reCAPTCHA !

Wikipedia's amazing success relies on the knowledge and time of millions of users creating and editing articles. A lesser known (nevertheless brilliant) example is what I bumped into recently.

Most of us would have identified distorted images of a word before creating an online account. While the main purpose of that is to differentiate between a human and a rogue program (which can create millions of spam accounts), Luis Von Ahn (a professor from CMU) uses this technique to help digitize books. If you wonder how this process of identifying distorted word images can help digitize books, watch this video

Nolan's report card

I'm tempted to give him "The God" status. Probably too soon for a director with just six movies under his belt. The variety and versatility in his story telling is exciting, even for me, who thinks twice before getting excited.

Chronologically his movies have earned increasing profits and almost resembles an exponential curve, if not for a small dip.

The dip corresponds to "The Prestige", a highly underrated movie, and quite understandably so(American public can be surprisingly unexcited by wonderful movies). On top of it, it had to beat "Batman Begins", well that's a daunting task. However it was compensated by "The Dark Knight". The excessive hype for the movie made it a worldwide blockbuster smashing previous box office records.

Not that, profits is an accurate metric for the quality of the movie. I believe making quality movies which is profitable is an accomplishment. How in the world can somebody pull of a "reverse chronological" screenplay to aptly represent a story revolving around an amnesiac. That's just inconceivable in my world.

Can't wait for "Inception".

Health care II

I have no idea how I keep stumbling upon these long articles on health care. What started as a casual read on the health care got a little bit involved. But as far as health care or financial reform goes, its absolutely impossible to understand or keep track of it from the daily tidbits in the media (for a layperson).

David Leonhardt's recent article on improving the efficiency of health care is informative and insightful. An elaborate discussion on how Intermountain, a health care system in Utah and Idaho, achieved better health care (at a lower cost) by establishing evidence based treatment guidelines for different clinical conditions. It is comforting to know that there is a solution to the health care conundrum. Implementation is a story for another day.

One of the interesting information to emerge from the article is the fact that Medicare has published a wealth of data on the web that compares hospitals based on various parameters (of health care). Check out the website here. I was immediately tempted to check the hospitals close by my locality and was astounded by the staggering amount of information available to people.

US health care

Health care has been receiving lot of well deserved attention after the economy showed trends of recovery. As a common man, be it the bail out money or health care expense the sheer magnitude of money involved is overwhelming. For instance, the health care expenditures are about $1.6 trillion in 2002 and projected to rise to $3.6 trillion in 2013. To put in perspective with the GDP of the country, the spending goes from a 15% to 18% of the GDP. It is hard to fathom the magnitude of problem, just by looking at the numbers.

A better way to look at the problem will be to compare US against other developed countries, on a per capita basis. In general, the health care cost per capita is a linear function with the GDP per capita for all developed countries except US which doesn't fit in the trend. Check out the plot
http://www.annals.org/cgi/content/full/142/10/847/F3
In 2006, US spent about 40% more than what it should have spent. That tells you how inefficient the system is, rather how much better can the system be. In terms of health care expense per capita is roughly $7000 (about 15% of the GDP per capita), instead of $5000 per capita had US followed other developed countries.

Apparently health insurance costs have been consistently rising by about 8~10% from the late 1980s to now, except for a period of slowdown between mid 90s to 2000. It is interesting to note how the health care industry evolved. The dynamics of the health care providers and insurance companies pushed the cost in the wrong direction.

Pre-1980s, hospitals in an effort to attract best physicians, tried to outdo the competition by having better facilities, resulting in higher cost. This didn't last quite long, as health insurance companies began contracting hospitals which agreed for a lower fee. The priorities changed for the hospitals, as they competed for patients, rather than physicians, driving the cost down. Unfortunately this desirable trend didn't last long either. The hospitals began to consolidate , resulting in multihospital systems. Now the hospitals dictated terms in price, as there were fewer hospital entities, and insurance companies have to contract them inorder to guarantee geographical coverage. Studies have shown how hospital mergers have contributed to increase in cost.

Breaking down the expenditure and finding the major contributors can be quite complicated and involved. Much of these statistics about health care spending can be easily distorted, either inadvertently or deliberately.

For instance, this nytimes article states that the US doctors make $200,000 to $300,000 a year compared to doctors in Europe who make $60,000 to $120,000. The author claims that as one of the prime health care expenditures. (http://www.nytimes.com/2007/07/29/weekinreview/29berenson.html?_r=2)

Professor Reinhardt's (an economics professor at Princeton) reply to the same issue states that how half of physician's salary goes to " physician's practice expenses" including that of malpractice premiums. This makes their take home pay half of the quoted numbers. On top of it, even if we were to cut their salary down by 20% to bring their pay on par to their counterparts in Europe, it will only reduce the US health care expenditure by 2% (http://economix.blogs.nytimes.com/2008/11/14/do-doctors-salaries-drive-up-health-care-costs/)
Often times, statistics can be difficult to interpret correctly. This one is a bad example.

Nevertheless without going too much into statistics, it is surprising to note that one of the prime contributors to the health care cost apparently is "technological innovation". It might be a little difficult to digest how technology drives the cost so high. Apparently in the medical field, technological innovations in some areas can lead to more capital, more labor and more cost in spreading the knowledge. One such area has been the treatment of myocardial infarction claims Thomas Bodenheimer. In his paper (http://www.annals.org/cgi/reprint/142/11/932.pdf) , he also explains how new technology can lead to overuse. For instance laproscopic chloecystectomy (removal of gall bladder) is 25% cheaper compared to open surgery. But 60% increase in chloecystectomy procedures since the introduction of laproscopy, increased the total outlay. He also cites examples of overuse of MRI and tomographic techniques. New technology diffusion happens rapidly because specialists encourage them (and receive income from them).

Looking back at one of my own personal experience, when I had to undergo a minor knee surgery ,and had to stay in the hospital for about 4 days. It so happened that I had a minor neck strain , during my stay in the hospital. One of the pathologist who was doing a routine check up on me was a little too concerned about my neck pain (inspite of me complaning about the fluffy pillows to be the main cause of it) and speculated that it could be meningitis. Neck stiffness is just one of the symptoms of meningitis. He suggested doing a MRI to make sure it's not meningitis. I was a little surprised by the doctor's suggestion. Doctor's response was "You have the insurance to cover for it, then why take the risk?" . Well that is one example of overuse of technology.

Infact Atul Gawande's article in the Newyorker "http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande" compares two towns which are geographically and culturally closer, yet incur remarkably different medicare expense per capita. Increased expenditure didn't result in the improvement of general health of the people. The conclusion he comes up is that the hospital cultures are very different in both these towns. He claims as to how one of the towns had a more business oriented approach to treating patients, by overusing technology and raking up profits.

Thomas Bodenheimer states that it is important to assess the influence of new technology before it gets adopted widely. In countries like UK, they have what is called health technology assessment, which provide scientific reports that answers questions like, Do the new technologies really improve on existing technology ?, What are the harms, benefits and cost-effectiveness of a technology? before adopting it widely. Other possible measures such as expenditure caps on physician services is an excellent technique.

There are other straightforward reasons for the rising cost, one such thing is the administrative overhead. In 1999, it was about 24% of the health care expenditure. Uwe Reinhardt in his article claims that excess spending in administration is enough to attain truly universal health coverage.

http://economix.blogs.nytimes.com/2008/11/21/why-does-us-health-care-cost-so-much-part-ii-indefensible-administrative-costs/

Private insurances are notorious for higher administrative costs, compared to government managed Medicare insurance. Apparently medicare pays one employee for 10,000 beneficiaries, where as private insurance has 15 or more employees. Hence public option is favorable in terms of cutting the costs.

Epigenetics

To quote from Wiki, "Epigenetics" refers to changes in gene expression caused by mechanisms other than changes in the underlying DNA sequence. In essence, genetic sequence by itself doesn't give us the complete picture of a person or organism. The way in which a particular gene is expressed can vary between two persons/organisms carrying identical genes.

A suitable example would be to consider "identical twins" who share 100% of their genes. Despite carrying identical genes, they could be different in ways that is stunning. For example, there are instances, in which one of the twins is autistic, while the other is perfectly normal. Also instances where in one of them might be prone to cancers, while other might not. Doesn't DNA sequences say everything about us?

The explanation for such marked differences is simply straightforward. Even though the underlying genes might be the same, certain parts can be turned on or off causing modifications in the expression of a gene. Infact this is not startling at all, for the simple reason that the cells in our body, though share the same genes, express themselves differently as blood, skin or neuronal cells etc. The fact that there could be tiny variations in genetic expression, within the same type of cells between individuals having same genes, is just taking it one step further. Epigenetics simply put tries to understand this process of how the same gene can express differently.

Another interesting example why the genetic sequence might not have all the details is the case where the deletion and inactivation of the same chromosome causes two different syndromes. Angelman syndrome - apparently manifests as neural disorder with developmental delays
Prader-Willi syndrome - causes obesity, low muscle tone and short statures
Both these are caused by the missing or flawed chromosome-15. It's interesting to note that depending on paternal or maternal origins of mutations of chromosome-15, Angelman or Prader-Willi syndrome occurs. This memory of the genes as to where they come from is called genomic imprinting.

As there are mounting evidence to show that DNA sequences merely tells part of the story, a remote town in Northern Sweden might have data to show a remarkable pattern that shows how these "gene expressions" can be inherited. Simply put, the particular way in which a gene is expressed may be inherited.

Overkalix, a small town in Sweden has detailed records of births and deaths over a few generations, that lived there during late 19th century and early 20th century. Inaddition the data also had detailed account on harvest i.e periods of famines and plenty were recorded. It so happened that an obscure Swedish researcher, trying to make sense of the data, showed some pattern.

-Occurence of diabetes/longevity of grandsons depended on what their grandfather was exposed to in his pre-adolescence or late childhood
-For the granddaughters, the conditions when their grandmother was still in womb mattered.

It is as if the environmental conditions during the sperm/egg formation of the grandfather/grandmothers becomes intertwined with the expression of genes itself. It doesn't stop there, these expressions are carried over generations.

For example, experiment with rats shows that, a single rat exposed to pesticides made a whole generation of rats susceptible to various diseases, i.e even though the underlying genes were the same, a particular rat getting exposed to a particular condition at some critical point in it's life affected several generations of rats.

While changes in genes or genetic mutations are very slow and happens over several generations, the epigenetics are smaller variations that respond to dynamic changes in the environment. If what is observed in the Swedish community is proved , that would change the perspective of humanity to come. Our environment during certain "critical moments" not only affects us but future generations in a specific way.


Sources:

NOVA documentary "Ghost in your genes"
http://www.nature.com/ejhg/journal/v14/n2/full/5201567a.html