Let Them Fail
If ever a company deserved to go out of business, it's US Airways.
In a memo to employees, US Airways chief executive Bruce Lakefield thanked those who helped “our customers during the operational meltdown we experienced over the weekend.” However, he criticized those who exacerbated problems by calling in sick.

“I have seen lots of excuses for why people took it upon themselves to call in sick, such as low morale, poor management, anger over pay cuts and frustration with labor negotiations,” Lakefield said. “None of those excuses passes the test. We all have our jobs to do.”

Union leaders representing workers in negotiations with the airline over further pay and benefits concessions denied any organized effort to slow operations.

“It’s poor management planning, that’s my opinion,” Teddy Xidas, president of the Pittsburgh branch of the Association of Flight Attendants, said Saturday. “We have sick calls every single year around the holiday.”

If you hate your boss or just don't want to go to work, find another job. Don't deliberately ruin other people's holiday travel.

Posted by Virginia at 11:40 PM


Managing Medical Care
This Gina Kolata article is a must-read for anyone concerned about the quality of health care. Medicine does, of course, entail many judgment calls. But so do most occupations. That doesn't mean the concept of "best practices" can't apply in medicine, just as it does in other fields. Certain very basic practices save lots of lives if they're made routine. Yet doctors, like every other sort of worker, sometimes need to be reminded to do things they know they should do.
Using incentives like bonus pay and deterrents like public humiliation, it is a bold new effort by the federal government, along with organizations of hospitals, doctors, nurses, and health researchers, to push providers to use proven remedies for common ailments.

And it is a response to a sobering reality: lifesaving treatments often are forgotten while doctors and hospitals lavish patients with an abundance of care, which can involve expensive procedures of questionable value. The results are high costs, unnecessary medicine and wasted opportunities to save lives and improve health.

Simple things can fall through the cracks....

At Duke University's hospital, for example, when patients arrived short of breath, feverish and suffering from pneumonia, their doctors monitored their blood oxygen levels and put them on ventilators, if necessary, to help them breathe.

But they forgot something: patients who were elderly or had a chronic illness like emphysema or heart disease should have been given a pneumonia vaccine to protect them against future bouts with bacterial pneumonia, a major killer. None were.

All bacterial pneumonia patients should also get antibiotics within four hours of admission. But at Duke, fewer than half did....

"Medical care is one of those very strange parts of the economy where you get paid no matter what the quality of the service you provide," Dr. Asch said. "It is like you went to a car dealership and your Mercedes is going to cost you the same as your Yugo."

Read the article, check out the charts, and look up your own local hospitals' performance here.

Posted by Virginia at 10:45 PM


Tsunami
British Foreign Secretary Jack Straw said it best: "For all the huge advances in the control of our lives through science and technology, an earthquake on this scale is truly humbling as well as profoundly tragic."

Yes, natural disasters are less lethal in richer, more technologically advanced nations, and yes Pacific coast residents have the advantage of some warning of tsunamis. But don't kid yourself. As most Californians know, nobody is truly prepared for an 8.9 magnitude earthquake. (Every quake, no matter how far away, is a local story in L.A., which is why I always turn to the LAT for coverage.)

You can make a contribution to the Red Cross International Response Fund here.

Posted by Virginia at 10:35 PM


New Iraqi Blog
It's called Democracy in Iraq, by blogger Husayn Uthman. He's eager to hear readers' comments.
Posted by Virginia at 10:05 PM


With the Troops
Both the WaPost and the NYT published Christmas-pegged stories on USO visits with the troops. The Post article, by Tamara Jones, is a vividly written feature that sympathetically captures the strange life of soldiers who are far away from home and, because these troops are in Afghanistan, threatened more by boredom than enemy fire. The story, which deserves reading in full, has many moods but one thing it isn't is snarky.
Last week, though, out of the flat, white sky, a Chinook chopper appeared, swooping down on a handful of bases to deliver a quick dash of holiday cheer, courtesy of an organization famous for that: the USO. From the dust cloud, two men emerged. One was a graying punk rocker, the other an actor few readily recognized.

And with that, a strange war briefly got even stranger.

Politically, Henry Rollins and Patrick Kilpatrick occupy opposite corners. Rollins, the 43-year-old frontman for the '80s punk band Black Flag, focuses now on "spoken-word" tours peppered with rants against the Bush administration and its motives for war. Kilpatrick, a strapping 55-year-old who specializes in playing on-screen villains, defends as righteous both the president and the invasions he ordered.

But the two entertainers share common emotional ground, believing that the troops deserve unconditional respect and gratitude. Their determination to express that, in person, put them on the same handbill when the USO organized a five-day, seven-base holiday tour to Southwestern Asia. This would be just meet-and-greet, handshakes and autographs, chitchat -- but no show. A chance to connect, no matter how fragile, or forced, or fleeting....

Rollins has barely had time to uncap his Sharpie when he hears an urgent voice somewhere near his elbow.

"You're in the outside world . . ." A squirrelly Marine has executed a stealth weave-and-cut maneuver to the front of the autograph line. Rollins turns to him politely.

"I heard Dimebag Darrell got killed. That true?" the Marine blurts out.

"Yes, he got shot," Rollins replies, recounting how heavy-metal guitarist Darrell Abbott was gunned down recently during a bizarre melee in Ohio as his band Damageplan played. The Marine looks ready to cry.

"That's so depressing," he says.

"Really depressing," Rollins agrees. This is his fourth USO gig in a year, and he has come to realize that just showing his recognizable face to a generation of fans now in uniform brings reassurance: "You make them kind of think, 'Okay, the world is still there.' " He tries to resume signing autographs and posing for pictures, but the Marine hovers. He begins to ramble about his old Black Flag and Pantera CDs. Dimebag played for Pantera, too. Somehow when the Marine moved overseas, his prized CD collection got cracked. Now the discs are gone and Dimebag Darrell is dead.

By contrast, the Times article by Thom Sanker is much duller--they don't call the Times the gray lady for nothing--and much less interested in the lives of the troops. It's keeps mentioning Bob Hope and Vietnam and is careful to bring up race and gender. (The USO performers are all white males except for the obligatory eye candy.)

One thing the two articles agree on: Robin Williams is popular with the troops.

Posted by Virginia at 09:55 PM


December 24, 2004

Coming Next Year...
I've updated the page for my Upcoming Appearances, which next year will include speeches at the University of North Texas and Cal State-Long Beach, both free and open to the public. Among conferences you have to pay for, a couple are noteworthy:
The Design Management Institute's Seminar at Sea, aboard the Queen Mary 2, sailing from London/Southhampton to New York, and featuring a special lecture and tour by the ship's designer. Schedule, registration, and fare information here.
There's a January 1 deadline for deposits.

Brand Identity & Package Design conference, featuring lots of interesting speakers including the always-fascinating Grant McCracken, April 18-20, 2005 at The Plaza in New York City.
Dynamist.com readers can get a 15% discount. Email me for details.

Posted by Virginia at 01:11 AM


December 23, 2004

Who Designed Your Great-Looking Site?
I get enough emails asking that question to suspect that folks haven't been scrolling all the way down to the bottom to see Adrian Quan's logo, so I've moved it up the column to the right. If you're looking for a designer, I highly recommend him.
Posted by Virginia at 12:33 AM


December 22, 2004

Books for Slovakian High School
Strengthen the Good is soliciting English-language books for a private high school in Bratislava. The StG website has more info on what books are needed, how to send them, and how to donate funds.
Posted by Virginia at 11:48 PM


The Glamour of Flight
The new movie about Howard Hughes could have had any number of titles, from the simple Hughes to the inflation-ignoring America's First Billionaire. But no alternative would have the magical attraction of The Aviator.

From the days of biplanes and silk scarves, the aviator has been the archetype of masculine glamour. Aviators have personified national ideals, from French elan to Soviet party discipline. They've inspired lust and admiration. They've turned sunglasses and short, utilitarian leather jackets into fashion statements. "Glamour boys," the press called Royal Air Force fliers between the wars, and the nickname stuck through their finest hour.

Charles Lindbergh's glamour was once as potent as any movie star's, powerful enough, imagines Philip Roth in his latest novel, to topple Franklin Roosevelt. When George W. Bush stepped on to an aircraft carrier in a flight suit, he wrapped himself in the aviator's aura. So did Sen. John McCain when his 2000 presidential campaign used a portrait of the candidate as a handsome young flier.

If glamour is, to quote from a fashion blurb, "all about transcending the everyday," what could be more transcendent than flight itself? Even today, when commercial air travel has become a dull yet stressful routine, a photo of a jet in the sky still has a glamorous power. It promises to transport us out of the everyday, to take us away to some better place.

Director Martin Scorsese, in an interview with The Boston Globe, recalls reading the Aviator script and "imagining Hughes up there in the clouds, flying over the world, that is transcending the mortal self." His movie is all about transcendence, aspiration, and illusion. It portrays glamour for a cynical, media-savvy age.

That's the beginning of my latest article. Read the rest here.

The smartest review of The Aviator I've read is David Edelstein's piece on Slate (though I'm guessing he's not a No Doubt fan, since he seems not to know who Gwen Stefani is). Roger Ebert's review is also good, noting that if Hughes "had died in one of the airplane crashes he survived, he would have been remembered as a golden boy." The movie opens nationally on Christmas Day.

Posted by Virginia at 04:45 PM


December 21, 2004

Store Your MRI on an iPod
From the otherwise annoying Apple startup page that overrides my browser-homepage preference comes a link to this cool article about radiologists using iPods to store and transfer medical images:
The iPod is not just for music any more. Radiologists from the University of California, Los Angeles (UCLA), and their colleagues at other institutions from as far away as Europe and Australia are now using iPod devices to store medical images.

"This is what we call using off the shelf, consumer market technology," says Osman Ratib, M.D., Ph.D., professor and vice-chairman of radiologic services at UCLA. "Technology coming from the consumer market is changing the way we do things in the radiology department."

Dr. Ratib and Antoine Rosset, M.D., a radiologist in Geneva, Switzerland, recently developed OsiriX, Macintosh-based software for display and manipulation of complex medical image data.

"We chose to do it on the Macintosh because of the high performance of Mac graphics," Dr. Ratib says. "The purpose is to be able to quickly and interactively manipulate very large data sets in 3D, 4D and even 5D. It's amazing how much performance we get."

How did the developers go from a music player to a medical storage device? "We basically wanted something that everybody could use," explains Dr. Ratib. "That's why OsiriX can be used with the iPod, iChat and other tools."

"Radiologists deal with a very large amount of medical imaging data," Dr. Ratib explains. "I never have enough space on my disk, no matter how big my disk is—I always need more space. One day I realized, I have an iPod that has 40 gigabytes of storage on it. It's twice as big as my disk on my laptop and I'm using only 10 percent of it for my music. So, why don't I use it as a hard disk for storing medical images?"

How about that--entertainment R&D (and a much larger market) supporting medical applications. It's not exactly what any industrial policy guru would have planned.

Posted by Virginia at 04:55 PM


The Long Tail
"On the Net, the bell curve reclaims its tails. The uncommon is as accessible as the common," I wrote in this 1999 Forbes ASAP column. Last October, Wired editor Chris Anderson published a great article called "The Long Tail" looking at what has in fact happened as this vision has turned into reality--and what may happen as that reality expands. He now has a book contract and a blog to refine and expand on his ideas.
Posted by Virginia at 01:33 PM


The Aesthetic Imperative Comes to Cars
When I was working on The Substance of Style, Eugene Volokh asked, once in conversation and once in the Q&A after a speech, why, if people care more about aesthetics, we don't see more car customization. It turns out that we do--just as extrapolating from my trend-spotting would predict. (The car-customizing trend didn't make it into the book but it did show up in my Wired article, much abbreviated from its original version, on aesthetic jobs.)

The WaPost and Fortuneboth feature articles on how automakers are trying to capitalize on the trend. From the Post piece:

The popularity of those over-the-top decorating shows for vehicles has pumped new life into the auto customizing business, as more mainstream consumers decide they want to trick out their car or truck with fancy accessories. The auto parts and accessories industry has doubled in size in a decade, reaching $29 billion in sales last year, according to the Specialty Equipment Market Association, or SEMA.

That's a stream of money too big for the auto industry to ignore, so car manufacturers are beginning to offer options up front that once were available only from the local hot-rod shop. Toyota blazed the way with its youth-oriented brand Scion, which offers such must-have accessories as glowing cup holders and multicolored dash displays.

"What some manufacturers figured out is if they contract with [customizers] or make the products in-house, they can make a lot more money," said Dan Kahn, a road-test editor at Edmunds.com.

While that seems like a predatory business move, small customizing companies actually welcome the trend, according to Peter MacGillivray, vice president of marketing and communications for the California-based SEMA.

"What they're really going to do is plant the seed, plant the notion of personalization and accessorization in so many more places than we ever could," MacGillivray said, adding that big car companies "have the single largest marketing budgets in the world."

The Fortune article reports from the SEMA trade show (and features a photo of comely autoshow women):

Heads are turning up and down the aisles at this year's show, and it's not just because of the short skirts. Diamond-studded lugnuts, 24-speaker stereo systems, nitrous-oxide injectors, underbody neon lighting, pneumatically adjustable suspensions, flashing tire-valve caps—the bling goes on for 12 linear miles of exhibits. SEMA has become the second-biggest trade show in the country, after the Consumer Electronics Show, and possibly the most important car show after Detroit. "We take it very seriously," says Ed Golden, Ford's director of design. Why? "We want them to be tuning up a Ford."

As the business of aftermarket parts has exploded--sales are expected to surpass $29 billion this year, more than twice what they were a decade ago--it has become something Detroit can't ignore. That's why Golden and fellow Ford designers Larry Erickson and Patrick Schiavone are here, their suits and gold name badges making them look a little out of place among the "tuners" in T-shirts and oil-stained jeans. "The thing is, today everybody's reliable," says Erickson, who designed the 2005 Mustang. "Everybody's quick. Everybody's got quality. So now the personality thing becomes more and more important."

That can mean anything from flashy chrome wheels to $10,000 entertainment systems with ten flat-screen TVs to paint that changes color when viewed from different angles. It started in the 1990s when California teens--much like their parents in the hot-rodding 1960s--started turning beaten-up sedans into street racers. Their racetracks were long blocks and riverbeds, some of them the same places where earlier generations competed in souped-up Mercurys and Thunderbirds. Only now technology allowed hot rodders to get high performance out of smaller, four-cylinder cars like Honda Civics. Some swapped out the computer chips governing engine functions; others lowered suspensions for better aerodynamics. Some just added bass speakers in the trunk or chopped off mufflers to add "noise." But now, a decade later, "tuning" has moved to the exclusive brands. At the SEMA show, there are Porsches with doors that scissor open like those on Lamborghinis, Jaguars with racing-style suspension, and six-figure Bentleys with tinted windows and 20-inch wheels (called "dubs" on the street).

At some point, I hope this trend will break out into serving a less flamboyant market: those of us who'd like a bit more color and style in our boring cars--maybe nothing more than a prettier paint job--but don't share the streetracer or hip-hop aesthetic.

Posted by Virginia at 11:42 AM


December 20, 2004

Another Reason for "Happy Holidays"
Today is December 20. If I wish you "Happy Holidays," today is included in the season (if not the literal holidays). More happiness all around.

Judging from my email, which is hardly a random sample, the people most adamantly against "Happy Holidays" are not in fact Christians but secularists determined to define Christmas as an occasion that has nothing to do with religious faith.

Posted by Virginia at 10:38 PM


The Latest Pain Reliever Warning
It's about naproxen, a.k.a. Aleve. It can also make you blow up with hives until you look like an alien. Or at least that's what it did to me.
Posted by Virginia at 10:33 PM


December 18, 2004

What's Wrong with "Happy Holidays"?
Lileks is against it, and he's part of a national movement. Among all right-thinking bloggers "Happy Holidays" is out and "Merry Christmas" is in.

To which I say, Come to Dallas. Nobody here (except me) will wish you, "Happy Holidays." Everyone will ask whether you're ready for Christmas and wish you a merry one. And if, like me, you don't want to cause anyone to feel bad, you'll respond politely and let them go right on assuming you celebrate Christmas.

I can't blame Christians, who are the vast majority of Americans and the ones whose religion is celebrated in all those carols at the mall, for wanting their holiday acknowledged in public. I don't get offended when Dallasites assume everyone, of course, celebrates Christmas. (Everyone they know does, after all.) And I hope to have a happy, though not necessarily merry, December 25. But I wish good-hearted folks like Lileks would consider that Christmas greetings don't make everyone feel good.

Why criticize merchants for including all their customers in wishes for a happy holiday season? The holidays do, after all, stretch from Thanksgiving to New Year's, both nonsectarian holidays. "Happy Holidays" includes Christmas, for those who celebrate it. But it also includes holidays we all share, as well as some others only a minority observe.

When you extend these greetings, are you wishing people happiness? Or affirming your Christianity? Do you want people who don't celebrate Christmas to be happy (or merry)? Or do you want to make them at least mildly uncomfortable? The answers will determine what you say.

Posted by Virginia at 01:20 AM


Liberty and Freedom

In this week's New York Times Book Review, I review David Hackett Fischer's massive new book, Liberty and Freedom: A Visual History of America's Founding Ideas. Here's the beginning:
When patriotic country music fans sing Lee Greenwood's lyric ''I'm proud to be an American, where at least I know I'm free,'' what do they mean? Is Greenwood's idea of freedom the same as Bruce Springsteen's or Francis Scott Key's? And is this freedom the same as the liberty of the Declaration of Independence, the Pledge of Allegiance or the statue in New York Harbor? In ''Liberty and Freedom,'' David Hackett Fischer, a historian at Brandeis University, argues that we cannot learn how most Americans understand freedom by studying political theory or intellectual debates. ''Most Americans do not think of liberty and freedom as a set of texts, or a sequence of controversies or a system of abstractions,'' he writes. ''They understand these ideas in another way, as inherited values that they have learned early in life and deeply believe.''

To probe those unspoken meanings and examine how they've evolved through the nation's history, ''Liberty and Freedom'' seeks to combine the ''new history'' with the ''old,'' using the habits and customs of ordinary people to illuminate the actions and ideas of political leaders. The book, Fischer says, is ''iconographic. It uses images, artifacts, and material culture as empirical evidence.'' Before he gets to images, Fischer turns to etymology, establishing a contrast between liberty, whose Latin roots suggest release from bondage, and freedom, which shares Northern European origins with friend. ''The original meanings of freedom and liberty,'' he writes, ''were not merely different but opposed. Liberty meant separation. Freedom implied connection.'' He makes much of this distinction throughout the book, favoring ''freedom'' and often disparaging ''liberty'' (associating it, for instance, with Southern racism). Yet he also declares that the creative tension between the two concepts has given English-speaking people ''a distinctive dynamism in their thought about liberty and freedom.''

Posted by Virginia at 01:04 AM


December 15, 2004

Thumbs Way Up
For an upcoming article, I was able to arrange a preview of The Aviator, which opens this weekend in LA and New York and everywhere on Christmas Day. The movie portrays 20 years of Howard Hughes's life, from the making of his movie Hell's Angels to his fight to protect TWA's right to fly internationally from PanAm's man in Congress. It's not a documentary, of course, but a psychologically compelling tragedy that should become a classic. Leonardo DiCaprio, Cate Blanchett, and Martin Scorsese all deserve Oscars, but they couldn't have done it without the brilliant script by John Logan. (Interestingly, it was DiCaprio's idea to make a movie about Hughes.)

As further research, I also got the newly released DVD of Hell's Angels. The dogfight and Zeppelin sequences are wonderful, justifying Hughes's insane perfectionism, but the movie is much more interesting as a historical artifact than as entertainment. Watching Hell's Angels is a little like reading pre-Marlovian Elizabethan dramas. They have their moments, and the potential is there, but the writing is too episodic, the characters too flat, the language too stilted. Hell's Angels has some great visuals, but the acting is so broad and melodramatic that it makes the annoying characters more so. I didn't care if they died; in fact, it was something of a relief. (Plus Germany looks remarkably like the Southern California desert.) It's amazing how much the movies improved after 1930.

UPDATE: Jesse Walkers writes to let me know that Hell's Angels is playing tonight on Turner Classic Movies, midnight ET. It's part of TCM's 13-film (and one-documentary) tribute to Howard Hughes.

Posted by Virginia at 11:29 AM


So Many Books, So Little Time
Inspired by the post below, Daniel Drezner posts on "an old parlor game among academics -- confessing the most important book in your field that you have never read." It's not clear what "my field" is. Since my formal training is in English literature, I might say Frankenstein (I intentionally avoided Ulysses, which means I'm not embarrassed). Given my current work, however, it's some combination of The Wealth of Nations and The Theory of Moral Sentiments. I've read parts of each but all of neither. Dan's reader comments suggest that Smith is vastly underread.

Responding to the original post, readers have been hard on Mark Edmundson, but I've got to give him credit for admitting that he'd never heard of The Road to Serfdom. It would have been easy to fake it with something like, "It's certainly been an influential book, but I have to admit that I haven't read it." As Dan's post implies, much of education is knowing what books you should have read, even if there are too many to master.

Reader John Brennan writes, "What I thought was particularly delicious was that it was THE VERY LAST question on the VERY LAST SHOW of Booknotes."

Posted by Virginia at 11:00 AM


December 08, 2004

Travel, Deadlines, & TV
Sorry for the light blogging, which will continue to be sparse until at least Wednesday. I'm back in Dallas to sleep before I go to the Baltimore/Washington area for a day. I'll be taping Wall Street Week with Fortune on PBS, which this week features a discussion of design in busines, tied to Fortune's special feature on the subject.

Oh, yeah, and I have two articles due by Tuesday afternoon. (I confess that I enjoy real writing more than blogging, at least at the moment.) But at least I'm not getting my wisdom teeth out, the original plan for tomorrow.

UPDATE: A transcript of the Wall Street Week segment is here.

Posted by Virginia at 11:49 PM


December 07, 2004

The Most Important Thinker You've Never Heard Of
Sunday's Booknotes interview with Mark Edmundson, author of Why Read? ended with this exchange, which is even more striking in the context of the long, erudite interview and Edmundson's thesis that students need (in the publisher's words) a "challenging, life-altering liberal arts education."
LAMB: Here`s an older book spoken about by Milton Friedman, on the other side.

EDMUNDSON: OK.

(BEGIN VIDEO CLIP)

MILTON FRIEDMAN, AUTHOR AND ECONOMIST: It`s a book well worth reading by anybody, because it`s a very subtle analysis of why, how it is that well-meaning people who intend only to improve the lot of their fellows, tend to favor courses of action which have exactly the opposite effect.

I think in my, from my point of view, the most interesting chapter in that book is one labeled, why the worst rise to the top.

(END VIDEO CLIP)

LAMB: He`s talking about "Road to Serfdom" - Hayek - a bible for people on the conservative political side.

EDMUNDSON: I`m glad to know about it. Until this moment, I`ve heard nothing about it. But I will write it down and give it a look.

For an introduction to Hayek's work, and the increased recognition of its importance, see my Boston Globe article here. The new issue of Reason has an interview with Hayek biographer Bruce Caldwell, which is not yet online.

Posted by Virginia at 12:20 PM


Online Shopping
The WaPost's Cynthia Webb's blog-like "Filter" column has a great roundup of articles covering trends in online shopping. It's big this year--no surprise, there--but the details of how, where, and what people are buying are interesting. If you don't want to follow the links, Webb offers excellent summaries.
Posted by Virginia at 12:08 PM


TV Appearances
I'm in L.A., reading and writing up a storm and furthering my TV career (such as it is). I'll be on the Dennis Miller Show on Wednesday (9 p.m. and midnight ET, 6 p.m. and 9 p.m. PT). I also taped a slew of comments on pop-culture topics for this Bravo special, which first airs on December 16. (Follow the link for all dates and times.) I have no idea whether they'll use anything I said and, if so, whether it will be anything intelligent.
Posted by Virginia at 01:12 AM


Dealing with "Too Much Choice"
Once, social critics decried markets for reducing everyone to the lowest common denominator, eroding personal expression for the sake of mass production. Now they damn markets for giving us so many choices we're overwhelmed. The psychological research today's critics cite is legitimate, but their static view of the marketplace isn't. Less variety isn't the answer. Rather, we need better ways to narrow down that variety to the choices most likely to suit our personal preferences. That's not a problem. It's an entrepreneurial opportunity.

For a special retailing section of the NYT, I look at the rise of "mediated shopping." Related pieces are here (on the "variety revolution") and here (on "shopping magazines").

Posted by Virginia at 01:06 AM


December 01, 2004

Repeal the Wright Amendment NOW
My latest NYT column was inspired by personal events (recounted in the lead) but turned out to be extremely newsy:
When I asked my editor whether I could be reimbursed for my travel to the American Economic Association meetings this year in Philadelphia, he agreed, with a caveat.

"Please try to get the cheapest air fare you can," he wrote in an e-mail message. "Southwest flies Dallas-Philly doesn't it?"

Well, no. It doesn't, even though both the company and its passengers wish it did.

Southwest is based at Love Field, not far from downtown Dallas. But it cannot fly from Dallas to Philadelphia - or Chicago or Las Vegas or Los Angeles or Baltimore-Washington or a host of other popular destinations - without violating federal law.

Like my editor, most people outside Dallas have no idea of this peculiar restriction. The so-called Wright Amendment, named for the longtime congressman from Fort Worth, Jim Wright, was intended to protect the newly built Dallas-Fort Worth International Airport. What it did was limit not the amount of traffic at Love Field (local rules take care of that) but where the airplanes could fly. It is a costly example of protectionist legislation.

In mid-November, Southwest called for the repeal of the law, reversing its longtime "passionately neutral" stance and igniting a heated local debate.

Read the rest here and lots of Dallas Morning News reports here.

The Wright Amendment offers an excellent test of Texas politicians, including the Bushies: Are they just crony capitalists? Or are they pro-market, pro-growth, and pro-consumer? For the past 25 years, the consistent answer has been "crony capitalists," more interested in protecting DFW Airport and American Airlines than in letting market competition serve the public (including a lot of Dallas businesses). A few politicians, including Rep. Pete Sessions, have come out for repeal. But, astoundingly, Dallas Mayor Laura Miller is defending the federal law that puts her own city at a competitive disadvantage. Or maybe it's not so astounding. It's Texas politics as usual.

Posted by Virginia at 11:57 PM



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