Two American (social) tragedies

When the team members entered the clinic, they were appalled, describing it to the Grand Jury as ‘filthy,’ ‘deplorable,’ ‘disgusting,’ ‘very unsanitary, very outdated, horrendous,’ and ‘by far, the worst’ that these experienced investigators had ever encountered. There was blood on the floor. A stench of urine filled the air. A flea-infested cat was wandering through the facility, and there were cat feces on the stairs. Semi-conscious women scheduled for abortions were moaning in the waiting room or the recovery room, where they sat on dirty recliners covered with blood-stained blankets. All the women had been sedated by unlicensed staff – long before Gosnell arrived at the clinic – and staff members could not accurately state what medications or dosages they had administered to the waiting patients. Many of the medications in inventory were past their expiration dates… surgical procedure rooms were filthy and unsanitary… resembling ‘a bad gas station restroom.’ Instruments were not sterile. Equipment was rusty and outdated. Oxygen equipment was covered with dust, and had not been inspected. The same corroded suction tubing used for abortions was the only tubing available for oral airways if assistance for breathing was needed…”[29]
[F]etal remains [were] haphazardly stored throughout the clinic– in bags, milk jugs, orange juice cartons, and even in cat-food containers… Gosnell admitted to Detective Wood that at least 10 to 20 percent… were probably older than 24 weeks [the legal limit]… In some instances, surgical incisions had been made at the base of the fetal skulls. The investigators found a row of jars containing just the severed feet of fetuses. In the basement, they discovered medical waste piled high. The intact 19-week fetus delivered by Mrs. Mongar three months earlier was in a freezer. In all, the remains of 45 fetuses were recovered … at least two of them, and probably three, had been viable.”

A classic back alley abortion mill, except that it was all quite legal.

This wasn’t supposed to happen after Roe vs. Wade. It is so uncanny that the doc (Kermit Gosnell) convicted yesterday of these 3 infanticides graduated from a med school in Philly (Jefferson) the same year (1966) that I graduated from another (Penn). At the time Philly had 3 more (Hahnemahn, Women’s and Temple).

What is so socially tragic about Gosnell, is that he was one of very few blacks in medical school back then. Our class of 125 at Penn had one, but he was a Nigerian Prince. Whether Gosnell liked it or not he was a standard bearer for what we hoped (at the time) was the wave of the future (it was). For just how very few Blacks were being educated at elite institutions back then please see

http://luysii.wordpress.com/2012/05/22/warren-harvard-and-penn-sanctimony-hypocrisy-and-fraud/

The second tragedy is a black woman M. D twenty or so years younger (Harvard undergrad, Penn Med followed by an MBA from Wharton) who lost her license to practice in NY State after she went off the deep end and became a holistic practioner (or whatever). She treated a new onset juvenile diabetic with diet and juice after which he came to the ER in diabetic ketoacidosis with a sugar over 300.

My father was an attorney as was my uncle, later a judge. They took it very personally when an attorney was disbarred for some malfeasance or another. I feel the same way when this happens to an M. D. Imagine how the black docs must feel about Gosnell, or the idiot, Conrad Murray, who basically killed Michael Jackson with Diprivan.

If you didn’t follow the link, I’ll close with a more uplifting ending from it.

My wife has a cardiac problem, and the cardiologists want her to be on coumadin forever, to prevent stroke. As a neurologist, having seen the disasters that coumadin and heparin could cause when given for the flimsiest of indications (TIAs etc. etc.), I was extremely resistant to the idea, and started reading the literature references her cardiologist gave me, along with where the references led. The definitive study on her condition had been done by a black cardiologist from Kentucky. We had a long and very helpful talk about what to do.

Diversity is not an end in itself, although some would like it to be. I’ve certainly benefitted from knowing people from all over. That’s not the point. Like it or not, intelligence is hereditary to some extent (people argue about just how much, but few think that intelligence is entirely environmental). The parents and grandparents of today’s black MDs, Attorneys, teachers etc. etc. were likely just as intelligent as their offspring of today. This country certainly pissed away an awful lot of brains of their generations.

The DSM again

The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-V) is in the news. The press has not been favorable, nor have two new books concerning it. Here are some links

l. A review of a book on it from today’s Nature (2 May ’13)–http://www.nature.com/nature/journal/v497/n7447/full/497036a.html
2. An article in the New York Times today concerning the Nature book and one other — neither favorable –http://www.nytimes.com/2013/05/02/books/greenbergs-book-of-woe-and-francess-saving-normal.html?ref=todayspaper&_r=0

Added 8 May ’13 The US National Institute of Mental Health (NIMH) will no longer use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to guide psychiatric research, NIMH director Thomas Insel announced on 30 April. The manual has long been used as a gold standard for defining mental disorders. Insel described the DSM as ill-suited to scientific studies, and said the NIMH will now support studies that cut across DSM-defined disease categories.

But, as Ernst Mayr once said — nothing in biology makes sense except in the light of evolution. Keeping that thought in mind, what I wrote a few years ago is relevant today. Here’s the post. Although it starts off in Mathematics, it gives some history which helps explain why the DSM is the way it is.

Even so, psychiatric wisdom should be taken with a good deal of salt. A psychiatrist in my medical school class (1966) knew people who were thrown out of their psychiatric residencies because they were gay, and back then homosexuality was a psychiatric disease.

Here’s the post of 3 years ago

Reification in mathematics and medicine

Can you bring an object into existence just by naming and describing it? Well, no one has created a unicorn yet, but mathematicians and docs do it all the time. Let’s start with mathematicians, most of whom are Platonists. They don’t think they’re inventing anything, they’re just describing an external reality that is ‘out there’ but isn’t physical. So is any language an external reality, but when the last person who knows that language dies, so does the language. It will never reappear as people invent new languages, and invent them they do as the experience with deaf Nicaraguan children has shown [ Science vol. 293 pp. 1758 - 1759 '01 ]. Mathematics has been developed independently multiple times all over the world, and it’s always the same. The subject matter is out there, and not just a social construct as some say.

A fascinating book, “Naming Infinity” describes a Russian school of mathematicians who extended set theory beyond the work of the French and Germans. They literally believed that describing a mathematical object and its properties implied that the object existed (assuming the properties were consistent). The mathematicians involved were also very devout mystical Christians, who were called “Name Worshippers”. They thought that repeatedly invoking the name of Jesus would allow them to reach an ecstatic state. The rather contentious theory of the book is that their religious stance allowed them to imbue all names with powerful properties which could bring what they named into existence and this led to their extensions of set theory. Naturally the Communists hated them, and exterminated many (see p. 126). People possessed of all absolute truths dislike those possessed of a different set.

Docs bring diseases into existence all the time simply by naming them. This is why the new DSM-V (Diagnostic and Statistical Manual of Mental Disorders) of the American Psychiatric Association (APA) is so important. Is homosexuality a disease? Years ago the APA thought it was. If your teenager won’t do what you want, is this “Adolescent Defiant Disorder”? Is it a disease? It will be if the DSM-V says it is.

There are a lot of things wrong with what the DSM has become (297 disorders in 886 pages in DSM-IV), but the original impetus for the major shift that occurred with DSM-III in the 70s was excellent. So it’s time for a bit of history. Prior to that time, it was quite possible for the same individual to go to 3 psychiatric teaching hospitals in New York City and get 3 different diagnoses. Why? Because diagnosis was based on the reconstruction of the psychodynamics of the case. Just as there is no single way to interpret “Stopping by Woods on a Snowy Evening” (see the previous post), there isn’t one for a case history. Freud’s case studies are great literature, but someone else would write up the case differently.

The authors of the DSM-III decided to be more like medical docs than shrinks. In our usual state of ignorance, we docs define diseases by how they act — the symptoms, the physical signs, the clinical course. So the DSM-III abandoned the literary approach of psychodynamics and started asking what psychiatric patients looked like — were they hallucinating, did they take no pleasure in things, was there sleep disturbance, were they delusional etc. etc. As you can imagine, there was a huge uproar from the psychoanalysts.

Now no individual fits any disease exactly. There are always parts missing, and there are always additional symptoms and signs present to confuse matters. The net result was that psychiatric diagnosis became like choosing from a menu in a Chinese restaurant, so many symptoms and findings from column A, so many from column B. (Update 2013 — Having been to China for 3 weeks this year, restaurant menus over there aren’t like that).

This led to a rather atheoretical approach, but psychiatric diagnoses became far more consistent. Docs have always been doing this sort of thing and still do (look at the multiple confusing initial manifestations of what turned out to AIDS back in the 80s). Different infections were classified by how they acted, long before Pasteur proved that they were caused by micro-organisms. Back when I was running a muscular dystrophy clinic, we saw something called limb girdle muscular dystrophy , in which the patients were weak primarily in muscles about the shoulders and hips. Now we know that there are at least 13 different genetic causes of the disorder. So there are many distinct causes of the same clinical picture. This is similar to the many different genetic causes of Parkinson’s disease I talked about 2 and 3 posts earlier. At least with limb girdle muscular dystrophy it is much easier to see how the genetic defects cause muscle weakness — all of the known genetic causes involve proteins found in muscle.

Where DSM-IV (and probably DSM-V — it’s coming out later this month) went off the rails, IMHO, is the multiplicity of diagnoses they have reified. Do you really think there are 297 psychiatric disorders? Not only that, many of them are treated the same way — with an SSRI (Selective Serotonin Reuptake Inhibitor). You don’t treat all infections with the same antibiotic. This makes me wonder just how ‘real’ these diagnoses are. However in defense of them, you do treat classic Parkinsonism pretty much the same way regardless of the genetic defect causing it (and at this point we know of genetic causes of less than 10% of cases).

There is a fascinating series of articles in Science starting 12 Feb ’10 about the new DSM-V. The first is on pp. 770 – 771. One of the most interesting points is that 40% of academic inpatients receive a diagnosis of NOS (Not Otherwise Specified — e.g. not in the DSM-IV — clearly even 297 diagnoses are missing quite a bit).

But insurance companies and the government treat this stuff as holy writ. Would you really like your frisky adolescent labeled with “prepsychotic risk syndrome” which is proposed for DSM-V. Also, casting doubt on the whole enterprise, are the radical changes the DSM has undergone since it’s inception nearly 60 years ago. We’ve learned a lot about all sorts of medical diseases since then, but strokes and heart attacks back then are still strokes and heart attacks today and TB is still TB. Do these guys really know what they’re talking about, and should we allow them to reify things?

That being said, cut psychiatry some slack. Regardless of theory, there are plenty of mentally ill people out there who need help. They aren’t going to go away (or get better) any time soon. Psychiatrists (like all docs) are doing the best they can with what they know.

That’s why it’s nice to be retired and reading stuff that it is at least possible to understand — like math, physics, organic chemistry and molecular biology. But never forget that it is trivial compared to human suffering. That’s why the carnage in the drug discovery industry is so sad — there goes our only hope making things better (written in 2010, but still true in 2013).

The New York Times does it again

http://www.nytimes.com/2001/09/11/books/no-regrets-for-love-explosives-memoir-sorts-war-protester-talks-life-with.html?pagewanted=all

This is a link to an interview with Bill Ayers, former weatherman and terrorist which appeared 11 September 2001. In it he says He says he ”I don’t regret setting bombs. I feel we didn’t do enough.” I think the interview was on the bottom left corner of the front page (at least the edition available in Syracuse that day).

Today (15 April ’13) they have an article by a prisoner in Guantanamo on the opinion page saying it’s killing him.

Tomorrow, expect stories about Muslims cowering in fear. Next week — Islam is a religion of peace.

Res ispa loquitur

Off to China in the Morning

Not much blogging in the past few months, not that there hasn’t been fascinating stuff to write about. Fortunately happy family events have kept me away.

The 40s seem to be the new 20s, as 3 family members are getting married in the next few months at ages 42, 45 and 46. We’re off to a Chinese Wedding Banquet for our oldest and his wife, followed by a wedding of our niece, followed by a wedding of our youngest son — all in the next 3 months. So stay well and keep thinking.

I am sweating the health of any progeny to emerge. For why, see the following post http://luysii.wordpress.com/2012/08/30/how-fast-is-your-biological-clock-ticking-ii-latest-results/

Q. E. D

The following are from two posts in August 2011, two months after Chavez first let the world know he was being treated for cancer.

My opinion of docs who diagnose over the phone, or who render opinions on people they’ve never seen is not high, although we all indulge in this from time to time. The worst example is that of the

1,189 PSYCHIATRISTS SAY GOLDWATER IS PSYCHOLOGICALLY UNFIT TO BE PRESIDENT! That determinedly flamboyant headline dressed the cover of Fact magazine one month before the presidential election of 1964. The entire issue was an examination of the “unconscious of a conservative,” based largely on answers to a questionnaire sent to the 12,356 psychiatrists listed by the American Medical Association. Of the 2,417 who replied, 657 said Barry Goldwater was fit for the presidency, 571 declined to take a position, and 1,189 called him unfit—the latter in no uncertain terms. Some of their opinions: “emotionally unstable,” “immature,” “cowardly,” “grossly psychotic,” “paranoid,” “mass murderer,” “amoral and immoral,” “chronic schizophrenic” and “dangerous lunatic.” One psychiatrist even felt that a proposed Goldwater visit to Hitler’s Berchtesgaden “is enough to convince me of his strong identification with the authoritarianism of Hitler, if not identification with Hitler himself.”

The unprofessional—not to say unbalanced—nature of such remarks brought immediate condemnation from the A.M.A. and the American Psychiatric Association. It said more about the state of American Psychiatry at the time than it did about Goldwater.For more details see: http://www.time.com/time/magazine/article/0,9171,838361,00.html#ixzz1WemleKVu

But here I am, about to indulge in the same thing concerning a very public figure. Why? Because what I’m about to say has received absolutely no attention in the press that I can find. First, look at these 3 pictures of Hugo Chavez.

http://www.guardian.co.uk/commentisfree/2011/jul/24/hugo-chavez-cancer-popular 24 July

http://www.guardian.co.uk/world/2011/aug/01/hugo-chavez-hair-cut-venezuela 1 August

http://www.guardian.co.uk/world/hugo-chavez 31 August

What’s the point? The rather remarkable change in his facial appearance over this short period of time. In just 6 weeks or so he has developed the classic face of someone receiving very high doses of corticosteroids (Cushingoid facies). The loss of hair due to his chemotherapy is irrelevant — it happens to most and is reversible when the chemo stops.

It also implies either that his docs are grossly overtreating him or that he is a very sick man. Doses of corticosteroids high enough to produce such massive facial change should never be used lightly. Back in the day, this was all I had for the flareups of multiple sclerosis, and it was never easy on patients.

We do not know what sort of cancer he has, if it has spread, and if so, how far. If his cancer was curable don’t you think it would have been trumpeted in one of his nearly daily press releases?

More worrisome for Chavez, is the fact that high doses of corticosteroids, invariably produce side effects. One you are seeing — the change in facial appearance. Two others are the invariable worsening of diabetes (should he have it) and the much increased possibility of stomach ulcers and bleeding. Both are fairly easily managed, particularly ulcers — none of my MS patients ever got ulcers because I began treating them as if they already had one (e.g. milk and maalox) when I started the corticosteroids. This was long before we know about Helicobacter and ulcers

High doses of corticosteroids usually produce a sense of euphoria. Cognitive processes aren’t as good, and they are one of the few known causes of reversible cerebral atrophy.

Far more worrisome for Venezuela and the rest of us, is the psychosis occasionally seen with high doses of corticosteroids. He is a man of enormous power, and hopefully no one has given him nuclear weapons.

So like my Cuban friend’s mother who prays for Castro’s health because her mother (who played cards with him when they were both young) is determined to outlive him, we must hope for a peaceful conclusion to Hugo’s illness.

From another post in August 2011

Also if he had a curable form of cancer, don’t you think he’d have told us exactly what it is? More likely, he’s putting on a front so his regime doesn’t collapse. Years and years ago I was a member of the Council on Foreign Relations in a western town. Various speakers were brought in — General Maxwell Taylor, etc. etc. The most interesting was the current Egyptian ambassador (or an attache). He said that the governments in the mideast were all ‘one bullet governments’ — which was all it would take to change their direction radically –all were run by one man at the top — this before the assassination of Anwar Sadat.

At least we see Chavez. Recall the last hospitalization of Yasser Arafat in France. We were told that everything was going well. What we were not told until very late, was that all this information was from the family and not from the people taking care of him. The investigative press was nowhere to be found.

This is unlikely to change. The powerful will always be able to warp the medical system to their desires. Think Michael Jackson, or even president Woodrow Wilson (incapacitated by a variety of strokes in his last years in office).

Now on to the present.
We are told by Chavez or someone permitted to speak for him, that he has a 2 centimeter lesion, either at the site of the old surgery or near it. Assume, for better or worse, that this is true. What does it mean? Well, one of three things:

1. Stop calling this a lesion. Only tumors act like this. No one gives chemotherapy enough to make your hair fall out for ‘lesions’ that aren’t tumors.

2. They couldn’t get the whole tumor out (meaning it’s incurable), and despite the high doses of steroids he’s on (recent pictures of him show his face even more Cushingoid than the 3 cited above) the tumor has grown further and needs to be removed (for any of several reasons, none of which is good).

3. At the time of the initial surgery, they thought they had removed the tumor, and the present 2 centimeter lesion has grown from something they didn’t see, because it was too small. Assume that what they missed was 1 milliMeter in diameter. Anything larger wouldn’t have been missed (assuming the people operating on him were competent — but ask Fidel about that — he’s still recovering years later from whatever they did). Since the lesion now 2 centimeters, this means that its volume in milliMeters is 4188 cubic milliMeters (4/3 pi r cubed, with r = 10). This is roughly 12 doublings of the tumor, or around 1 doubling every 17 days. The chances of a benign tumor growing this fast are remote (although my late mother had exactly that in her pelvis and lived another 40 years).

Everett Koop M. D. RIP

Not many outside medicine know just what he did before becoming surgeon general and famous. He essentially invented the subspecialty of pediatric surgery. Sure, surgeons had been operating on kids from time immemorial, but that’s all Koop did. One of his triumphs was esophageal atresia, meaning that in a newborn part of the esophagus was either absent or too small to pass even fluids, meaning death. The size of the organ in the newborn is a pencil or smaller, and Koop figured out a way to replace or hook up (anastomose) the parts of normal size.

As a med student in Philly, I was lucky enough to make rounds with him at CHOP (Children’s Hospital Of Philadelphia) in the 60′s. He was a typical Pennsylvania Dutchman, very solid, no nonsense, serious, not pompous, rather reserved.

Probably the most accomplished Surgeon General we’ve ever had. I was particularly appalled when Senator Ted Kennedy mau-mau’ed him. Koop was devout and against abortion, and the attacks on his character by the hero of Chappaquiddick were disgusting to those of us who knew him.

Even though Reagan didn’t want him to do it, he was very outspoken about AIDs, and didn’t try to sweep it under the rug as a punishment from God etc. etc. This prominent and early focus probably saved millions of lives, as ignoring it, would have just helped it spread even faster and farther. This is basically the physician’s focus — to deal with the world as it is, not as we wish it to be, and do what we can even for those whose behavior brought misfortune on them. Koop was just being a doc.

To Kennedy’s credit, he later apologized to Koop.

A solution to America’s obesity problem

Who knew it would be that simple?   Not only that, but the same country has figured out a way to give anyone who wants one, an absolutely free college education.  Interested?  Read on.

These thoughts occurred after listening college classmate, lecture to a bunch of us alums about a trip he took to a foreign country a few months ago, along with 15 or so of our classmates and their wives.  He’d been in the foreign service and had even served as an ambassador to a nearby state.

All is not sweetness and light however.   Housing is scarce, and newlyweds have two choices about where to live — with the groom’s parents or the bride’s.

Vintage car fans love the country, and one of his slides showed a Chevy from my youth in the 50s.

Ecologists love the fact that the country has a very low carbon footprint.  Even though 20% of the population is involved in agriculture, mechanization hasn’t taken over, and draft animals abound.  The fields shown looked quite lush.  They get plenty of rain.

One of the slides was of a food distribution center.  Mayor Bloomberg would be pleased.  No junk food.  Well, actually very little food and the shelves looked rather barren.  This is where people go to get their free food.  A slide was shown of one of the ration books currently in use.

Well the food is rationed.  How else are you going to stop people from eating like pigs?  The talk was fascinating and went on for an hour with numerous slides.  Perhaps 100 or so denizens of the country appeared in them.  None were fat.  Hosanna ! !

My classmate rattled off the current rations, but it went by to fast for me to reproduce.  Hopefully he’ll fill me in.

What with the free college and all, there has to be someone paying for it.  There is — the graduates.  They all get 20 dollars a month salary, and the taxi driver of the vintage Chevy was a chemical engineer.  85% of the populace works for the government.  My classmate found this arrangement heartening, as it made just about everyone an entrepreneur (to survive).

People worried about discrimination against the elderly will appreciate the fact that pay (say 20 a month vs. 15 vs. 10) is strictly on the basis of seniority.  No silly merit pay for them.  This has the expected effect on output.

Those upset about the disparities in income and wealth here will find true equality nirvana over there.

Medical care is universally available and free.  Quality is difficult to ascertain.

This paradise is only 90 miles from Florida.  It’s called Cuba.

 

We do have one comparable institution in this country where

l. all are equal

2. food is free

3. housing is free

4. medical care is universally available and free

5. no Republican has ever stolen an election

It’s called prison.

Medical tribulations of politicians — degrees of transparency

Remarkably on the last day of the year, 3 political figures and their medical problems are in the news.  Here they are in order of medical transparency (highest first).

l. George Bush Sr. — the most transparent.  We are told what he has (pneumonia), when he was admitted to hospital when he was in the ICU, when he came out.  Docs call pneumonia ‘the old man’s friend’ not out of cynicism, but because its a mode of death with (relatively) little suffering.  The patient lapses into unconsciousness and usually dies quickly and quietly.  It took my cellist’s father only a day or two to pass away this month.  Clearly it isn’t invariable fatal, and Bush Sr. was now out of the ICU at last count (he’s 88).

2. Hilary Clinton — admitted to the hospital yesterday with a ‘blood clot’ somewhere, said to be a complication of the concussion she suffered a few weeks ago.  Also said to be under treatment with anticoagulants.  Most clots due to head trauma are inside the head and treating them with anticoagulants is a disaster.  The most likely type of clot given the time from the concussion is a subdural hematoma.  It is possible that she’s been so inactive since the concussion that she developed thrombophlebitis in her legs, in which case anticoagulation would be indicated.

More disturbingly, is that her passing out a few weeks ago is a sign of something more serious going on.  Hopefully not.

The powers that be should have told us where the clot actually is.

Update 5:50 PM EST — Well the powers that be did open up and it is a most unusual complication of head injury (and one I’d never seen in nearly 4 decades of practice) — a venous thrombosis in the head.  I’m not even sure it’s due to her head injury.  It might have even caused her syncope, but presumably she had some sort of radiologic study of her head when she fainted, which should have picked it up.  The venous sinuses draining the brain in the back of the head are notoriously asymmetric, so a narrowing attributable to a clot could just be a variant anatomy.  One very bad complication of cerebral venous thrombosis back there (which I saw as a complication of chronic mastoid bone infection — not head trauma) is pseudotumor cerebri.  I really wonder if these guys have the right diagnosis.

3. Hugo Chavez — Yesterday it was announced that he’s had a third complication since his surgery for cancer 3 weeks ago. Naturally, we’re not told just what this complication actually is. This is consistent with the information that has been released about his case.  We know almost nothing about his actual tumor (except that he has one).  He most assuredly is not free of cancer as he stated last fall.  He is said to have have a bleeding problem and a lung infection as the first two complications.

My guess for this third complication is that it is a dehiscence of his abdominal incision, which must have been fairly large for a 6 hour operation.  Dehiscence just means that the wound has spontaneously opened up exposing abdominal contents (which means that peritonitis is not far behind).  Why should this happen?  Two reasons — he’s had radiation to the area which inhibits wound healing, and he’s been on high dose steroids in the past (and perhaps presently) which also inhibits wound healing.

I don’t think he’s going to be able to take office 10 days hence, and doubt that he’ll come back to Venezuela alive.  Transparency has been zilch.  Hopefully the people of Venezuela are beginning to realize just how misleading the information they’ve been fed about his health has been.

This is the sort of thing physicians taking care of really sick people deal with daily, which may explain why your doc friends aren’t as jolly as you are at the New Year’s Eve parties you’re about to attend.

Nonetheless, Happy New Year to all ! ! ! !

Information please !

There is a tremendous amount of press coverage about something called the fiscal cliff, which will arrive 1 Jan ’13 unless congress does something.  I receive hysterical missives nearly daily from AAAS to write my congressman to avert any cut in research funding, etc. etc.   Despite all the uproar, I can’t find the answers to several fairly simple questions, despite searching the web.

l. What is the size of total federal spending predicted to be –

a. as things stand now with the cliff averted and nothing else changed (e.g. tax cuts left in place, no spending cuts)

b. if the cliff comes to pass

2. What is the size of the deficit (both in absolute number and as a percentage of federal spending)

a.  as things stand now with the cliff averted and nothing else changed (e.g. tax cuts left in place, no spending cuts)

b. if the cliff comes to pass

So it’s just 6 simple numbers that I can’t find anywhere.  If anyone knows feel free to write a comment with the numbers and the source.

I do recall reading somewhere, that some 40% of federal expenditures are being financed (e.g. the deficit) and that even if the cliff occurs we’ll still have a deficit of 600 billion.

Happy families are all alike

No posting for a while.  My wife and I have just met one wife and one probable wife to be of our two sons in the space of 14 hours.  Why they waited until ages 44 and 46 is beyond me, but their choices were worth waiting for. Next Feb it will be 50 years since my wife and I met (she was 19 at the time).  The boys have missed decades of good times (and bad) together.  So all you 20, 30 and 40 somethings out there — get moving.

For a few choice words on what your biological clock is doing while you wait — see http://luysii.wordpress.com/2012/08/30/how-fast-is-your-biological-clock-ticking-ii-latest-results/

In particular the men should read this one