Categories: "Society" or "Bank of America" or "Magyar Hírlap és cigánykérdés" or "Outsourced Customer Support" or "Stem Cells" or "Tolerancia" or "Verizon: My Battle w/ the Behemoth"

Of Dinosaurs and Bigots

Link: http://en.wikipedia.org/wiki/American_Museum_of_Natural_History

I have been a member of the American Museum of Natural History. I think it is an amazing place. Every time I go, there is a nice crowd, with lots of kids, mostly mesmerized by all the incredible sights: dinosaurs, giant sloths, ancient fishes, and display of the mind-boggling variety of current species, arranged by taxonomic order.

I support the Museum; I consider that a worthy cause. I think the Museum itself is amazing (see link on Wikipedia: http://en.wikipedia.org/wiki/American_Museum_of_Natural_History). The story how the elder Roosevelt (the president's dad) helped Albert S. Bickmore's vision become a reality.

Today, the Museum is one of the biggest of any museum, of the entire world. It's staggering size is only surpassed by the breathtaking beauty and diversity of the exhibits. The diversity, which is reflective of the amazing diversity of our Earth, due to the plants and animals that populate it.

Evolution, driven by natural selection (first realized and shared with the rest of us by the genius Charles Darwin), is everywhere. You cannot look at all these exhibits and not see that. This is the 32 million specimen testimonial to evolution, driven by natural selection. Another genius of evolutionary biology, Stephen Jay Gould (who BTW built a career on the theory of punctuated equilibrium, which is contrasted to phyletic gradualism or gradual pace in evolution, more or less what Darwin seemed to have believed). Gould, as a child, spent time in the Museum and I don't think it is far-fetched to suggest we can largely thank the Museum for the inspiration that ultimately helped create the genius of Gould, who is one of my heroes (besides of course Darwin).

As I was going through the fantastic exhibits of the Museum and saw the children with apparent natural joy and fascination with the animals, present and past. I could not help ask myself: would those that deny evolution (who tell their kids that the world was created by god in 7 days and no more than 10,000 years ago) let their children fully delve themselves into these joys? Or would they view the astonishing display of biological diversity these exhibits offer as evil that bother them for being ideologically "wrong"? As if nature is wrong?

I don't know. But as a parent I certainly cannot imagine any ideological agenda to take away such joy from my kids; the discovery that is one of our core values as humans, the opening of their minds. I don't think any caring and loving parent should let anything compromise all that.

I feel something may be wrong with blocking and meddling with science when it comes to kids, interfering with the way they could acquire the beauty of this world we happen to live in. Crippling the future objective vision of these kids, who are in a fertile age and can absorb anything. Of course we do have much bigger problems, poverty, suffering, disease, etc. But blocking our future generations chance to become free-minded scientists and thus the ability to tackle our future scientific challenges is a great liability. Who knows how many Stephen Jay Goulds (or Charles Darwins, for that matter), Nobel prize winners, discoverers of new therapies, pioneers of biotechnological breakthroughs those bigots have managed to let never be, taking away their chance to be inspired by those dinosaurs and the fascinating diversity of biology as shown in the American Museum of Natural History.

"Popular Vote" Anyone?

Link: http://www.newsday.com/news/nation/obama-romney-race-enters-last-100-days-1.3867423

I am just reading around about the elections this year. I have not voted ever, either in the US or in my native Hungary, either for local or for general elections, except for 1990 when Hungary had their first free elections. Generally, I never believed that my vote could make a difference. First, because it has such a minuscule effect on the final count; but second, more importantly, even if I had the power to decide between party A versus party B candidates, what difference really would party A make against party B and vice versa? Nothing. They are all just politicians who will say whatever gets them elected and then pursue their own agenda, whatever that may be, and try to mislead their electorate about that in a highly sophisticated manner. In fact it is so sophisticated and thus requiring so much time, effort, and resources, that current democratic politics is all about the reelection for those in office and not really work toward long-term goals to actually help their voters' causes. Who cares about long term? If you are removed from office at the next elections, then long-term is irrelevant. So it is irrelevant. And that is why we will never get things right in this system. But anyway, that's not what I wanted to discuss, even though that's a good discussion for another day.

What I was mulling about is the issue of the "popular vote". Well, I am actually a permanent resident, eligible to apply for US citizenship. I am excited about that, even though I have been so busy I really did not have time to think about the application. That's despite having been eligible for years now (although not quite yet at the last presidential election). Now, considering this is an election year, I toyed with the idea to get my citizenship in place by election day so I can vote. Not because my generally negative opinion about the significance of voting has changed, but just as I voted once in my life in 1990 for the sake of history, this could be historical. Back in 1990 I became eligible to vote for the first time in Hungary (with everyone else there) and now I could be eligible to vote for the first time in the US.

When I discussed this with my immigration attorney, he pointed out that I should really not sweat it, in terms of elections, as my vote in Maryland would make no difference anyway. MD is likely going to be going strongly democrat and isn't considered one of the 9 swing states where the elections are expected to be decided (see attached article). Then I recalled the infamous Gore-Bush election when it was announced that Bush won after all (although it depends on your point of view), but also that Gore won the "popular vote".

Excuse me? The US electoral system discards people's vote, their right to vote, just because their state is strongly going one or the other way? Then it doesn't really count toward the final tally? Once a district is won by a candidate, then it matters none how strongly. In effect, many people could be like me: they can vote if they want to, but that really does not make any difference in a non-swing state.

I wonder how nobody is outraged by this to the point of wanting to overhaul it. Clearly, all what should matter is the popular vote. If this is one country, which they say it is, then states and districts should not represent themselves as a whole but have each of their voting citizens represent themselves as individuals, period.

Anyhow, it looks like I won't have my citizenship ready by elections anyway, as nothing has been filed up to now or even getting ready for that. So the time certainly will be too short for my paperwork to go through in time for the elections. But, as my lawyer suggested, I won't really bother about the fact that means I cannot vote in November, because turns out my vote would not have made the slightest difference anyway, thanks to the system that uses the "popular vote" as some curiosity as opposed to what it absolutely deserves: to be the only kind of vote to decide the next president of the United States.

Aurora: There Will Be More (Unfortunately)

Link: http://www.huffingtonpost.com/robert-v-taylor/aurora-no-more_b_1691814.html

...and there isn't much you can do about it. That's more than upsetting. It is horrible. But this is one of the aberrations of our society, the "democracy" we love, the American history, and human nature.

The link on Huffingtonpost is to an article by Robert Taylor to ask your advocacy, with a title "Aurora: No More". But realistically, as much as I wish advocacy could help, it is a lost cause. Politicians operate by polls, liability, and their perception what gets them re-elected. That's why gay marriage is becoming interesting, electorally speaking, as the public polls cut it right around the middle, 50%. Therefore, you cannot safely bank on either side for political gains any more. I suspect the gay marriage issue, as much as it is so intriguing to most, will be marginalized and pushed off of the top of electoral rhetoric (which I think is good, because this issue, while important to an important minority, definitely isn't the most critical issue we have to spend a lot of time addressing).

Not so with gun control. In this case the split is NOT in the middle, but per latest polls only about 44% of people support stricter gun laws and declining (there may be a transient surge as a result of each mass murder committed by a psycho with "legally" obtained guns, but the general trend is downward). Which is a clear and unconditional victory for the gun lobby.

To somebody who grew up in a country where guns were essentially outlawed and thus gun violence was essentially non-existent, on the surface it is baffling how in the face of incomprehensible tragedies there isn't a massive outcry, uprising, and riots for profoundly stricter gun controls on the federal level. How one tragedy like this after the other, getting only greater in their scope, won't produce a reaction of sense, humanity, and reason (which is a society wide full and uncompromising overhaul of gun laws).

But then again, we are dealing with the US population, bred increasingly on a culture of hate and intolerance, and justified violence. It is honorable to kill fellow humans, for whatever reason, in another country, as long as they are labelled by somebody as "enemy combatant" or something like that. We encourage violence as long as it is directed against foreign cultures and "dictators" we decide are against our values or (in our assessment) are trying to destroy us. (Don't get me wrong, I do realize we have to defend our interests and that there really are people who are trying to hurt us, but then how we deal with them is what the major decision point is.)

That culture, i.e. encouraging and honoring the killing other humans as long as that happens under an arbitrarily established set of circumstances, plus the romanticizing of violence in pop culture will definitely mess up minds. BTW on that notion of circumstances, the soldier who went on a rampage killing residents randomly (including women and children) got confused and probably still does not get it why he isn't a hero instead of a villain some now try to label him (and investigate, criminalize him, etc).

Unfortunately, looking at the 44% figure, if you follow Mr. Taylor's advice and do the right thing to call your representative, even if all the 44% of us will do (who support tougher gun control laws), we will still be weighed, in the eye of our representative, against the other 56% of constituents, who are against tough gun laws. You do the math. Of course this is not as simple as this, as that 44% figure is from a national poll. I am sure in Colorado we are probably looking at a sub-10% figure.

Why would a senate or house of representatives candidate listen to you, preparing their next campaign, when they know promising an agenda toward tougher gun laws would surely mean a good number of lost votes going (as the majority is against tightening gun laws) and in fact could even effectively mean a lost seat (and what else can matter more). Or why would either of the presidential candidates take this on? To save human lives? To start creating a culture of sense and humanity? Are you kidding me? With this electorate and what they feel about stricter gun laws, it would be a stupid move, possibly a political suicide attempt to step up there and advocate tightening gun control.

As pessimistic that sounds, I suggest that calling your representative is not the only thing you can do. I think we can only help this society if we educate and ultimately change the culture of guns, the minds and hearts. There is no other way in the present construct. You could litigate this through courts, doing the right thing against public majority opinion, like what's happening with gay marriage (assuming opponents are still is a slight majority), but there the constitution is on the right side. In terms of gun control, it is on the wrong side.

You can write about this (like what I am doing), talk to people, discuss, educate, fund related causes, whatever you can do. Like the public opinion changed so much on gay marriage, it can happen with gun controls, too. That will likely take years and many massacres, but that's what will have to happen, I don't see an easier way out of this.

Another Communication Gem with BoA

I would like to share a "secure" email exchange I recently had with BoA customer support as I think it is humorous. It relates to the fact they closed my savings account without my knowledge or consent. I just logged in one day and found that my account was gone. I thought this was some sort of an error or display issue, so I sent them an email. I am not enclosing all of the initial ones, only the most recent ones. Basically they informed me that due to zero balance and no account activity, they closed my account. They maintained they mailed me a letter a month before closing the account. I confirmed they have my correct postal address on file. I never received any letter from them about this.

The issue is of course not a big one, as far as my Savings Account is concerned. I cannot care less if I have that account or not, I don't even remember why and when I opened it, I most certainly have not been using it (if I have to save money, I can transfer to other accounts with higher yield than BoA savings). The fact they would just close it without my consent is another matter. It is not that I am a lost, deadbeat, inactive loser-user, who cannot be found or barely uses his accounts. I also have 2 credit card accounts with ample activity, plus my main checking account is also linked, with at least $25k cash flow monthly, including direct deposit, etc. I would think I deserve a bit more attention and respect than unilaterally intruding my finances and closing accounts for me, WITHOUT making sure I know and am OK with that or offering/discussing an alternative.

But even more bothersome or interesting (depending on your point of view), which ultimately is why I decided to write, their response to this fiasco is highly typical. Instead of owning up to it, offering to reopen the account, or at least apologizing, they go out and insult my intelligence with heavy and deep BS.

The moral of the story is two-fold. First, even though banks may be offering email customer service it isn't worth very much. I have posted some of these emails on other matters in the past and 90% of the time their agents are either do not get it what your problem is or they do not want to get it. One way or another, you are no better off, after wasting time emailing. They are probably disincentivized escalating matters as that could negatively affect their performance measures or bonus, whatever. They try to "solve" the problem, but without the experience, intelligence, or authority that would be needed to help.

Second, if it is true they mailed something and for some reason it was lost and wasn't delivered (if you would like to give them the benefit of the doubt), then they have an insufficient system in place for a number of reasons. First, I have fully digital banking, for years I have not received any statements or anything, I manage everything on-line and all notifications and correspondence comes by email. Why on earth would they then send a snail mail over this relatively important matter? Also, it would seem to me that closing an account would warrant some confirmation; some proof that they actually reached me. Keeping the account alive until I get back and confirm that is OK probably is more costly to them by 15 cents than just closing it and worry later about the possibility the customer never got the note. That is the customer's problem, not the bank's. Which likely what happened here. They saved 15 cents up front, but then my many emails, even if handled by a barely literate $5/hour worker some distant part of the world, probably created more than 15 cents in cost, so it may just be another example of trying to cut costs mindlessly in the short term eventually ends up costing more. I am not a business analyst therefore it is also possible that I am only one in 10 customers causing a stir (and thus extra cost in the back end) and overall it still makes sense to them to save the 15 up front...

"Subj: RE: Other Online Banking Features

Dear Zoltan Mari,

Thank you for your inquiry dated 2/22/2012 regarding the closed account. We will be happy to assist you.

We apologize for the inconvenience in resolving this matter via email. You are a valued customer, and we would like the opportunity to retain your relationship with Bank of America.

Please be informed that we are unable to assist you regarding your closed account. To assist you better please contact us on 1.800.432.1000. We are available 7 a.m. to 10 p.m. Monday through Friday 8 a.m. to 5 p.m. Saturday and Sunday Local Time.

We value you as a customer and appreciate your business. If we may be of further assistance, please contact us again by email. Thank you for choosing Bank of America.

Sincerely,

Aayan Kites
Bank of America

-----Original Message-----
Hi,

I did not know that policy. I really wish you notified me before you are closing any of my accounts without my permission or even notification. That actually is rather drastic and I am baffled. I don't really need that savings account, so it is not a big deal, I only used it occasionally, but the fact you would even do such a thing, not even letting me know (please allow me to not eat the BS that you sent anything, I check my snail mail every day, I did not get any letter, plus you obviously have my phone number and email address, so it is bizarre to propose you cannot reach me). Anyway, it is a bit of an insult to my intelligence what you are saying (that you mailed anything), I am sorry. You did not mail anything as I would have received it if you had. Besides, if you wanted to reach me you could have. What happened is you closed my account without my consent or knowledge and you should acknowledge it like a man, rather than coming up with BS stories like you mailed !
me about it. Please.
ZM

---------Reply Separator---------

Dear Zoltan Mari,

Thank you for your inquiry dated 02/18/12 regarding the closure of your account. We are committed to provide you with the best banking experience possible and we will be happy to assist you.

We understand that you are concerned with the closure of your account.

Please be advised that accounts in a zero balance are closed after three months of inactivity.

When the account is inactive for two consecutive months, a letter is sent to your home address indicating that a deposit must be made in order to avoid closure.

We apologize for any inconvenience that this may cause. We value you as a customer and appreciate your business. If we may be of further assistance, please contact us again by e-mail. Thank you for choosing Bank of America.

Sincerely,

Alejandro Cabezas
Bank of America "

Spine Surgery in Community Hospitals: Outcomes Please?

First of all, I would like to declare that my utmost respect goes to all my surgery colleagues who are solely driven by their professional mandates, care only about the well-being of their patients, and practice accordingly. Undoubtedly, this most certainly applies to all my neurosurgery colleagues at Hopkins and likely at other academic institutions. Second, I don't mean to come across as elitist or anything like that, so I would also like to extend my appreciation to surgery colleagues in ANY hospital, institution, geographical territory, or organizational level who operate according to the above principles. However, years of practicing as a neurologist, plus to some extent my own experience as a patient as well as stories by friends, made me wonder if some of my personal observations are actually trying to show or adding up to something relevant.

This is a blog and not a scientific work. Also, as you can see on the main page, none of this is in any way related to my daytime job or shared by Hopkins or anyone in particular or anything organizationally related to Hopkins. The opinions are solely mine, an individual with a personal blog.

Here is the essence of my observations. I have yet to see (or hear of) a single neck pain/back pain patient that experienced lasting clinical improvement from any spine surgery performed in the setting of community hospitals and the like. I am not talking about the obvious cases, with trauma, abscess, tumor, etc. I am talking about those patients who complain of neck pain and/or back pain, get imaged, and then on the MRI some degenerative disc disease (DJD) or spondylosis will show and, perhaps, to the point that there is (usually) "moderate" narrowing of the spinal canal or the foramina. Usually at multiple levels. Typically with no significant (or just minimal) impingement on the cord and/or the routes.

Chances are if you image the spine of 100 random people off the street in their 60s and older, at least 51 of them (if not more) will have some degree of DJD (and even some impingement if you really want to see it that way). If something is so prevalent (and obviously not causing much of any symptoms in most) then the causal connection of back pains and neck pains to these changes is already highly questionable. But what is even more questionable is how at the community level we go about managing these symptoms...

I have seen so many times that the community neurosurgeon, after reviewing those MRIs and allegedly examining the patient, will conclude that he is very pessimistic about the outcome of conservative management options, which, in his opinion, have been "exhausted". And then the nature of the procedure, the risks, etc have been explained to the patient, blah blah blah.

Then the surgery is scheduled, if the patient is fortunate nothing really bad happens (such as screws breaching the spinal canal or the foramina), the patient recovers and finds that they are either no better (or sometimes worse) and a revision is immediately necessary (typically multiple) OR they are better, but that doesn't last long. I have seen hundreds of patients with history of back or neck pain who underwent one of these decompressive spine surgeries, with the overwhelming majority needing additional surgeries down the line, and none with a lasting improvement.

So what is happening here?? There seems to be some form of a symbiosis of sorts, where both parties get something out of it. This may sound like a blasphemic or at least harebrained idea, but considering I have seen a lot of psychosomatic issues from the neurology/movement disorder perspective, I think it is not implausible. Pain is a subjective complaint and we doctors all take patients' words at face value on reports of pain, and we should. However, what if some of the back pain and neck pain (especially when following some work or other external party liability related injury) represents at least in part a psychosomatic component. Of course that can never be either proven or ruled out, but for the sake of assumption let's say that's the case. What would be this patient's prime interest? Obviously to have objective proof or record showing their illness is valid, "organic", and evident to anyone with medical and medico-legal expertise. Will MRI deliver such proof? Well, not necessarily. What if it only shows those rather banal, minimal to moderate, changes that the majority of the 60+ (but perhaps even 50+) population has (mostly without any symptoms). Clearly, not all physicians would unequivocally conclude that this is THE proof. There would be skeptics. And if there is a medico-legal or other type of review where such skeptics are abound, then the evidence may even look weaker.

How about surgery then? Well, then we are talking about a whole different level. Surgery sounds like a good proof... To even propose that a surgery was "unnecessary", skeptics would need not only to be much bolder, they actually should have strong proof to that effect (i.e. the surgery was unnecessary). So is there a way to have such strong proof (that a surgery was unnecessary), after those rather unimpressive MRI changes, unimpressive physical exam findings, AFTER the surgery? There is absolutely no way to do that. In fact, assuming the patient after the surgery reports (temporary) improvement in pain, there actually seems to be proof to the contrary. In other words, the fact somebody was willing to operate this patient WILL de facto provide THE evidence needed to prove their illness was "legit", i.e. organic.

So now you can see how the patient "benefits" from this symbiotic relationship, usually not realizing that their "improvement" (which is temporary) is only a placebo effect and probably would be exactly the same had they had "sham" surgery (i.e. opening up the wound but actually not doing anything to the spine).

What is it in for the surgeon then? That is why I singled out community hospitals. In community hospitals surgeons are absolutely incentivized to operate. The more, the better: the greater their income, the more secure their job, the better their leverage when negotiating about anything with their management/administration, etc. In other words, their greatest currency is their volume. If they see a patient, who is desperate to have a surgery, either because they just want to do anything to get rid of their (psychosomatic or not) pain and not knowing better that the surgery is not the panacea for their pain OR in order to get the ultimate stamp proving that their problem is "legit" or organic, when there is even the slightest potential for medical justification, what will the surgeon do?

Then of course after the surgery there will be multiple notes, from the neurosurgeon, neurologist, PM&R specialist, PCP, you name it, documenting that the patient had a good outcome, BUT there seems to be this and that, so they will need a repeat surgery. One year, two years, multiple years later, doesn't matter. Usually multiple repeat surgeries. The story may continue such that the original problem, albeit helped temporarily, now returned, or the scar tissue is now the culprit, whatever.

You can of course say that all that time, even if temporarily, the surgery helped, no? That is a very valid way of helping patients that suffer from pain, right? Not necessarily. I have seen patients, who relate that their original pain (before the first surgery) was nowhere near the pain they are experiencing now, years later, after multiple surgeries. And no matter how many additional surgeries they have now, there is no help. Scientifically, you can't really say whether or not they would be better or worse off: you don't really have a good control, i.e., the patient himself or herself, taken back in time and taken into an alternate present where they had NOT had the surgery they had. Any other control would be some way flawed.

The academic setting is much different from that community setting. Here the surgeons' most important currency is NOT their volume, but much more so their reputation, with their outcomes vigorously tracked. Their referrals go through the roof so they do not have to operate on every patient that walks in, because they CAN afford to be selective and conservative. They CAN restrict their surgeries to those who are without a doubt in need of surgery and operate ONLY on those. They can still fill their quotas easily as they have plenty of appropriately referred and selected patients waiting and they are under no pressure to increase their volumes. In fact their currency relates to job performance measures, including teaching, publishing, grants, and quality of their work, which is constantly monitored or even scrutinized constantly by trainees, colleagues, and administration.

Although you cannot change the culture of medicine as a whole easily, I think there must be a way of altering the current "currency" system in the community hospital level, where volume should be a very small factor and outcomes would be a huge factor in determining "currency". Where surgeons would be totally incentivized to produce medically superior outcomes as measured not only by patients (who, for one reason or another, may be willing to go along with unnecessary surgeries), but by peers and/or independent reviewers. I believe this would be the only way to eliminate questionable spine surgeries that increase health spending and produce little true and lasting help to patients.

BoA's Handling Another Dropped Ball! Educational (Typical?) of Advanced Corporate Customer Care Habits...

Wow. This is very interesting! I'll try to be brief, even though right now I'm rather dazzled by this.

Here is the story, straight and simple. On 12/20/11, around midnight, I went to an ATM near my house, to deposit a check. I did that and that's all I wanted to do. The machine was unusually slow processing every step, which was a bit concerning (after taking the check it was showing a blank screen for very long seconds), but eventually the deposit did go through. When I asked for the card to be returned, it made an apparent attempt to eject it, but the card stopped at a point just short of sticking out, inside the slot. The screen instructed me to take the card, but there was no edge of it to grab.

I quickly looked for any make-shift forceps, like small pieces of wood, to try to get it out, which I almost managed to do, but I got timed out: the card was pulled completely back into the machine and it announced that the card was taken and blocked and that I should call customer service. Which I did immediately, only to learn that they had no service after hours. OK.

I called the next day, on the 21st, to report this and ask for a new card. I spoke to a rep, who seemed to understand the situation. I also explained that within a day I'd be going on vacation abroad. She said the mailing of the card was to take 7-10 days, which obviously meant I would not get it before my trip. She also said I could get a temporary card in the meantime, by walking into a branch. SHE ABSOLUTELY, POSITIVELY, UNEQUIVOCALLY confirmed that a replacement card was being mailed to me ASAP (irrespective of whether or not I decided to go to a branch for a temporary card).

I decided to not get a temporary card because I actually had enough cash on me to get through my travels. I then returned to the US, thinking my card would have arrived by now. In the mail, I found some checks that I needed to deposit, but what I did NOT have in the mail was the replacement ATM card! Even though it wasn't technically 10 business days since I made the request, I find those estimates typically way overstated, so I suspected something was wrong and I called BoA.

The guy I got on the phone informed me that he saw record that on 12/21/11 the card was blocked due to being left in an ATM, but that there was no record of a replacement card ever being mailed or requested (!). I got pretty agitated hearing this and requested to speak to the supervisor, who soon joined the call. She introduced herself as Andrea Anooshian. Both she and the entry tier rep consistently called me "Mr. Mari", despite the fact I introduced myself as Dr. Mari, but this was just a very small issue.

She confirmed that there was no record of a replacement card mailed or requested. Here comes the interesting part. She said there is no way to find out what was said during my 12/21/11 call, essentially questioning my claim that I did request one (and that I was told one was being mailed). I asked her if it made ANY sense to her that no such request would be made. In other words, would the assumption be that the customer reports a lost or stolen ATM card, which then gets blocked, and that's the end of story? The customer declares himself ATM card free and no longer in need of one. Does that make sense? I asked her.

Her response was just as sensible, which is to repeat it over and over that all she can tell me was what she saw in the system, which is that there was a report of a lost card and it was blocked, without a new/replacement card being mailed. She repeated what the first rep on 12/21/11 said, which is that I can go to a branch and ask for a temporary card. I explained that I cannot, because I am working from early AM to late PM on business days, being a doctor so I cannot just walk to a branch at a chosen time during normal business hours.

I made a specific request to have the FedEx $20 charge waived. I explained that this whole story is a string of BoA's dropped balls while I only did everything by the book with no mistake whatsoever on my part: (1) the dysfunctional ATM that failed to return the card; and (2) the incompetent rep who failed to have a new card mailed. These errors caused significant frustration and inconvenience. I also pointed out that I pass some $20k a month in various transactions through my multiple BoA accounts and that I have been a customer for some 11 years. I asked if all this was worth BoA to through in a $20 one-time consolation.

The answer was repeated and unwavering no. Andrea left no doubt over her conviction this issue and my frustration was not worth $20.

I actually don't really care about the amount, this is a story about principle. Andrea is absolutely confident in handling the issue this way because she knows I will get no better service with another bank. She is certain that the convenience of online banking among other perks will be a force strong enough to making it unnecessary for BoA to concede in this dispute in which they clearly were morally obligated to expedite the shipment of the replacement card at no extra charge.

I wish I could just say here that she is wrong. But I can't. (Not yet anyway.) At this time, out of the 4 or so banks I currently have checking BoA is offering the most comfortable and convenient banking between a really strong Android app, bill paying system, etc. However, the way they treated me suffice to say I have zero loyalty and should the smallest reasonably compatible alternative emerge, I will get rid of all my BoA accounts.

And that day, I think (hope) is not too far. Online banking is already pretty good (I also have an e*Trade account that has some of the functionality at least as good, but I can't just walk into a branch, which at this point may still be a small issue). For example, I enjoy the fact that BoA ATMs are so ubiquitous and I can just find an ATM everywhere (at work, near home, etc), which I mostly use for depositing checks. Paypal (where I have an account too) already allows scanning checks (with some limitations, such as a very long takeover, maximum amount) using my Android phone and other banks are starting to offer this as well. I trust close is the day when I can finally wave goodbye (or badbye that is) to BoA and never look back.

Ethics: The Philosophical Science of Morality

Link: http://www.parkinson.org/Professionals/Professionals---On-The-Blog/September-2011/Ethics--The-Philosophical-Science-of-Morality

I was pleased when I was asked to provide a blog on ethics, as this topic has personally intrigued me throughout my career. “Ethics” per se, is the division of philosophy that deals with issues that pertain to morality, which has such a tremendous significance in everything we do as doctors: caring for patients, conducting research, and teaching trainees. Ethical or moral behavior of course is a very important topic for any profession, but is perhaps most discussed in the field of medicine.

Ethics, the philosophical science of morality, has been a central interest to thinkers, philosophers, and doctors since the ancient Greek times. Socrates, Aristotle, Aristippus, Epictetus, and later Jeremy Bentham, John Stuart Mill, and also Immanuel Kant all addressed ethics. As much as we can enjoy reading the works of these great thinkers, in our everyday life and in medicine, it is probably pragmatic ethics (e.g. John Dewey) or postmodern ethics (e.g. David Couzens Hoy) that would be most applicable. In his writings, Hoy particularly addressed the powerless, which of course patients belong to, in this sense.

Ethics and conflicts of interest (COI) have long been associated with medicine. The general view is perhaps one where the good doctor navigates COIs well and resolves conflicts without compromising integrity and morals. Yet, COIs and morality aren’t entirely synonymous. Morality should deal with behavior and a code of ethics that has nothing to do with enforceable laws. In other words you could be a perfectly law-abiding citizen and still be immoral. Morality, according to its scientific definition, addresses behavior that is within legal limits.

In our practice, in our teaching activities, and in our research, we do so many things where moral behavior and ethics come into play. In fact there probably is very little that we do where ethics are not applicable! A colleague once said that everything we do every day is infiltrated by conflict of interest (COI) and that you cannot ever eliminate COIs. Of course we hear plenty about COIs such as undue industry influence in continuing medical education (CME) programs, and in research studies, as well as practitioners receiving “freebies” and other favors (creating the urge to reciprocate, perhaps in their prescribing behaviors). However, those are only a small fraction of COIs in medical profession. Most COIs we are not even aware of and most don’t necessarily pose a moral dilemma.

When you take out milk from the refrigerator, there are competing interests (i.e. whether you should satisfy your urge to drink now or wait until later, when you may need it more; whether somebody else in your household might need it more; if this will trigger a need to go to the grocery store today, which you really don’t want to do, as opposed to tomorrow when you were going anyway, etc.).

Likewise, in academic medicine, it is critical that while working with students and residents (and making sure they get the education they need), at the same time also focusing on research achievements (which lead to promotion), we do not compromise the quality of medical care provided to our patients.

Some instances of poor conduct in the recent past have triggered a backlash prompting new legislation. Once, thus there is state legislation or an apparatus that enforces moral order, the related ethics issue ceases to exist. For example, should animal experimentation become illegal in a society, it would no longer pose an ethical dilemma (it will become a legal issue).

On the other hand, as remarked by another colleague, Dr. Joe Jankovic, one cannot achieve 100% ethical behavior through enforcing rules and laws. No matter how many rules and laws there are, there always will be loopholes, and if willing, individuals who can go around them. So what can we do?

1. Transparency. Well, since we already established COIs cannot be eliminated, our only option is to find a way to live with them and manage them the best way we can. How do we do that? The very first critical ingredient is transparency. Appropriate access to vital information bz concerned parties is half the battle. Also, when I speak of transparency, I mean true actual transparency, access to pertinent data in a way that makes sense to an average patient.

Of course we cannot open up our research folders and patient medical charts to the public. HIPAA and other regulations as well as research contracts restrict what can be accessed. However, “de-identified” data should be made accessible to all concerned parties. Transparency would enable patients to determine how many patients their doctor sees, what their office practices are, what research and teaching obligations she or he may have, including their financial relationships.

Disclosure of financial relationships is mandatory now for all CME work. However, patients may also want to know whether their physician, who recommends a certain treatment, is actually on the payroll for the company that stands to financially benefit if more patients are receiving that treatment. Similarly, a simple, easy to understand list of all professional activities and relationships reflecting potential COIs (financial or otherwise) of each health care provider should be prepared and made available to patients upon request.

Such disclosure would likely preserve, or in some cases, restore the trust between patients and their health care providers, eliminating most concerns about COIs and the potential for immoral conduct that could affect patient care. Of course disclosure in itself may not guarantee that everyone will all of a sudden become ethical, but disclosure of these data would help advise patients to make choices about their health care providers.

2. Healthcare metrics. Another important way to keep people honest is by tracking their performance. If a physician is navigating multiple, complex COIs, yet is providing highest quality healthcare to his/her patients, then we may be less concerned about COIs because ultimately what really matters is their level of care and professionalism. Of course we would need to have accurate and relevant healthcare metrics in place that are also practical and feasible. There is an entire branch of science dedicated to this, but patient advocacy groups definitely could push for and help support such efforts.

3. Selection. No matter what measures we take or regulations we put in place, our best guarantee that future medical professionals will practice medicine in an ethical manner is to select candidates of the highest moral caliber. Also, as medical educators we have to place a greater emphasis on medical ethics in the training process.

Medicine and morality are intertwined in so many ways. The Hippocratic Oath illustrates this relationship. In modern healthcare with so many potential COIs, no matter what regulation and measures we undertake to ensure moral conduct, it probably still is the rigorous process of selection and training that most helps to ensure that our healthcare providers are truly and genuinely driven entirely by their internal sense of right and wrong, as opposed to all the rules and regulations. Ethics in research and health care will remain an intriguing and important topic for generations to come, and the principles will remain the same as when the Hippocratic Oath was written in Ionic Greek in the late 5th Century BCE: “I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.”

The problem of Republicans run into when it comes to God, religion, and the public eye

Link: http://www.theatlantic.com/politics/archive/2011/08/is-rick-perry-as-christian-as-he-thinks-he-is/243616/

I found this article particularly helpful and relevant. It talks about Perry and his prominent denial of landmark laws separating state and church, in the context of his recent joining the race for presidency, but I think the points made in the article are actually farther reaching than anyone's presidential bid.

I think the main point, well and often (but perhaps not visibly enough) made and discussed before by others, is about the contrast between the hypocritical, double-standard embracing "religious" evangelical right-wing America's faith (God this, God that, church going, etc) and what they actually fight for (deprive the poor, basically).

Jesus taught of tolerance, not intolerance. What seems to emerge from evangelical subtext supported by the religious right aligns much better with intolerance.

I know religious people, who believe in God, and feel that whatever humans have used the name of God for (and abused) is despicable. To love God, you don't need church, political affiliation, none of that. All you need is a personal relationship with God and whatever you believe in. That is your business. What you believe in does not make you better or worse than your fellow human beings who happen to believe in something else, or happen not to believe in something supernormal at all. Most importantly, you are not supposed to announce and show off your religion to score political points with a certain group of phony and hypocritical individuals.

Android, Motorola, and the Patent Wars

Link: http://www.informationweek.com/news/mobility/business/231400090

Ever since the arrival of the Motorola Droid, hailed as the first serious Android contender to the iPhone, changing the smartphone (or rather app phone) landscape forever (and arguably not to the advantage of Apple), I have been a Motorola Droid user. I had 2 units of the original Droid, then at my 3rd Droid 2 Global.

Overall, I should say I am generally happy with both the platform and the hardware. There are of course glitches and frustrations, which I think is unavoidable to some extent with such gizmos (at least knowing me they are), but in general there are no major reasons for me to move away from this combo that I have relied on for almost 2 years.

Why, some of you might ask, do I all of a sudden seem like brand loyal diehard, when I have made the point so many times before that it is always the actual facts, functions, and needs that determine for me what I buy, no matter who makes it. My motto was "zero brand loyalty". Also, you might ask, why on earth would anyone stick with Motorola, when fancier and flashier Android competitors are abound with better and brighter alternatives? Take, for example, Samsung. Don't they have the "super AMOLED", a screen that is praised as ~30% brighter than any other company's best display option and the only touchscreen technology choice today, which can produce a visible interface on a smartphone in direct sunlight? Or take HTC! There does not seem to be a month go by when they don't come out with something jaw dropping. Specs are following some dizzying exponential accelerating hardware curve, set out by HTC for themselves (and for the rest of the market to follow). It is incredible what they can put together, technologically, in a phone. Google itself is turning to these (Samsung, HTC) for manufacturing its own "Google" phones, the Nexus series, not Motorola.

If you look at the article, however, I think you might get a sense as to (in part) why this newly embraced "brand loyalty" towards Motorola. I mean I do like them in general: I had several Motorola phones way before the smartphone era, and I do believe they do an outstanding, truly highest quality job when it comes to manufacturing. Reliable, business grade, sturdy, dependable are just some words that occur to me thinking of their manufacturing.

However, that is irrelevant here. Manufacturing is expected to be pretty perfect today anyway, technological perfection is a minimum from any of the main Android manufacturers. Patent portfolios aren't equally perfect across the board, though. As pretty much every one of the main Android device makers are tangled in a patent lawsuit (or usually multiple suits) with Apple, who has launched on an ultimate mission to exterminate all its competitors with patent-based weaponry; actually the strength of patent portfolios will weigh in tremendously and determine how exactly the apps phone world will look the day after tomorrow.

At a minimum, Motorola (and maybe only Motorola) can fend for itself, when it comes to legal challenges in the patent arena. In that regard, if you look at all the various Android makers, Motorola stands out by a mile. Pundits have been evaluating Apple's patent assault strategy. HTC was obvious. Small patent portfolio, easy target. Samsung was another must-have target, especially considering the danger it poses with its super AMOLED display and the resulting phenomenal performance on the market. Certainly these fights are showing results, just look at Vodafone's decision to suspend sales of the Samsung Galaxy tab in Europe. It was generally assumed that Apple will not go after Google itself any time soon, as that "clash of the titans" may be a bigger piece than what even Apple can swallow and, albeit that conflict clearly building up, has the dubious prospect of total annihilation of one or the other giant.

Instead, switching gears from small targets to larger beasts, perhaps testing the waters for the ultimate clash, now it seems Apple decided to go after Motorola (Xoom, in Europe), which will definitely be a major test of my assumption (in which I generally concur with the writer of the linked article that Motorola is patent-invincible). Motorola is most certainly a formidable opponent in any patent fight when it comes to phones. Just as explained in the linked article, it can well be the last bastion, even after Google (!), in the Android wars.

In any case, I remain assured, for now anyway, that nobody will announce tomorrow that the sales of Motorola Android based phones are halted until further court order. As to HTC, Samsung, etc devices, well, I am not so sure...

AT&T: Confusion at All Levels About LTE-4G

Link: http://www.att.com/gen/press-room?pid=19878&cdvn=news&newsarticleid=31959&mapcode=mk-att-wireless-networks|wireless

Oh Boy. The "4G" arena has become a complete zoo. Not only do we have a problem on the consumer side to navigate this mess, but things have gotten out of hands so much, that sometimes it is just too complicated for the employees of wireless providers as well. Right, Ashley (at the AT&T shop in Arundel Mills Mall)?

Carriers have been often criticized for frivolous use of the term 4G, which is meant to loosely indicate "fourth generation" in wireless data protocols, obviously to describe that is better (faster, more reliable, etc) than the data protocols grouped under the also very loose category of "3G". You can find the ITU requirements for 4G as well as other useful technical data on 4G here: http://en.wikipedia.org/wiki/4G.

According to this, this should not be that complicated... Only 2 protocols among today's available technologies measure up to the 4G requirement, LTE and WiMAX. All other wannabes, HSPA+, HSPDA, etc, offer amazing rates and other wonderful things under laboratory/artificial test conditions, but in real life they stay far below 4G, i.e. LTE or WiMAX, in performance (see the "notes" column in the table under the above referenced Wikipedia page's "Comparison of Mobile Internet Access methods" table for "real life" speeds). In other words, all the marketing for anything but LTE or WiMAX as "4G" is flawed and purposefully misleading.

I did not intend to address that flat-out lying or even the comparison between the 2 currently available true 4G protocols, in which Verizon's LTE humiliated Sprint's WiMAX (see http://www.bgr.com/2011/04/01/verizon-4g-lte-blows-away-sprints-wimax-in-1000-speed-tests/), even though those points are relevant in their own right.

Here I just wanted to share a highly interesting, even shocking, experience I had at the above AT&T store, to underlie the 4G confusion at even customer service level. I walked in teh Arundel Mill Mall AT&T shop, with my GF, who has AT&T cellular service, but without a high-speed data plan, and wanted to explore her data options with her preference of doing business with AT&T (as opposed to opening a 4G/LTE account with Verizon, that I have). She wished to keep all her mobile needs serviced by the same provider, as opposed to spreading different wireless subscription across multiple carriers. I went with her, even though I personally no longer have any relationship with AT&T. Considering the hype and multiple news announcements on AT&T's new plan to roll out their 4G/LTE on some markets by the summer (starting with Chicago) and then 15 markets by the end of the year (http://www.att.com/gen/press-room?pid=19878&cdvn=news&newsarticleid=31959&mapcode=mk-att-wireless-networks|wireless), we were interested in learning more about this.

I have Verizon LTE with a USB data card and I let my GF test it on Amtrak between DC & Balto. It tested very well (good speeds, stable connection). That is the reason I argued that she should get Verizon LTE now, which is available and working well today (at least where she would be mostly using it), as opposed to AT&T, which may have it available by December in our market and we don't know how well it will work (I had a AT&T 3G data card a couple of years ago and the service really sucked with extremely low speed and unreliable connection, for why I switched to Verizon LTE when it became available, and I have been very pleased so far with that, although my experience is still somewhat limited).

In any case, it was logical to check with AT&T, regarding their LTE; i.e., when will it be available in the DC-Balto market, what pricing and data usage numbers are we looking at, etc. And here comes the shocker. Ashley at AT&T flat out declared that LTE was ALREADY available in our market and she offered LTE phones! I was surprised. I was pretty certain of my news intelligence about AT&T's announcement about their plans rolling out LTE starting in the summer (meaning it is not available ANYWHERE at this moment) so I asked her to confirm.

She confirmed with absolute authority and attitude. She repeated many times that LTE is only available in select markets, but that it WAS already available, today. Her confidence was gigantic, hard to process for us. She even appeared a bit annoyed at my double checking giving me the meta-communication (between the lines) of "did you not hear me, what's wrong with you?" kind of message. I was baffled. I have not seen anything like this before. She was obviously dead wrong and was sticking with it. In her describing the total BS, she kept falling back on using 4G term, as opposed to LTE, which kind of hinted that she was not as dead set on her claim about LTE, but when I specifically addressed that point, although she did declare that 4G and LTE were the "same".

I agreed (that LTE was 4G), but reminded her that the other protocols, currently available on AT&T and marketed as "4G", are not strictly speaking meeting the requirements for "4G" and pointed out that what she probably meant was not LTE, but likely HSDPA or HSUPA, which AT&T "generously" calls 4G, when it is not (see above), and that LTE, to my knowledge, was NOT yet available on the AT&T network. She grew more and more annoyed by my stubbornness. At this time I pointed to one of their USB data devices hanging on the wall right next to us and the box announced in orange color that it was "LTE ready". I asked why it would use such announcement, being "ready", if LTE was already available, as she claimed. The way it was announced as "ready" to me suggests that it will be compatible with LTE when such technology will be available. Well, she did not have a very good explanation to that, other than clearly communicating with even more attitude and body language the same message, i.e. that she already told me many times LTE WAS available on AT&T now, period.

We walked out, but this highly unusual and unprofessional behavior actually bothered me. How can you be so arrogant, as a paid employee who's job is actually to be informed correctly and inform customers correctly, that not only you are dead wrong, you stick to it, with an arrogant attitude, despite all sorts of information that help pointing it out to you in clear terms that you were off on that one. I looked up a random news link from my phone (http://www.pcworld.com/article/228405/atandt_and_verizons_battle_to_deliver_lte_to_heat_up_this_summer.html) and went back to show it to her. This happened to be a PC World article, but the news sites are all over this (that is how I heard about it in the first place). She looked at the article, scrolled up to the address bar to look where it was from and then announced that this was an unreliable source! She STILL insisted that LTE was actually available, as she told us from the beginning, and that the news on this story I was showing her was entirely incorrect. Not only that, but she "informed" me that she participates extensive, daily company trainings, where she gets information that is up-to-date, highly accurate and superior to what I am claiming, so that I am just making a fool of myself with all this effort trying to convince her that she was wrong on LTE. Wow. I walked out of the shop again and was baffled even more.

At this point this issue was clearly not relevant to my GF's decision regarding what data service to consider, it became my personal quest (which it kind of still is, considering I am writing all this). I pulled the AT&T official news announcement about LTE on my phone (see the main link for this posting or go to here). I went back to the shop, just before they closed for the day, with the above page on my phone, and showed it to her. This time, she read it again, scrolled all the way to the top to look at the source again, where she saw it was the official AT&T announcement. It spells out the markets where LTE is going to be rolled out later this year.

Well, she could no longer stand by her BS story at that time. She was speechless for a couple of seconds. She still displayed the same overarching confidence, "I know everything and I am telling you" attitude, and moderate level of annoyance. She acknowledged the total defeat by saying "OK then". No apology or any acknowledging her behavior up to this point (including the fact she was dead wrong and was standing by it with arrogance and attitude). There were no other customers in the store so she could not shrug me off with the excuse that she needed to attend to something else. There were another 2 colleagues next to her, who overheard the entire conversation, one of them seemed to be a supervisor or something like that. They were all looking elsewhere, conveniently avoiding eye contact or any mention of the fact they not only gave completely incorrect information, but they insisted despite many obvious signs suggesting what they claimed was wrong (i.e. the claim that LTE was already available on AT&T's network).

My GF repeatedly told me I should drop the whole thing and I can totally see the rationale of that approach. She told me (in Ashley's defense) that she (Ashley) probably truly believed in what she was saying (as opposed to decidedly and knowingly trying to mislead). I understand all that. I do believe she didn't know better. But that is not the issue. The issue is the fact she was wrong (which is not acceptable for somebody in her position where she is paid to have at least the basic facts relevant to her company's services). Of course it did not help matters that on top of that she handled herself rather strangely about that, which might just have been a personality issue. Or lack of training on the "customer is always right even when they are wrong" principle. In this case I was right, she was wrong, yet she absolutely handled me as if it was the other way around...

This may have been an isolated incidence (I hope so) with little relevance to the "big picture". However, I have experienced situations before when customer service agents are exceedingly uninformed or misinformed about their own company's future plans and technology news. I had somewhat similar experiences with several other phone companies, where the customer service agent, clearly not using the advanced service options or devices offered by the company she/he works for, but also is suffering from sub-zero technology news intelligence relevant to the company she/he should be informed about. I think it would be strongly recommended that scheduled employee training included a technology news component as well, so that they can advise customers who get their information from the news. The experience yesterday felt as if I was teaching the company employees about their own company, but my students were highly ungrateful for the free education.

Are You On The RIGHT Plan?

I thought I'd share 2 recent observations. The first one (from which the title) was with Verizon Wireless. The second one was shared by my GF.

1. Verizon story.

I happen to have a fantastic deal as far as my wireless subscription is concerned. As a Hopkins employee, I get a 25% discount already, plus (as I use the phone in large part for work), my bill is partially paid from my discretionary account at work. All in all, the total cost is little and the difference I would save going on a lower minute plan is even smaller, close to negligible. Therefore, I am now on a 900 min/month plan, even though I don't use more than 200-300 (also, I use 1-2 texts, under a 250/month plan). I know I could save a few bucks by going to a lower min plan, but since its costs are negligible, I don't mind the cushion of extra minutes.

The other day a Verizon Wireless rep called me on my cell and announced that she wanted to review my usage, to make sure I am on the "right" plan, implying I am not paying more than I need to. So we went into the details and there was very little question she was looking for overage. Not only there was no overage, but the opposite. Quite a bit of unused minutes. She then checked a few previous months, where the same pattern showed. This caused her to pause, as she was really not ready to "address" that (very clearly, she was all warmed up to convince me that it is really to my benefit if I upgrade). After the pause, she realized there is no upgrade that could be sold (I guess if one uses 200 minutes on a 900 min plan, trying to explain that it is for their best to go for a far more expensive 1350 min plan would be somewhat of a stretch, even for the best sales person with superior intellect that this particular rep clearly didn't have). So she concluded that I was on the "right" plan, congratulations.

Right. The "right" plan for whom exactly? Clearly, not for me. If I am using 200 min on a 900 min plan and 2 texts on a 250 SMS plan, I am obviously subscribing to far more services (and pay more) than I need. This call made it very clear that such a problem is not a problem for Verizon. If it is a problem for me, then it is my job to deal with it, not theirs. They are not going to call me (and pay an employee for their time, etc) to help me save money and allow them to make less in profits. That makes sense. We live in an individualistic capitalist society, where everyone should attend to their own interest, nobody (especially a for-profit entity, working solely to pursue their shareholders' interest) will look out for you.

Yet, I can't help but noticing the sneaky representation of this marketing effort, which is intended to trick you into something you probably don't need (i.e. if you just occasionally go over your minutes by a few, which they try to use as an excuse to sell you a more expensive plan, chances are you will end up paying far more with the standing higher subscription than the occasional overage, otherwise they wouldn't bother calling you). Of course there may be a few customers who actually pay more in overage on a regular/recurrent basis than they would if they upgraded their plan. But almost all of those will figure that out themselves and buy the plan they need as opposed to wasting money. I agree a few people may not be noticing that and the call from the phone company asking to upgrade actually could save them some money. But that will never make this tactic overall benefiting the customers versus the phone company. Again, if it did, they could not justify the costs reaching out to you. The minority of players may actually win on slots and even win the lottery, but there is no question who benefits as a whole.

I think the experience I had just showed how blatantly false is the representation that this call (and review of the usage and the plan) would help customers find the "right" plan. When I was obviously on the wrong (for me) plan, subscribing to a plan with far more services than I used the rep absolutely did not discuss or mention the possibility I was over-subscribing and in fact I could save money going on a cheaper plan. Well, that obviously wasn't in the cards, wasn't her (and her company's) plan, and the idea of finding the "right" plan really was taking a shot at perhaps selling a more expensive subscription under the disguise of helping to find the "right" plan. In other words what she was obviously told was to "try to sell the costliest plan you can, based on any remotely rational-appearing references to the usage data and ensure everyone is paying the most we can make them to pay". Clearly, with such instruction, she was not to inform me that I could actually benefit from downgrading my plan.

2. Personal Banker

The other story I would like to share is similar in that it involves a company, solely looking out for their own interest of increasing profits, representing to their customers as they cared about them. (Well, they may care about the customers, as long as that caring works towards increasing their profits.)

My GF runs a consulting business and she has her business premium accounts with the same bank (will keep it anonymous for the purposes of this blog and I also don't think there is a lot of difference in this regard between different banks) as she has multiple personal accounts with as well (including credit, checking, mortgage). She has a "personal banker" "helping" with matters related to her business account. Turns out the personal banker shared with my GF that her mortgage account was overdue (which she knew very well as she prefers to pay the mortgage after the first due date, technically late, so that the funds earn interest during the overdue period before reaching the penalty date). Now this personal banker should have absolutely no dealings with her personal mortgage!

Another time, the personal banker commented on my GF's personal checking account balance. That she also should not have accessed! So my GF had trust issues with this personal banker, and when she went to the bank to deposit a large check and to get some other minor banking work done, she went to the teller as opposed to the personal banker (who also was in the bank at that time). The personal banker noticed this and came over to the teller's desk, and from behind his back, was checking out all my GF's personal accounts. When my GF asked the teller about this, he obviously was somewhat inconvenienced by the situation , but said that the personal banker only wanted to make sure things are good, in her effort to "help" my GF. Right.

From this story one thing is clear. This personal banker's main interest was to protect the bank from any possible liability (that could stem from my GF's personal finances), snooping around my GF's personal accounts that she was absolutely not asked to do. Looking into my GF's personal finances could not have possibly be of help to my GF in any way as it relates to her business banking. The personal banker's job should have been strictly limited to the business accounts and she should not have been even aware or knowledgeable about the fact my GF had personal accounts with the same bank. Again, a "personalized" approach to "help" customers or just another way a company is looking out for its own interests disguised as something that looks like something else.

CONCLUSION

These every day observations are minor and many of you will say that there's nothing surprising about this, what do you expect? Yet, when you don't pay attention and subconsciously assume genuine help (as that is how you are) on the part of a for-profit entity, you may forget that you are vulnerable to the tricks and tactics that exploit that natural and subconscious assumption of true help intent most good-willed humans have.

Another Hotmail Account Hacked, Another MS User Deserting for Good

Started using Office 2010. Hoping to explore "cloud" options more, prompted to log in to hotmail. I do have a login, but haven't used in years. Login failed (even though I'm sure my pw is correct). I ask to reset pw, where it shows me an alternate email as "ma*****@brturbo.com.br". Clearly not mine, my account clearly hacked. I try to report. Takes me to all sorts of pages, asking questions like what my IP was on my last successful login, what the answer to the secret question is (without showing what the secret question is), etc. Not using this account, I obviously don't have an answer to those. I tried to reach MS at their main #, where I was directed to MSN live. It disconnected me as I don't have a currently paying account. I was willing to do anything (even paying for a support call, despite the fact it is their scewup) because of concern over my hacked account, but apparently MS perfectly seals itself off so that what they view as unqualified people can't bother them. I usually figure out some backdoor despite service providers strong defense mechanisms to ensure their customers needing help won't get to them. But I have to say (and kudos to MS), in this case I failed, MS won. They triumphed in ensuring I got no help, remain with a hacked account, frustrated, without a solution, screwed. Fine.

In general I do not harbor any sentimental influence when selecting products and services. I pick whatever works for me at the moment. No loyalty or any of that. My previous experience only matters as long as it is relevant to the present status. If another product is better I go with that, brand doesn't matter. Also, bad experience in the past has no meaning as long as for some reason the same providers offer the least unfavorable option at the moment.

But in this case I have to say I will be willing to put up with some personal inconveniences in the future and pick less than most favorable solutions in an effort to avoid MS products.

Perhaps iPhone/iOS is not exactly losing to Android overall?

Link: http://www.appleinsider.com/articles/10/12/13/androids_weak_sales_drive_verizon_toward_apples_iphone.html

Some have accused me of being biased toward Android... Well, I am not biased that way, I think, just a user, not even particularly loyal (i.e. if something works better for me I don't hesitate for a second to switch).

I have, however, been somewhat biased against Apple, because of their controlling marketing behavior that reminds me of communism (which nevertheless clearly works; I wished I owned some of their stock as Forrest Gump).

New market research now shows that the big hype behind the Android-VZW presumed juggernout actually stands on weak legs... See attached link.

I think the iPhone is a great product, I never questioned that. It does not work for me, due to the fact it allows less flexibility (and I am customizer, but not jailbreaker type). If Verizon heeds Steve Jobs' controlling approach, that's because the Android dream failed (at least for the short term, at least for VZW).

However, if the roumor proves correct that the VZW iPhone, presumably coming out after Xmas, will be 4G/LTE, it definitely be a shocker.

BTW, I just ordered my VZW 4G/LTE USB modem...

Tax Cuts in America, 2010: The War on the Middle Class

Link: http://www.youtube.com/watch?v=H5OtB298fHY

PF: The economy is not a zero sum game. Those who are poor are not poor because the rich are rich. Scaring away the rich (and they will go, they can afford it) will not help anyone in the economy.

ZM: It is not a zero sum game, at least not 100% a zero sum game. But it is hard to deny that the separation between the rich and the poor will get wider with the rich making it a game to get even richer, and it does help the poor get poorer, to some extent. E.g., the $100K/yr tax cut to the guy making over a million, if instead spent on supporting the less fortunate (i.e. extending jobless benefits) will prevent the less fortunate to get even poorer.

Consequently, as to the economy, I disagree. The concept of "let's help the rich and corporate interests with massive tax cuts because that will help create jobs and will trickle down to the bottom of the social ladder" has been prominently proven wrong over and over again.

Somebody on the verge of losing ANY income at all, I think is more likely to spend on basic life necessities, pretty much 100% of that sum, if you give them an extra $50k/yr than if you give the same amount to the guy making $1mi and already possessing everything they need/already able to buy.

PF: ok, we can agree to disagree, but a few points;
1. you are not "giving tax cuts" to the rich, you are just taking slightly less away from them. similarly you are not "helping the rich". you just leave them more of what is theirs.
2. are you saying that higher taxes have no negative effect on jobs? I find that hard to believe. The more you tax, the more jobs go abroad. Kind of self evident.
3. Is the "separation between the rich and the poor" what really matters? Not to me. If I can choose between earning 5 while the other guy gets 8, or earning 6 while the rich guy gets 50, I would choose 6 anytime. Wouldn't you? Why? If you start making comparisons, make comparisons globally. But even that doesn't make sense.

ZM: Well, this is a philosophical question... Let me also add a couple of points, if I may (looks like I am re-generating the blog I was going to write anyway, in parts).

1. So why even tax at all? Why take away anything from people out of what's theirs? What purpose does it really serve to pay taxes in the first place?
2. If you say we should help the USA become a "Banana Republic" with policies benefiting the richest Americans (and thereby helping the social gap get wider), because otherwise their business and money will land in another less civilized part of the world, you quasi propose we become less civilized as well. Like 3rd world countries. In other words, rather than showing the entire world the way and creating an example of maturity and altruism, some of the most advanced and noble human qualities, we should instead just move the clock back closer to the time we lived in caves where the strongest always had his way and the only rule was the rule of strength? Where the weak had no protection?

The way we distribute and redistribute wealth is an indicator of the society's maturity as a whole, marker of our collective intelligence and conscience. I am not a communist and I do believe we need to allow stimulation that is consistent with and based on greed and selfishness. That definitely produces a force that moves things ahead. I am a capitalist in that sense. But I also feel there should be very carefully tailored policies to help our society remain stable and in good conscience. And that is to prevent the poor getting even poorer and to prevent the middle class being eliminated/becoming less affluent. The collective well being/quality of life of the society as a whole is at stake, which I think is a greater concern than any one individual's wellbeing or the satisfaction of the most greedy. We have to guard our society's values by not allowing the social division to grow to the extremes. I would be ashamed to live in a "Banana Republic". The society's collective conscience is in danger if we act otherwise.

I personally am grateful to be fortunate enough to be capable and gifted enough to be able to achieve what I have. However, instead of using all that as a jumping board and basis to distance myself more from the less fortunate, I am all for giving back for the fact I happened to be more fortunate, a token of my gratitude, if you will. I could not have a good (personal) conscience if I acted otherwise.

People in this country like to ride on the high wave of patriotism where we give the utmost credit to those who are willing to sacrifice their lives for their country's world-power, religious or corporate agenda. Giving your life, I guess, is the ultimate sacrifice, the greatest level of altruism. It is kind of encouraged here... Altruism is good, encouraged, appreciated!

My question then to some of my fellow countrymen: By way of altruism, how about giving up a few percent of your already enormous income, where your fellow Americans are suffering and hungry here, today?

LTE and the separation of voice and data: how long can they force the concept of "voice" calls on people, to the sole benefits of carriers and their shareholders (against everyone else)?

Link: http://www.pcworld.com/article/211760/verizon_readies_lte_what_to_expect.html

This post discusses some thoughts regarding wireless business strategies and their relevance to our way of living in the context of emerging LTE technology; a relevant news article may be viewed at http://www.pcworld.com/article/211760/verizon_readies_lte_what_to_expect.html

The separation of church and state is believed to be (by a narrow majority) a good thing. The artificial separation of voice and data, on the other hand, unless you are a Verizon Wireless (or other mobile carrier) shareholder, would seem like a really bad thing.

Wireless companies, for the sake of maintaining their traditional business model, try to make everyone believe (including the FCC, who so far agreed to go along with this) that voice and data should be separately handled. At the age of 4G and 3MBS+ wireless data speeds, that is simply untrue; this is simply an artificial discrimination of digitally transmitted data that's only purpose is to help wireless carriers' profit.

Companies whose business is based on service delivery inherently are faced with the challenge of juggling the conflicting interests of shareholders and customers (which is BTW also the main issue that plagues the private health insurance system). Giving too good of a deal to customers could eat into profits (to shareholders' dismay), but on the other extreme, blatantly disregarding customers' interests to the point of defrauding could backfire, too. Where is the healthy balance? -will always be a tenuous, sensitive, and dynamically changing question...

With the innovative technology referred to as "LTE", it became clear early on that the separation of "voice" from "data" over mobile networks no longer will be a technological necessity. In the end, all will come down to just zeros and ones, no matter how you are going to make use of it.

Several analysts had predicted that voice calls, including international ones (especially international ones), will soon drop dramatically, and 4G/LTE customers will be able to pick a one-rate plan, where overall data traffic will be measured and paid for, irrespective of how the data is used.

What an idealist view! Turns out, at least until now, they were wrong. The reality, if you look around, is completely something else... Mobile carrier companies are digging in deep to fight this concept as hard as they can and they spare no time, money, and energy to sabotage any opposing movement or initiative. Clearly, to customers, such a simplified one-rate system would be a tremendous bonus and it indeed would very likely make voice calls (especially long distance and international ones) far cheaper. Why, then, should those companies do everything possible, throw everything they got, to harm their customers' interests?

Because this is a situation, where the classical conflict of interest service providers face, if resolved to their customers' obvious benefits, would directly translate into giving up some artificially maintained profits. and pretty big ones... Big enough for them to think that their entire business could fold if letting go on this one...

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Importantly, this whole thing comes down to supply-demand basics. Voice calls, if translated into bits, considering current demand, would become far under-priced compared to the same amounts of bits that are used for, say emails or internet browsing. In other words, due to our demand and dependence of voice calls, which are much harder to live without (than browsing, for the majority anyway), voice bits can be sold at a premium price on today's market. Why would anyone, who is on the sales end of this, discount that potentially higher price and announce a unified data rate plan that includes voice, when they have a market for the voice bits at a much higher sales rate? And that gives the practical basis for mobile providers to even be able to force something artificial as this on the public.

One alternative would be to set a unified data rate somewhere between the current voice-data equivalent and data rates. This would mean we would pay less for voice and more for what we now have in our data plans. Unfortunately, this would probably be DOA, from the perspective of both the customer and the carrier. First, nobody would ever consider paying more for data than they pay now. Second, such voice discounting would only push the system toward eventually all (voice or otherwise) data being discounted to the lowest overall rate.

Therefore, what naturally follows, is that mobile carriers are in for a (what they perceive as their last straw they can hold on to stay alive) long and desperate fight to maintain the artificial and arbitrary separation of voice and data, "discriminating" between different kinds of bits and bytes... The FCC, the friendly arbiter, for some reason, goes along with this clearly outrageous anti-customer and non-sense artifact that only maintains profits for a small privileged group. I think the main reason (besides the obvious and cynical assumption they were bribed) is that they are scared of the industry changing commotion potential their decision otherwise would carry.

In other words, by letting the voice-data separation business stand (for now), they sign off on letting this go along "business as usual", versus turning things completely upside down, where voice service would get devalued to dirt status and business who's primary income is from voice would simply become history.

But how long can this situation be maintained? Not sure. Looks like it won't be the FCC (or customer groups) that will bring this artificial situation (to keep traditional mobile careers on life support) to an end. The clearwire, cricket, and other high-speed local/mid-range city-neighborhood-WiFi etc initiatives may as well help accelerate the decay of this rotten system. Those WiFi phones right now still have to be tied to one of the big carrier networks in order to make them functional outside of your home city. But as cheap as high speed connections are and as ubiquitous they get, VoIP only phones will soon become more popular and old traditional mobile carriers could find themselves irrelevant (together with their voice-data separation obsession and artificial "voice" overpricing model) as fewer and fewer people will not need them.

Telecom Billing Culture: Changing? Hidden charges and other tricks and the FCC

Link: http://www.nytimes.com/2010/10/04/technology/04webphone.html?src=busln

When I moved to the US in 1995 and opened my first telephone account in NY I was excited that the service was fast and I had a dial tone in a day or so (compared to Szeged, Hungary where I was lucky that only after 3 years I got a phone, despite the fact that the previous owner of my apartment in Szeged already had it all wired, others before me sometimes waited 10 years).

My enthusiasm quickly evaporated when I began receiving bills. Month after month there were some (usually small) charges that I did not recognize or that did not make sense. The entire bill was extremely complicated to begin with (this was before the FCC ordered telecoms to clean up the outlay of their bills to make it simpler and comprehensible to people with below PhD education).

To me these billing errors were just as unusual as the fast service was, as in Hungary if there ever was an error on the bill it tended to be in my favor.

When I called they always agreed to remove the charges (after giving me a little bit of a run-around). The plus charges were said to be the result of some "error". These errors usually were related to international calls (when they played with the rates), but not always. Typically the extra charges were amounting to less than $5, but in one instance it was several hundred dollars (all of which was credited back after I called).

After a short while, I started to suspect that this relatively consistent phenomenon actually may not be completely due to some random error, as they implied, considering almost every bill had some "error" and 100% of the time it was an extra charge, to the benefit of the telephone company and never to the opposite direction. If this was random error, I thought, it must be going more or less 50%, on average, to each direction. However, it was 100% unidirectional.

The possibility that this was a deliberate scam by the telecom then made me rather angry. I assumed that if they just try this crap, with thousands and thousands of customers, perhaps millions of them, and they get away with it say 10% of the time (which might include people who are very busy and only look at the bottom line and if that is not very unusual or outrageous they just pay, without reading every line of the multi-page overly complicated bill, especially if $5 really doesn't matter to them, or incapacitated or disabled customers who may not have the ability to fully comprehend the complicated bill), they will handsomely improve their profits by collecting free money.

I thought, then, how is this possible in America? How come nobody complaints? How come regulators are not after these practices? I slowly realized that this relates to representation and eventually politics. Regulators are obviously pulled by opposing forces, including the outcry of duped customers and the silent workings of telecom deep pockets.

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With the revolution of technologies underlying the telecom industry of course the pricing structures and the entire business model had to be changed. This, to the most part, greatly limited to nearly eliminated the above practices. Not because of a step-up in regulation alertness or enforcement, but simply because nobody has a large land-line bill anymore that includes "long distance" or even less so international call charges, nowadays in the age of Skype and Google Voice, and of course increasing numbers of cell phones where flat-rate all-North America calling plans are more the norm than the rarity.

However, as seen in the linked article, telecoms, still not fearing from customer and regulatory ire, pursue those low practices even today. I find it particularly arrogant now, when they should be really making good with their customers in the middle of the telecom revolution.

Particularly arrogant is for Verizon to say they are refunding customers now (those who have been complaining and ignored for years), because they care so much. Bullshit. The only reason they refund anybody is because they are being forced to do so by the F.C.C. and had such pushing not existed, they would just continue ignoring these complaints ever as arrogantly and in an in-your-face manner as they have so far.

Then the question becomes whether the FCC should penalize Verizon Wireless, beyond just having them refund what they stole. The fact that this is even a question to anyone is frustrating. When you go rob a bank, pocket $1 million, and you get caught, do you walk away free as long as you return the money? Of course not. You will be thrown in jail even if you pay back more than what you stole. That's a great part of what keeps people from stealing. If you don't face such penalties, you will just keep trying again. Who knows, perhaps next time you will be luckier and will get away with it. And hey, the worst case scenario is that you just have to return the money and wait until your next try.

Not only should they be penalized, but I would urge the FCC to create a highly deterrent example. To the point where telecom companies introduce so efficient protections against "erroneous" overcharging that they rather err on the side of their customers than the other way around. Of course that would very likely eat into their profits and with that their lobbying and other influencing powers, which of course would close the loop.

As we are transitioning into a new, digital, internet based era of communications, which mostly relies on cell phones and computers, before telecoms can develop a new model of criminally overcharging their customers, it is particularly important to make a strong precedent and make it clear that consumers are strongly protected against crimes, because in the end they (consumers) are the ones who drive the economy and should be ultimately protected.

Android versus iOS: Pay Attention to the Context

Recently, I posted this comment on a friend's FB page where this popular question came up. I thought my blog readers may be interested in the pros and cons as well...

This is applicable to somebody who so far has not invested in either and is about to make a choice. Watching Hulu and using flash, as well as good and reliable high speed data coverage were among the factors that were relevant to this friend.

I think if you add everything up (including coverage, flexibility, options, freedom, costs, future) the only reason you would want the iOS at this time is if you are already "hooked" on the iPhone "universe", i.e. its feel and unique integration of hardware, OS, and software.

If you are not addicted to iPhone already, it may be a more rational choice to go with Verizon (superior/dependable coverage) and android (you may want to wait for the Droid Pro, in a couple of months, which will have BOTH a CDMA and GSM radio). But it mostly depends on your needs and personality, which are of course individual so there is no universal good choice or bad choice.

First, data speed. Regarding speed, AT&T has the edge over Verizon. On the other hand, Verizon has the edge in coverage and reliability, both for voice and data (to me voice actually is a big issue, for why I went to Verizon in the first place).

Many believe WiMAX (Spring 4G) is a dead end. The larger carriers will soon roll out LTE as their version of 4G and that will have overwhelming advantages overWiMax. LTE will come in 2011 to most big cities, most carriers, including Verizon. Only consider WiMAX/EVO if you really can't wait any more and want Hulu and the maximum available data speed now.

Cost, another aspect (that people often do not mention). I needed a new protective hard-case last week, for my Motorola Droid. On eBay I got one for $3.20, including shipping. Try that with a case for iPhone. You will be looking 4 times that, at least. Same goes for cords, other accessories, etc. Overall, in the apps arena you will be paying more in the iPhone apps store, for equivalent functionality, but this could change in the future.

Finally, this is a choice that has a lot to do with your personality. Growing up under communist regime, I am allergic to the "bad landlord" like tyrannic and controlling approach, where the big and all knowing Steve Jobs comes and says: "We will tell you what you want and we will bring it to you". As long as you like it, you will be happy. If you want anything differently, too bad.

E.g. I like to play around, tweak around my gadget. Bad idea with iPhone. Another example, I need to switch SD cards (to use the phone as a storage device I carry), switch batteries (in case I don't get to charge). Well, if you want to do things like that w/ iPhone, you are out of luck. Batteries can be defective or simply age so you may want to replace them. With iPhone you will have to ship the entire phone to Apple for a battery replacement...

In the end, I can certainly understand those who are so emotionally attached to the iPhone and "biased". I am not emotionally attached to my Droid, I will replace it in a second as long as something that better fits my needs comes along. But I think overall, for me anyway, Droid (in combination with Verizon) is a better choice.

HP desperately tries to give another spin to the lame sex scandal story...

Link: http://www.marketwatch.com/story/wsj-hurd-tried-to-outflank-hp-board-2010-08-16

Even with that oversensitivity in mind, this Hurd sex story certainly did not seem to amount to the level it seemed to escalate to, i.e. to question the ability to lead (of somebody that on paper has been so effective so far)...

Of course that skepticism was fueled by rumors that it actually was the issue of the BOOKS (where serious discrepancies were found on profits reporting etc) where Hurd was primarily vulnerable. Now THAT sounded far more credible as far as his ousting goes...

Clearly, such story (as opposed to some sex scandal) can be potentially far more damaging to HP stocks... That is why, I think, they are now desperately trying to give another spin to the sex story, to make it sound like a bit more credible: the bad Hurd tried to "outflank" the board for why they got so pissed.

Well, I am not buying it. Expect more to come, like "Hurd used expletives with several board members during a heated argument over his sex case" or "Hurd completely ignored HP board and HP bylaws in an egregious case of corporate misconduct". Let's throw in ANYTHING, but talk about those books, right? We'll see how the shares respond to those smear campaign attempts :)

Verizon Wireless tests how their Droid users tolerate insult on intelligence

Link: http://www.wired.com/gadgetlab/2010/08/verizon-droid-android-update/

OK, so Froyo (Android OS 2.2) is supposedly coming to my Droid this week. Great news, no? Yes, that's what everyone thought at first.

But now, Verizon announced that the news is generally true, but there is a "but". It is Froyo, but MINUS tethering and mobile hotspot features.

OK, I guess the story was just "too good to be true" and I kind of understand that these features they would like to make extra cash on. That doesn't necessarily upset me. In the end it is business, right? You pay for services.

What threw me off is their commenting this, i.e. saying the reason these features (otherwise available in Froyo) aren't offered to Droid users as part of this upgrade, b/o Droid's hardware limitations.

That kind of BS makes me mad. Why is that necessary? Why insult the intelligence of the Droid community? That was absolutely unnecessary. Everyone knows the rooted Droid can well do both, so it can't be the hardware.

I just wonder (and chip in with your ideas) what the "genius" strategist at Verizon had in mind when he/she came up with this maddening bullshit. Was he/she thinking that consumers are just really THAT stupid to suck that just right in? Or is it their arrogance that was deciding? Probably both. This is shameful. I don't feel like a Verizon Wireless fan right now.

On cutting Medicare Payments to Doctors

Link: http://mailview.custombriefings.com/mailview.aspx?m=2010060901ama&r=4763043-01b4

Many believe doctors should make less money. After all, theirs is just another job, just like everyone else's, so why is it they have to make more? Sure, long hours, being available on nights and weekends, etc. But if that's what they chose, well, suck it up and be modest.

Many doctors (I like to think most) chose this profession for reasons other than being financially attractive (i.e. trying to help the sick, overall helping the society with one of the most important needs: fighting disease). However, the problem is that if you degrade doctors societal and financial rewards, some degree of contra-selection will ensue. In other words, no longer would the best and brightest want to pursue this career, at least some of them wouldn't.

Such contra-selection could compromise the overall intellectual standing of this group. I am afraid that can drive up health care costs (less experienced or smart doctors are, thinking that's their best strategy to fend off lawsuits, more likely to order all sorts of tests and services "to be safe" that industry makes them think are needed, as their lack capacity to have their own research and opinion on these matters).

Cutting Medicare payments to doctors will likely further the process of "elitism" in practice, i.e. popular, "successful" practices will increasingly refuse dealing with Medicare altogether, while the Medicare providers will increasingly be at the lower end of the professional hierarchy. Unless of course states make it mandatory for any physician with a license to accept certain number of MC patients, in which case they pretty much artificially down-regulate all practitioners' income. That obviously will accelerate the contra-selection process, which (as explained above), paradoxically will drive up health care costs, something cutting doctors' fees was hoped to counter in the first place.

How High Can We Go? On the Question of Rising Health Care Costs as a Function of the Health Improvements they Help Achieve

The fact health care costs are rising doesn't surprise anyone. As complex as the reasons for these increases may be, the bottom line nevertheless is that we justify the increases in cost for ourselves by the (correct or incorrect) assumption of improving outcome measures.

The question then becomes how much improvement can you justify by a unit increase in costs. E.g. extending a cancer patient's life by a month may mean the world for them (e.g. being able to live to see the birth of a grandchild, etc), but may be a very minimal improvement if you look at it from the health economics standpoint, for, say a 10% increase in cost.

Unfortunately we don't have infinite means to spend as much money on health care as it takes. As compassionate as we may be, we have to draw the line somewhere. Some would argue that we shouldn't double our health budget in order to achieve a marginal improvement, but at the same time it feels wrong to refuse better care for financial reasons, even when it is the financial reality.

Also, even if we took the stand of erring on the side of human life and health protection and did everything possible to maximize spending on health care in hopes to improve lives of patients even if by ever so minimally, that would clearly mean that we would have to make severe sacrifices elsewhere, which we have already been trying to do and could be detrimental to health and human life in other (indirect) ways.

It brings us to the perennial dilemma of how much human life and health is worth to the society, as opposed to individuals who are currently sick. For the healthy ones maximizing health outcomes at the expense of skyrocketing costs is obviously a much lower priority than to the sick ones, which represents a conflict. We have been struggling to address this conflict and find the right balance.

As our society ages (thanks to medical advances and investments in research and health care...), paradoxically we will have even more people with health needs and thus the balance will have to shift to reflect that, but at the same time, we might have even less resources as sick people may be less productive.

I don't know what the long term answer is to resolve this conundrum. I think once we can truly genetically cure disease and enhance health, as well as be far more efficient and productive, as a society, due to technological advances, we could find a better balance. Or we just roll back on technology and advances and accept we, humans, were born to live a limited life, which disease may be part of, and simply we just can't expect to live 150 years. We need a lot of thinking to figure this out and opinions surely vary widely. Until we can actually figure out, the dilemma of how much extra spending it is worth to produce (relatively/arguably) small health improvements will remain a somewhat scary and unsettled question.

Which is "good": Comcast or Verizon?

Link: http://zneuro.net/blog2.php/2010/03/26/verizonagain

It is hard to say "which is good". I am inclined to say "neither". The issue goes down to the model of customer oriented businesses.

The way they make money is to have "efficient" customer support, which includes saving money on hourly wages (obviously getting sub par semi-idiotic and/or outsourced customer support staff) and making customers' interest the lowest possible priority (i.e. not bothering with the fact you have to hold the line for hours on the phone, not having effective communication and coordination system to protect your time and avoid inconvenience, not putting sufficient resources to have a billing system which avoids over-billing, etc).

At the same time, some of the money saved ignoring customers and having shitty customer care, will go into propaganda where they say in a pleasant loving voice all they care about their customers' satisfaction.

Bullshit! They absolutely DO NOT care about that, more than some bare minimum that allows them to stay at or above "industry standard", which is horribly low. What they care about is to make money, for their shareholders. Obviously these interests are conflicting. If they were all super loving and caring, making sure every customer received 1st class service, the shareholders would boot the management for wasting money, as that kind of customer service most certainly wouldn't pay off.

That is exactly the epitome of this question, the "industry standard" of customer service and satisfaction. Because it is so low, you can't solve the problem. You are stuck. So answering your question, neither is good. Same thing with the banks or other "competing" customer oriented businesses. If you switch to the competitor, it is just a question of time and luck when you will be in for the same exact type of shit you decided to leave the other company in the first place.

There is nothing you can really do to make it better than it is, this is still the best system, because at least there IS a bare minimum industry standard. In other words, the shareholders and management do get incentivised to NOT allow customer satisfaction into a free fall, i.e. going well below industry standard, because then the competitor would start picking up business. At the same time nobody (except for customers who just hope for a miraculously good deal by improved support) are much interested in improving customer support above the industry standard minimum, as for every dollar invested above that level you get declining returns.

The only way the model perhaps could accommodate people like me, who could afford (and without thinking would pay for) "premium" services, in other words a tiered support system. It exists, there are many examples, but most mainstream big volume providers (banks, internet, phone companies, etc) did not quite bite on it yet. The ones that are working, are not working very well (I tried for example CompanionLink, a software to sync Outlook and Google), where I purchased the premium customer support level, only to realize it is not exactly working too well...).

Verizon: Almost One Year Later

Link: http://zneuro.net/blog2.php/2009/07/01/1st-followup-to-verizon-saga

Just a another Verizon followup (or rather, a brand new post) from today, 3/26/10, nearly a year after my first similar posts...

Last night I went home and found that my internet wasn't working. I called tech support and after the usual hold (or perhaps a bit longer than usual) I got somebody to tell me that the account was suspended. Without being able to confirm it, the person told me that seemingly this was due to "non-paying" (I have always paid all my bills in full, on time). I was also told that nothing could be done to this (to activate my internet connection) at that time (it was 11 PM), and that the issue needed to be addressed during normal business hours.

I took the time and called today. I was on the phone for an hour and a half (!). Let me summarize (below) what happened during that 90 minutes...

Somehow I was connected to FiOS support first (navigating through the tricky menus I selected the option that I wanted a new service, hoping that would give me quick access to a live person, assuming their incentive to sell you "new" services), but then when asked about the type of service I just dialed zero.

Interesting that I still had to hold 20 minutes despite the hope of a quick sales line. Nonetheless after 20 minutes I did get a live person, albeit a FiOS one.

Anyhow, I did get a live person. After some 5 minutes on the line with her (asking all my account information etc), she determined I needed to be transferred to the DSL people. BTW, she offered, so that next time I don't get connected to the wrong area, a "direct" line to DSL (800-567-6789). Very nice, I said, that actually was the number I called in the first place for how I managed to get to her...

After another 10 minutes of music (which wasn't too bad, at least for the selections, the quality was sub par), I now got the usual outsourced accented gentleman. We started chatting in a friendly tone and after a little while I learned from him that he is actually sitting in the dial-up department. He courteously offered, however, to transfer me to the DSL department. Not only that, but he even helped me further than that. He actually went ahead and offered to disclose the DIRECT number to DSL (800-567-6789).

Unfortunately, at this point, my friendly attitude waning, I declined, citing the fact that was the very number I called in the first place (and the only number I always call), yet managing to get to all sorts of departments around Verizon, with the only common denominator being they can't help me. The outsourced gentleman, with apparent modest to moderate communication challenges related to the use of the English language, unfortunately did not understand exactly why I would decline his help offering this secret, direct number, so he said it anyway.

As calm as I was earlier, this was getting a worthwhile experience. My cognitive self-therapeutic efforts focusing on not becoming frustrated, showed some wear and tear at this point.

Now, as you probably guessed, came more transfers... I finally got to the DSL folks, which, on the surface, you would think is a good thing. Right? Wrong. After another almost 10 minute hold and getting to another outsourced gentleman (who sounded exactly like the previous one), I had to painfully realize that no real progress was being made.

Anyhow, I share the account info, answer all security questions, describe the problem, to this new gentleman, my new friend. My account is suspended, I am told, therefore the billing department should be working with me. Great. Yes, that means TRANSFER!

So I weather another transfer with some mix of apathy and frustration, and this time sounds a non-outsourced voice on the other end, hurray. Of course the hold time adds on again. After share my convoluted story, which includes the fact I moved my voice part of the account to VoIP (Vonage) recently and I suspect this had caused the issue in the first place (and all I want is internet only, restored right away, something I previously had been told was possible).

Unfortunately, the billing person is confused, challenged, frequently puts me on hold to look into things. As the situation is getting more and more hopeless for him, he even (cautiously) tries the "t" word (transfer), which, by that time, had become my rage trigger.

Increasingly seeing no way out between his intellectual limits and the complexity of the situation at hand, as a punchline at the height of tension, the line gets dropped. After 90 minutes total.

I call back. This time I use a different approach. How about if I pick the "cancel" account option from the main menu instead of trying the sales lines. In fact I did not have to fake it. At that point I was determined to do it too (i.e. cancel the entire Verizon account for once and all).

Surprise! I get somebody on the line in less than 5 minutes! So I share my story for the 6th time in 90 minutes. Another surprise: the person speaks English well (understands almost everything I say), plus, as an added bonus, actually he is almost semi-competent. Huge contrast with all the earlier imbecile folks. Makes me wonder if they pay higher for the "cancel my account" reps as that is of even greater relevance than the new sales and definitely greater than customer support. If I can give you one advice here, if you have a problem and want to get somebody on the line quickly, go for the account cancellation option...

The guy relatively efficiently reviews notes, maps out the situation, and it becomes clear to both of us what had happened. My act of moving the voice away from Verizon did not automatically activate a "dry loop" (I wonder why they call it that way) DSL only subscription under the same account, but somehow caused suspending my account. The reason for that is that when you change your subscription that way you have to pay, up front, using a credit card, before anything else happens (I thought I would just be billed as I do normally).

OK, now that the investigation of history is done, let's look into the future and figure out what can be done. Again, my intention at this point is still to try to just simply reactivate the account.

There is some complexity regarding how the still technically open DSL subscription from a discontinued DSL+voice subscription, in the context of moving the voice to another provider, plays out, so I won't further complicate this technologically heavy post. Enough to say that my internet service was in "limbo" (that's the exact word the guy used), so we needed to make some decision regarding how to proceed.

Turns out, my internet service, after all this, could not simply be re-activated. If I wanted Verizon DSL internet back (in a "dry loop" manner), I would have to do the entire setup from scratch.

Why is that relevant? DSL tends to be a bit more complex than cable, including setup. My situation is even more complex, because I opt to not use the Verizon DSL modem as a router (which would be the routine setup), because I use my own (gigabit) router and use the DSL modem solely as a bridge, which requires some special account setup, which is a nightmare.

When the guy revealed that all my account settings were now erased and if I wanted to have my internet reactivated (without voice; i.e. "dry loop"), I would have to do the setup from scratch.

OK. At this point my decision matured to the point of no return. Cancel my account. I felt bad, because all day this was the only time I spoke to the most competent, and nice sounding gentleman, who was actually helpful and was on top of the situation. He was classy. Once I told him I just wanted to cancel, he acted accordingly.

Of course, I am writing this post before I see any further development, letters, bills, etc, so I'm pretty sure it is appropriate for me to say now (about this blog): "to be continued"...

The end of Palm

Link: http://www.businessweek.com/technology/content/feb2010/tc20100225_755804.htm

Palm is now irrelevant. Caput. A sad story of internal turf battles compromising mission.

Jeff Hawkins, Donna Dubinsky, and Ed Colligan, the original inventors of the Palm Pilot and founders of Palm Computing, founded Handspring, after 3Com was taking the Palm division to a direction they didn't like. 3Com folks were... pleased to seemingly win the turf battle by letting these innovative folks be pushed out.

Then these turf winners were pissed seeing the success of Handspring at the same time they were doing OK at best. Handspring's Treo was a tremendous success and the model 600 (which I owned in its heyday) was the 1st truly smart mainstream smartphone.

As pissed as the Palm/3Com folks were, they struggled to convince their shareholders to acquire Handspring, which eventually happened. Their agenda, however, was perversely (and obviously against their shareholders' best interest) to suffocate the immensely popular Treo line, to make a point about who's boss.

In fact not only did they suppress Treo R & D and marketing budgets, but they funneled funds to develop their own children projects, directly competing with Treo (Tungsten W, Centro). Now how screwed up is it to develop competition internally for your own products?

I guess in their ideal world, the Centro and other Palm (non-Treo) smartphones would have reached greatness and glory, to contrast with the "failed" Treo line acquired from Handspring.

Well, it did not work that way. While the Treo got a serious hole and began to sink, the other Palm products never caught on, RIM and Apple moved in and claimed rapidly increasing market share in the smartphone world, that Palm and Treo helped create/pioneer.

After shareholders got alarmed they demanded change. The Treo line received some renewed support and then last year Palm orchestrated a respectable comeback with the Pre and Pixi, running WebOS. Great reviews, decent products. But nothing to change anything in a cut-throat competitive smartphone market, where the faith of Palm had already been determined at the time years prior, when they suppressed (rather than aggressively riding on its success) the Treo line.

This is an educational story about greed and turf, minds obscured by power and immature human conflict, driven by insecurity, where a "turf battle" can compromise the entire mission.

As a result, Palm is now dead and will soon be looking for a buyer and likely at a discount. I hope we can all (intelligence community, paying attention?) learn from this sad story and make sure we always keep the mission on the top and not let it be compromised by conflict of interest, such as turfs.

Acronis and Independent Hardware Restoration

I would like to believe my horrendous experience chronicled here is just likely an exception and my sample size is just too small to draw far-reaching consequences. But being in contact with Acronis Customer Support 5 times and getting the same experience every time, it is becoming statistically significant and perhaps others learn from it.

Early last week I called Acronis to inquire about a hardware-independent restore need I have (my old PC is a Dell Precision 670 w/ a SATA RAID0 and I would like to load that system volume image onto my new PC, which is a Lenovo Thinkstation D20, w/ SAS RAID0 RAID as system volume and of course this PC has a different chipset and hardware components).

I use ShadowProtect from StorageCraft as well, but that failed to do the restore in this case as the target volume was a GB smaller than the imaged original partition. I called Acronis and asked whether the specific task I had could be solved with their newest and bestest software, Acronis True Image Home 2010 (http://www.acronis.com/homecomputing/products/trueimage/) with its trumpeted Plus Pack (http://www.acronis.com/homecomputing/products/trueimage/plus-pack.html).

I had a chat session with one of their people and I was reassured it was "absolutely" possible. I was skeptical so I specifically asked to consider my relatively involved hardware requirements. Based on that recommendation and went ahead and purchased the upgrade and the PP.

I created a boot CD and since my old machine ran ShadowProtect (and installations of the 2 imaging rivals cannot exist on the same PC at the same time), I did not have Acronis image of my old PC. I created one from the boot CD's restore environment and then I went ahead and attempted restoring that image onto the new PC.

That's when I ran into problems and contacted support I had the worst of experience. The agents were incompetent and unhelpful. Overall I had 5 chat sessions (including the initial). Some of it can be found here:

1. http://docs.google.com/Doc?docid=0ATbiHn2rgwJOZGZxMmZyY2tfMjg2YzRjYjluYzM&hl=en

and

2. http://docs.google.com/Doc?docid=0ATbiHn2rgwJOZGZxMmZyY2tfMjg1ZHpydzNmZ3Q&hl=en

These 2 samples accurately capture the way all sessions went down. I received a feedback invite, which I filled out at first with all of the questions answered with the worst available (1) answers and then when I hit "submit" it produced an error (imagine my frustration that on top of struggling much already, trying to find a channel to relieve my frustration, I lose many paragraph of writing.

In any case, I repeated the survey, this time making sure I don't pick all bad choices (in case the system filters those and that's why an error message was produced) and it went through. Here are the screen shots of the survey (http://docs.google.com/fileview?id=0BzbiHn2rgwJONWE4ZTkzOTQtMGQ1Ny00MTRiLTgwNzMtMzI5MmM0ZWY5NjBj&hl=en) and the text as not all of that is visible in the screen shots (http://docs.google.com/Doc?docid=0ATbiHn2rgwJOZGZxMmZyY2tfMjg3Y214emhmaGQ&hl=en). Please match the numbered text in the doc file with the free text fields of the survey.

Basically, I blasted them for (a) not being interested in solving my problems; (b) running a customer support system that is dysfunctional because of the quality of the agents.

I am not in this business, but I know providing software support is immensely costly and difficult. The price of the software does not cover an hour of wage, if you want to employ a competent and capable agent. You could instead hire somebody in an outsourced facility for 1/10 or 1/15 of that rate, which some of these companies opt for. However, you end up with a completely incompetent and useless bunch of imbeciles.

For example, in my case, I spent hours and hours chatting over several days and my problem was not solved. Maybe it is an aberration. But the problem I was having, even if not widespread, not unique either.

I believe (and saw samples of it elsewhere), there are 3 main ways of improving efficacy and overall customer care/technical support experience, without necessarily increasing the costs to the point of hurting the business model.

1. A tiered model of customer support is almost a must. The 1st line pawns should be encouraged to escalate a problem that they can obviously not solve. When it comes to escalating, I am afraid the current system disincentivizes 1st tier agents. They are pushed to do as many calls as possible and document that it was "resolved" in some manner. They wish that by luck they get all no-brainer easy calls. They dread complicated issues. When they get a problem that cannot be easily solved, they are faced with a dilemma. If they are ethical, they escalate it, maximizing the chance the problem actually does get resolved. But if they escalate too often, they increase costs, because higher tier agents need to be involved and higher tier=higher cost.

Therefore they feel a pressure to call problems "resolved" to avoid escalating. A good compromise is to give the customer dummy tasks that take time. That way they get rid of a complicated problem (so that they can work with easy ones to improve their stats and let some other loser get the complicated problem when the customer calls back finding at the end of the dummy task that their problem is unresolved). The dummy task option works perfectly for complicated problems they realize they can't resolve, by moving on from it quickly while not hurting their stats. The problem is that it can only go so far as there is only a limited number of "dummy tasks" that customers (who may not be complete dummies themselves) may not eat any sh*t the agent tries to sell (i.e. questions if an obviously unfeasible task is given to them).

So what can they do when all obvious dummy tasks are exhausted? Again, they are faced with a dilemma. They could either escalate at this point, if they are minimally ethical, or they could lie. They could suggest another dummy task that they know is completely useless AND EVEN THE CUSTOMER WOULD KNOW that it is completely useless HAD THEY BEEN HONESTLY INFORMED about the specifics of the recommended task.

But that's the point. The agent has to lie about the task, otherwise the customer would just hang on further. In our example, the agent first (after clearly realizing he could not solve the problem) suggested we discontinue the chat session and he would email the solution. Right. You know when he would have emailed. Of course he might not have realized that I saved the chat, but then again, the chances this would have come back to hurt him in any way or form are almost nil and he knows that.

Of course I refused the email offer (see the 2nd chat link above), knowing it was just a cheap trick. Then he came up with the ISO file, which was clever on his part, I should say. Given we discussed earlier (see chat file) that I burned a boot CD from an ISO I created from the Home Image 2010 software AFTER I installed PP (which is how it is supposed to be done), he sends me a link to an ISO file that contains a boot CD for version 2009! Of course that is not obvious from the name of the ISO and I only found out this when I burned the ISO and booted my PC from it.

Obviously, had he told me that the ISO he was sending was an EARLIER version of the software, which lacks the universal hardware support of the newer version, I would have told him that we should just forget that step as there was no conceivable chance it would have worked after the later version failed. In any case, I tried, and, as expected, it did not even go as far in the process as the 2010 version.

Sometimes older versions can work in certain situations better than the latest version, because some features in the new version are no longer available. If he tried to explain to me that the reason he wanted me to try the Home Image 2009 was related to some similar assumption, I would probably have gone with that, very skeptically, and asking further assurances and information. Clearly that is not how he did it. He pretty much got me on this one and achieved what he wanted, which is to end the painfully long and hopeless chat session and move on. On his end, he probably documented everything was perfectly resolved as I received an email from Acronis to that effect.

2. I digress, but let's get back to the "perfect" customer support system. The second element (additionally to a multi-tiered model, which is a must) is proper followup. Rather than sending an email next day and a survey, etc, a supervisor should check after EVERY call or chat session as to what happened, how the session ended, what was resolved what not, and why. Presumably the supervisor would be a higher paid, literate high tier agent, who could rather quickly figure out what happened. Tier 1 agents performance would be then rated based on the supervisor's documentation. If the problem was not resolved as it should have been, the supervisor could either reconnect to the first Tier 1 agent, connect to another one, or help solve the problem himself/herself, depending on the situation. If a task is given, the supervisor could check if that was appropriate. E.g. in this case, when (after seeing the 3 days of chats, especially the last one) a supervisor saw that the Tier 1 agent linked me to a clearly hopeless earlier software version, he could have then connected back to the Tier 1 agent and questioned him for why this was done and would have offered a more appropriate solution. If such a system existed, I am pretty sure my problem would not have required me to contact them 5 times and would not have still been left without a resolution.

3. Finally, in terms of incentives, at least for customers, it would be better to incentivize the Tier 1 support staff based on percentage of problems actually resolved as opposed to how many calls they could take in a given time. I sense some companies have this right. The agents are rather aggressive about the problem and pursue some form of followup as opposed to finding ways of moving on (and documenting the problem as "resolved"). I know there is more into it than what I can grasp based on the information I have. There may be some strategic decisions about how this should be handled and given the relative rarity of highly complex issues (and thus, because of their rarity, their low financial impact), it is more financially viable to have a large work force of Tier 1 agents, who are exceedingly low paid (and thus are unintelligent) and incentivize them by the number of calls taken as that system will satisfy 90% of customers (and exorbitantly piss of 10%, but if they are pissed, it probably doesn't matter how much they are pissed; the fact they are 10% limits their impact one way or another anyway).

Wilson and Lies

Link: http://www.washingtonpost.com/wp-dyn/content/article/2009/09/13/AR2009091301559.html

There has been much attention to the unorthodox manner US Congressman Joe Wilson decided to further the dialog on the health care reform proposed by President Obama. Obviously the health care battle is already heated to maximum. I posted a detailed blog on the greater issue of health care reform already (http://zneuro.net/blog2.php/2009/08/21/healthcarereform2009) and I will not repeat the specifics discussed there. But I felt I really needed to make a brief comment about the Wilson phenomenon, as it has far reaching implications.

BTW, on the issue of breach of house rules, it is interesting that in the referenced Fox Sunday interview posted on the internet by the Washington Post (http://www.washingtonpost.com/wp-dyn/content/article/2009/09/13/AR2009091301559.html) Wilson said the fact his colleagues are giving him a hard time about some "rules" was pure "politics". I.e. he believes the fact he is being held to keep the rules represents "politics". Why have rules then? Everyone could just do the "right thing" as dictated by their faith and feelings, and not let themselves get slowed down by some senseless rules dictated by "politics", as in yelling disrespectfully, verbally or even physically abusing others (whatever deemed necessary in the heat of the moment or otherwise driven by their unshakable sense of righteousness). No?

Wilson is now caught between the "positive" results of his shameful act, as seen in the great national (and international) attention and outpouring of support/campaign dollars (even calls for "Wilson for president") that are produced by his blatant disrespect to his floor colleagues and to a President some like-minded folks love to hate (for whatever reason, including his race; a race not usual for a president per these folks, but more usual for maids like the one Wilson's hero Thurmond got pregnant, revelation of which affair tarnishing Thurmond's legacy unfairly, per Wilson) and the "negative" aspects of it, like being seen as a reckless idiot by most law obeying and civilized folks. BTW, I do agree with the NYT (http://www.nytimes.com/2009/09/13/opinion/13dowd.html) that Wilson's dislike of blacks likely contributed to his "lapse", although he may have some mental health issues, too. I am not his doctor.

Nevertheless, the main conflict Wilson and his followers have about illegal immigration has not started with this latest brouhaha. Wilson's comments may, on the surface, suggest that he wants illegal immigrants GONE. Clearly, he certainly does not want them to receive tax-dollar-sponsored coverage of health care. That is a fair standing.

So what to do with those immigrants? Not let them in? Remove them? Find them all and deport them to their country of origin? Or jail them in federal prisons? I guess not letting them in in the first place would be logical if we don't want them to have medical care. Otherwise, i.e. if we wanted them here to help us with cheap labor, but wanted to provide no medical care to them, we would not only act unethically, but we would actually pose health risks to those of us who reside here legally. Well that may be something Wilson and Co. are either incapable or unwilling to comprehend/acknowledge. I believe it is the latter as they are not dumb.

Let's just examine the love-and-hate relationship the GOP has with illegal immigration. On the front end they want to please their xenophobic constituencies by harsh public bashing of illegal immigrants. On the back end they don't really want to stop illegal immigration to please their big ticket sponsors who enjoy the financial benefits of (ab)using undocumented workers.

Why would they not do everything to stop illegal immigration? Most people agree it could be stopped or at least drastically reduced, if that is what the US wanted to do. After all, illegal immigration is not only illegal, but it poses major risks to the rest if the US, including relinquishing control over potential terrorist influx.

So why is it that they are not more aggressive fighting illegal immigration? Well, that's because of the aforementioned "business aspects" of the issue. Completely congruent with the GOP's fundamental campaign philosophy (i.e. sell socially conservative tickets on the campaign trail, then focus legislative work on business interests once in office), the GOP likes to slam illegal immigrants publicly every chance they got, but then when it comes to legislation they drag their feet in the effort to curb illegal immigration.

Frankly, many businesses would not be pleased if they had to replace their work force of illegals (that needs no 401k, pension, healthcare, workers comp, is not unionized, has no right to complain, report, speak up, is not subject to minimum wage laws, does not even exist in the eye of authorities) with a work force that has all that and obviously costs a lot more in wages, too. Clearly, that replacement would eat into their profits big time (which would hurt campaign contributions, of course).

In an ideal GOP world, in order to maximize profits, the working class would produce labor at a substantially lower cost, would have no rights whatsoever and would be forced to provide underpaid labor, child labor, among other things. US businesses (supporting GOP political campaigns), by outsourcing work to countries where labor organization and regulation are absent, clearly improve their profitability. It could be even more efficient if they did not have to outsource, but found labor here within the US, with no workers' rights, similar to the Far East sweat shops. Therefore, undocumented laborers are "perfect" as they are here, they just keep "shut up" no matter what happens as they are greatly incentivized to stay invisible to authorities, and thus can be abused every which way without risk or review.

One area of particular importance is health care in that process. Wilson (and his large following) obviously can become quite emotionally charged over the issue of health care to illegals. But wouldn't it be a morally sounder and more logical approach to try to enforce immigration laws and reduce illegal immigration in the first place? Perhaps that way we would not be talking about what to do with them and the dilemma about health care to them would not be so biting.

The issue of how to limit illegal immigration is complicated and is not the focus of this posting. However, I would like to point out that Wilson's anger and "brave" protest when he suspects (incorrectly) that the Administration was proposing health care coverage to illegals may elevate him to a level of a folk hero to some, but it actually raises an issue we would all need to think about in a more civilized manner.

I am not proposing we should insure illegals and I definitely do not support illegal immigration. An immigrant myself I can tell you that going through the loops associated with LEGAL immigration is just beyond imagination. For me, a medical doctor and scientist, who never committed any crime and considered by most standards a rather productive and desirable member of the society, there were immense hurdles to go through to become a legal resident. I find it rather ironic that as much effort and resources have been allocated to making sure people like me don't get in easily or without painstaking review, as little is done to stop the totally illegal entry of thousands of uneducated and unskilled workers (clearly posing much greater public health threats and other threats than the influx of foreign born doctors).

I do think that shoving our heads into the sand about illegals is neither moral nor responsible. It is true that for Wilson it is just convenient to have undocumented folks that ca be abused every which way, while not costing anything at either business or societal level, and still available to public bashing for immediate gratification of xenophobic constituents with little insight of the related deeper issues. However, coming back to the importance of preventative health care (http://zneuro.net/blog2.php/2009/08/21/healthcarereform2009), illegals' lack of care and registering process poses significant health risk for the rest of us and Wilson can't yell himself out of that reality. These people are not isolated from the rest of us and without review they can serve as natural reservoir of infectious agents, including HIV and TB. And I did not even mention the costs to hospitals when these people get really sick.

I believe the right thing to do (as opposed to yelling disrespectfully at the president like in a rowdy bar full of rednecks) is to:

(1) Maximize efforts to limit illegal immigration. This is a complex and huge task with multiple facets and clearly bipartisan approach is necessary. Politicians will have a hard time engaging in this, as their campaign contributions can come under fire, given the likelihood some of their major campaign contributors won't like this plan. But they could perhaps translate the outpouring anger we are witnessing in demonstrations, town hall meetings, and protests in DC into cash for their campaigns, to make up the revenue lost from illegal labor loving big business folks, effectively turning their legislative work from special interest driven into grass root driven. Wouldn't it be nice that politicians actually were answerable to voters and not big special interest donors?

(2) There should be a path for illegal aliens, who are already in the US and working here, to become legal, tax-paying citizens. And sorry, their employers should also pay taxes and all necessary fees and contributions, according to US labor laws. That way a "public option" wouldn't mean we would be spending good legal taxpayer money on illegals, but it would mean we would have a choice of a not-for-profit health care option for all of us, legal and tax paying residents, sponsored from the taxes we all pay.

The epitome of right-left conflict, as reflected in the healthcare reform debate

Link: http://www.cbsnews.com/stories/2009/08/21/opinion/main5257556.shtml

I think most healthy minded and reasonably moral humans would agree that arguing against the use of preventative medicine is egregiously unethical (if not all of them; depending on your definition of "healthy minded and reasonably moral"; one could argue that the very fact someone does not agree that prevention is good medicine actually is a proof they are either not healthy or not moral).

Now, that said, I absolutely agree with the need to have a dialogue. Dialogs are useful and usually constructive. Certainly a much preferred way of dealing with disagreements than violent methods or yelling. I also do not advocate name calling. I don't think that is useful or helps any cause really.

Then how come my first paragraph apparently insulted the writer of the cited CBS piece, calling him names (i.e. either mentally sick or immoral) and/or refusing to have a dialogue he apparently has helped develop by penning his opinion? Well, that's just to show that most things are not absolute and sometimes you have to make an exception. Would you agree that, however healthy and positive the idea of a dialog is, there is probably no need to consider it when it comes to Nazi ideology? Or would you agree that it's OK to call Hitler immoral (or crazy)? Well, those extremes just demonstrate that you "never say never", even if it comes to rules on dialogs being generally healthy and name-calling generally being bad.

In a society where there is as much wealth as in the US, I believe it is justified to think we can afford to consider improving the quality of life of all, including the less fortunate. The argument against it, i.e., the less fortunate will just have to suck it up because they don't deserve a share of the wealth they did not help produce (and probably largely if not entirely are responsible for their "bad luck", perhaps even other ailments of the society, so "the least" they deserve is no "goodies" they did absolutely nothing for), not even to the point of basic needs such as health care, still boggles my mind. That somebody can come out with a straight face and announce that those folks deserve to die young leaves me speechless... Well, actually not really, for why I decided to write this.

I would like to get something out of the way up front. I don't think health care reform should be bipartisan. In fact I do not think it can be bipartisan. The fact of the matter is that the voters in the US spoke last November and they trusted the President and his ideas, including those on healthcare. Do you think if the Republicans had won, they would now be reaching out to win Democratic support for a plan (if they ever had one) where they sought to advance the cause of industrial interests and capital? I believe this question was voted on. The voters spoke. If you will, there already was a referendum on the issue.

Of course it does not sound very team-spirited to say that. But I believe the healthcare reform debate drives right to the heart of the fundamental disagreement about how we collect our common wealth (i.e. taxation) and how we then redistribute it (i.e. public spending). I believe most of us reasonable folks would agree that you cannot distribute taxes exactly in proportion of their collections and the way their distribution is disproportionate is that lower payers receive benefits out of proportion/in excess of their contributions. The question is really just the degree of disproportion; a continuum with communism on one end and extreme capitalism on the other.

Republicans and democrats are decidedly on opposing ends of the debate with republicans believing paying less taxes is the ultimate heaven, at the expense of public spending; while democrats are leaning to benefit the public at the expense of taxing the wealthier. The health care reform cuts to the heart of this disagreement, because the public option is funded on taxes and benefits the public, in a relatively major even radical manner, aiming to overhaul a health system that is huge, dysfunctional, but overall inclined to benefit the wealthy and the industry.

Why then, as it may seem to you, would the public be having a problem with a proposal that aims to benefit them, at the expense of the wealthy minority and insurance industrial interests? Sure, there is much trumpeted opposition. One that is marked by outrage, foul language, disrespect, disorderly conduct, visceral and emotional outburst. Then this opposition is pointed to by Republican media (and occasionally Republican political leadership) as "evidence" of public opposition to the health care reform plans. A grand campaign of misinformation, purely motivated and directed by minority interest, absolutely not grass-root, leading to much upheaval and emotionally charged riot type reactions. The media, of course, will cover these, as anything that sells (and people with overcharged emotions acting out of the ordinary, especially in the context of a big ticket political debate, is definitely as coverage-worthy as it will ever get) they cover. The right-wing media is particularly incentivized to cover these phenomenal manifestations of public outbursts opposing the reform. The right-wing media apparently makes a concerted attempt to display the situation as if the reform plan would need any selling to the public. Frankly, that is NOT the case. The angry yelling people at town hall meetings are NOT the public. The public is what voted this president in office with the notion there would be a public health plan, which was quite prominent in his campaign and win. Besides, all relevant polls indicate the public still favors public health care option, which is remarkable considering that is despite the insurer industry's mega-campaign to mislead them.

Yet, these people yelling at senators from the bottom of their lungs is quite a spectacle. Have we seen something like this before? Actually, misinformation is a well tested tool, a routine, in which special interest groups are cynically misinforming and fueling emotional outbursts to benefit their cause. The fact of the matter is that when people are really angry in a democratic society, that's usually because they don't understand something.

I am very sorry they are misinformed and that they are angry. They should be better informed. And I fully agree with the administration's willingness to reach out and educate, in their effort to make all the damage done already undone. But this is just a distraction without any true grass-root foundation. In terms of spending energy on their education, in the same time, effort should be focused on actually pulling the reform off and pushing it through, bipartisan or monopartisan, as it won't be an easy task and efforts are needed...

***

Let me come back to the immorality of the argument this CBS piece has made regarding preventative medicine. It is stated that screening (as one example of preventative care) is bad, because it does not pay off. Let's just assume a respective medical society issues a guideline or practice parameter, based on scientific evidence, that a certain screening is recommended to people of certain age (let's just keep it simple and say that is regardless of race, education, or income). To stay with the example in the CBS article, this costs $500. The uninsured (likely poor, etc) will obviously not get it, while the insured will get it. What difference will that make? The small minority whose cancer is caught in time as a result of screening will live and their unscreened counterparts will die (unnecessarily early or in a way that could have been prevented). The writer says that is quite all right, because we cannot afford to screen all the masses to save a few. Their lives are less worthy, he determines.

The writer of the CBS piece wants people (I assume poor people/uneducated people and/or minority people, whose longevity is generally shorter) dead young and not bother spending on prevention and spending on keeping them alive when they are old. As, in his world, preventative medicine will only make them gratuitously live longer, only to increase healthcare costs paid for by good and wealthy citizens. That by adding up [1] the costs of increased preventative health care; plus [2] all the even costlier ailments these folks will end up suffering when growing old. I.e. if the young Hispanic or African American factory worker, the writer most likely had in mind, dies from a heart attack at age 45 with never having seen a PCP, he would cost virtually nothing or maybe (if he makes it to the ER alive) a (relatively limited) sum of unpaid bills in the hospital. He, on the other hand, of course would eat up thousands and thousands of dollars more in health care costs going for regular checkups from age 30 and living all healthy up to 75, when gradually one medical problem would pop up after another, making him a disaster, (sort of) living with bad multi-disciplinary problems for another 10 years or so, perhaps with constant medical care in the last couple of years, costing an arm and a leg to the society.

Not from my hard earned dollars! Only through my dead body! Says the writer, protecting his paltry tax dollar. Why not then, just pass a law in Congress that people are allowed to live until age 45 or until healthy, whichever is sooner, and then be executed by lethal injection so that no health care costs are inflated to care for them... Maybe not for all the same way, maybe with some amendments to the law allowing exceptions from the lethal injections. Perhaps the "exception" would be something that would be available to the privileged, right?

Seriously: what if those dozens of healthy years added by preventative care actually mean something MORE than just the fact we, as a society, have to pay for extra preventative health care dollars for them and they lead to senile incontinent nursing home vegetables (a disappointing vision that enhances his remorse over the futile death of those beautiful dollars even further)? What if living to see their grandchild graduate from college, growing old enough to see the world become a better place, to be able to tell the new generations how the world was many years ago, could actually mean something MORE than dollar thousands rendered to the care that helped them achieve this. No? Extending the life of a human by another 3 decades may be worth something? Perhaps even as much as the money that pays for the preventative checkups or even their nursing home care in the end while they ready themselves for a solemn and respectful exit, with dignity all humans deserve? Clearly, not for the writer of the CBS article.

Also, I am not living in dreamland. I know somebody would need to pay for it. Sad reality is that we just can't finance what it takes to provide top health care solutions and cutting edge medicine to everyone, as we would go broke. But making an argument that preventative health care is a lost cause is clearly a blatantly immoral notion.

Nevertheless, in his conviction and righteousness about letting people die young, I think the writer ignores a significant financial aspect of the issue. What if allowing the individual live longer actually lets him/her extend their years of production? What if with prevention we can keep the population healthy and longer in the workforce and these are the folks who already have had the most training and experience. Can that pay for the extra prevention cost and even the end game? Well, we can argue about it. The writer would probably think (or even say) that "well, these folks are the low level unskilled workers, who, even if employed, are not very productive, so then what added productivity are you talking about by making them live longer?". I would counter that although they may vary on a wide range in skills and experience, many who would be saved by improved preventative care probably could produce enough to help pay for the costs their extended life causes and if not, the rest of us should.

***

It is interesting how in (mostly industry sponsored) scientific articles on anti-cancer drugs it is argued that a 6 months extra survival can mean the world to the patient, as that 6 months could help them survive to see something major (e.g. one of my great-grandfathers died a month before I was born). And that is priceless (even though there definitely is a price tag on the new cancer drug in question and it costs dearly). How then is it OK to argue (by the writer of the cited CBS piece) that forgoing saving decades of life is the wrong thing to do? Isn't this a conflict? Also, drug companies and medical device makers would probably be pleased to see an older and sicker society; there would be more business for them, no? Just as would be for insurance companies, too! How can we resolve this apparent contradiction?

Well, by being a bit more specific. That it is only helpful not extending the lives of the poor and the "unworthy" (in the writer's and his party's view). I am sure the writer would not agree his own life for example should go short in the altar of cost-saving, would he? The poor and uneducated add little, the writer would say, the only thing they can do is they eat up costs and do no good. That seems to resolve the apparent conflict. To put it in simple terms: saving lives for the productive, educated, and wealthy = GOOD; saving the lives of the unproductive, uneducated, and poor = BAD. That kind of sums up the message of the CBS article. So now there is no conflict, right?

Well, actually there still may be some. The writer may even seem confused as to whose interest it is he really wants to defend most. He is only clear on whose interest he is NOT interested in protecting, i.e. the public and I sort of discussed and analyzed already why that is. But then there are several ways you can support anti-public interests as there are more than one interests out there! Namely three.

First, his own tax dollar. He just does not want that to go to the "wrong" cause, i.e. to help others who are in more need. That's fair, I guess. I am not sure about the writer's financial situation, but I assume he is not homeless or hungry or without medical insurance. He probably has all the ingredients of a modern day comfortable life with safe retirement, etc. Could he afford to not go for one extra vacation or not buy that extra home in Florida? I guess he could. Make no mistake, I am no communist. I do think individuals and business should deservedly be rewarded according to their talent and market success. But how much we contribute to help the needy is a constant area of disagreement among us and a highly ethical one, something far beyond the scope of this blog (maybe for another time). But nevertheless the question of taxation and distribution of public wealth apparently drives the writer primarily. The writer's clear incentive against insuring the 47 million uninsured is probably his main motive, not allowing his tax dollar to go to "waste".

Second, there is the interest of health insurance companies. They are also against a public option and in some ways their interests are aligned with the writer's, perhaps in the second most important manner after his self-interest described in the previous paragraph. Health insurance companies are administrators with great power in how care is actually provided. I have seen many many examples how powerful they really are. In the same time they are arrogant and leave little need for guessing as to what their motives are. A recent example of this patient I saw in our Ataxia Clinic. Because of the course of her disease I suspected paraneoplastic etiology (http://en.wikipedia.org/wiki/Paraneoplastic_cerebellar_degeneration). The most sensitive test is a combination of CT and PET, not a cheap way of imaging. I don't order it on everyone, only when strong clinical suspicion arises. (There are alternative methods, which are less expensive, but which also miss the majority of cancers.) As usual, it was denied by the insurance company. I wrote an appeal and I also spoke to the decision maker at the insurance company ("medical director", and MD). He was unfamiliar with the concept of paraneoplastic disease! He told me (on the phone and also in a letter of denial) that PET is NOT a proven way of detecting malignancies in the brain!! When I explained that we were actually looking for cancers in the body OUTSIDE the brain, he was confused and did not understand how a cancer in the ovarium or the gut can cause problems in the brain/cerebellum.

So the appeal was denied and a 3rd, too. The patient had the study done nevertheless (costing several thousands of dollars), paying out of pocket (not a wealthy patient) and it revealed a lesion retropharyngeally with high glucose uptake, very likely cancerous. This is unfortunate to the patient and it would be an even more heartbreaking story if it is now in a more advanced stage with respect to prognosis than it was 7 months ago, when the 3-round appeal saga began with the insurance company. But from the perspective of this blog and the point I am making the punchline is that the insurance company, as opposed to what you and I would probably do, i.e. feel very bad for the earlier denials, denied to pay for the study, EVEN knowing it revealed a likely cancer. BTW another lesion, which is being further investigated as I write this, along with the retropharyngeal lesion, in the colon was discovered as well.

The writer of the CBS article argues that the existence of 52 insurance companies is in itself a glowing proof of healthy competition, a diametric opposite of monopoly. All good then, job well done, huh? So why do we even need to talk about health care reform if all is good? Oh, those liberal bastards just want to "spread the wealth around" and now this health care reform is their newest excuse. Those bastards.

One problem, to circle back to the conflict between the 3 interests the writer likes to align with at one point or another, is that insurance companies, too, would want sick people and insured people. So why allowing insurance for more is not their interest. Well, because the public option would be a competition to them.

However rosy the mentioning of 52 insurance companies seemed, a government/taxpayer funded public option would be a huge crushing competition for them, as a whole, and who wants to compete now, all of a sudden, when they managed to bribe themselves into a perfectly settled and relaxed position?

"But it's also true that government programs, even ones that start out fairly simple, tend only to grow and expand over time and grow less efficient as their competition is eliminated and the political power of those who draw salaries and contracts from them grows." This is of course, true. Government workers are people, too, with all the human defects. As the private sector is at risk for ignoring the health of the public for profit motives (see the example above about my patient), government agencies are prone to allow corruption. However, vigilance, transparency, and continuous public debate can help reduce these risks. Which is better? Allow the private industry "compete" (for greater profit, that is the only measure of their survival and in a true Darwinian capitalist marketplace) and run the risk of letting them kill people on the way or run the risk of government agencies becoming large and corrupt and an impediment to their own cause? The writer leaves no doubt he prefers the first. Do I prefer the second? No. I prefer maximum transparency and accountability and fair and strict business regulation in the area of healthcare business, the area where we have the most direct and continuous impact on human life.

Third, the interest of those drug companies and device makers. Does the writer of the CBS piece support their cause? Well, maybe to some extent. At least if it comes alongside opposing public interest, but definitely not beyond that (i.e. not against the special interests #1 or even #2, discussed above). Nevertheless, he seems to be somewhat supportive of their cause... I believe it is rather revealing as the writer opines "And if labor responds to financial incentives, capital is even more sensitive: slash the profit margins of drug companies and medical device manufacturers, and inevitably there will be less investor capital for those companies and less coming out of the pipeline in terms of drugs and devices that save or improve lives."

Wow! Improve lives, huh? Are these companies in any way incentivized to "improve lives". Come on. Will their shareholders praise them for improving lives? Right. No, they are incentivized to increase their profit, and only that. Period. It is true, they are in a business where their products compete with other products that are used in healthcare and as such, will improve lives. But that's not because this is their core mission. That is just a side effect of the type of business they are in. Do you think drug companies who repeatedly and consistently conceal knowingly adverse clinical trial data unfavorable to their marketing incentives are acting in pursuit of "improving lives" (when they actually destroy and end lives)? Do you think that paying off leading doctors to help bring about studies with falsified data so that their sales improve and cause deaths of children are driven by greatness, humanity, and altruism? No.

Having said that, of course we do want private industry in medical care and research. With tight oversight. Making it a transparent and fair marketplace. No crazy landfall profits, CEO extravaganza, nothing like that. This is not the area for it. Not in pharma and medical device industry where human lives are at the line. My solution to the conflict affecting this industry (the conflict between making profits and serving patients' interests) is total and maximal transparency of policy and corporate behavior (of course not counteracting competition, i.e., there still would be classified and sealed data for later review, but still accessible by Congress if need be).

The writer is right, the absolute health care cost cannot be less if add more. However, it is unquestionable we need health care reform, as the current system is absolutely unsustainable, corrupt, and inefficient. It is also clear we must include a public healthcare option to give healthy competition to private insurers. We perhaps should consider supporting health care co-ops, where partners are the same as beneficiaries and are very disincentivized to inflate overhead and bleed into big administration, but also profit-taking against their own care. We need to be very thoughtful how we regulate the private sector connected to health care, as they inherently have a major conflict of interest between being accountable to their shareholders and being moral toward their sick clients/customers. All government activity must be exemplary transparent to the public with tight and constant oversight.

Finally, human life must be respected above all and cynical right-wing anti-humanists should never convince us that preventative health care is bad policy unless they begin forgoing it themselves first.

On tired dictators and tired analysts in the context of Clinton's North Korea visit

Link: http://clivecrook.theatlantic.com/archives/2009/08/north_korea_tests_the_limits.php

I read the linked writing on "The Atlantic" with interest. Especially, for it being exceptionally short (its greatest asset; I clearly have work to do in that department to come close). But besides it is short, I'm afraid not much praise is due.

This and many other "analysts" commented in all sorts of negative ways about Clinton's trip. Some including the cynical view that he was trying to help his wife's diplomatic clout and success (which is clearly a less than analytical comment, given it was the North Koreans who apparently picked Clinton, over other candidates.)

Even the analyses that sort of positively approached the issue almost invariably failed to even mention a rather significant aspect: this whole trip was about 2 unfortunate individuals, whose lives (or at least a likely horrible 12 years of it) were at stakes. That bothers me to the point to making me write this.

It is quite disturbing how a "know-it-all" wisecrack "analyst" comments in the above referenced article that "But what more is there to say? Precisely nothing. Watching cable news and especially CNN give this topic blanket coverage and color commentary from all hands, for lack of anything else to report in a slow week, was sometimes almost harrowing." (which kind of includes about half of the entire writing BTW). Nothing, huh? I am sure the families of the 2 freed journalists would rather sharply disagree. I am not sure if Clive Crook considers himself a journalist, but if he did, some professional sympathizing wold have been nice, too.

Crook sums up the story as "Tired megalomaniac dictator trades ego-stroking photo op with former US president for two US hostages." In turn, Crook himself seems to be tired of the media coverage of this "nothing", while talking about the 2 lives as subjects of the trade, nothing more.

Well, in my opinion what is truly "harrowing is exactly the process of this all-crusted and tired, bordering apathetic, approach, which completely ignores the fact there actually was saving of 2 human lives here. I know we all see much greater human suffering and toll on a day-to-day basis. We are tired of that, of course. But that should not make it less significant when we witness good will and humanity, which leads to saving human life, even if it was just a couple of them, even if there is a major sensationalism component associated.

So who is having a prejudice problem here?

Link: http://www.cnn.com/2009/POLITICS/07/24/haberfeld.police/index.html

Did the President of the United States speak out prematurely on a sensitive issue? Where he probably would have done service to himself (and the police, most of the public, etc, etc) by being more cautious? I believe so.

Well, here is the problem. Nobody was there, except Harvard Professor Henry Louis Gates and Sgt. James Crowley. They have stories that differ in some critically relevant details. You can never ever get objective and verifiable record of what happened. Those critical differences clearly decide who is at fault.

Usually, in similar disagreements, it turns out that the truth is somewhere in the middle. That is perfectly possible here, too. We just don't know and have no way of knowing. Can it be that Crowley's story is closer to the truth and Gates, being a racially conscious and proud individual overreacted, creating a legitimate circumstance for arrest on the grounds of "disorderly conduct"? Or is this closer to the all too familiar police rational profiling situation, just as claimed by Gates? Does it really matter?

Well, I am not sure. But the stakes became higher now that the president decided to call the police, as a whole, "stupid", over this unfortunate event.

I really can't know more than anyone else regarding what really happened. All we can do is use the information we have at hand to try to figure what has likely happened. Information, such as past behavior and other objectively verifiable data.

I must say if Crowley happened to be an individual, whose background was "decorated" with reports of racial profiling, brutality, racially insensitive comments, etc (something perhaps some other police officers have, so goes the public stereotype), we would have very little question as to whom we should believe in this case. A Harvard Professor, a high achiever, a clearly credible individual, or an officer, who already was in trouble not dissimilar to the one at hand.

But that is not the case here. Far from it. In fact, as far as anyone can know, Crowley has been an exemplary officer, even with regards to race issues, including being involved in education of officers about racial profiling. As far as we can tell, he is a professional, only following procedure.

Hm. That makes this more complicated. I don't meant to be cynical, but just to play the devil's advocate, can we rule out that Gates, somebody who takes into heart African American issues so much, did not mind an opportunity to bring national media attention to this issue? I am not suggesting he set up the whole break-in and all, purposefully testing the response of the police in a break-in case where they find a black man at the property. Again, no one knows and not knowing leaves us with lack of verifiable knowledge of the events and cannot exclude any possibility.

I think that is where that story should have ended. The police could conduct their own review/investigation and conclude whatever, likely to find no evidence of wrongdoing (although then the question comes why and who decided to drop the charges?). Gates, on the other hand, will likely continue his personal crusade against police, clearly increasing his own visibility (although the leadership of Harvard could ask whether such visibility is 100% wanted or not).

The problem is when the President of the US gets involved. It makes no sense. He declares he does not know everything. To complete logical contrast to that he then goes ahead and blasts the police. Excuse me? Why? He felt personally indebted to Gates, so much so to take this huge risk and go that far? Not good.

I believe the best thing the President can do at this point is to issue a formal apology to the police, stating he was mislead by prejudice and he is very sorry. The President of the United States should definitely excuse himself from commenting on issues like this. (The fact he is black and friends with Gates does not make the situation a bit less complicated...)

The President is no god, nobody expects him to rule and judge on everything, from petty crimes to world peace (in fact I am disappointed with the media for even asking him on this issue; what purpose was that for other than to create a great, but completely unconstructive story). He could have politely bowed out of this one and he should have. (Of course if he were to do that, I would not be writing this blog and using my time for something more productive myself :))

We are all human, we make mistakes, and I wish this was the biggest mistake Obama was ever to make. It will be a test of his maturity and humility whether he issues an apology. I hope so. That would likely short-circuit this pointless media brouhaha, a distraction the President hardly needs right now at a time of major national and international emergencies.

I still don't have a working checking/ATM card... Anyone surprised?

I thought I give you an update :) As stated in the subject line, I still don't have my card. Well, there is a bit more into the update. Here goes it...

As described in detail in the earlier posts, I was hoping to receive the card before I was going out of the country on 7/10/09. Well, it did not get here, but when I got back from Hungary on 7/19/09 I found a couple of door tags by FedEx. "Great" I thought "now I missed that one." And so it was. I called FedEx (a little bit of frustration there by their "automated" tracking option, which is designed to make customer annoyance automatic while not at all helpful in tracking anything) and eventually learned that the package (presumably with my new ATM card) was returned to the sender.

However, while wading through my mail, I found a regular mailed envelop from BoA, which had a brand new ATM card! Wow! That is something I definitely did not expect! A pleasant surprise! I almost began to feel bad about all the public posts I am slamming them in, while a wave of warmth flooded my heart. I called and activated the new card without a problem. I, for a moment, deluded myself in the belief I again had a working ATM card and the saga ended.

Well, you probably suspect what that indicates. Yes. Whenever you think it is over, you are in for a brutal surprise for your stupidity to think something actually worked out in your favor and to your convenience, especially when such positive outcome develops unexpectedly.

The only reason I called BoA at this point was actually NOT that I suspected something was wrong (things appeared to be panning out right, which should always suggest there is something wrong). I guess I am still too naive. No. I was in fact calling them to verify that the returned FedEx shipment actually WAS theirs (to make sure I did not miss something else, as I sporadically order things from the internet, especially eBay, not necessarily remembering each and therefore not specifically expecting the delivery).

Eventually I did get through to customer support and spoke to a live person. He kindly confirmed that the FedEx shipment WAS theirs and identified my activation of the new card. But then he became apologetic, which made no sense on the surface, given all signs indicated I just managed to end a nearly month-long ordeal after my ATM card got "confiscated".

Well, he was apologetic because he informed me that the new card I just activated was also blocked, due to "security concerns". I guess I must be on some criminal watch list. I only want to have a regular check card, which I can use to deposit checks and occasionally withdraw cash. That's all. I don't do crazy stuff. I don't use it extensively. I don't engage in questionable practices and push the envelop to give reason for security concerns. I am just an orderly guy with very orderly and average usage habits, why do I have to raise all these red flags, leading to card confiscation, blocking, etc?

I guess we will never know. They wouldn't say. I still don't know why my card was confiscated in the first place. BTW they never actually formally apologized for it, other than the agent on the phone when I first reported it. Of course that is easy to do, but means relatively little in light of the aggravation this whole ordeal ended up causing.

In any case, I will just go on, subjected to whatever they please to subject me to and accept this as something I have no control over.

The agent also said I could go to a branch and get help there. Well, that is not possible today. I am doing intraoperative monitoring all day, possibly to very late night. Tomorrow I have other commitments and so on. I found that the regular mail option is really the best for me and I told the guy. He was not very happy with this and informed me that it will take nearly 2 weeks for me to get it that way. I told him that is a penalty I would happily take, when I look at the big picture (where suffering has been in a lot bigger scale than just waiting 2 weeks for a card, which actually does work and ends a "beautiful" saga).

So there we are right now, awaiting the card. I definitely update you on how this evolves...

Mammutokról és toleranciáról az SZDSZ bukása kapcsán.

Link: http://www.magyarhirlap.hu/cikk.php?cikk=173335

Hát persze, h már megint Bayer Zsolt és Magyar Hírlap és persze, h a tolerancia (illetve annak hiánya), az örökzöld témakör, ami írásra ragadott. Igen, örökzöld téma ez, talán mondhatom, h sajnos. Mégis olyasmi, ami mindig nagyon érdekel. És a jelek szerint kimeríthetetlen.

Nem érdekel a politika. Kifejezetten előnytelennek hiszem a demokrácia olyaténképpen történő; megvalósulását, ami politikai pártokba való rendeződést jelent, mert ezáltal sokkal inkább a csordaszellem és "másik" csoport ELLEN történő hadakozás (ami törzsi harcos múltunk csökevénye) kerül előtérbe, mintsem a tényleg fontos kérdések alapos megértése, a társadalom szervező erőinek az emberek tényleges érdekében történő mozgósítása. Az érdekeink minden mástól függetlenül megvalósítása, az adott kérdésben véleményünk és akaratunk kifejezése talán nem pártos, képviselős, reprezentációs, hanem referendum formában volna a legszerencsésebb, mert egy ilyen elven működő rendszer egyszerűen az emberi gyarlóságggal és megvesztegethetőséggel nem kompatibilis. Ugyanakkor a referendum alapon működő társadalmi szerveződés ma már a technológiailag egyre inkább lehetséges (pl. egy Wikipedia típusú törvényhozási mechanizmus, abszolút profi és karrier alapú végrehajtó hatalommal).

Messzire kalandozok. A lényeg, h nincs semmilyen politikai motivácóm, egyik pártot se szeretem vagy támogatom, úgy az egész párt alapon működő rendszert tartom korruptnak. Magyarul abszolút nem célom egyetlen párt vagy politikai vagy egyéb csoport védelme sem, nem ezért írok. A tolerancia ellen irányuló támadásokat érzem veszélyesnek és köteleséggemnek érzem, h ha veszélyeztetve látom a toleranciát, illetve kifejezetten egy csoport, rassz, nép, stb ellen képződik retorika, azt csírájában igyekezzem elfojtani vagy legalább felhívni rá a figyelmet, tenni valamit, bármit, amit én egyszerű kis polgárkánt tehetek.

Blogomon már találtok egy korábbi cikket, aminek megírására Bayer korábban megjelent nyíltan rasszista hosszászólása késztetett (http://zneuro.net/blog2.php/2009/02/14/velemeny-a-ciganyba-369-noezes-es-politi). Most pedig az újabb SZDSZ-hez kapcsolódó szösszenete döbbentett meg (http://www.magyarhirlap.hu/cikk.php?cikk=173335).

Bayer pezsgőt bont az SZDSZ összeomlására. Hm. Miért is? Hol jó ez neki? Nem teljesen világos számomra, h ez is csak vmiféle sötét gyűlölet, amit egy másik csoport minden tagja iránt érez pusztán a másságuk miatt avagy cask a “dögöljön meg a szomszéd tehene is” típusú ősi káröröm vezérli Bayert, esetleg mindkettő.

Bayer írásából cask az nem derül ki, h pontosan mi is az, amiért az SZDSZ ilyen végtelenül feketelistás nála és ezzel mi is az, ami az SZDSZ kárában ilyen eufórikus pezsgőbontásos reakciót vált ki belőle. Mik azok a konkrét politikai nézeteltérések, filozófiai, társadalomszervezési, hitvallásbéli konkrétumok, amik ilyen jelentős érzelmi alapokra csúszó szembenállást indukálnak?

Azt hiszem minden magát legalább közepesen intellektuálisnak tekintő ember egyetért a dialógus fontosságával, a másság tisztelettudó elismerésével és az egyet nem értés, nézeteltérések előre vivő hatásával és jelentőségével. Feltéve, h a dialógust civilizált síkon, a másik fél legalább olyan tiszteletével, mint amilyet magunk is elvárunk, tudjuk lefolytatni. Olyan módon, hogy a véleménykülönbségeket a legkonstrukívabban, lehetőleg minél kevesebb primitív érzelmi behatás és ősi zsigeri ösztönök befolyása alatt tudjuk megtenni. Valahol éppen attól vagyunk homo sapiens (úgy értem mindannyian, cigányok, zsidók, SZDSZ-esek, FIDESZ-esek, és bőrfejűek egyaránt), h erre képesek vagyunk.

Sajnos az érzelmi alapra helyezett “politizálás” sok jóval nem kecsegtet. Viszont óriási hagyományokkal rendelkezik. A gyűlülködés, uszítás, vitathatóan a legintenzívebb hatásokat tudja produkálni, a leghálásabb módszer a tömegpszichózis eléréséhez. Mi, európaiak, sajnos nagyon súlyosan éltük meg az ilyen módszerek és hozzáállás “sikerességét” és “eredményét”, amikor sikeres.

Kárörvendeni emberi sajátság. Szinte mindannyian átesünk szociálpszichológiai fejlődésünk bizonyos primitív szakaszában ilyesmin, amikor óvodában a másik gyerekre ömlik a forró leves, vagy amikor az iskolában a padtárs kap rossz jegyet vagy büntetést. Van, aki ezen a szinten felnőttként is megreked, de ez még nem igazán jelent veszélyt és ha Bayer megmaradt volna a pezsgőbontásos bejelntés szintjén, most nem írnék.

Ami viszont ijesztő, az ahogyan a kommunistázás és zsidózás be lesz csempészve az írásba, az SZDSZ bukásának "örömhíre" kapcsán. Mintha csak a kommunisták és zsidők bukása volna itt az igazi örömhír. Megintcsak nem a konkrétumok felsorolása és elemzése a cél Bayernél, nem igazán az, h pontosan MI IS a gond ezeknek az embereknek a programjával, elég csak a kommunistázás és zsidózás úgy önmagában. Az úgyis mindent elmond (annak, aki érti az ilyesmit, félszavakból is). Bayernek a jelek szerint untig elég ennyi és úgy tűnik a kiadónak és talán az olvasók egy részének is. Ez talán az egészben a legszomorúbb és riasztóbb. A józan észt és jó érzést alázó. Mármint az, h mi magyarok, társadalom szinten nem vagyunk elég érettek az ilyesmi teljes lenézésre és kiközösítésére, h ne legyen érdeke a kiadónak ilyesmit publikálni, mert senki nem eszi.

Azt hittem, a kommunistázás megszűnik egyszer, ahogy telnek az évtizedek a szabad választások megjelenése óta és kihalnak az egykori aparátcsikok és velük együtt az őket gyűlölők is. De Bayertől megtudhatjuk, h a kommunisták “csemetéi” is ma már ott viszik tovább a stafétabotot és vele a gyűlöleti céltáblát. Feltehetőleg öröklődik a dolog. Mint ahogyan a zsidóság is, tehát az ő csemetéik is megérdemlik Bayer haragját.

Vajon mit is kéne csinálni ezekkel a zsidókkal és kommunistákkal és csemetéikkel, úgy 'en bloc', úgy értem ezen csoportok minden tagjával (még inkább ha ezek keresztmetszetében vannak!)? Nem az a gond, h mit csinálnak, mondanak, képviselnek (hiszen aligha elképzelhető, h MIND ugyanazt tennék vagy képviselnék), hanem az a gond, h kommunisták és zsidók és persze ezek csemetéi ők (és aztán vélhetőleg majd a csemeték csemetéi és így tovább). Mit kéne velük csinálni, h Bayer elégedetten megnyugodjon, h ne érezze magát fenyegetve tőlük, h végre nyugta lehessen? Hogy minden este pezsgőt bonthasson? Hiszen attól tartok írását olvasva, h pusztán az SZDSZ feloszlása, bár kétségtelenül nagyon örömteli fejlemény, még nem tesz pontot az i-re, hiszen a feloszlott pártból bizonyára ezek a kommunisták és zsidók (és csemetéik) be fognak várhatólag szivárogni máshova, ki tudja miféle pusztítást okozva majd ott ezáltal.

Hiszek benne, h a józan ész és humanitás felülkerekedik a tolerancia hiányán, a gyűlölködésen, a zsigeri ösztönlény mivoltunkat stimulaló alantas uszításon. A Magyar Hírlap nyilvánvalóan nem ennek jegyében járt el Bayer írásának leközlésekor és szégyelheti magát.

P.S. Úgy érzem a fenti témához kapcsolódik egy írás a Népszabadságban, ami viszont közel áll a szívemhez: http://nol.hu/lap/hetvege/20090725-alompart

An Independence Day "Present" from BofA

Link: http://www.zneuro.net/Files/BofA_04_Jul_2009.MP3

When Giannini established Bank of America (http://en.wikipedia.org/wiki/Bank_of_america) and gave this grand and pathos provoking name (although he already had a pattern of such big naming habits, i.e. Bank of Italy, then Bank of America and Italy), defining his banks's independence financially, he might have associated this major achievement with an even grander and greater connection of America and Independence.

He must have had a grand vision for the Bank then. I hope he would be disturbed to know what BofA hands out in today's America, as "Independence Day present", to its custmers. Well, I have to say that just one petty customer's issue of being denied access to his paltry money certainly does not measure up in significance to either establishment of the biggest bank in the US or the celebration of independence of one of the greatest countries in the world. However, I felt this experience still "counts" in my micro-environment and may be applicable to many more little people like me. Because both the bank (however big) and the entire country is related to everyday people and such way we are grand. That is how I just could not help making these grandiose associations, also out of lack of better options, and decided to summarize my experience today...

This morning, on July 4th, 2009, I was depositing a check at an ATM near my office. It accepted/deposited the check, but then it refused to return my ATM card. A message appeared on the screen saying that for security reasons the card could not be returned and that I should address this issue with customer service.

Not having the ATM card, I did not have their phone number or my card number, so I called another number (for one of my credit cards with BofA), where I spoke to a rep who gave me the number for the checking customer service (800-432-1000) and also transferred me. When he transferred, an automated voice told me that they were shut down for the holiday and I should please call back Monday. There was no mention of a fraud report back-door at that time. I hung up.

I called the number (800-432-1000) back (follow link for the recorded conversation) at which time with a minor lie (i.e. I had to go for the "fraud" option as if my card was stolen; well it wasn't exactly stolen, but since the ATM machine retained it against my will I made it qualify for a steal, knowing that was my only option to speak to a live person). At this time I was told that there was nothing that could be done. It was acknowledged I had cash in my checking account and I had no way of accessing it, but I was told I should just use my checkbook in case I am so determined to spend my money over the holiday weekend. Although I appreciate the "choose to save" campaign, this was not the right moment for it, especially when somebody else "chooses" for me against my will, forcing me to "save".

I am leaving for Hungary in a few days and as crazy as my schedule is during the last few days I have before my trip, I simply cannot waste an hour (which is how long it took me to wait in line last week when I visited a branch for another issue that I may address in a separate blog) to have a temporary check card. Thus in effect this also means I will be without access to my checking account (and cash) through ATMs until at least late July when I return from Hungary.

Again, I am no expert of customer service management and strategy. But to me taking somebody's card away (and with it, his/her access to their checking account) appears to be such a major intrusion that I would have extreme caution and measures in effect, infallible, to make sure such a thing would not happen inadvertently or for the wrong reason.

If there is a security issue so severe that taking away one's ATM card is deemed warranted, if any respect to customers was of even the slightest priority, I would spare no time and energy invested in ensuring that the customer is contacted, even it has to be a long distance call (they have my home number, as they often leave unwanted marketing messages about their other products I never wanted or ever would want; they have my email, where I get all my statements, etc; and they also have my cell phone #). Clearly, marketing contact somehow does make it across, but not when such a major security issue (presumably) emerges which makes their system take my card away. If the customer cannot be contacted, I would take the risk of some security issue related losses than causing such a major disruption to the customer's life.

If however, for the slightest security warning or concern, the bank has working policies to shut down the account (which happens often with my credit card accounts, every time due to a presumed security concern later found not valid or existing) or take away the ATM card, it may mean that they have no respect for their customers and their priorities are aligned very strongly skewed toward protecting their own bottom line and sacrificing anything they can on their customers' end.

For example, if a severe security concern emerges, they probably can instantaneously and automatically (based on some algorithm built in their management software) shut down an account or have the ATM card retained at close to zero cost to them, i.e. they lose nothing. With that of course their customers would be left with extreme inconvenience and frustration, which is not of much interest to them if it essentially carries no real cost/financial risk (a screaming and yelling customer is not really threatening the bottom line, especially they shut down customer service for the holiday). On the other hand, reaching the customer by telephone clearly means extra costs (up to tens of dollars, depending on how hard it is to reach them), not even mentioning the scenario when there is a valid security concern and they decide to err on the side of preventing their customers' loss of access versus losing real money to fraudsters, recovery of which is of course being truly expensive. In other words, they go with the least costly option (an automatic computer-managed zero-cost shut-down of an account or retention of bank card) at the expense of customer frustration that costs less, on the long run.

Of course, I don't know what exactly happened in this particular case (as the representative seemed to suggest that some error at the actual ATM machine's level might have been the cause). But if ATMs are so unreliable and faulty, I am even more concerned about how a company manages their customer-based retail-level business operations.

I know I always come across as cynical and assume that for-profit-companies care only about their profit/bottom-line and since that is the sole thing that drives them, as a result, aberrations like this will necessary occur. And since that business strategy is driven by what is less costly, there is not much one can change. Well, here is my 2 cents. If pissing off customers to the extreme (i.e. by egregious examples like shutting off their account for no good reason or taking their bank card away) proves to be actually more costly to them in the long run, they could decide to revise their policies. Granted, the extra costs would be pushed onto us, but in the same time I rather pay a penny more in whatever fees they are to build this in (security fee?), but I take it any time if that small fee will mean they will reach me to alert me regarding a problem before I am left out in the total cold without options, totally screwed. In any case, from our end, I think we should just have to find ways of increasing their cost-perception of the otherwise easy-appearing option of automatic account shut-downs and access denials.

I am not sure what the best ways are to do that, but public debate, discussion and brainstorming seem to represent a good option to get started...

On this day of Independence, I feel actually not very independent of practices and habits of American companies. I am actually rather dependent on them. They can just stop my access to my own cash in a glimpse and tell me I should just suck it up. Wow. Pretty strong sentiment there. So who is independent here? How are we independent of really? Does that make us independent?

However, I don't want to feel terrorized and let thrown into total desperation over this issue or for feel lack of independence. I think our spirits are still independent, no matter what, which is exactly why we can start doing something about these issues. E.g. I helped relieve my frustration by writing about this particular issue. I know BofA or any other bank won't change just because of this blog or even if we all reported our horror stories. I still feel independent and part of that spirit pushes me to not let it go and at least document it, allow others to share their comments and experiences. It is an uphill battle, of course, with close to zero chance of changing anything no matter what we do. But if we just sit and do nothing, or do as they say we agree to "suck it up", our chances of having a different experience next time or changing anything at all will certainly be zero.

1st followup to Verizon Saga

When I decided to create an entire category of blogs for Verizon, I had 3 contributing factors/reasons in mind.

First, I wanted to do the blog as we take an umbrella to improve our chances it won't rain. I.e., it is a hassle to carry an umbrella for no reason. One can even feel stupid for it. But that mini frustration is leverage, a lesser of 2 evils, a price, we decidedly pay to avoid a bigger evil, plus we buy the illusion of being in control with it. I figured I could look somewhat stupid for doing a blog on Verizon, which is something I am willing to take happily, over the unfortunate situation of having to deal with them. In other words I felt if I write about this crap, it will help me avoid it. I jinx it :)

Second, I felt so out of control, so beaten, so without options, so helpless. When I came to the idea of publishing my experiences on the web I suddenly felt relieved. I felt I actually AM doing something about it. It may not help solve the problem, but it does start something, I create something over it, I felt productive, leaving a mark out there, which is available forever (supposedly).

Third, I hoped to start some discussion over the "big picture", the philosophy of customer service management and strategy of large companies, which could be a pretty stimulating conversation (BTW feel free to make comments here, that's part of the idea).

With that, in line with the first motive, I actually expected to have this prolonged and worn out PIN debacle with Verizon to be solved relatively painlessly.

As you probably figured by now (if you got to read to this point), my flawed and detached hopes of a resolution were murdered. Raped. This of course starts to question the concept I raised in the previous post, i.e. the possibility of this whole thing just being a totally random and sporadic bad luck in the field of a generally OK-working system (as opposed to a system that is not working for the most part, but we just don't hear about it more due to customer apathy and lack of time/practical forums to raise hell).

Well, nothing "extraordinary" happened, I think, only that I ran another round in the match and realized that I am back in square one (which is BTW the same as the "red corner").

Of course, despite this being a major burden, I managed to make time to call during the communism-like 8-5 weekday-only slot, today. Actually, the wait time was a lot shorter (remember, 28 min in the previous case). Of course, the same navigation skills through dead-end and customer-killer menus were required again, but I was actually talking to a live person within 8 minutes!

This time, no "rewards" or "billing" departments were recruited or mentioned, but the gatekeeper person (I think correctly, for the first time during this saga) realized my issue belonged to the "e-whatever" department. Not only that, but actually when I got transferred (and again spoke to a live agent) it still appeared I was in the right place.

The e-agent spoke little English and we had a few minutes spent on clarifying what kind of PIN I really needed. However, when this was clarified, I suggested I go to the same website, where she was to navigate me through the process.

This time we chose the call home phone option for PIN delivery. She was somewhat unhappy and shocked I wasn't home (it was about 2.30 PM EST-daylight saving) and declared this could be a problem. Nevertheless, when it was revealed I had an answering machine, she said it should work, as the automatic system would leave the PIN on the answering machine.

The idea was that I would go home, get the PIN off my answering machine, then go online and everything is solved! I did go home and I did find 3 messages on my answering machines, each one the same, an automated voice asking to press 2 and that they would call back. Of course, there was no PIN or any actable information, thus my only conclusion was that (1) I got fooled again; and (2) achieved nothing.

Clearly, my next plan is to request a phone-delivered PIN when I am actually at home. If you don't see any more Verizon blogs that is because I succeeded... However, even if that happens, I am still likely to post a final analysis on this...

Verizon "Customer Service": the bad, the ugly, and the frustrating

OK, after all those years, I decided I should do something about my frustration with customer service (or the lack thereof) utility companies (and others) "provide".

For years, I felt truly helpless. I felt they can do ANYTHING and you can do NOTHING. Of course you can always scream or yell. Or break the telephone. Or something like that. But that does not address the sad reality: you are absolutely screwed.

Yes, there is Better Business Bureau, etc. You can even call local politicians or newspapers, I guess the most egregious instances (assuming you have a lot of time at hand and are EXTREMELY determined) warrant/justify such action. It still won't guarantee your problem is going to get solved or that you won't have similar problems again. And if you look at the invested time+energy/results ratio, even if your issue does get fixed with fanfare and you emerge as tough customer-fighter, in the end, you are still a loser, actually.

But what are you going to do with plain BAD customer service? Something not necessarily newsworthily egregious or fraudulent per se, but bad enough to turn any levelheaded analytic head into an overheated lilac pressure chamber or boiling pot. Also, what if you just are not able to spend a month full time pursuing BBB and similar avenues?

Of course, you can just ignore bad customer service and quit at the point of service (i.e. lack of it). Well, this likely won't work either. First, it is time-consuming (and mishap-prone) to discontinue one service and start another. Second (even more importantly), the sad thing is that from the "competitor" you will be getting almost exactly the same service (lack of it) and frustration as before, so this option is generally not recommended.

I started Verizon service in January 2009 (of course, I had had them MANY times before, in one way or another). I was switching from Comcast (one day I will summarize my experiences with them, too; well that won't be a blog, but a book, to give you some hint why I wanted out, in a totally delusional false hope Verizon would offer something better). In any case, I wished to register online w/ My.Verizon (or something called like that) to be able to view/manage my account on-line and I have been trying to achieve that since January. Without success, obviously.

At first, I was told I needed a PIN. However, they could not just give it to me over the phone (no matter what level of personal secure information I could provide to verify it was really me; BTW banks, where I have accounts and where security to access accounts obviously needs to be tighter, don't have this cumbersome customer-defeating system).

Verizon insisted the PIN be mailed to me. All right, I said. Then nothing came. After I while (weeks later) I revisited the issue and called them again. I don't have to mention that every time I call I am on hold and/or repeatedly transferred to the wrong area, dead-ends/no-human automated menus, etc. Eventually I had the fortune to speak to a live representative, who promised to have the PIN mailed again. This happened a few times, but then, miracle, the mail actually DOES show up with the PIN! I had a few tears running down my face with warmth spreading throughout my body. My legs trembled. Yes, my persistence paid off! Actually, no. All the uplifting emotions turned into something else when the PIN just DID NOT WORK!

But even then, I made myself believe there was hope! Because on the website, www.verizon.com/registertoday/ I actually found a link (which I did not see before) that promised generation and delivery of a new PIN! This was exciting! I got started on it immediately, but the process was stalled as it wanted my last bill's amount or the date when I paid it (when my very reason to want to do these things on-line was because I am not too good keeping snailmail).

OK, then I went back on the phone, calling "customer care". I called the 866-326-7937 number. I only had to wait 28 minutes, before I had a human with whom I shared my experience. She was very pleasant and it was just a little bit more than minimally distracting that in the background the loud and boisterous bursts of laughter only ceased briefly, intermittently allowing the obviously happy crowd to relax for a second or two, also to listen to the next joke.

She agreed there was a problem and repeatedly apologized. It probably might have also been useful if she actually understood what my problem was. I am still unsure if she is aware what the words "internet" or "online" encode and clearly, the challenge of getting that I am having trouble setting up my online account and needed a PIN was way above and beyond what anyone could expect her to grasp.

For the lack of a better idea, she decided to solve the issue and told me she was going to transfer me to the "Rewards" department. I did not know Verizon had rewards or that they had such department. As it did not seem to connect with my problem after I was told I was being transferred "Rewards" I just asked "why", as it obviously had absolutely nothing to do, not even possibly or remotely, with anything I said.

This "intrusion" was obviously not expected and her jovial and sweet attitude seemed to be challenged for a second at which time she decided to punish me for being such a difficult customer. She turned tough on me by announcing that OK then if I don't want to go along with the nice and friendly plan of being transferred to the "Rewards" dept (who were still open), my problem all of a sudden now belongs to the "Billing" department (which is closed). Although I guess the word "online" might have still been circulating in her challenged mind without a hope to connect somewhere firm, and "Billing" probably came as close as it was possible, I guess.

I was told at this point they (billing) were only open from 8 AM to 5 PM. The sentence was delivered: you CAN'T get this fixed. Not with me, not tonight. I sadly remarked during those hours I see patients and cannot spend hours on the phone requesting a PIN and asked her for any alternative. She announced no alternatives existed (i.e., appeal NOT granted).

In other words, she pretty much declared that if I was unwilling to abide by their rules, I can just go and screw myself. We politely thanked each other, she asked if I was interested in getting help with "anything else", which sounded like a joke as I obviously did not get help with ANYTHING let alone "anything ELSE", and I was let on my way.

I know nothing about the internal dynamics and science that drives the customer care policy decisions of these companies. Clearly, the only thing they care is to improve profits and thus these experiences must be somehow connected to that main drive. And somehow it must have been confirmed by data that shitty customer service (where customers are left on hold for prolonged periods and transferred to the wrong departments and/or receiving inadequate/incompetent service), which likely negatively correlates with how much funding is allotted to this area, saves money/improves profit.

What is it that one as a hapless customer looks for when faced with these frustrating situations. Clearly, preserving piece of mind, avoidance of frustration and wasting time. Given there is a conspiracy as these companies are not truly competing with one another, at least not on the level of customer service, we are all left boiling in our own frustration. I think this is a national crisis and we, as society, waste so many hours on stupid things like this that makes it a very relevant matter at the national level.

I am not sure what the solution is. I do not have the internal information or the business training to allow me understand the situation. Can it be that these companies are barely profitable and can function with taxpayer help, but they are so essential they have to be kept alive. Then they just have no choice but cut costs anywhere they see an opportunity and customer care is a low lying fruit. Or can it be that they simply make decisions to save money to be more profitable?

I am not sure. I guess it is also possible that my consistently outrageous experience with customer care is simply an aberrant rarity and if that is being the case I shall not waste any more characters on this topic. However, until I am convinced that the latter is the case, I will continue posting my experiences as it seems to at least let some steam off even if I fixed nothing else with doing so :)

Fly Swatting and PETA Bashing

Link: http://www.reuters.com/article/newsOne/idUSTRE55H4Z220090618

There was significant news coverage (see http://www.reuters.com/article/newsOne/idUSTRE55H4Z220090618) and YouTube sensation (e.g. http://www.youtube.com/watch?v=cxcRQ72TM0I) over the bravado of Obama's ability to swat a pesky fly while on air for CNBC.

Shortly thereafter PETA seemed to have developed an urge to be part of the show, trying to claim some attention, riding the ticket of a fly being an animal (which they are out there to protect) that was mis-treated (by no less of a person than the President of the US himself).

Don't get me wrong. I love animals. Moreover, I do think animals deserve ethical treatment and this cause deserves our attention (with reason and moderation). But I also feel PETA deserves no kudos for their contribution to the fly-swatting brouhaha, especially for their sending a special fly-trapping device that allows handling flies in a humane and ethical manner.

Wow. This is truly great entertainment, for all. Attention to PETA (seeking of which was the purpose of this bizarre action) granted. But please! Swatting a fly unethical? Where do we stop then? Using poisons against cockroaches is about to come under scrutiny? Using antibiotics against bacteria is to be deemed unethical next? Give me a break, please.

Besides, we, inhabitants of Earth, do have a long history of killing one another. That's part of nature. Killing animals is not something we could ever function without on Earth. Of course, it is prudent to be considerate in how we use our tremendous advantage over the other species. Killing them unnecessarily and with cruelty should be avoided. We need attention and proper representation of this, which I consider a noble cause. But criticizing the US President for swatting a fly only ridicules PETA. Unfortunately, that runs the risk of hurting public support for PETA's very cause of protecting animals.

Ga. State Stem cell bill could hurt business: MSNBC

Please review link: http://www.msnbc.msn.com/id/29683060/

Comment:
For some time now, there have been highly charged emotions spurred by the public debate over stem cells and our society is growing increasingly divided over this issue. I find that the development in Georgia, ironically shortly following a much trumpeted reversal of a federal funding ban on stem cell research, is particularly relevant and captures the very essence of the problem. The article is well written, with carefully selected and abundant quotes, demonstrating key elements of opposing views.

At this time, experts agree that embryonic and non-embryonic stem cells are NOT equivalent, from the perspective of their potential to help cure human disease. Therefore, in this comment when discussing anti-stem cell propaganda, sometimes I don't make a clear distinction between "stem cell research" versus "embryonic stem cell research" versus embryonic stem cell research on pre-2001 lines only (approved by Bush), as I believe those distinctions are not very relevant to this debate. I do realize that one of the main arguments of the anti stem cell research moral ideologist camp is that non-embryonic stem cells are just as good, but I don't buy the argument of limiting any part of the research on "moral grounds" as it would nevertheless be a limitation, i.e., we would be doing less for our patients than we could, a limitation that is driven by ideology, which I believe is not acceptable. I do think discourse over how inferior non-embryonic stem cells to embryonic ones are is valid. And intelligent, scientific, non-ideology motivated discussion over the ethical and moral aspects of any research is not only valid, but absolutely necessary. Limits of any research are necessary, too, but they should be determined by true scientific and moral principle, not any one ideology.

Gov. Sonny Perdue would like to "draw the line", based on "moral" and "ethical" grounds. As a veterinarian, he is no stranger to life sciences. Yet, he takes a stand in favor of a particular ideology that goes against mainstream science. His ideologically motivated stand happens to be the basis of his political constituency. BTW, it is not unusual for him to disregard minority views (including atheism) that hold less political value to him for gubernatorial use, e.g. by leading the pray for rain campaign (http://www.msnbc.msn.com/id/21767716/), on behalf of "all people" of Georgia (including those who don't believe in prayers).

Social conservatism is a function of geography (i.e. "Bible Belt") and despite the fact that about two thirds of Americans support embryonic stem cell research (even greater percentage if it is likely to help a relative, although there is some variability of the polls), some states choose to back anti-health ideology. One might even think those living in regions laden with anti-science ideology should "enjoy" every consequence of policies driven by such ideology, but of course penalizing misinformed folks for being misinformed would be unfair to them.

I believe the argument against stem cell research is a particularly representative manifestation of political hypocrisy. I do not wish any of the activists vocal against stem cell research or the politicians voting against it to see their relatives come down one day with a disease that could be helped with advances made through stem cell research. But I would be curious to find out how staunch supporter of such ideologically extreme and practically anti-human views would those people remain in case their loved ones were to be potentially saved by stem cells. In other words, as I would say to them: let's run the litmus test of how much your showy and politically gainful "moral" beliefs about stem cells is worth? It appears to be worth somebody else's health or life. Is it worth your loved one's health or life?

Of course, nobody would want to willingly destroy human embryos for another human life, and all informed citizens should know that stem cell research is not about that. We are not talking about embryos that are "farmed" or produced for the sake of stem cells, but embryos that are somehow became available and would be otherwise discarded. However unfortunate it may be that they cannot have the chance to grow into full human beings, one cannot blame stem cell research for the fact these embryos became available. They are capable of supplying cells, which, on the other hand, may help other humans. Humans, who are full human beings, with families, loved ones, memories, thoughts, feelings.

In my opinion what is truly morally unacceptable is to step up and declare with a straight face that these full human beings who suffer from incurable ailments do not deserve the chance of benefiting from every tool our state of the art science may offer, because touching otherwise discarded human tissue is morally "wrong". Again, I wonder if those who have the "courage" to hold such views would be able to do so in front of their dying mother or child, and whether they would feel morally "elevated" (i.e., answering to "higher" set of moral values, elevating their sense of morality above the level represented by the death of a loved one) by seeing their otherwise technically salvageable loved ones die in front of their eyes, to their total moral catharsis. Would they have the courage to say to their loved ones the often abused excuse that "we don't have to" use embryonic stem cells, as we have other means to help, such as through non-embryonic stem cells (which option has repeatedly been shown as not fully equivalent with what embryonic stem cells can offer). Or would they say to their loved ones that "god wants you to die now, so be it, I am sure you would not want to disobey god's will, and I certainly don't".

My prediction is that almost all of these people would quickly reverse their position on stem cells as long as change of their views would save a family member. And that is why their position is hypocritical in the first place (i.e., as long as it is to help somebody else's life/health, I oppose it, as long as it is to save my loved one, I support it).

The hypocritical position of a politician on stem cells research is a very intriguing manifestation of opportunism. As long as a potentially stem-cell-curable health problem is not hitting home, the politician gains more by opposing, as his opposition scores valuable political points among his/her constituency of social conservatives. The opportunistic calculation shifts, however, when his own health (or a health of a loved one) comes into play. Then he/she may benefit more by embracing a medical option to save self or a loved one; when the political gains of opposing are eclipsed by a direct threat to health; when death's dark shadow is dreadfully cast on their own household or circle, the political charade becomes irrelevant, the posing to make political gains becomes meaningless.

Then there may be a small percentage who would stick with their anti-health views even if it meant untimely and preventable death of their loved ones. Those I would not call hypocritical, but crazy fanatic. Practically indistinguishable from those who refuse standard life-saving medical care (such as transfusions) on religious basis or those suicide bombers who blow themselves up in the name of some god. Sacrificing human life has long been part of religions, supported by their specific (and cruel) way of interpreting "morality". But as part of our advanced medical care system trying to cure disease and fight human ailment, we should not allow this modern reiteration of human sacrifice happen to anyone. In fact we should keep out of policy regarding health care all religions that encourage any practice that can threaten human life or health, or promote interference with best scientifically sound research and health care.

Some religions can have a "conflict of interest" when it comes to human life and health. Humanism (http://en.wikipedia.org/wiki/Humanism) calls for absolute respect of and regard for human life and well-being, above anything else. As modern day physicians, we have a lot to share with the concept of humanism, as the most fundamental principle of the Hippocratic Oath (http://en.wikipedia.org/wiki/Hippocratic_Oath) is to not harm. Religions, on the other hand, often hold something other than respect for human life more important and when it comes to that there could be a conflict.

In this example about stem cells, I see that in some ways religious ideology clashes with humanism again, over human life. In this example, religion driven ideology would sacrifice human life (i.e. not do everything to cure disease) for ideological reasons, nothing else. (It is interesting that ideologists sometimes refer to themselves as "pro-life". Observe how they can part and parcel their pro-life view, in that they would call it pro-life the "respect" of discarded tissue left peacefully in the waste basket, as opposed to using it to save human lives, but those lives to be saved don't really qualify to be considered in their "pro-life" definition, i.e., the life of a tissue wins over the life of a full human.)

There is little question in my mind that neither hypocritical political maneuvering playing on religious conservative voters' sympathy, nor religious fanaticism should drive policy at the societal level. Sound science and scientific methodology should. Truly open discourse over morality should. Because of the impact of geographically specific distortions in public view based on misinformation, state legislation should have limited power over how it can act against its own citizens' health, even though it should have the right to drive business out of the state, based on "moral grounds". It is unclear what the Ga. stem cell bill will mean to Ga. and other states. But we should applaud that at the federal level policy is heading to the right direction. As a physician, I would never be able to support anything that artificially limits the way we can care for the sick. I am glad the majority of our society agrees. We should allow diversity in views and opinions. But legislation, especially at the federal level, should be driven by common sense and scientific method, not ideology.

Vélemény a cigánybűnözés és politika ügyében

A cikk a borzalmas veszprémi gyilkosságról az alábbi linken elérhető:

http://www.magyarhirlap.hu/Archivum_cikk.php?cikk=159771&archiv=1&next=0

Hozzászólás az USA-ból.

Én személy szerint nem fogok minden cigányt és feketét gyűlölni csak mert néhány rassz-társuk állat. Hívjatok liberálisnak, de így érzem helyesnek. Az viszont biztos, h rendnek kell lenni. A közbiztonság nagyon fontos. Nincsenek csodák. A rendőrség ereje és hatékonysága azzal van arányban, h mennyi pénzt fordítunk rá. Ez egy politikai kérdés. Itt az USA-ban érdekes módon pont a liberálisok (demokraták) azok, akik több pénzt akarnak a rendőrségre költeni, mert ők érzik jobban szívügyüknek az elsősorban a szegényebb rétegek problémáját jelentő romló közbiztonságot. A gazdagok tesznek rá, h kiket ölnek halomra a rossz környéken, nekik nem kell ott élniük, megengedhetik az ingatlant drága környéken, ahol jó a közbiztonság. A jobb oldal azért küzd, h minél jobban megvágják a közügyekre való költekezést, többek közt a közbiztonságra, mivel ez nem az ő problémájuk elsősorban és ha rendőrségre kevesebb pénz megy, akkor a millárdosok zsebébe még több pénzt tudnak ezzel tenni adó csökkentés formájában (aminek egy része pedig visszaforog politikai kampány támogatásra és így zárul a kör).

Persze ebből az alsó középosztály és a munkásosztály szív legerősebben, mert oda nem jut rendőr, ahol ők élnének. Aztán nagy ritkán történik egy magas profilú bűnügy, ami nem a szegények szinte már hírként se minősülő minden napos triviális mészárolgatásába tartozik, nagy sajtónyilvánosság, stb, és akkor érdekes módon senki nem a közbiztonság költségvetésének megnyirbálására (amit olyan habzó szájjal követelt a jobboldal) mutogat, mint okozó faktor, hanem a fekákra, stb.

Itt az USA-ban még tovább komplikálja a dolgot, h a jobb oldal egyik legmagasabban rangsorolt célkitűzéseként propagálja a személyes használatú lőfegyverek jogi felügyeletének csökkentését. Ezt persze kizárólag azért teszi, mert a lőfegyver gyártás és forgalmazás kiemelkedő profittal üzemel és ebből bőven jut politikai kampányuk támogatásra is. Minden épeszű ember számára nyilvánvaló, h ha több lőfegyver van az utcán és könnyebben elérhető, akkor több és magasabb impaktú bűnözés származik ebből, amit persze tudományos vizsgálatok is igazoltak. Erre a jobboldal azt mondja, h nem a fegyver öl embert, hanem ember öl embert, azaz a lőfegyverek könnyű elérhetőségének nincs köze a bűnök előfordulási gyakoriságához és súlyosságához, ami szimplán szólva szemen szedett hazugság.

A másik fontos oldala ennek pedig az, h itt az USA-ban az uralkodó réteg annyira srófolja a társadalmi különbségeket, amennyire csak lehet. Ettől a kizsákmányoló és rövidlátó stratégiától persze nő a munkanélküliség, illetve ami még riasztóbb, h az aktívan dolgozók is elszegényednek. Hát ez se segít olyan nagyon a közbiztonságon, mert ha az embereknek nincs mit enni, akkor nekik semmi se drága és sokkal "vállalkozóbb" szelleműek minden opció irányába, ami a bűnözést is magába foglalja.

A közbiztonság romlása tehát főleg a kiváltó háttér (szélesebb társadalmi rétegek elszegényedése) és a nem megfelelő felügyelet (a közbiztonsági költségvetés inszufficienciája) kölcsönhatásából adódik. Véleményem szerint olyan társadalmi beállításokra kell törekedni, ahol a bűnözés kiváltó okait minimalizáljuk és olyan közbiztonsági rendszert alakítunk ki, ami megfelelően tud reagálni a kihívásokra. Teljesen igaza van azoknak, akik ezt politikai síkon közelítik meg. Azonban nem hiszem, h megalapozott ezt a kirívó és borzalmas veszprémi esetet a kommunisták nyakába varrni. Ugyan mi haszna volna az MSZP-nek abból ha széndékosan védelmezni (vagy támogatni?) próbálná a cigány bűnözést? A "kisebbségiek" fizetik a kampányukat? Ugyan már. Ennél sokkal mélyebben gyökerezőek a problémák.

Egyébként is paradoxnak tűnik a baloldalt cigányvédelemmel vádolni. Pont abban a kommunizmusban, amiben MSZMP vezetés alatt felnőttünk volt zéró cigány bűnözés. Ha hőzöngött egy cigány a kocsmában vagy az utcán, az perceken belül úgy eltűnt, h soha senki nem látta megint. Azzal kezdték, h bevitték az őrsre és úgy lerúgták a veséit, h rálépett, aztán ki tudja hogyan folytatták. Próbált volna csak az állampolgári jogaira hívatkozni (ha tudott volna beszélni kivert fogakkal és kitépett nyelvvel). Ez tabu volt, nem lehetett róla beszélni, csak azt láttad, h nem volt cigány bűnözés. Nem volt nagy hangsúly a jogszerűségre fektetve. Úgy voltak vele az elvtársak, h 100x inkább tévedjenek az egyik oldalra (azaz tegyenek el egy cigányt, aki tulajdonképpen ártatlan volt), mint fordítva. A bolsiknak semmi se volt szent. A cigányok jogai a legkevésbé. Most lehet kommunistázni, h milyen brutális és igazságtalan volt az a bánásmód a cigányokkal!