An Economist's Lament

I hope my thoughts on economic issues will resonate with those of you who are either economists or people not turned off by the dismal science. I am not going to rant, I am not going to throw mud at any particular schools of thought. President Truman had an interesting point of view about economists: he said, “Please find me a one-armed economist. I’m sick of hearing from my staff ‘On the one hand this, on the other hand that.’”

We economists all have a list of pet peeves and we hope to write a journal article or a book about these issues, but we tend to leave the work for later. For economist PALS, later might become rather a short period. The great Doctor Samuel Johnson famously said nothing concentrates the mind more than the prospect of hanging in the morning. ALS has concentrated my mind and galvanized me into focusing on at least a few of my pet peeves:

Cost-benefit analysis
Regulation theory and policy
The fiscal policy shell game (i.e “deficits don’t matter”)
Hedge fund managers who avoid taxes
Tax cuts for the rich
Economics of ethanol
Relentless rampant privatization of government functions
The fox in the chicken coop (EPA, OMB JUSTICE INTERIOR) and many others
Supply side economics
Self-regulation
Voluntary emissions reduction
Tax cuts for the rich
Folks who advocate defunding of most federal social programs
The Wall street casino and the risk management oxymoron
The glorification of quantification

One important public debate that draws on many of these peeves of mine is the food fight over global warming. The overwhelming majority of technical people accept the science, which says we humans are messing with the atmosphere. We have a serious problem b/c the level of greenhouse gases is starting to inflict real damage. We cannot reduce the amount of CO2 that’s up there already. It lasts for hundreds of years. Therefore all we can realistically expect to accomplish is the slowdown the rate of accumulation of additional greenhouse gases. Even the somewhat draconian Kyoto plan will be a drop in the bucket. The failure of China and India to sign on to Kyoto dooms any prospect of seriously capping greenhouse gas production. The gas that China and India are putting into the air in increasing quantities will eventually spread around the globe, so they and the US really need to join the effort. India and China say that we are denying them the right to have their own industrial revolution.

Before we think about means to reduce production of greenhouse gases, we need to know a lot more about the present and future costs of the phenomena that we are observing: dying polar bears, wild weather, shifting temperature zones, melting icebergs and glaciers, etc. We also need to have a better idea of the present and future costs of doing anything to remediate the effects from warming. Until we can do an honest cost-benefit analysis (CBA) of any remediation project, we need to answer those questions.

Unfortunately it is very easy to make a CBA come out the way we want it to by leaving out important elements or incorrectly estimating costs and benefits. Sometimes it only takes a small change in an assumption to change the direction of the conclusion. On a large project such as a dam or river-diverting exercise, the people who want the project to go through may overestimate the benefits and underestimate the costs.

Environmentalists opposing the project may do the opposite. And whenever it gets to the point of getting an honest CBA about global warming, we will not be able to go from a simple decision tree analysis to determine what we need to do and when and how to do it. We also have to think about the inter-generational aspects of our policies. If we do nothing today we may be handing future generations a terrible legacy. On the other hand, if we invest billions today for the future scenario that is not as devastating as some expect we have wasted today’s resources.and increased the debt burden on our children.

To start the decision tree we have to decide whether or not we accept the science . There are still a few flat-earth types in high places who aren’t on board. I think we can safely start on a journey without them. The next step, assuming we have come up with an honest CBA of a project to deal with warming, is to.run it through a series of expertly designed scenarios.

To be continued

Spasms and spasticity

Spasm and cramps often begin early in the progression of symptoms. Simple things like tonic water (gin is optional) can help but most PALS have to move to muscle relaxants such as Baclofen. I opted for a Baclofen implant which pumps the Baclofen into my spinal fluid. It was placed under my skin during a simple surgical procedure. It is about the size of a hockey puck. A catheter connects the implant to the spinal fluid, so the medicine bypasses vital organs and goes directly to where it is most needed. I have no discomfort from the device. The medicine gets topped off every six months. The doctor can change the rate of dosage by sending signals from his palm pilot to the computer in my implant. It works very well for me. I am loose as a goose.

I wear hand splints to keep my fingers from curling up and becoming locked. I wear heel boots to deal with toe drop and my twisted ankles. Massage gives short-term relief to spasms.

How are others coping? I hear that pills can have unpleasant side effects. Any experiences with this?

Sex for PALS

It appears that sexual function, at least for males, does not involve voluntary muscles. Lack of motor neurons is not correlated with impotence. Antidepressants, however, can “curb your enthusiasm” (love that show!) This blog is not going to offer a manual on techniques (a la “Helga and Bernd demonstrate 100 sex positions” or “The Joy of Sex”). I’m not compiling a list of best practices or offering Dear Abby or Dr. Phil-type advice. If you want more discussion on this, go to the yahoo group site (Living with ALS). All I will say is that the essential elements are present – the problem is the physics of getting to an end result. Where there’s a will, there’s a way. Rock on!

Transfer devices

The nature of transfers changes radically during the progression of ALS. Transfers can cause a lot of stress for patients and caregivers when they go awry. When manual transfers become impossible, there are devices which can deal with PALS up to and including quadriplegics. I chose the “easy pivot” device at first. I have now switched to using a hoyer lift. I made the transition for a number of reasons. First, the physical therapist observed me in a transfer and said that the easy pivot was no longer appropriate because the loss of muscles in my back made it much harder for the caregiver to get me into it because I was unable to assist her. The caregiver had to pull on my arms to get me into position, and that was dangerous for me because this can lead to painful dislocation of the shoulder. It was also dangerous for the caregiver, who began to have shoulder pains.

I’ve been using the hoyer lift now for a month and it is working out well. It is not as scary as it looks in the film clip provided by the easy pivot people. Advantages: it is easier for the caregiver to use, CNAs are more likely to know how to use a hoyer lift than an easy pivot so less training is needed, it is easy to position me on the commode or in my wheelchair, repositioning is much easier, and it makes it possible to get someone up from the floor. I keep the sling under me all day, so the caregiver just has to put the loops on the hoyer lift and I’m ready to go. My lift is hydraulic rather than battery operated, and that works for me (I weigh about 170). I would recommend getting an alternate sling so one can be washed while the other is being used.

My hoyer lift was provided by hospice. I suspect that Medicare would pay for most of the cost of one.

What works for you?

Communication Devices

I knew what was coming in this area and I did a lot of research on communication devices. The ALSA assistive technology person was very helpful. Working with the VA, where I got my medical care, I had the opportunity to try out various devices. The one I liked the most was the Vanguard Vantage System (http://www.aroga.com/Com_Aids/ca_products_detail.asp?Item%20ID=2101). It gives you the choice of both a picture-based overlay and a word-based overlay. I found the picture overlay to be counterintuitive. I am told it is better for children. They are wired differently than us senior citizens. I used the WordCore overlay but I found it was quite difficult to program. Once the data was in the machine, though, it worked very well.

I was lucky to have my device provided by the VA. Does anyone know if Medicare covers this machine?

Has anyone else researched or does anyone currently use this machine? Any other devices with which you have had success?

Pix from October 2007 Walk to D'Feet ALS

This is my team (Tony's Trotters) at the 2007 DC Walk to D'Feet ALS. We had 50 members. Over the last three years we have raised $30,000.


This is my golf team buddy, Dahn Linkins, and his family. They have walked all three years.
This Ellen Cochrane and Hank Willner. Ellen runs the support groups and patient services at our local ALSA chapter. Hank is my hospice doctor. He has made ALS his "hobby." He is a fine golfer and we have a great time when he comes over.

8 Things I Would Rant About if I Had the Time

In 1961 Newton Minnow, head of the FCC, described television as a "vast wasteland." In a recent book, someone said something very similar about the internet. Major contributors to the terabytes of stuff include blogs, videos and spam. The first category of blogs is personal on which we are forced to read about what someone has for breakfast every day. The second category is the blogs that pass on jokes or links to feel-good sites. Another category fills the scene with pictures and videos ranging from the blatantly X-rated to the slightly cloying pictures of animals. Many blogs are socially redeemable. They are issue-specific and often include helpful information (hopefully like my blog) or express views that may be in the form of bleats, venting, rants, philippics, and even jeremiads. You may have thought from the title of this posting that I’m about to go on a rant, but you would be wrong. I don’t have the time to tell you about all of my pet peeves; I’m not going to be an Andy Rooney. Rants often provoke scathing replies and can trigger instant defamation of character, which can only be erased by hiring a special consultant. I am providing a Letterman-like laundry list of things that bother me. You can probably tell where I stand on these issues; however, by not expanding on any of them I hope I will be able to escape instant defamation of character.

Speed humps
Reality shows
Fearmongering
Traffic Calming devices

and finally the 4 greatest cons ever pulled on Americans:
SUVs
McMansions
Ethanol
Bottled Water