Archive for November, 2013

Before I was a programmer, I was a software trainer for Manpower in Chicago.  In fact, I started teaching myself programming to pass the time during long stretches when the trainees were busy working away on their tutorials.  I was stuck at a desk with a PC, reading books or magazines in front of the paying customers was a no-no, so why not make use of the time?

The training consisted of step-by-step instructions that walked the trainee through the basics of working with, say, Microsoft Word or Excel.  I soon noticed that the trainees fell into one of two categories:  those who viewed the instructions as gospel that must be followed to the letter, and those who viewed the instructions as a means for learning the software.  I thought of them as process-oriented vs. goal-oriented.

The process-oriented people would drive me a little nuts sometimes.  We’d have conversations something like this:

“Excuse me, I did something wrong here.  The next step shows that I should have a table with six columns, but mine only has five.  Should I start over?”

“No, you’ve already typed all that data into the table and I’m sure you don’t want to type it again.  Do you understand how to create a table?”

“Yes, I think so.”

“Then just move on.”

“But the picture in the sample shows a table with six columns.”

“That’s okay.  You probably just typed the wrong number of columns in the dialog box when you created it.  If you understand how to make a table, you can move on.”

“But mine doesn’t look like the instructions say it should.  Can I do this exercise again?”

“If you really want to, sure, go ahead.”

These people had learned what they needed to learn.  But they hadn’t followed the process to the letter and seemed to think they’d get a black mark on their permanent records if they didn’t go back and successfully complete every instruction.

By contrast, the goal-oriented trainees usually skipped past some of the instructions once they knew they’d grasped the concept.  They understood that the point of the training was to learn the software, not to be a slave to training process.

I witnessed a laughable example of the follow-the-instructions mentality when I was working as a contract programmer at Disney.  This was 1999, and most of us were busy rewriting database systems to make sure they were Y2K compliant.  We had regular meetings to ensure that we met conversion deadlines set by upper management, and some dim-bulb administrative assistant was put in charge of running the meetings and writing progress reports.

At one of those meetings, she announced that we were supposed to certify seven systems that day.   I had created one of those systems using Access 2000, which was Y2K compliant.  I demonstrated the system’s functions, showed that it would handle four-year dates, and figured that was that.  My boss (who unfortunately wasn’t also the dim bulb’s boss) nodded his approval.

Then the dim bulb explained that her Y2K process manual said we should have a document from Microsoft stating that Access 2000 is Y2K compliant.  I told her I’d already gone online and checked Microsoft’s technical specs, which stated specifically that Access 2000 is Y2K compliant.

“But we’re supposed to have a document.”

At that point, my boss jumped in.

“Tom just demonstrated that it’s Y2K compliant, and Microsoft has stated that it’s Y2K compliant.  It’s Access 2000.  They wouldn’t release software called Access 2000 that can’t handle dates starting in the year 2000.  Let’s move on.”

“But we don’t have a compliance document from Microsoft.  The manual says we should have a compliance document for the files.”

My boss sighed.

“Okay then, Tom will find out how to get a compliance document.  Let’s move on and certify the other systems.”

“We can’t do that.  We’ll have to reschedule.”

“Reschedule?  Why would we reschedule?  Everyone’s here and we have the meeting room for another hour.”

The dim bulb referred to her printed meeting agenda.

“It says here we’re going to certify the following seven systems at this meeting.  But we can’t, because we don’t have the document for Tom’s system.”

“Yes,” my boss said slowly, as if speaking to a toddler.  “So let’s certify the other six and we’ll come back to Tom’s system next time.”

The dim bulb checked her agenda again.

“But it says here we’re going to certify these seven systems.  We can’t certify one of them today, so we’ll have to cancel this meeting and reschedule when we’re ready to certify all seven of them.”

For a minute, I’d thought I’d actually see my boss (a very affable man) blow a gasket.  Instead, he pointed to her printed agenda and spoke through gritted teeth.

“Well, you see, what you have in front of you there is just some ink on a piece of paper. The goal here is to get systems certified.  There’s no reason we can’t certify the other six systems on the list and then come back to Tom’s system next time.”

“But it says here we’re supposed to certify seven systems today.”

“There are seven systems on the list because that’s how many we thought we could demonstrate in the time allotted for this meeting.  These systems have nothing to do with each other.  They just happen to be on today’s list.  So let’s certify the other six.”

The dim bulb looked confused for a moment, then sought clarification in her printed agenda.

“No, it says here we’re supposed to certify seven systems.  We can’t do that today.  We’ll have to reschedule.”

So the meeting ended with eight of us rolling our eyes and the dim-bulb satisfied she hadn’t violated the dictates of some ink on a piece of paper.

It took me about 10 minutes to find and download the document the dim bulb needed.  I forwarded it to my boss and told him I would have found it sooner, but Chareva had called me from the grocery store.  She’d gone there with a list of 12 items to purchase but discovered the store was out of one of them.  So she had no choice but to put the other 11 items back on the shelves and reschedule the shopping trip.  My boss liked that one.

So what does all this have to do with health and nutrition?

Well, I thought about the slave-to-instructions mentality when several readers sent me a link to an article about a mom in Canada who (eek!) violated government nutrition guidelines:

A Manitoba mom was slapped with a $10 fine because the lunches she packed for her kids’ lunches didn’t have any Ritz crackers.

Kristen Bartkiw sent her children Natalie and Logan to daycare with lunches of leftover roast beef, potatoes, carrots, milk, and oranges.

That sounds like a pretty decent lunch for a kid.  What could possibly be the problem?

The daycare providers evidently didn’t think the wholesome lunch fit the nutritional bill because Bartkiw was subsequently charged for the Ritz crackers that the lunches had to be ‘supplemented’ with.

According to Metro News, Manitoba laws require that daycares provide children with a nutritious meal as prescribed by the Canadian Food Guide.  That means one milk, one meat, one grain, two fruits.

Oh, dear.  Mrs. Bartkiw didn’t include a grain product in those lunches.  The Canadian Food Guide says each lunch must include a grain product, so by gosh, the rule-followers had to jump and give those kids a Ritz — because we must always obey the process, and because everything (including stupidity) sits better on a Ritz.

Let’s look at the ingredients for Ritz crackers:

Oh, yes, definitely … those are the ingredients that turn a nutritionally deficient meal into a nutrition powerhouse.

This is what I mean by confusing the goal with the process.  The goal is for kids to be healthy.  Anyone with a brain should recognize that there’s nothing about the meal Mrs. Bartkiw packed – beef, vegetables, fruit and a potato – that’s going to harm her children’s health.  And anyone with a brain should recognize that adding Ritz crackers to that meal isn’t going to make her kids any healthier.

That’s why I want governments to get out of the nutrition-advice business.  The “advice” becomes a set of rules, and then the rules must be followed.  Everyone involved becomes a slave to the process.  The original goal that the process was intended to support – helping people become healthier – ends up having nothing to do with any of it.

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Dr. Malcolm Kendrick plugged his data into that new risk calculator developed by the American Heart Association and the American College of Cardiologists and discovered that he’s overdue to begin statin therapy.  As he reported on his blog:

I now find that I should have started statins eight weeks ago. Naughty, naughty, me. My blood pressure was a bit higher than the calculator liked 138/82, my cholesterol quite a bit higher at 6.0mmol/l.

Which means that I have already passed the 7.5% ten year risk score. O….M…..G. (I think my picture makes me look a bit younger than I am, although it was only taken last year – honest.)

What to do?  I am now well beyond my ‘Statin by date.’ No longer can I be healthy without taking a statin.

Can I be reassured that my parents are both alive and healthy in their late eighties? My grandmother, on my mother’s side, lived to one hundred and two.

You can read the rest here, and I suggest you do if you enjoy a good laugh.

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I was already impressed by Dr. Doug McGuff, but now I’m even more so.

Dr. McGuff’s book Body by Science (co-written with trainer John Little) is one of the best I’ve read on exercise and fitness.  It’s a how-to guide for high-intensity resistance training, but also a nice primer on the science of how your muscles work, adapt and grow.

When you read this book, you’ll learn about the different types of muscle fibers and how they’re recruited during exertion.  You’ll learn why there’s really no such thing as “cardiovascular fitness.”  (All fitness comes down to muscular fitness.  Your vascular system doesn’t become “fit.”)  You’ll understand why you will never – no matter how hard you work – develop eye-popping muscles like a body-builder or professional athlete unless you’ve been blessed with an unusual ratio of fast-twitch vs. slow-twitch muscle fibers.  That’s the bad news.  The good news is that you’ll also learn how to become as fit and as strong as you can be by lifting weights correctly during brief but intense workouts.

I’ve also seen Dr. McGuff give a couple of speeches on diet, exercise and health that I thought were excellent.  The man knows his stuff on those topics.  I expected that.

I didn’t expect him to be equally impressive speaking about economics, but he is.  (Any doctor who can talk intelligently about Milton Friedman’s spending quadrant is cool in my book.)  After last week’s debate in the comments about insurance and ObamaCare, a reader sent me a link to this speech Dr. McGuff gave in 2012 titled Fitness, Health and Liberty.   It’s more than an hour long, but worth the watch if you want to understand the economics of how and why our medical system got so screwed up in the first place.  (Hint:  products and services rarely become prohibitively expensive as a result of too much freedom.)

As an emergency-room physician, Dr. McGuff has seen what happens when people wind up in the medical system,  which he calls “the belly of the beast.”  I’d suggest paying close attention to the end of the speech, when he offers advice on how to avoid winding up in an emergency room in the first place.

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Dear American Heart Association and American College of Cardiology:

I’m writing to thank you for issuing your new expanded guidelines on prescribing statins.  I must admit, I was hopping mad when I first read about them.  I mean seriously, we’re talking about a drug with lots of nasty side-effects that prevents maybe one heart attack (not necessarily one death) for every 100 people who take it – and that’s only for men who already have heart disease.   So you can understand my anger when I read paragraphs like these in an online article by New York Post:

The nation’s first new guidelines in a decade for preventing heart attacks and strokes call for twice as many Americans — one-third of all adults — to consider taking cholesterol-lowering statin drugs.

The guidelines, issued Tuesday by the American Heart Association and American College of Cardiology, are a big change. They offer doctors a new formula for estimating a patient’s risk that includes many factors besides a high cholesterol level, the main focus now. The formula includes age, gender, race and factors such as whether someone smokes.

“The emphasis is to try to treat more appropriately,” said Dr. Neil Stone, the Northwestern University doctor who headed the cholesterol guideline panel. “We’re going to give statins to those who are the most likely to benefit.”

Well heck, you guys, I knew even before I continued reading that “treat more appropriately” would somehow translate to “give statins to even more people.”  And you didn’t disappoint me:

Doctors say the new approach will limit how many people with low heart risks are put on statins simply because of a cholesterol number. Yet under the new advice, 33 million Americans — 44 percent of men and 22 percent of women — would meet the threshold to consider taking a statin. Under the current guidelines, statins are recommended for only about 15 percent of adults.

Only about 15 percent of adults may not sound like much, but as you and I both know, that’s only because adults includes people in their twenties and thirties.  One-fourth of American adults over the age of 45 are already taking statins, and since I read elsewhere that the new guidelines could double the number of statin-takers, I figure that means your long-term goal is to sell statins to at least half of the over-45 population.  We all know why:

Roughly half the cholesterol panel members have financial ties to makers of heart drugs, but panel leaders said no one with industry connections could vote on the recommendations.

“It is practically impossible to find a large group of outside experts in the field who have no relationships to industry,” said Dr. George Mensah of the heart institute. He called the guidelines “a very important step forward” based on solid evidence, and said the public should trust them.

Riiiiiight, we should all trust the panel of experts who have financial ties to statin-makers.  I’ll rank that one right up there with “Read my lips – no new taxes!” and “If you like your current healthcare plan, you can keep it – period!”  If any of you members of the panel ever decide to give up medicine, you should seriously consider running for office.

Anyway, as if I weren’t already suspicious enough of the new guidelines, I read these tidbits in a New York Times article online:

Last week, the nation’s leading heart organizations released a sweeping new set of guidelines for lowering cholesterol, along with an online calculator meant to help doctors assess risks and treatment options. But, in a major embarrassment to the health groups, the calculator appears to greatly overestimate risk, so much so that it could mistakenly suggest that millions more people are candidates for statin drugs.

Mistakenly suggest? Heh-heh-heh … as we programmers like to say, “That’s not a bug.  That’s a feature.”

The problems were identified by two Harvard Medical School professors whose findings will be published Tuesday in a commentary in The Lancet, a major medical journal. The professors, Dr. Paul M. Ridker and Dr. Nancy Cook, had pointed out the problems a year earlier when the National Institutes of Health’s National Heart, Lung, and Blood Institute, which originally was developing the guidelines, sent a draft to each professor independently to review.

This week, after they saw the guidelines and the calculator, Dr. Ridker and Dr. Cook evaluated it using three large studies that involved thousands of people and continued for at least a decade. They knew the subjects’ characteristics at the start — their ages, whether they smoked, their cholesterol levels, their blood pressures. Then they asked how many had heart attacks or strokes in the next 10 years and how many would the risk calculator predict.  The answer was that the calculator overpredicted risk by 75 to 150 percent, depending on the population.

On Saturday night, members of the association and the college of cardiology held a hastily called closed-door meeting with Dr. Ridker, who directs the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital in Boston. He showed them his data and pointed out the problem. On Sunday, officials from the organizations struggled with how to respond.

Here’s how I’d suggest you respond:

“What we said was that if you like your insurance, you can keep your insurance, period, as long as it meets certain conditions we’ll write into the law later.  And besides, it wasn’t the law we passed that canceled your insurance; it was your insurance company.  And we actually did you a favor by passing a law that canceled your insurance because your insurance was substandard.  But even though it wasn’t the law we passed that canceled your lousy insurance and we actually did you a favor by canceling your lousy insurance, we’re now going to fix the law we passed that didn’t cancel your lousy insurance so you can keep your lousy insurance for another year.”

Wait … sorry.  That was my advice to someone else who got caught lying.  In your case, I’d suggest going with something like “Dr. Ridker’s study subjects didn’t have nearly as many heart attacks as our risk calculator predicted because he accidentally studied unusually healthy people.”

The chairmen of the guidelines panel said they believed the three populations Dr. Ridker and Dr. Cook examined were unusually healthy and so their heart attack and stroke rates might be lower than expected.

Good work.

Anyway, the New York Times article goes on to explain that under the new guidelines, “your average healthy Joe” would end up being told to take statins.  And that’s why, in spite of my initial anger over your brazen attempt to sell more statins, I’m now writing to thank you.

What prompted my change of heart (pun intended) was receiving an email from someone who liked one of my old blog posts – the one in which I thanked the USDA for giving my kids a competitive advantage in life by ordering schools to serve crappy grain-based meals to the other kids and thus suppress their brain development.  That in turn got me thinking about the movie Idiocracy, in which a soldier with an average IQ participates in a botched experiment and wakes up hundreds of years later to discover that he’s now the smartest guy on the planet.

That’s when I realized how much your new guidelines will benefit me personally.  You see, as a software programmer, I’m what’s known as a “knowledge worker.”   My livelihood depends entirely on my ability to memorize, conceptualize, and think my way through complex problems.  In my field, experience is considered a major asset, largely because solving a software problem often involves recalling how we solved a similar problem in the past.  It’s no coincidence that most of the other programmers I work with are in their 40s or 50s.

So as I was chuckling to myself about a couple of the scenes in Idiocracy, it occurred to me:  How much more valuable would I be if my fellow programmers all started taking statins and became a bit stupid?  Give them a few years on a high dose of Lipitor, and I daresay I could triple my billing rate.  I’d be the only one remaining with enough cognitive ability to tackle the really tough assignments.

I could probably even get away with relaxing my programming standards.  Since I’m not a government contractor, I test and test and test the software I design before rolling it out – partly because I’m persnickety by nature, but largely because in private industries, people who launch mission-critical software systems that crash and burn tend to get fired.  But if your new treatment guidelines convince everyone over age 45 to start taking statins, I’m pretty sure I could avoid the blame for any lousy software I created.  I suspect the conversations would go something like this:

“Naughton!”

“Yes, boss?”

“The foreign incoming royalties module of the payment distribution system keeps crashing!  Did you write that module?”

“Well, I … uh … No, sir.  It was Crockett.”

“Crockett!”

“Yes, sir?”

“Did you write the foreign incoming royalties module?”

“Uh … I don’t remember.  Maybe.”

“Well, fix it!”

“But I don’t remember the logic.”

“Well, damnit, get Naughton to help you.”

“If I’m going to help Crockett fix the mess he made, I’m going to need another bump in my billing rate.”

“Yeah, yeah, okay.  Just promise you won’t quit.”

So while I know providing me with job security wasn’t your intention, I’m grateful nonetheless.

By the way, would it be possible for you to convince the federal government to subsidize statins and provide them to needy people in the developing world, sort of like the USDA does with grains?  It would be awesome to know I won’t lose my programming gig to some guy in India.

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All those nice birthday wishes here on the blog, bunches more on Facebook and in emails, plus a few more of those “your documentary changed my life” emails in the past couple of weeks … very nice.

But just so you don’t think it’s all kisses and hugs and holding hands and singing Kumbiya around here, I thought I’d share one of “those” emails.  I received this one on my birthday:

You are an idiot! Please stop trying to “un-educate” people about food that is cancer causing, environment rapping and destroying, slave making, and propaganda filled. You are the problem with American Society, eating right from the evil corporate hands that feed you. Keep your undereducated, moronic opinions to your self and stop spending lies that could persuade people to continue hurting them selves and giving money to the very CEO’s providing the means of pain and suffering.

you disgust me,

Marja

Heh-heh-heh … can’t please everyone.

Now I’m off to set up the disc-golf course for my birthday shindig.  I don’t plan on rapping the environment (or jazzing it or even rock ‘n’ rolling it) or enslaving anyone in the process, but the day is young.

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Well, I finally qualify for senior-citizen discounts at Denny’s and other fine dining establishments.  Yup, 55 years old as of 12:01 AM this morning.  I believe I’m supposed to spend the day feeling depressed about my wasted youth and my impending decline and eventual doom.

Nope, not gonna happen.  I’ll be spending today doing some shopping with Chareva, playing some disc golf, watching my Titans get hammered by the Colts on Thursday Night Football, and feeling pretty good about life in general.

If I’d been a lean jock-type as a young man, maybe the then-versus-now comparison would be a little depressing.  But here’s the “then” comparison for me — two pictures taken sometime in my early or mid 30s:

And here’s me twenty-some years later, shortly after stepping out of the shower on the morning of my 55th birthday:

I’m not cut, I’m not at 10% body fat, and I still have some residual softness around the middle that may never go away.  But considering how I looked and felt for most of my adult life, I’ll happily accept where I’m at now.

Back then, I loved to eat, but also considered food my enemy.  Food was the stuff that made me fat.  Now I still love to eat, but consider food my friend.  I don’t try to semi-starve myself into being leaner.  If I’m hungry, I eat something.  I just had to learn which foods to eat.

And now I’m off to enjoy my birthday.

p.s. — To everyone who wants to leave a Happy Birthday comment:  I’ll thank you all now instead of within the comments.

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