D Gary Grady

Review: Sense and Sensibility (1995 movie)

Posted on 2015-05-25 by GaryJuly 27, 2015

When Mr. Dashwood dies, his son inherits everything, and despite having made a deathbed promise to his dying father that he would look after his three half-sisters and his stepmother, the son lets his obnoxious wife convince him to turn them out with only a token income, so they find themselves suddenly reduced from wealth and comfort to bare survival.

Eldest daughter Elinor, a woman as intelligent, sensible, and emotionally reserved as her mother, is played very well by Emma Thompson, who also wrote the screenplay.

Before she and her sisters are actually evicted from their Sussex country estate, Elinor meets the brother of her half-brother’s aforementioned obnoxious wife. (Yes, these relationships do get a bit hard to follow. Then again, my car was once totaled by my ex-wife’s cousin’s ex-husband’s ex-wife. Let’s see Jane Austen top that.)

OK, let me try again: This is all happening in southern Regency England, in the early 1800s. Elinor’s father had a son with his first wife, and under the rules of primogeniture he’s the one who inherits the father’s home. After his first wife died the father had married again, and Elinor and her sisters are the children of Mr Dashwood and the second Mrs Dashwood. This makes the three younger offspring half-sisters to Mr Dashwood’s son by his previous wife. That son is married to a rather obnoxious woman who persuades him not to make any provision for his stepmother or half-sisters regardless of having promised his dying father that he would do so. Said obnoxious wife has a brother herself, and it’s that brother (a half-brother-in-law to Elinor?) that Elinor meets before being evicted along with her mother and two sisters from their previous home. I don’t know if that makes things any clearer, but I tried.

Anyway, the man Elinor meets, the brother to the obnoxious wife of her half-brother, is Edward Ferrars (Hugh Grant), who turns out to be nothing at all like his obnoxious sister. If anything, his personality has a great deal in common with Elinor’s, and they quickly become friends, which annoys his obnoxious sister and makes her even more obnoxious.

As I mentioned, Elinor has two sisters. The older of them, Marianne, is not much younger than Elinor and equally good-hearted but less rational and much more naive and romantic, basically the McCoy to Elinor’s Spock, though they get along rather better.

Margaret, the youngest Dashwood sister, is a little girl full of enthusiasm for maps, tree houses, travel, and adventure. (As I recall this was all invented for the movie; the original novel doesn’t have as much to say about the youngest sister.) Margaret shares Elinor’s good opinion of Edward Ferrars, getting him to teach her fencing and making plans for him to accompany her on her future adventures (possibly involving piracy on the high seas) as her assistant, with responsibility for such things as swabbing.

But Elinor’s budding romantic feelings and Margaret’s fencing lessons both end when Elinor, her mother, and her sisters have to relocate to a cottage in Devonshire generously provided them by a jovial, wealthy, and gossip-loving older couple who are somehow related to them, which isn’t surprising since pretty much everybody’s related to everybody one way or another.

There the middle sister Marianne (Kate Winslet) makes quite an impression on a neighbor, Col. Brandon (Alan Rickman), a well-to-do bachelor. Alas for him, the attraction isn’t mutual. Marianne thinks him too old and stodgy, and whatever hopes Col. Brandon might have entertained are crushed when she has a storm-tossed encounter with a dashing and handsome young hero, John Willoughby. In despair Col. Brandon changes his name to Snape and takes up the study of the dark arts, though I might be thinking of another movie. But Mr Willoughby might not be everything he seems.

Hugh Laurie has a small but memorable supporting role as another wealthy country gentleman whose chief form of exercise is rolling his eyes when his wife says something.

Unsurprisingly, given that it’s based on a novel by Jane Austen (her first published one, I think), the film is full of delightful romance, drama, and comedy, with plenty of interesting, well-realized characters, made even better by Thompson’s script. (It does commit a few minor historical errors, but they’re unlikely to be noticed. At least I didn’t notice them until they were pointed out.) Thompson is also immensely likable as the reserved Elinor, whose joys and sorrows we infer in spite of her Vulcan-like emotional reserve. The one time she breaks down and weeps openly, it’s all the more affecting for being so entirely out of character.

I enjoyed the film quite a lot, but I was sometimes confused (wait a minute, who is that character related to again?), so I watched it a second time and liked it even more. I’d love to see a series of adventure sequels featuring an older Margaret trying her hand at exploration, naval warfare, and the like.

Link: https://youtu.be/Ns17RQr1yK8

[Update multiple times within 48 hours of the original post in an effort to improve clarity and at least once since, not that it necessarily helped.]

Simple nutrition recommendations from Aaron Carroll

Posted on 2015-05-24 by GaryMay 20, 2015

Pediatrician, medical educator, researcher, and author Aaron Carroll MD — who somehow seems to have way more time than the rest of us — talks about simple nutrition guidelines for healthy people:

Link: https://youtu.be/PhEwfaFLrd0

You can read his New York Times article on the same subject here.

To summarize: He recommends that you prefer fresh food to processed and home cooking to eating out. Fat and salt aren’t bad in moderation. Don’t consume too many calories in liquid form. The conflicting nutritional advice reflects the difficulty of good nutritional research, plus the fact that many foods contain be contain both harmful and beneficial things. And of course people with food allergies and other reasons to restrict intake of specific things should pay attention to advice from their doctors.

Elsewhere (see for example this earlier post), Carroll has suggested that most people don’t need nutritional supplements and pointed to the fact that in many cases supplements don’t contain what they claim to do.

Evidence that bullying may be in decline

Posted on 2015-05-22 by GaryMay 26, 2015

For a number of years bullying has attracted a lot of attention, and schools have justifiably come under heavy criticism for not doing enough to stop it. The good news is that the pressure appears to have started producing some results. The problem is far from solved, but there’s evidence that it may — may — be starting to get better.

Every odd-numbered year the School Crime Supplement to the National Crime Victimization Survey polls students aged 12-18 all across the U.S. to ask about their experiences with various types of school-related crime in school. Since 2005 the questions have included bullying. In 2013, the most recent year, the percentage of students reporting being bullies was about 22 percent. It’s higher for girls than for boys by several percentage points. This is outrageously high and intolerable.

But the percentages in 2013 were also noticeably lower than in previous years: Reports of bullying peaked at 32 percent overall in 2007, and in 2005, 2009, and 2011 the number was about 28 percent. So 22 percent is a non-trivial reduction, even if still far too high in absolute terms.

The declined holds across almost all subgroups — for boys and girls, for every grade, for urban, suburban, and rural areas, and for blacks, whites, Asians, and Hispanics. The only exception is that overall bullying numbers actually went up a little in private schools, but that could possibly reflect a sampling error or other statistical fluke.

Of course, it’s also conceivable that the statistical fluke is in the rest of the numbers. Or maybe 2013 was an unusually low year as 2007 was an unusually high one. The report for 2015 will give us a better idea.

Incidentally, I’m once again getting this from a blog post by pediatrician Aaron Carroll. There a lots of links to source material and other commentary in his post.

As Dr Carroll notes, odds are the improvement won’t attract much attention in the news media. More press coverage may cause people to think the problem is getting worse, just as many people think that crime overall is rising whereas it actually peaked in the U.S. a little over 20 years ago and has since fallen to levels not seen in half a century. Excessive pessimism isn’t limited to perceptinos of crime rates. Many people think the U.S. federal budget deficit is increasing when it’s actually been falling faster than over any comparable period since the 1940s.

Jonathan Chait on anti-Obamacare “doomsday cult”

Posted on 2015-05-20 by GaryJuly 18, 2015

It occasionally happens that a fringe groups, often religious, will confidently predict the end of the world, and when the deadline passes and The End does not come, they have to deal with it. Some admit they were wrong. Some are confused and don’t know what to think. A lot of True Believers manage to convince themselves that they just got the date wrong, or that God gave them a brief reprieve perhaps as a reward for their own faithfulness, or even that The End really came after all, despite appearances, but just hasn’t fully manifested itself yet.

In an article published on the New York magazine website back on April 2 (link), Jonathan Chait likens some opponents of the Affordable Care Act (Obamacare) to the members of a failed doomsday cult who won’t give up.

His main example is a piece by Michael Tanner for National Review (link) that was published, appropriately enough, on April Fool’s Day. Not everything Tanner says is wrong, but a lost is at the very least seriously misleading.

For example, it’s true that some people ended up with more expensive policies than they had, and some people lost policies that they wanted to keep. But Tanner greatly overstates the number of people who lost coverage as a result of the ACA, and of course the net number of uninsured is today much smaller. He also neglects to note that the main reason some people are paying more is that they’re getting much better health insurance. Under the Affordable Care Act, insurance companies can no longer refuse to cover pre-existing conditions or arbitrarily cancel coverage for people who get something expensive to treat. Nor can they refuse to cover costs over a certain amount. It’s the customer whose out-of-pocket expenses are limited.

Moreover, many working people with individual health insurance are seeing both better coverage and lower prices thanks to subsidies for both health insurance premiums and, for lower-income people, help paying the uninsured part of their medical bills.

Tanner assumes that ACA has raised the cost of healthcare for employers and the government, but Chait points out that overall healthcare costs are in fact growing much more slowly than they had been doing prior to the ACA,. Indeed, the federal government has in fact ended up spending less on healthcare than it was projected to before the ACA was passed.

On the broader economic front, Tanner claims that higher costs have hurt economic growth, despite the fact that 2014, when the main provisions of the ACA first came into full effect, saw the fastest growth in the U.S. economy since 1999. Tanner also assumes that the ACA has led employers to push more workers into part-time jobs. It appears he’s relying on a predicted result of a provision that hasn’t actually taken effect yet, and in reality the share of part-time workers has gone down.

Tanner complains, “The potential impact on the quality of care remains troubling.” Maybe it is to him. Perhaps he’s worried that the ACA will prove so successful as to damage the Republican Party. I hope he doesn’t rate political advantage above healthcare, but some certainly have done so, as witness the statements quoted in this earlier post.)

In any case, there’s evidence the ACA is improving the quality of care. Since more people are insured and still more have better coverage, fewer are delaying care for financial reasons. In addition, improvements in hospital care promoted by a little-known part of the ACA have saved tens of thousands of lives (see this other recent post).

The ACA isn’t perfect and could be improved. For example, given that Medicare works pretty well and is rated higher than private insurance by those who have it, we could simply expand Medicare to cover everybody. Or we could adopt the Australian system or the Dutch one or the German one. By objective measures, many other developed countries have healthcare outcomes as good as or better than ours, and yet they spend a smaller total amount of money from all sources — businesses, individuals, and the government — than does the government alone in the U.S.

But given our political gridlock (and the complete failure of the Republicans to offer any alternative to the Affordable Care Act), the ACA seems to be for now the best we’re going to get.

Why hospital death rates jump in July

Posted on 2015-05-19 by GaryMay 18, 2015

In most U.S. teaching hospitals, medical students, interns, and residents move up to the next level in July. The same thing happens in the United Kingdom in August. According to a May 12 article from Politico (link), this makes July and August bad months to get seriously sick in those countries, because medical errors take an upward jump, by 6 to 8 percent in Britain and by 8 to 34 percent in the U.S.

(I’m vaguely reminded of something a resident in internal medicine at Duke told me back in the early 1980s: He’d received a phone call from an orthopedics resident who said he’d just given a patient 10 units of folderol, or whatever it was, and asked, “Was that a good idea?” The internal medicine resident replied, “Don’t do anything. I’ll be right there.”)

The article also mentions the fancier treatments VIPs can get. I have no particular problem with this provided the difference amounts to fancier accommodations that the hospital charges for and then uses the profit to provide better care for everyone. But it’s another matter when, for example, hospital staff is shifted from where they’re more needed to VIP floors to provide the rich with unnecessary one-on-one nursing. There are some people who think medical is just like any other service, but I think more of us are uncomfortable with the notion that middle class and poor people are less deserving of life-saving care.

The article is based on a book titled The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital by Alexandra Robbins, based largely on conversations with nurses, who probably know more about the realities of patient care than anybody.

Fortunately, though the article doesn’t mention it, there are people in the medical profession who do take these problems seriously and are trying to do something about them. The overall rate of hospital errors in the U.S. has declined, and that rate has accelerated because of some little-known provisions in the Affordable Care Act. (See this previous article.)

Bill Maher on British accents in movies

Posted on 2015-05-17 by GaryNovember 1, 2015

I recall that when Robin Hood: Prince of Thieves (1991) was released in 1991 a lot of people complained that the star in the title role, Kevin Costner, didn’t speak with a British accent. Of course, a few centuries ago the typical accent in England was probably as close to a modern American accent than any of the British accents we hear today, and Robin Hood, if he existed, might well have spoken Norman French at home (if he was a Norman nobleman as in some tales) and some form of early Middle English with the Anglo-Saxon common folk.

But in movies we have come to expect that everyone from medieval knights to ancient Greeks and Romans to characters in a fantasy universe (as with most of those in HBO’s Game of Thrones) speak with a British accent appropriate to their socioeconomic status. Here’s Bill Maher having some fun with that:

Link: https://youtu.be/fOWCnMwBJL0

On the other hand, American accents have become standard for some purposes. For example, I recall correctly, most of the actors on the television series Hercules: The Legendary Journeys (1995-1999) and Xena: Warrior Princess (1995-2001) had American accents even though both series were produced in New Zealand and many of the actors were from there or Australia. For that matter, many famous Australian actors such as Hugh Jackman, Chris and Liam Hemsworth, Cate Blanchett, Nicole Kidman, Mel Gibson, et al are much more often heard speaking with an American or British accent than with their native one.

Of course, if a character in an English-language film is supposed to be speaking another language ancient or modern or invented, it makes sense to have the character speak in English, and then they have to use some accent. There’s no such thing as unaccented English. (My father once asked someone he met in Paris if he was Australian, and when the man replied that he was, my father said, “I thought I recognized the accent,” and Australian smiled and said, “I haven’t got an accent, you’ve got an accent!”) What’s curious is that German characters supposedly speaking German, or French characters supposedly speaking French, will sometimes speak English with a German or French accent, which if you think about it is a bit odd.

Even odder, in the film Moon Over Parador (1988) Richard Dreyfus plays an American actor working on location in a fictitious Latin American country who has no problems pretending to be the country’s dictator, whom he happens to closely resemble, even in private conversations with the dictator’s friends and acquaintances. The implication is that the residents of Parador don’t speak Spanish, they just speak English with a Spanish accent.

Did the ACA’s hospital improvement efforts save 50,000 lives?

Posted on 2015-05-15 by GaryMay 28, 2015

What’s commonly called “Obamacare” is also known as the Affordable Care Act (ACA), but the full formal title is the Patient Protection and Affordable Care Act, a mouthful that makes it obvious why the shorter names are way more common in practice. But efforts at patient protection are indeed in the act as well as the name. That’s one of the reasons the text of the law is so notorious long: There’s a lot in there.

In a speech on March 25 (link) President Obama said the law is “a major reason why we’ve seen 50,000 fewer preventable patient deaths in hospitals.” That would be a remarkable achievement. It even sounds too good to be true.

But the figure turns out to be a reasonable estimate of lives saved since the law was passed, possibly even an underestimate. Not only that, but it’s likely that the reduction in harm also saved $12 billion in health care costs.

U.S. hospitals have long had a problem with preventable illnesses and injuries, and for some time there have been efforts to do something to reduce the numbers of them. The good news is that the statistics have been gradually improving for some time, and the rate of improvement seems to have accelerated thanks at least in part to provisions in the Affordable Care Act.

Both The Washington Post‘s Fact Checker column (link) and Politifact at the Tampa Bay Times (link) have looked into what Obama said. Their analyses go into some detail about how the figure was arrived at and what it means and what the Affordable Care Act has to do with the changes observed. Politifact reports that independent third parties find the the claim credible:

Lucian Leape, an adjunct professor of health policy at Harvard University’s T.H. Chan School of Public Health, told PolitiFact, “I think these data are reliable, and the ACA (Affordable Care Act) deserves credit.”

Leape, who has been studying preventable hospital deaths since the early 1990s, credited improved data collection and the work of Partnership for Patients, “which has been a serious – and successful – effort to engage hospitals in achieving specific goals, such as reducing infections.” He said it’s the kind of effort he and others called for a decade and a half ago but “never got before the ACA. Hospitals were improving their safety slowly on their own, and this gave it a big boost. It’s the first time we have seen measurable, significant decreases in any of the harms that we cause by treatment failures.”

David Nash, dean of the Jefferson School of Population Health in Philadelphia, agreed that the numbers are credible. “This is in part due to a huge amount of work on the part of hospitals,” Nash said.

Politifact rated the claim “Mostly True” except for a couple of what it called “fairly minor caveats” (because the president didn’t make it clear that the number was an estimate rather than an exact count and neglected to mention that the situation was slowly improving before the ACA took effect).

The Post’s Fact Checker normally rates the honesty of a statement with one to four “Pinocchios,” with one meaning “Some shading of the facts. Selective telling of the truth. Some omissions and exaggerations, but no outright falsehoods” and four applied to outright “Whoppers.” This time they awarded Obama’s statement a rare “Geppetto Checkmark,” reserved for claims judged to contain “the truth, the whole truth, and nothing but the truth.”

Healthcare Triage on nutritional supplements

Posted on 2015-05-13 by GaryMay 18, 2015

In case you didn’t already read this news back in early February, tests conducted by the state of New York found that very few herbal supplements they tested contained any at all of what they claimed to contain.

This brief video from pediatrician Aaron Carroll quickly summarizes what they found:

Link: https://youtu.be/TQI3dlQP5gI

For more, see reports from NPR (link) and The Washington Post (link).

If you want an even quicker overview, here it is:

On February 3 of this year, the New York State Attorney General’s office reported (link) that tests of herbal supplements sold by major retailers showed that only 21 percent had any at all of the herbal ingredient advertised on the label.

I repeat: If you bought one of those supplements, then on average four out of five times were getting absolutely none of what you thought you were buying. Instead you were getting ground up house plants or asparagus or heaven knows what. In fact, as Dr Carroll notes, at least one supplement contained wheat but was explicitly labeled “gluten free.” (Gluten is of course a protein found in wheat and related grains.)

Moreover, these weren’t supplements sold via spam emails or out of the back of a car; the ones tested were bought from GNC, Target, Walgreens, and Walmart, and they are almost certainly sold by other retailers as well. Of the supplements bought at Walmart, only 4 percent contained any detectable trace of the herbal ingredients listed on the label.

Speaking of supplements, see also Dr Carroll’s recent report about new studies on vitamin D.

Review: Hotel Transylvania (2012 movie)

Posted on 2015-05-13 by GaryMay 13, 2015

Dracula, who operates a resort hotel where monsters can vacation free from human persecution, invites his fellow famous monsters to the huge party he’s putting on for for his daughter Mavis’s 118th birthday. (Vampires must mature slowly, since she looks and acts 18.). Things are complicated by the arrival of a young American backpacker named Jonathan who naturally hits it off with Dracula’s daughter, much to the horror of Dracula.

There are some good laughs, and I particularly liked the wolf-man, who looks beaten down by life. (At one point he tells Dracula that only the youngest of his multitude of offspring still respects him.) On the other hand, I couldn’t understand what Mavis saw in the rather air-headed Jonathan, and I was annoyed by the film’s suggestion that a first infatuation is the only romantic love one can ever know.

A bunch of past and present Saturday Night Live writers and cast members teamed with Sony Picture Animation to produce this tolerably amusing if lightweight computer-animated quasi-romantic farce.

Link: https://youtu.be/q4RK3jY7AVk

Review: Frankenweenie (2012 movie)

Posted on 2015-05-12 by GaryMay 11, 2015

Back in 1984 a young Tim Burton directed a highly stylized half-hour live-action short for Disney, featuring Shelley Duvall and a number of other recognizable character actors, about a young suburban boy named Victor Frankenstein whose brings his beloved dog back from the dead with lightning. It was originally supposed to be distributed as a short with the re-release of Pinocchio, but it proved too upsetting to children at test screenings, and that led Disney to part company with Burton for a good while not long after.

Nearly 30 years later Burton produced this expanded version using stop-motion animation. The story takes place not in suburbia but in a strange town where the hero’s schoolmates resemble movie monsters and there’s a thunderstorm every night.

One day a creepy little girl tells Victor that her equally creepy cat dreamed about him the previous night. She knows this, she explains, because she found Victor’s initial in the cat box, something that has always been harbinger of a major event for good or ill in the life of the person so identified. And so it is for Victor: His beloved dog Sparky is killed in an accident later that day. But when the science teacher (who looks a bit like Vincent Price) demonstrates how electricity can produce muscle twitches in a dead frog, Victor sees a way to bring Sparky back.

There’s some funny material here, and the stylized characters, a little in the spirit of Charles Addams, are well executed. In the end I liked it more than I disliked it, but in a lot of ways it’s rather disturbing.

Link: https://youtu.be/H1yR-gEldC4