Monthly Archives: January 2011

Beautiful code, ugly fonts, and the architecture of diplomacy

In this podcast, we have a story from California-based freelancer Corey Takahashi on a new exhibit in Silicon Valley that traces the history of computers and their languages.  When Corey and I talked about how to approach this story, we decided that language was the key. Computer programming languages are world-famous among computer programmers, but almost completely unknown to the rest of us. I mean, have you heard of Fortran? Have these languages developed the same way as other languages, acquiring grammatical rules, then  breaking them? Is there such a thing as beautiful code, worthy of our gaze in a museum?

Also, new research suggests that hard-to-read typographical fonts may help us remember the ideas they spell out. Jonah Lehrer spoke to the BBC about this. He writes a blog for Wired on neuroscience. Last September he wrote a post about using his kindle. He found the kindle-reading to be incredibly comfortable and easy — maybe too easy.  More recently he noted that new research appears to confim that hunch. It suggests that we are less likely retain information if it is written in a clear, easy-to-read typeface like Clearview:



Maybe we should all switch to a font like Lucinda Blackletter. OK, maybe not on the roads, but in classrooms:

Part 3 of the pod concerns the architectural grammar of the United Nations Security Council. The design layout of the Council’s chamber and adjourning rooms is considered so important that replicas have been constructed during refurbishment.


Our man in New York Alex Gallafent does a fantastic job of turning a tour of the temporary chambers into an audio history of how architecture and design have shaped the history of UN Security Council.

Listen in iTunes or here.


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Political language before and after Tucson

After the Tucson shootings, we hear from Dutch and German journalists about political discourse and violence in their countries.

Like many Europeans, the Dutch used to think of their country as less violent than the United States, in both word and deed. That’s no longer the case, after the street assassinations of politician Pim Fortuyn and film director Theo van Gogh. After Fortuyn’s murder in 2002,  the political left came under fire for the tone of their verbal attacks on Fortuyn, who was a populist right-winger — something of a foreshadowing of the Tucson shootings, albeit with the politics of the accused and accusers switched.

In Germany, political discourse is far more subdued. There is, of course, a historical reason for that:  hate-mongering speech during  1920s and 1930s that led to political assassinations, firebombings and the rise of the Nazis. Moreover, there are certain things in Germany that you cannot say;  most famouly, you cannot by law deny the Holocaust. Also, libel law is more stringent than in the United States. Josef Joffe, the German journalist we talk to,  says that as a result, German political rhetoric today is “almost boring.”

Sarah Palin’s equivalent in Germany — should such a person ever exist — almost definitely would not have used the term blood libel. With its Jewish associations it would have been beyond the pale. It was strange enough to hear it in the United States. Defending herself against charges that her own harsh language contributed to the Tucson shootings, Palin said journalists and pundits were “manufactur[ing] a blood libel.” See her video message here.

Historically, as my colleague Alex Gallafent reports, blood libel is a “false accusation that Jews murder others in order to use their blood in ceremonies.”  This form of anti-Semitism goes back centuries. After the false accusation was made, more extreme rhetoric followed, often ending in ethnic violence.  Sarah Palin’s use of the term seems misplaced, insofar as she is neither Jewish nor is she accused of orchestrating or relishing the death of anyone. Still, it did draw attention to Sarah Palin, which may have been the point.  It meant that Barack Obama’s oratory at a memorial ceremony inTucson later that day, while receiving high marks, did not get the banner headline coverage than it might otherwise have done.

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Teach yourself Babylonian, and teach the Ashes to the Ashes

A couple of weeks ago, a listener to the podcast asked whether I’d ever featured the Isleños,  the Canary Island Spanish of Louisiana. The answer then was no —  but now it is yes.  It comes from the Big Show and reporter Bruce Wallace.

The piece explores the Isleños — fishermen descendents of  Canary Island immigrants — and their “lost songs”: songs dating back decades, and perhaps longer in some cases, sung in the décima form of 16th century Spain. Hurricane Katrina and the BP oil spill have played havoc with the Isleños’ lives:  many were evacuated in the wake of Katrina, and then their fishing waters were polluted by the spill.

There are more songs here, as well as a story told by an Isleño about exterminating bugs.

Next in the pod, an interview with Mr Ancient Babylonian, Martin Worthington. Worthington, of Cambridge University, has assembled an audio archive of Babylonian poems. He’s also written a Teach Yourself book on Babylonian.  Splendidly useless, Babylonian. Won’t get anyone into business school.

We also have a conversation with a Squamish Nation chief on the original name for Stanley Park in Vancouver. The Squamish are campaigning for the park to be re-named Xwayxway. Not going to happen any time soon.

Finally, the Ashes: a story of cricket, Twitter, and babysitting. This is how a 22-year nanny from Massachusetts nicknamed The Ashes came to attract a Twitter following of thousands of cricket fans — cricket’s fiercest rivalry, Australia vs. England is known as The Ashes. The woman, Ashley Kerekes, ended up being flown to Australia on an all-expenses-paid vacation. She went to matches, learned the rules of cricket and met the stars (and the Aussie prime minister).  You can read the highlights of her Twitter feed here.

Listen in iTunes or here.

Photos:  Los Isleños Festival, St Bernard Parish, Louisiana (Alysha Jordan/Flickr); Peter Graham (Stanley Park/Wikipedia).


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Tuareg tales and the R word

The first pod story of 2011 comes from Mali, where a group of people are trying to use storytelling to preserve the Tamasheq language. The language is spoken by a dwindling number of the nomadic Tuareg people.

That’s followed by a conversation about the merits of the King James Bible, which turns 400 in 2011. In secular Britain, those merits aren’t strictly religious. In fact, people like former UK poet laureate Andrew Motion view the King James Bible as a literary giant, second only perhaps to Shakespeare. He argues that we are fast forgetting how it has shaped English-language poetry, fiction and rhetoric.

Then, the main event: the R word.  Or perhaps the R-rated word: rationing. For manyAmericans, the idea of rationing is, well, unAmerican. In Britain though, rationing is part of the national psyche: it got the country through two world wars, and its collectivist values are at the core of Britain’s government-run health service. Now though, the emergence of expensive, new end-of-life drugs are challenging Brits’ belief in rationing.

During World War II and for nine years after, the British government rationed most food items: meat, flour, eggs, sugar. The government also strictly controlled the supply of gasoline, soap, stockings—even the number of buttons on jackets.

Although there was wartime rationing elsewhere, including in the United States, it generally applied to fewer items over fewer years and was quickly forgotten. In Britain, however, rationing became a part of the national identity.

Many older Britons speak of rationing as a great legacy of those wartime and post-war years, when people sacrificed their own interests for the greater good.

After World War II, the British government extended this societal approach to health care. It created the National Health Service, the NHS.

Today, 95 percent of Britons get their care through the government-run program. In order to provide care to everyone, the government says it must place limits on the care it provides. It must ration.

Limits to Care

“We have a limited budget for health care, voted by Parliament every year, and we have to live within our means,” said Michael Rawlins, chairman of a government agency called the National Institute for Health and Clinical Excellence (NICE).

NICE decides which drugs and other treatments can be prescribed by NHS doctors.

NICE was created in 1999 to clarify the reasons why certain drugs are approved and others are rejected. “In the old days it used to be done in secret, behind closed doors, in smoke-filled rooms,” Rawlins said. “Now it’s explicit. Everybody knows what the rules are.”

NICE’s rationing decisions start with a basic premise: The government should spend its limited resources on treatments that do the most good for the money. NICE calculates cost-effectiveness with a widely used measure called a quality-adjusted life year (QALY).

In essence, NICE asks these questions: How much does a drug or procedure cost? How much does the treatment extend the average patient’s life? And what is the quality of that life gained?

The calculations are complicated, but imagine that a cancer treatment costs $100,000 and that it extends the life of the average patient by four years. That means the cost of the treatment per year gained is $25,000.

Now imagine that for part of those four years the patient will be in pain and bedridden. NICE might figure the quality of that life at 50 percent of perfect health. Under NICE’s formula, that would make the drug half as cost-effective. In other words, the result would be $50,000 per quality-adjusted year gained.

NICE has set a maximum that it will spend on a treatment: about $47,000 per quality-adjusted year gained.

NICE tends to assume, without always performing calculations, that most common treatments are cost effective—including insulin for diabetes, cholesterol-lowering drugs for heart disease, and kidney transplants.

Instead, NICE analyzes only selected therapies, such as expensive new drugs that may extend life at the end of life. It has calculated that some of the more expensive drugs meant to slow the progression of Alzheimer’s Disease and some cancers fall below the cost-effectiveness threshold. In such cases, NICE says, the NHS shouldn’t pay for the drugs.

NICE chairman Michael Rawlins acknowledged that his agency’s decisions deprive some patients of drugs that may extend their lives by several months or more.

“We do recognize that the end of life is a very special time,” Rawlins said. “[It] allows people to attend weddings, see a grandchild born, seek forgivenesses.”

But he argued that if Britain spends a lot of money at the end of life, “we’re going to have to deprive other people of cost-effective care.” Rawlins said that might mean spending less money at the beginning of life—and might result in a higher infant mortality rate.

A Cancer Patient Fights Back

“Imagine how I feel when I hear people saying that if they give me the drugs I need to stay alive, babies are dying,” said David Cook, one of a growing number of British cancer patients speaking out against NICE and its rationing formula.

While sipping strong English tea in his village farmhouse kitchen, Cook argued that NICE’s logic breaks down when you go from the abstract formula to specific patients—like him.

A senior government manager in his fifties, Cook was diagnosed with kidney cancer in 2004. Two years later his prognosis was bad.

Cook’s doctor said he would die within months unless he got a drug to slow the growth of his tumors. But the cost of the drug was high—too high for NICE in light of the advanced stage of Cook’s cancer—and the NHS refused to pay for it.

Cook fought back. He contended that NICE’s rationing formula calculates cost-effectiveness based on the average patient, but individual patients might do better on a given treatment, which would make the drug more cost effective than NICE suggests. Cook’s doctor believed that was true for him, so Cook pleaded his case before a panel of experts.

“I had to persuade a total of six people that were in the room” he said. “I had to talk for my life.” Cook won his appeal—he got the drug—but he resented that he had to fight for it, that he was treated as an exception.

Cook has other complaints about NICE.

He says the agency treats patients inequitably; it is more likely to reject drugs for rarer cancers like his because the treatments are more expensive than those, say, for breast cancer or lung cancer. “We’re being penalized for having…the ‘wrong’ type of cancer,” he said.

Cook contends that NICE overreaches by measuring the quality of a patient’s life. He said it should not be up to bureaucrats to decide that the life of a bedridden patient, for instance, is worth a quarter or a half that of someone in perfect health.

Cook further argues that NICE neglects an important fact—that by helping a patient live longer, a drug may improve not only that patient’s life but also the lives of loved ones. For his part, Cook remains active and working and has helped care for his wife, who has been diagnosed with breast cancer.

Public Backlash

Stories like David Cook’s—about the government restricting access to life-saving drugs—have become common in the British media.

Part of the reason is that many new cancer drugs have become available in the last few years, and some of these drugs are extremely expensive.

NICE’s rejection of such drugs has fueled a growing backlash against the agency. Patient groups and drug companies have called it heartless and indiscriminate.

NICE’s future now hangs in the balance.

In May 2010, Britain’s ruling Labour Party, which founded the agency, lost a general election. The new Conservative-led government has said it will establish a cancer fund, totaling more than $300 million a year, to pay for some cancer drugs turned down by NICE.

This comes at a time of economic crisis in Britain. The government is making large cuts in just about every other public service.

Health economist Alan Maynard of the University of York said it may seem compassionate to set up a cancer fund, but it undermines NICE at a time when the country needs to be reminded of the value of rationing.

These days in Britain, few speak favorably about an agency that was set up to ensure that the government could provide the best care to the most people.

“NICE is not very popular,” said writer Lionel Shriver. “I may be the only fan of NICE in the country. After all, it’s the organization that says ‘no.’”

Shriver is an American who lives in London. Her latest novel, So Much for That, is about the U.S. health care system and how, in her view, it failed a woman who was dying of cancer.  Shriver said her novel would have turned out “drastically differently” if she’d been writing about the British health care system.

The novel follows a character who has mesothelioma, a rare but deadly disease that is usually caused by exposure to asbestos. The character is partially based on a close friend of Shriver’s who lived 15 months after being diagnosed with mesothelioma. Shriver says her friend’s treatment cost $2 million.

“If she had been in the UK, that character would have been given palliative care alone,” said Shriver. “They would have tried to keep her comfortable and out of pain, but they would have skipped the major surgery. They would have skipped all that excruciating chemotherapy.”

“I think that my character and indeed my friend would have been better off in the United Kingdom,” Shriver said.

A Model for Other Countries?

Britain’s medical rationing has been noticed around the world. A steady stream of health officials from countries like Brazil, China, and Poland have visited NICE to see if setting up a rationing agency along similar lines makes sense for them.

Some American health care experts wanted to establish an agency like NICE as part of reforming the U.S. health care system. But after Sarah Palin cited Britain as the inspiration for what she claimed was an Obama Administration plan for “death panels,” that idea was dropped.

In fact, in this year’s health care reform law, Congress specifically prohibited British-style rationing. Medicare, for example, cannot apply quality-of-life tests in determining the cost-effectiveness of treatments.

Lionel Shiver is not pleased with that outcome. She said Americans still don’t seem ready to focus on some key end-of-life questions. “At least in the UK we’re having the conversation. How much is a life worth? And what kind of quality of life is that?”

But as other countries look to Britain as a model, it’s far from clear that the model itself will survive.

And that begs the question: Can explicit health care rationing work anywhere if it’s in trouble in the very country that may be best equipped to take it on?

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