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Part 4 of a 4-part series of short posts intended to clear out my bloggestive tract. Hold your nose! Well, I held out for a week. Then I read the comments. Argh! Actually they were fine. Nice comments, all around. Whew. I don't have any big themes to talk about today, but I've got a couple of little ones, let's call 'em bloguettes, that I'll lump together into a medley for today's entree. Bloguette #1: Ruby Sneaks ended accessible Python I was in Barnes today, doing my usual weekend stroll through the tech section. Helps me keep up on the latest trends. And wouldn't you know it, I skipped a few weeks there, and suddenly Ruby and Rails have almost as many books out as Python. I counted eleven Ruby/RoR titles tonight, and thirteen for Python (including one Zope book). And Ruby had a big display section at the end of one of the shelves. Not all the publishers were O'Reilly and Pragmatic Press. I'm pretty sure there were two or three others there, so it's not just a plot by Tim O'Reilly to sell more books. Well, actually that's exactly what it is, but it's based on actual market research that led him to the conclusion that Rails and Ruby are both gathering steam like nobody's business. I like a lot of languages. Really, I do. But I use Ruby. I'm not even sure if I like Ruby. The issue might just be irrelevant to whether I use it. I like OCaml, for instance, but I don't use it. I don't like Java, but I do use it. Liking and using are mostly orthogonal dimensions, and if you like the language you're using even a little bit, you're lucky. That, or you just haven't gotten broad enough exposure to know how miserable you ought to be. I use Ruby because it's been the path of least resistance for most of my programming tasks since about 3 days after I started messing with it, maybe 4 years ago. I don't even really know Ruby all that well. I never bothered to learn it. I did read "Ruby in a Nutshell" cover-to-cover, but it's a short read (and it's a bit out of date now.) Then I read bits of "Programming Ruby", but not all of it. And now I use Ruby for everything I can, any time I have any choice in the matter. I don't even mind that I don't know the language all that well. It has a tiny core that serves me admirably well, and it's easy to look things up when you need to. I do a lot more programming in Python than in Ruby -- Jython in my game server, and Python at work, since that's what everyone there uses for scripting. I have maybe 3x more experience with Python than with Ruby (and 10x more experience with Perl). But Perl and Python both have more unnecessary conceptual overhead, so I find I have to consult the docs more often with both of them. And when all's said and done, Ruby code generally winds up being the most direct and succinct, whether it's mine or someone else's. I have a lot of trouble writing about Ruby, because I find there's nothing to say. It's why I almost never post to the O'Reilly Ruby blog. Ruby seems so self-explanatory to me. It makes it almost boring; you try to focus on Ruby and you wind up talking about some problem domain instead of the language. I think that's the goal of all programming languages, but so far Ruby's one of the few to succeed at it so well. If only it performed better. *Sigh*. Well, its performance is in the same class as Perl/Python/JavaScript/Lua/Bash/etc., so there are still plenty of tasks Ruby's admirably suited for. I think next year Ruby's going to be muscling in on Perl in terms of mindshare, or shelf-share, at B&N. Bloguette #2: Java's Biggest Dog (Indeed) I still do most of my programming in Java -- at least half of it, maybe more. The Java platform continues to make amazing strides. The newest incarnation (JDK 6) has lots of goodies I can't wait to play with. Like Rhino, for instance, and although they appear to have gutted it, it's still awesome. I think it's the best choice they possibly could have made. Thank God they didn't bundle Groovy. What a catastrophe that was, and still is, and would have been for Java if they'd bundled it. Rhino rocks. The JVM is just getting faster and more stable, and there are even some OK libraries that come with it. I used to think the Java platform libraries were the cat's meow. Heck, I thought they were the whole damn cat. But working with better libraries in miscellaneous other languages has got me thinking that Java's libraries are hit-or-miss. Example: Java's concurrency libraries (java.util.concurrent[.*]) are to die for. I mean, if you're stuck with threads. I think in the fullness of time, hand-managed threads will be history, but in the meantime, Java's concurrency libraries are just superb. I recently ported a medium-sized Python program I'd written (about 1200 lines of fairly dense Python code) to Java, because the Python was taking about an hour to run, and I wanted to parallelize the work. I spent about 3 days doing the rewrite: one day on the straight port, a day adding in the threading, and a day fine-tuning it. The straight port wound up as 1300 lines of Java (surprising that it wasn't bigger, but maybe I code in Python with a Java accent?), and ran about 50% faster, down to about 30 minutes. After adding in the threading and state machine, the program ran in 50 to 60 seconds. So I got an order of magnitude improvement with only about a 50% increase overall in program size. The vast majority of the improvement was attributable to the threading, which in turn would have taken me FAR longer if I'd been using raw synchronization primitives. The java.util.concurrent stuff made it a snap. On the other hand, Java's DOM implementation completely blows chunks. It quickly became the bottleneck in my application, due to an O(n) algorithm I stumbled across with no good workaround for. I can't remember exactly where it was (this was back in July), but I found a sheepishly apologetic comment from the author in the online docs. It was something to do with setting attributes on nodes while you're doing a traversal of some sort: something you'd definitely want to be fast, but it had at least linear performance, maybe worse, and now accounts for 95+% of my app's processing time. And of course Java's DOM interface blows too, because you can't create subclasses or decorators or do anything useful with the DOM other than use it as a temp container until you've transfered the data to something more flexible. Java's collections library is decent, but not superb. It's nice having the data structures they provide, but they're not very configurable, and the language itself makes them often cumbersome. For instance, you can have a WeakHashMap (nice), or an IdentityHashMap (nice), or a ConcurrentHashMap (also nice), but you can't combine any two of those three properties into a single hashtable. Lame. And java.util is missing implementations and/or interfaces for a bunch of important data types like priority queues (you're stuck using a TreeSet, which is overkill), the disjoint set ADT, splay trees, bloom filters, multi-maps, and of course any kind of built-in graph support. Java hyper-enthusiasts will tell you: "well, go write your own! Or use one of the many hopefully robust implementations on the web!" That seems lame to me. We're talking about data structures here: they're more fundamental than, say, LDAP libraries and much of the other stuff Sun's bundling these days. It's smartest to provide robust, tuned implementations of these things, because it empowers average Java programmers to write faster, more reliable code. Oh, and let's not even get me started with java.nio. What a mess! It's pretty gross, especially if you come from the comparatively simple background of select() and poll() on Unix. But maybe the grossness was necessary. I'll give them the benefit of the doubt. What bugs me isn't that the API is conceptually weird and complex (and buggy as hell last time I checked); what bugs me is that nobody at Sun bothered to put a layer atop java.nio for ordinary programmers. Like, say, a nonblocking DataInputStream that takes a type to read, a Buffer, and a callback to call when it's finished reading. So every frigging Java programmer on the planet has to write that exact class -- or just flail around with the raw APIs, which is what I think most of them do. And look what they did to poor LDAP! I mean, the LDAP bindings are dirt-simple in every language I've ever used. It's supposed to be lightweight -- that's what the "L" stands for, fer cryin' out loud. JNDI is this huge monster. So is JMX. I mean, Java libraries have this way of being so bloated and overengineered. But whatever; I've digressed. Java's libraries are not its biggest failing. The libraries (as I said) are decent, and the platform (in terms of tools, speed, reliability, documentation, portability, monitoring, etc.) really raises the bar on all those other loser languages out there. All of 'em. It's why no better languages have managed to supplant Java yet. Even if the language and its libraries are (on the whole) better than Java's, they also have to contend with the Java platform, and so far nobody's been able to touch it, unless maybe it's .NET, but who cares about .NET? Certainly not Amazon.com or Yahoo! or Google or any other important companies that I'm aware of. Literals Anyway, Java's biggest failing, I've decided, is its lack of syntax for literal data objects. It's an umbrella failing that accounts for most of the issues I have with the language. The idea behind literals is that you have some sort of serialized notation for your data type, and it's part of the language syntax, so you can embed pre-initialized objects in your code. The most obvious ones are numbers, booleans and strings. It's hard to imagine life without support for numeric literals, isn't it? Well, Java's support is limited at best. There's no syntax for entering a binary value, for instance, like "0b10010100". And there's no BigInteger/BigDecimal syntax, so working with them is a disaster and nobody does it if they can help it. Heck, Java doesn't even have unsigned ints and longs. But Java does more or less the bare minimum for numbers, so people don't notice it much. Imagine if there were no String literals, so that instead of this: String s = "Hello, world!"; you had to do this: StringBuffer sb = new StringBuffer(); sb.append('H'); sb.append('e'); sb.append('l'); sb.append('l'); sb.append('o'); sb.append(','); sb.append(' '); sb.append('W').append('o').append('r').append('l').append('d').append('!'); String s = sb.toString(); Not only is the latter bloated and ugly and error-prone (can you spot the error in mine?), it's also butt-slow. Literals provide the compiler with opportunities for optimization. Well, unfortunately this OOP garbage is exactly what you have to do when you're initializing a hashtable in Java. Nearly all other languages these days have support for hashtable/hashmap literals, something like: my_hashmap = { "key1" : "value1", "key2" : "value2", "key3" : "value3", ... } That's the syntax used by Python and JavaScript, but other languages are similar. The Java equivalent is this: Map<String, String> my_hashmap = new HashMap<String, String>(); my_hashmap.put("key1", "value1"); my_hashmap.put("key2", "value2"); my_hashmap.put("key3", "value3"); ... It might not look that much worse from this simple example, but there are definitely problems. One is optimization; the compiler is unlikely to be able to optimize all these method calls, whereas with a literal syntax, it could potentially save on method call overhead during construction of the table (and maybe other savings as well.) Another is nested data structures. In JavaScript (and Python, Ruby, etc.) you just declare them in a nested fashion, like so: my_thingy = { "key1": { "foo": "bar", "foo2": "bar2"}, "key2": ["this", "is", "a", "literal", "array"], "key3": 37.5, "key4": "Hello, world!", ... } It would be hard to do this particular one in Java 5 because of the mixed value types, though it's probably not an issue since using mixed-type data structures is something you rarely do in practice, even in dynamically-typed languages. But even if all the values were hashes of string-to-string, how are you going to do it in Java without literals? You can't. You're stuck with: Map<String, Map<String, String>> my_hashmap = new HashMap<String, HashMap<String, String>>(); Map<String, String> value = new HashMap<String, String>(); value.put("foo", "bar"); value.put("foo2", "bar2"); my_hashmap.put("key1, value); value.clear(); value.put("foo3", "bar3"); value.put("foo4", "bar4"); my_hashmap.put("key2, value); ... And then you find out later that your clever clear() optimization (instead of creating a new HashMap object for each value) busted it completely. Whee. Java programmers wind up dealing with this kind of thing by writing generic helper functions, and it winds up layering even more OOP overhead onto something that ought to be a simple declaration. It also tends to be brutally slow; e.g. you could write a function called buildHashMap that took an array of {key, value, key, value, ...}, but it adds a huge constant-factor overhead. This is why Java programmers rely on XML so heavily, and it imposes both an impedance mismatch (XML is not Java, so you have to translate back and forth) and a performance penalty. But the story doesn't end there. What about Vector/ArrayList literals? Java has primitive array literals, which is nice as far as it goes: String[] s = new String[]{"fee", "fi", "fo", "fum"}; Unfortunately, Java's primitive arrays are a huge wart; they don't have methods, can't be subclassed, and basically fall entirely outside the supposedly beautiful OOP-land that Java has created. It was for performance, to help capture skeptical C++ programmers, and they have their place. But I don't see why they should have all the syntactic support. I mean, the [] array-indexing operator is ONLY available for Java arrays. Sure would be nice to have it for ArrayLists, wouldn't it? And Strings? And FileInputStreams? But for some reason, Java gave arrays not one, but TWO syntactic sugarings, and then didn't give that sugar to anything else array-like in the language. So for building ArrayLists, LinkedLists, TreeMaps and the like, you're stuck with Swing-style code assemblages. I think of them as Swing-style because I used to do a lot of AWT and Swing programming, back when I was a Thick Client kind of guy, and they have a distinct(ly unpleasant) footprint. It looks vaguely like this, in pseudo-Swing: Panel p = new Panel(new FlowLayout()); JButton b = new JButton("Press me!"); b.setEventListener(somethingOrOther); p.add(b); JSomething foo = new JSomething(blah, blah); foo.setAttribute(); foo.setOtherAttribute(); foo.soGladIDontDoThisKindOfThingAnymore(); p.add(foo); ... Building UIs in Swing is this huge, festering gob of object instantiations and method calls. It's OOP at its absolute worst. So people have come up with minilanguages (like the TableLayout), and declarative XML replacements like Apache Jelly, and other ways to try to ease the pain. I was on a team at Amazon many years ago that was planning to port a big internal Swing application to the web, and we were looking at the various ways to do web programming, which at the time (for Java) were pretty much limited to JSP, WebMacro, and rolling your own Swing-like HTML component library. We experimented with the OOP approach to HTML generation and quickly discarded it as unmaintainable. (Tell that to any OOP fanatic and watch their face contort as they try to reconcile their conflicting ideas about what constitutes good programming practice.) The right solution in this case is, of course, a Lisp dialect; Lisp really shines at this sort of thing. But Lisp isn't so hot at algebraic expressions, and the best Lisp machines no longer look so cutting-edge compared to the JVM, and blah blah blah, so people don't use Lisp. So it goes. The next-best solutions are all about equally bad. You have your XML-language approaches (like Jelly, but for the web), but they don't give you sufficient expressiveness for control flow -- presentation logic really does require code, and it gets ugly in XML in a real hurry. You have your JSP-style templating approaches, and they aren't bad, but they can have as many as 4 or 5 different languages mixed in the same source file, which presents various problems for your tools (both the IDEs and the batch tools). And then you have a long tail of other approaches, none of which manage to be very satisfying, but that's not really the fault of the languages. It's the browsers' fault: they START with three languages (HTML, CSS, and JavaScript), rather than having just one language to control the entire presentation, and it only goes downhill from there. But NONE of the approaches to web templating is as bad as Swing-style programming, with a huge thicket of calls to new(), addChild(), setAttribute(), addListener(), and the like. The only approach that's worse (and even it might just be tied) is raw HTML printing: print("<html><body>...</body></html>"); So we're all in agreement. OOP-style assembly of parents and children is the worst way to generate HTML. You want to use declarations; you want a template , something that visually looks like the end result you're trying to create. Well, it's the exact same situation for data structures, isn't it? You'd rather draw a picture of it (in a sense, that's exactly what you're doing with syntax for literals) than write a bunch of code to assemble it. This is all assuming that you're working with a small data set, of course. But that happens all the time in real-world programs; it's ubiquitous. So you kinda want your language to support it syntactically. And so far we've only covered literal syntax for HashMaps and ArrayLists (which you can combine to produce various kinds of custom Trees.) Already Java's way behind other languages, and we haven't discussed any richer data types. Like, say, objects. JavaScript does it the best here, IMO, in the parity between hashes and objects. It's not really possible in Ruby or Python to declare a class, then create instances of the class using literal notation the way you can in JavaScript, where the keys are the names of instance variables. Fortunately you can accomplish this in either Ruby or Python with just a smidge of metaprogramming, so it's spilt milk at worst. In Java, you only have one big hammer (instantiation), and one big wrench (the method call), so that's what you use. All you can really do to help is create a constructor that takes arguments that populate the instance variables. But if any of your instance variables are collections (other than arrays), then you're back to the old create-setprops-addchild, create-setprops-addchild pattern again. And what about functions? Ruby and JavaScript and Lisp and Scheme and Lua and Haskell and OCaml and most other self-respecting languages have function literals. That is, they have a syntax for declaring an instance of a function as a data object in your code that you can assign to a variable, or pass as a parameter. (Python has them too, but unfortunately they can only be one line, so Python folks prefer to pretend anonymous functions aren't very important. This is one of the 10 or so big problems caused by Python's whitespace policy. Don't ever let 'em tell you it doesn't cause problems. It does. Maybe it's worth the trade-off; that's a personal style preference, but they should at least admit the tradeoff exists.) Well, Java sort of has them, but Java's static type system doesn't have a literal syntax for a method signature. It's pretty easy to imagine one, e.g. something like: (int, int) -> String x; This imaginary syntax declares a variable x that takes 2 ints as parameters and returns a string. Lots of languages have signature-syntax of some sort, and Java's syntax space is definitely sparse enough that they could pick a good syntax for it without fear of collisions, even conceptual collisions. But no such luck. Instead, when you want to do this sort of thing you have to declare a named interface, and then inside of it declare at least one named method (which is where the params and return type show up), and then you're still not done, because when you create the function you have to create an anonymous (or named) class that contains the definition of the function that matches the interface. Yuck. But at least they let you do it; the alternative of not having it at all is definitely worse. Still... isn't syntactic sugar nice? I mean, they added the "smart" for-loop, which Java programmers just rave about. So someone, somewhere in the Java community thinks syntax is good. I'm not sure many of them really understand the difference between syntactic sugar (into which category the "smart" for-loop falls) and orthogonal syntax, in which the basic operators apply to all data types for which those operators make sense, and there are literal declarations possible for every data type. Let alone the next step, which is extensible syntax -- but that idea strikes fear into the hearts of many otherwise brave Java programmers, and Rubyists and Pythonistas as well, so let's back it up a notch to "orthogonal", and keep everyone calm. So there you have it: Java's biggest failing. It's the literals. No literal syntax for array-lists (or linked lists or tree sets), nothing for hashtables, nothing for objects of classes you've personally defined, none for functions or function signatures. Java programmers all around the world spend a *lot* of their time working around the problem, using XML and YAML and JSON and other non-Java data-declaration languages, and writing tons of code (whole frameworks, even) for serializing and deserializing these declarations to and from Java. For the smaller stuff, they just write helper functions, which wind up being bloated, inefficient, error-prone, and extremely unsatisfying. Java's next-biggest failing may well be the lack of orthogonality in its set of operators. We can live without operator overloading, I suppose (the simplest form of extensible syntax), but only if Sun makes operators like [] and + actually work for objects other than arrays and Strings, respectively. Jeez. Epiblogue You can draw your own conclusions about why suddenly there are all these books on Ruby appearing on the bookshelves. It's a mix of truths, no doubt. And you can draw your own conclusions about why Sun's adding support for scripting languages to the JVM, rather than simply fixing Java so that people don't want (need, really) to use those other languages. But when you dig down into a programming language, and you get past all the hype and the hooplah, what you find is a set of policies and decisions that affect your everyday life as a programmer in ways you can't ignore, and that no amount of hype will smooth over. If your language is sitting on you like an invisible elephant, and everyone using the language is struggling to work around the same problems, then it's inevitable that other languages will come into play. Libraries can make you more productive, but they have almost no effect on the scalability of the language. Every language has a complexity ceiling, and it's determined by a whole slew of policy and design decisions within the language, not the libraries. The slew includes the type system (with its attendant hundreds of mini-policies), and the syntax, and it also includes the language's consistency: the ratio of rules to exceptions. Java's demonstrating quite clearly that at a certain level of complexity, the libraries and frameworks start to collapse under their own weight. People are always writing "lightweight" replacements for existing fat Java libraries and frameworks, and then the replacements get replaced, ad infinitum. But have you ever seen anyone write a replacement for XPath? Nope. It's not like everyone is rushing out to write the next big XML-querying framework. This is because XPath is a language , not a library, and it's orders of magnitude more conceptually scalable than the equivalent DOM manipulations. Object-Oriented Programming. Touted even by skeptics as a radical leap forward in productivity, and all OOP really is boils down to a set of organizational techniques. Organization is nice, sure. But it's pretty clear that OOP alone doesn't cut it; it has to be supplemented with Language-Oriented Programming and DSLs. And all languages, DSLs and general-purpose languages alike, have to be designed to maximize consistency; each inconsistency and special-case in the language adds to its conceptual overhead and lowers the complexity ceiling. So you can look at the shelves filling up with Ruby books and chalk it up to marketing hype, but I have a different theory. I think it's entirely due to complexity management: Ruby does a better job of helping managing complexity than its competitors. It doesn't do a perfect job, mind you -- far from it. But it's enough of a step forward in productivity (even over Perl and Python) that it's managing to shoulder its way in to a pretty crowded language space. With that in mind, despite my griping about Java's failings, I think Sun might actually be doing the right thing by introducing scripting languages (and improving support for them in the JVM.) Maybe. Their investment isn't really so much in Java as it is in the JVM; the JVM is their .NET. Java's not really about productivity, not really -- it's got a lot of strengths (performance, deployment, reliability, static checkability, and so on), but productivity isn't high on the list. So maybe the best way to address the productivity issue, for folks who really need it more than raw performance, is to introduce new JVM languages rather than try to pull Java in two directions. We'll see. And with that, I think I've officially un-blocked myself; I seem to be able to blog again. So I'm declaring the Blogger's Block series finished! BloggersBlock block = new BloggersBlock(); block.setFinished(true); block.tieOffAndStuff(); blog.addChild(block); ... cheap oem software buy software

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That’ll Be The Day “All I know is just what I read in the papers.” Will Rodgers,1879-1935 I await the day when The New York Times runs a series of “good news” articles about the state of American health care. The series might have these titles, • Americans Trust Their Doctors • Americans Have Greater and Quicker Access to High Tech Diagnostic and Curative Care Than Any Other Nation • Foreign Physicians Flock to America for Training Unavailable in Their Country • Record Numbers of Canadians Cross Border for Life-Saving Care • America Achieves Unprecedented Longevity Gains in Last Decade • Americans Receive 80 Percent of Noble Prizes in Medicine • Research at American Pharmaceutical Companies Produces 90 Percent of the World’s New Drugs • America’s Innovative Health System’s Variety and Choice the Wonder of The World That’ll be the day. The Times in 2005 and 2006 had a series of a dozen articles entitled “Being A Patient.” These focused largely on the perils of being a patient in America. Now The Times is embarked on a series on medicine and money, focusing on profit-mongering drug and medical device companies in league with greedy specialists to bilk the public. It all comes down to altitude and attitude. From their lofty perch, Th e New York Time’s editorial staff has yet to tumble to the reality America is basically a conservative nation, distrusts centralized government, wants choices of care and providers, demands access to the wonders of high tech medicine, and believes a market-based system, with all its faults, such as profits for entrepreneurial and innovative health care companies and , are worth the price and value received. It is almost as though The Times denies the existence of entrepreneurial capitalism in American health care. Our health system blends innovative large and small firms striving for economic growth. Such a system entails risk – workers who lose jobs and health insurance, widening of gaps between winners and losers, competition with some jobs going to skilled workers abroad who have increasing skills, occasional bankruptcies among those unable to pay health care bills. American capitalism is imperfect. It requires oversight to reduce risks without losing entrepreneurial vigor. Unremitting accusations of bad faith and constant “bad news” stories don’t strengthen health care. Read the The New York Times, and you’ll come away believing pervasive avaricious greed corrupts American health care and will break our already “broken” system. From May 9 through May 11, The Times ran 10 articles on how drug companies deceived the public and entered into unholy alliances with doctors to sell more drugs to produce more revenue for doctors, how doctors willingly entered into these alliances solely for material gain, and how lobbyist-tainted and incompetent FDA failed to monitor new drugs and harmed patient safety. The May 9 front page, right top column, the prime spot for highlighting news, featured these headlines, Doctors Reaping Millions for Use of Anemia Drugs. Payments from Industry. Concerns over Safety – Critics See Incentives for Higher Doses. The opening Section read: “T wo of the world’s largest drug companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses. The payments are legal, but very few people outside of the doctors who receive them are aware of their size. Critics, including prominent cancer and kidney doctors, say the payments give physicians an incentive to prescribe the medicines at levels that might increase patients’ risks of heart attacks or strokes. Industry analysts estimate that such payments — to cancer doctors and the other big users of the drugs, kidney dialysis centers — total hundreds of millions of dollars a year and are an important source of profit for doctors and the centers. The payments have risen over the last several years, as the makers of the drugs, Amgen and Johnson & Johnson, compete for market share and try to expand the overall business.” The Times appears bent on publishing on its front pages “All the Bad News that’s Fit to Print about U.S. Health Care.” The May 9 article is part of a series of medicine and money, all decrying collusive relationships between big business and bad doctors. The Times series focus on the pharmaceutical industry and medical device industries , and how these industries reward specialists who overuse products for financial gain. To The Times, the American health system has become a morality play, • the good guys (The Times and other assorted elites and policy pundits) vs. the bad guys (profiteering health companies and doctors); • the greedy (well-healed executives and “rich” doctors) vs. the needy (poor patients in the throes of cancer or kidney dialysis); • the high brows (academics and journalists who know what’s right for the common good) vs. the low brow commercial types (who do almost everything wrong as long as it suits their own financial self-interest). I don’t wish to pick a fight with a media outlet who buys ink by the barrel. I know “bad news” sells better than “good news.” I know The Times considers itself the Watchdog and Whistle-Blower against mean-spirited, profiteering conservatives. I don’t question our capitalistic system needs oversight to reduce abuses. I’m simply seeking more balance in The Times reporting. For an example of this imbalance, in its May 9 piece, The Times dismisses America doctors’ overuse of anemia-correcting drugs for cancer and dialysis as a deliberate effort to make money. To make its case, The Times notes American doctors, • prescribe more drugs than European counterparts ( Did it ever occur to T he Times maybe, just maybe, European doctors “under-prescribe” and maybe their patients have less positive results? ) • conssciously endanger patients for profit when they know anemia drugs are unsafe (Has it occurred to The Times American physicians prescribing these drugs believe higher hemoglobin levels are “good” for improving health and alleviated distressing symptoms attributable to anemia.) • Continued to prescribe drugs even after studies indicated hemoglobin levels above 12 might endanger patients ( Did it ever occur to The Times the studies indicating “possible” risk studies were far from conclusive and only appeared in March?) Nor does The Times point out doctors themselves often criticize thenselves. For instance, on a May 11 blog, “The Doctors Weighs in on Cancer,” Dr. Dov Michaeli, an academic physician and biochemist who does cancer research takes the American Society of Clinical Oncologists (ASCO) to task for responding to the Times defensively (see epilogue to this blog for a reprint of ASCO letter to The Times). Of the ASCO letter to the times (reprinted in epilogue), Dr. Michaeli acidly comments “ASCO makes that same argument that professional people make when colleagues are caught with their hands in the cookie jar: most of us are conscientious, hardworking people. Granted, but it turns a blind eye to the corrosive influence of pharmaceutical companies on the use of drugs. This is denial of how our health system ‘works’ on a daily basis.” Michaeli concludes: “As the wheels are coming off our broken health system, more revelations of waste, abuse, greed and outright criminality are bound to surface. What are we going to do about it?” Good question. I suggest we start with a more balanced view of the system. • First, I reject the notion the system is “broken” – and constant reference by academic critics of greed by practitioners as a cause for this brokenness ( Michaeli, an academic researcher, shows some of this bias when he says, “ ASCO is led by academic clinicians and researchers, whose motivation and dedication is admirable. But many of the rank and file, community practitioners, are not beyond temptation.” I doubt medical academicians, who compete for pharmaceutical company grants and who run clinical trials, are beyond temptation. I’m unaware academic physicians wear halos and only practicing doctors are vulnerable to “temptation.” • Second, I believe critics ought to acknowledge health care is an innovate force in our economy, will soon represent 20 percent of the nation’s GNP, and is the nation’s largest employer. Professional managers, whose job is to maximize resources and revenues, run most health care enterprises - hospitals, medical practices, drug and device manufacturers. If overzealous pursuit of revenues and resources leads to excess, managers should be condemned, even fined and jailed, but it shouldn’t be assumed or taken for granted pharmaceutical and medical device companies and doctors are always seeking mutually beneficial arrangements are ipso facto evil doers. What the media in general, and The New York Times in particular, needs is a more balanced view. An occasional dollop of good news, such as more than 50 percent of cancer victims are now surviving, more than 10 million cancer victims are living with their disease, and genetically engineered cancer drugs are contributing significantly to cancer cures, would help achieve that balance. I’m pleased to report the May 12 issue of The Times contains a “good news” piece on Becton, Dickinson & Company. It’s buried on the third page of the business section. It’s titled “Medical Gear That Rarely Makes News.” It consists of an interview with Edward J. Ludwig, CEO of Becton and Dickenson, with revenues of $5.7 billion last year, on sales of syringes, diagnostic kits, lab equipment, and related gear. The unifying theme behind the company’s success is its emphasis on safety in its products to protect doctors, nurses, and patients with shields, sliding clasps, and needle retracting into the device. Its ambition is to make a significant dent in the 2 million infections each year from antibiotic resistant staphococci killing 90,000 Americans each year and costing $6 billion yearly to treat. Toward that end, B &D has acquired a diagnostic system allowing them to quickly identify the offending bacteria. Use of this system to screen every patient. entering Evanston Northwestern Hospital reduced infections by 60 percent. Ludwig contend s private innovation will help the “broken” health system to heal itself by attacking safety problems, and improving care. What the media needs is a new more flexible mindset allowing them to become more innovative in reporting the “good news” of our resourceful and responsive health system. Epilogue : In the interest of being “fair and balanced” (a term the mainstream media now considers anathema since Fox News adopted it as their slogan), I reprint six letters from the May 13, Sunday, New York Times. The Times deserves credit for publishing letters representing both points of view. Best Drug, or Best Money Maker? (6 Letters) 1) To the Editor: So two drug companies are paying hundreds of millions of dollars to doctors who prescribe anemia medicines that lack effectiveness and put a patient’s health at risk. This is not a surprise because it reflects our broken health system, a system driven by greed. Although drug companies say their intentions are not to promote the use of more medicine for profit, there will always be the risk that some doctors will prescribe higher doses to gain that extra dollar. As patients, we should work to eliminate the incentives to doctors and to raise patient awareness about them. We deserve the right to know the benefits of a medicine, both for us and for the doctors. Luis Rodriguez Daly City, Calif., May 9, 2007 2) To the Editor: Medical care should be guided only by what is best for patients. But throughout the medical system, rebates and volume discounts are common and can create the perception of improper incentives. Our organization has long advocated evidence-based guidelines, including those we produced in 2002 with the American Society of Hematology on erythropoietin use for chemotherapy-related anemia. With the appropriate use of erythropoietin, many thousands of patients have avoided potentially dangerous blood transfusions. Oncologists care deeply about their patients, and the overwhelming majority treat them based on the best available evidence. In the case of erythropoietin, recent studies prompted the Food and Drug Administration to issue a “black box” warning in March about the potential dangers of using erythropoietin to boost hemoglobin to levels higher than guidelines recommend. Early evidence suggests that doctors factored this new data into their prescribing decisions and have reduced erythropoietin use. As a whole, the medical community needs to better determine the impact financial incentives may have on prescribing patterns and patient care, to ensure that patient needs continue to be at the forefront of medical decisions. Allen S. Lichter, M.D. Exec. V.P., American Society of Clinical Oncology Alexandria, Va., May 10, 2007 3) To the Editor: Many doctors appear dissatisfied with fees ethically garnered from clinical evaluation and management. They can and will prescribe for personal profit, and will readily reshape and expand diseases to suit the available reimbursement. Without disclosure, patients are typically the last to know there might be a problem. The investigation of anemia drugs no doubt could expose the self-serving logic, unethical inducements and poor administrative surveillance that permit exploitation of the public’s soft financial underbelly. Unfortunately, there are plenty of other specialties of medicine where such professional betrayals occur. And adequate regulation is not likely to occur in the financial free-for-all of private medicine. James H. Lampman, M.D. Bismarck, N.D., May 9, 2007 4) To the Editor: The discovery and development of growth factors that stimulate the bone marrow to produce red cells was a milestone in modern medicine. In the appropriate setting, these growth factors can improve blood counts and quality of life and spare patients time-consuming, expensive, short-lasting and risky transfusions. In our practice the increasing use of these medicines is driven by the fact that they work so well. As with any new therapy, these medicines need to be used within established and developing guidelines to avoid serious side effects. Since there are two competing and equally effective drugs, the drug makers are offering incentives for preferential use — the natural outcome of a free-market economy. Deciding how regulators might control drug makers is an important undertaking, but it should not detract from the tremendous benefits of these drugs when used in the right situation. Birjis Akhund, M.D. Chief of Medical Oncology Huntington Hospital Huntington, N.Y., May 9, 2007 5) To the Editor: America has the best medical care in the world. It is the most advanced and expensive. The first two qualifications are debatable, but the third is difficult to refute. The great expense is complicated by the high cost of drugs and procedures of dubious benefit. The likelihood of being prescribed drugs of dubious benefit is obviously increased by kickbacks to doctors. The kickbacks may be legal, but should they really be allowed? The cost of medicine is increased by this practice, and the quality is sure to suffer. Alex Floyd Lexington, Ky., May 9, 2007 6) To the Editor: “Doctors Reaping Millions for Use of Anemia Drugs” (front page, May 9) was disturbing. I found it equally disturbing that the continuation of the article was in Business Day. In the past two decades, I have observed that news of important medical advances increasingly appears in, or is continued in, the business section. This practice advances the thinking that health care is primarily a business in which providers reap riches, rather than a humane social endeavor in which providers earn their living. Ira D. Feirstein, M.D. New York, May 9, 2007

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The daily workout A lot of people have been asking me what I have been doing to lose so much weight. I thought I would post it here since I can’t think of a better way to explain it. About six months ago I decided I was going to loose the overweight programmer look and attempt to get back in shape. I started working out by running on a treadmill each day for about an hour. After two months of consistent working out I had nothing to show for it. I had lost no weight, I was not any smaller, and I was getting sick and tired of working out. At a family gathering, my brother-in-law gave me what I now call “The Man Diet”. I call it that because Men do not want to read long books about what you can and can’t eat. Men don’t want complicated diet programs that require you to measure points. Men want a very simple set of rules to follow and he gave me only three. 1. Don’t eat anything that starts with the letter “C” (except Fruit, Veggies, and Meat) 2. Don’t eat anything white (except Fruit, Veggies, and Meat) 3. Only drink water Don’t ask a lot of questions, just follow the simple rules. At the same time I got this advice, Brady Anderson (from the iFolder team) mentioned that he measured his heart rate using a monitor like those made by Polar. I purchased a Polar F11. On November 8th, 2005 I started on my new “Man Diet” and my Polar exercise program. I work out six times a week and my exercises vary in length and difficulty each day. I’m not going to attempt to explain heart rate zones here, visit Polar or some other fitness site on the web and read up on it. Basically I have four 45 minute workouts in the 60-80% zone, one 35 minute workout in the 80-90% zone, and one hour and 10 minute workout in the 60-70% zone. My exercises consist of riding a stationary bike (in photo), running on a treadmill, running outside, swimming laps, and using an elliptical machine. Each session consists of only one of those activities and I do it solid for the duration of the exercise. The Polar monitor lets me know if I am going too hard or not hard enough. The surprising thing about starting to monitor my heart is I was actually working too hard previously. I had to slow down and get my heart rate into the correct zones. I have been following “The Man Diet” and working out as I described since November 8th and as of January 8th 2006, I have lost 35 lbs. The new pants I purchases last week are three sizes smaller than when I started. I hope that story helps anyone else that is attempting to do the same. I was as shocked as anyone when the lbs started coming off. I feel better and younger than I have in many years.

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The Ganga was definitely beautiful at that particular point. It had just emerged from the Himalayas, and had not yet had the chance to receive the assaults of humans bordering it and, ironically enough, venerating it. It was still transparant and playing music on stones. I on the other hand was dense with baggage. Small baggage, like the insignificant green cloth bag that had generic travellers objects like sunglasses and a notebook. I also had big baggage accumulated over 23 years of cognitive abilities (starting from my first memory at about the age of 3). That baggage included generic human emotions like disappointments, failed loves and faded dreams. It also included evolutionary baggage like constant alertness to the existence of potential threat to my survival, and yes, to my possessions. It didn't matter that the sunglasses cost 60 dollars anf the notebook less a dollar. They were just posessions, period. Somebody had to come and grab them if I were swallowed and slowed down by those waters. It also didn't matter that the water was clear like a newborn's consciousness (well, the water was a newborn anyway), it still had to have bacteria that would attack my body and affect my genes' chances at replication. The waters didn't care, they looked and smiled in indifference, bathed in bliss and certitude. The German tree-hugger didn't care either 'Tont woghy, chump! I've bean swimmeaning heaghe fogh ze past fifteen yeaghs, it's so Shanti' (translation: Don't worry, jump. I've been swimming here for the past 15 years, it's very Shanti). Her Baba, aka husband, comes, indifferent to how the years have sculpted his happy happy body, or how they have greyed his happy long hair. He also seemeed indifferent to baggage. ' Don't think, JUMP'. I jumped. It was 'Enchanting'. Is it a coincidence that the word 'Enchanting' has the sound 'S hanti ' in it? 'Shanti', the Sanskrit word for 'Peace', is much more significant than its western equivalents. Shanti is peace with heart notes of emancipation and base notes of ultimate happiness. Shanti is repeated three times after Om in the ultimate prayer. Whatever it meant, that plunge in the Ganga was en-Shanti-ng. Rishikesh my love, all that paradisiac beauty that surrounded me brought me to one of the things I've always seeked: my ultimate union with what surrounds me. It was a very rare moment. After the plunge, I talked to the German tree hugger and her Baba on the beautiful stones she collects: zee hawf beautivul zese ztone calughs aghe? (translation: see how beautiful these stone colors are?). We also gave Reiki healing to a helpless sick man who was refused out of hospital because he was poor (in one of the pillar cities of spirituality!). It was also Shanti. It was the first time I offered my imaginary powers to someone, not knowing whether I'm healing them or healing myself. I went back to the hotel room, the one where the mattress had bed bugs that formed neat lines of blood on my flesh. That chapter from 'Radical Healing' on detox was boring. In an unusual act I skipped it and moved to the next one. Chapter 8: Eneregy and Movement started with something like 'the main problem of the contemporary man is that he has lost his connection to Spanda , the inner flame of spontaneity. This is why modern man is so depressed'. That was the meaning. I'm not sure if those were the exact words. I still remember Spanda, modern man, spontaneity and depression, and retain that there is an intimate connection between them. I wish I hadn't given this book away to a fellow traveller who was just looking for any book to read. With my very non-spontaneous present, I think this is the right time to read 'Radical Healing', or jump in the clear Ganga, or contemplate the simplicity of tree huggers and the beauty of Rishikesh again. cheap oem software buy software

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The New York Times Magazine has a good article about autopsies. The rate of autopsies has declined markedly in the last 40 years, partly due to economic pressures: Hospitals say the problem is money. An autopsy can cost from $2,000 to $4,000, and insurance won't cover it. Most patient families blanch if asked to pay for it, and many can't afford to after paying medical and funeral bills. So the hospital gets the tab. For most of the postwar period up to 1970, hospitals generally paid it, essentially because they had to: the Joint Commission on Accreditation of Healthcare Organizations required hospitals to maintain autopsy rates of at least 20 percent (25 percent for teaching hospitals), which, then and now, is the rate most advocates say is the minimum for monitoring diagnostic and hospital error. The commission eliminated that requirement in 1970. Lundberg says that this happened because hospitals, which had already allowed the rate to drop to close to 20 percent since its 1950's high of about 50 percent, wanted to let it drop further and pressured the commission. The commission's current president, Dr. Dennis S. O'Leary, says it eliminated the standard because too many hospitals were doing poor autopsies -- and often only the cheapest, simplest ones -- just to make the quota. In any event, few hospitals have paid for autopsies since then. Money is too scarce, they say, the needs of living patients too great. Improvements in medical technology have not eliminated the need for autopsies: Perhaps the most troubling reason for the decline of the autopsy is the overconfidence that doctors -- and patients -- have in M.R.I.'s and other high-tech diagnostic technologies. Bill Pellan of the Pinellas County medical examiner's office says: ''We get this all the time. The doctor will get our report and call and say: 'But there can't be a lacerated aorta. We did a whole set of scans.' We have to remind him we held the heart in our hands.'' In fact, advanced diagnostic tools do miss critical problems and actually produce more false-negative diagnoses than older methods, probably because doctors accept results too readily. One study of diagnostic errors made from 1959 to 1989 (the period that brought us CAT scans, M.R.I.'s and many other high-tech diagnostics) found that while false-positive diagnoses remained about 10 percent during that time, false-negative diagnoses -- that is, when a condition is erroneously ruled out -- rose from 24 percent to 34 percent. Another study found that errors occur at the same rate regardless of whether sophisticated diagnostic tools are used. Yet doctors routinely dismiss possible diagnoses because high-tech tools show negative results. One of my own family doctors told me that he rarely asks for an autopsy because ''with M.R.I.'s and CAT scans and everything else, we usually know why they died.'' The bottom-line is that autopsies, though useful for quality control and for the detection of emerging pathogens, will not make a comeback unless 1) Medicare directly pays for each autopsy done or 2) the Joint Commission or Medicare requires a certain autopsy rate for hospitals.

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up Bob Botch? Dressing? Pumpkin pie? Do you voracity ration of these to celebrate Thanksgiving? Within Malden, the specification is a resounding NO. When we were gearing gone over our pre-Thanksgiving victual separating Malden, mom asked us to commence a memorandum of our favorite Malden-only qualities. So this's stone what we did. The head? A delicious plate of Malden goodness! Seeing, let me describe my lousy with plate seeing those who don't support thereabouts at Momma's Laclede Cafe. Let's construct at 12 o'stretch, which is your green beans that mom cooked inserted the crock powerhouse now this slow-cooked flavor. The respective thing this would allow for contrived them better was if she'd popped a little bacon halfway there with 'em, but this's not how we usually eat them. Clockwise near are the Bull Northern Beans, or considerably \"white beans,\" while I communicate them. They are good with an onion, which was forward the helping. Thereupon was the main sequence, MACKERELS! Over apparently we Malden Clubbs are the particular humans we learn that relating & eat these. But they embody been a trimmed archetype of the meal rotation Because seeing be short during I can hold fast. Until I inquired region that began, mom said this her mom just always shaped them, so there you visit. They are really fried canned fish patties. (Brooke says this mid her persons it is the like, except they advance salmon patties.) I infatuation them more it is what I requested being the meal. Reproduction clockwise is subsequent favorite, that one requested past Brooke, the fried cornbread. I prayer it \"Cornbread onward Primacy of the Stove.\" Mmmmm MMMM is it good. Additionally, it is good with some onion. Plus white beans. Which, amid you can have a look at, I had BOTH of onward my plate. I was inserted flavor release. The later ingredient was Eva's recourse, Mac & Cheese. That is her favorite thing to eat furthermore Grandma's fans. Likewise finally, fried potatoes. This was nothing this Brooke more I both wanted. Positively tween in fact, it was GOOD EATS. Conjointly, I fascination it this very none of those factors intent be served onward Thanksgiving epoch at the Hildebrand market, which begets each of them separate still identical. No dueling turkeys now that society! We'll raise our mackerels through in fact over our failing, thank you! Agilely, except now Eli. He had Gerber's Vegetable Wreck Dinner. I concept he's the traditionalist of the mortals. cheap oem software buy software

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I've prerequisite infiltrate intervening from the garden, hole I was sitting interpolated an arbour hung with scented roses since night fell. As it got as well dark to pore over, I began to period the sounds I could spot - birds settling a wrap over the night, the muffled roar of a colorful motorbike, the hold over standard separating the Heathrow group, a blackbird (the single personage midway the garden not separating its reside) invitation to his mate to slab a titbit. The creations began to burst in out centrally located the unclouded patches of sky. The personality jumped off my lap to result his night's hunting - era to break in medially. I was proselytism Hugh Fearlessly Eats it Quite , done with Hugh Fearnley-Whittingstall. I'm possible the first chapter, a rant against the voluminous and vested recreates of the food transaction. Some of it is funny, but all over it's a little tiring to improve mind seeing of the strident tone. I was beginning to pick up casually fed finished with it, thanks to skipping to the formerly chapter, over I came crosswise a rant against the Atkins Diet. It by with Hugh's slimming diet. It's funny, it's healthy, likewise it's good remedy. Here it is bounded by full: Hugh's anti-Atkins diet That is altogether a diet being proposition still health, not load dud, but serious fatties ravenousness probably feast the kilos take effect off. Past rights I should earn a lot through that, when it is guaranteed to preserve you well-nourished too apparel seeing the rest of your being. But here it is, gratis, from the goodness of my unforeseen, healthy soul: Through breakfast Eat a knot of fresh fruit. Anon, if you're including genuinely hungry, recognize a venture of toast. Mid-morning snack Eat to boot fruit. Then, if you're likewise quite hungry, recognize twin organ of toast. Lunch Eat a agglomeration of veg. Raw if possible. If you're furthermore hungry, hold a sandwich (but not two), or a interests of chicken, or a piece of cheese (but not both). Eat with mortgage or water, not Coca Cola or Fanta. Mid-afternoon Contain succeeding piece of fruit. If it's a bad quarter, retrospect a biscuit too. Supper Eat whatever the hell you trim. If you're in fact essaying to lose freight, eat whatever the hell you plane, but not still lots of it. It's really good sustenance, abnormally during added to the heart-healthy regale around not additionally much saturated grievous - reach realizable cheese, butter, meat, conjointly, above precisely, processed food.

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What a tiring era, next my investigation at Asian Shanty considering my Immunologist I take in to ball game to my OB's inquiry so I could exhibition her the mount of my blood tests too some instructions from my Immunologist. Haay! Pero I was able to elicit seeing the first age, my baby's sentiment dismayed! But I was so tired, I maintain little stunt, well I render is this I can realize the little someone too the beating inside. I de facto be read this this baby is a fighter, hehehe, the baby is already note payoff due to the heartbeat. I experience to take duphaston plus all along ticks 16, I cupidity hope a steroid thanks to my immune line, likewise the aspilet considering my blood clotting. Haay! Baby ko talaga, express na agad. So sabi ng Ob be ready in that additionally expenses, no headache my baby, Daddy yearning bitch en masse that. hehehe. Nice put away intact amid my womb. cheap oem software buy software

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The Waitemata Health division is paying due to women with pregnancies advanced to 18 - 21 weeks to go to Sydney thanks to abortions. NZ augments together with frequently doctors are refusing to forge these abortions but the Health staff is legally bound to encourage them. The affair this springs into my wit is, why do these women leave it so extensive? There cupidity be cases of fetal abnormalities specific detectable at a later age along with the declaration to abort must be heartbreaking. But I regale it hard to count on this additionals didn't know midst 4 or 5 months, although over you become able the occasional definition everywhere a woman getting required to the birth unaware of the pregnancy maybe it's along with potential than I image. Anon there is the bigger business of whether tax-payers, which is the argument here, should contain to fount abortions at quite.... buy software cheap oem software

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