Google Gears and WordPress Crashes


As I have exchanged links with a fair number of bloggers who are using WordPress I thought this might help out some. Earlier this week a problem developed where WordPress would crash while uploading pictures if run in Firefox. There was no problem in Internet Explorer. This began on both my notebook and my home desktop. I tried replicating this on a computer in an exam room which I don’t normally use for blogging and found that Firefox did not crash. After comparing things like version of Firefox I finally found one thing which was different. I had Google Gears enabled on my notebook and home computer, but not on computers at the office which are not used for blogging. I just disabled Google Gears on my notebook  (through the tools menu in Firefox) and the problem seems fixed. I will also check this out on my home computer, but for now I think that Google Gears was responsible for the crashes.

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Now Terrorism Against Topless Coffee Shop


What a sad week. We’ve seen right wing terrorism with the murder of an abortion doctor. We’ve had a case of Islamic terrorism with the murder at an Arkansas army recruiting station. Now an arsonist has burned down the Grand View Topless Coffee Shop in Vassalboro, Maine. The coffee shop had received national media coverage for having coffee served by topless waiters and waitresses.

I hope that they manage to rebuild and get this business back up and running. It might not be an appropriate time for joking about the coffee shop, but I can’t resist a comment from a post I had planned but never completed when the coffee shop previously made the news. I had been hoping for an R-rated  east coast remake of Twin Peaks. Imagine Special Agent Dale Cooper remarking on the “Damn good cup of coffee and damn good…”

Misconceptions On Government Run Health Care and Quality Measurements

Ezra Klein has repeated a misconception which is common in the liberal blogosphere, often based upon a flawed article in The Washington Monthly, that the VA has the best health care around.  The problem is that many who have first hand experience with the VA, either by working in health care or by being patients, are unlikely to be mislead by such faulty statistical analysis and making such claims undermines the credibility of those promoting health care reform.

Based upon real world experience, the VA system is highly mixed. I have seen examples of both excellent care and terrible care. In many ways they are years behind. I have a number of patients who go to the VA to get free medications but also see me because the care is so poor from the VA. For example, while there is general consensus that patients who are at high risk of heart disease should have their LDL Cholesterol lowered to under 70, as this promotes reversal of blockage, I have had the VA refuse to pay for increased medications on patients once their LDL is under 100 (an older goal).  The VA also refuses to pay for newer types of insulin which are far more effective than the older but less expensive types they will pay for.

Measures of quality in health care are very poor,  making comparisons based upon such reports very misleading. They are generally measures not of what is being done but what is being reported. Most doctors in private practice do not have the time to report everything we do with regards to following protocols. The incentive payments for such reporting are typically far less than the administrative costs of reporting the data. Often insurers try to extract data from claims data but the results from this turn out to be highly inaccurate. I’ve often seen reports claim that patients have not had certain tests when the insurance company preparing the report from their claims data has also paid for the test.  Quality reports are also frequently inaccurate because of having incorrect diagnoses for the patients. Frequently they aren’t even evaluating the correct information. As I often read EKG’s at the hospital on all hospitalized patients I am submitting claims on a tremendous number of patients without being involved in thier actual care. Patients who I have had no contact with other than reading an EKG often make up the majority of patients included in reports on me. This is rather meaningless data.

The VA comes out ahead because they have a computer system set up to submit the data and they have employees who follow their instructions on submitting data. This makes their numbers look better, but has little to do with the quality of care. It is purely a measure of how often they report meeting a certain quality goal. To use the example above, often such measurements use the old standard of an LDL under 100. The VA, which follows the old standard but reports all their data through their computer system, comes out better than those of us in private practice who get the LDL in our high risk patients under 70 but do not have the computer sytems to report these results.

Many patients in the VA system report problems similar to the horror stories often told about the British system. Americans are not going to back such government run systems to replace their current coverage. Not only is it inaccurate, but it is counter productive to promote such government-run systems when nobody who is actually involved in health care reform actually advocates such a system.

Joe Biden’s Tie

In my comments on the first part of Inside The Obama White House I noted that it was best to watch in HD. This was primarily because of many of the views of the White House. In the second part there was another benefit. When Joe Biden was interviewed I’m not sure how well his tie would have showed up without HD. Biden’s was wearing a donkey tie–and it was actually one of the better variations on donkey ties I have seen. Doing an internet search of stores selling donkey ties I have not been able to find the one he was wearing.

Both parts of the show will be rebroadcast on Friday night.