James Fallows

James Fallows is a national correspondent for The Atlantic and has written for the magazine since the late 1970s. He has reported extensively from outside the United States and once worked as President Carter's chief speechwriter. His latest book is China Airborne. More

James Fallows is based in Washington as a national correspondent for The Atlantic. He has worked for the magazine for nearly 30 years and in that time has also lived in Seattle, Berkeley, Austin, Tokyo, Kuala Lumpur, Shanghai, and Beijing. He was raised in Redlands, California, received his undergraduate degree in American history and literature from Harvard, and received a graduate degree in economics from Oxford as a Rhodes scholar. In addition to working for The Atlantic, he has spent two years as chief White House speechwriter for Jimmy Carter, two years as the editor of US News & World Report, and six months as a program designer at Microsoft. He is an instrument-rated private pilot. He is also now the chair in U.S. media at the U.S. Studies Centre at the University of Sydney, in Australia.

Fallows has been a finalist for the National Magazine Award five times and has won once; he has also won the American Book Award for nonfiction and a N.Y. Emmy award for the documentary series Doing Business in China. He was the founding chairman of the New America Foundation. His recent books Blind Into Baghdad (2006) and Postcards From Tomorrow Square (2009) are based on his writings for The Atlantic. His latest book is China Airborne. He is married to Deborah Fallows, author of the recent book Dreaming in Chinese. They have two married sons.

Fallows welcomes and frequently quotes from reader mail sent via the "Email" button below. Unless you specify otherwise, we consider any incoming mail available for possible quotation -- but not with the sender's real name unless you explicitly state that it may be used. If you are wondering why Fallows does not use a "Comments" field below his posts, please see previous explanations here and here.
  • Another Bloomberg Editor Explains Why He Has Resigned, Over Its China Coverage

    "For the international press, there are many reasons for crimped ambitions."

    A graphic for "China's Red Nobility," from a 2012 investigative series on corruption among the country's leading families. ( Bloomberg )

    Four months ago, The New York Times ran a big story contending that Bloomberg editors had quashed an investigative report about corruption among leaders in China. The Times story was clearly based on informed comment from people inside Bloomberg who were unhappy about the result. It said that higher-ups at Bloomberg were worried that the story would hurt the company's sales of financial terminals—the mainstay of its business—inside China, since the main purchasers would be directly or indirectly subject to government control.

    Like the NYT and some other Western news organizations, Bloomberg was already "on probation" with the Chinese government, because of some very brave and probing official-corruption stories the previous year—including the one on "Red Nobility" that is the source of the graphic above.

    As a reminder, here are the main story steps since then:

    • The FT did a similar report (here, but paywalled), also clearly based on inside-Bloomberg sources and also saying that Matthew Winkler, Bloomberg's editor-in-chief, had ordered the story killed, for fear of ramifications inside China.
    • Bloomberg denied the reports, in categorical but not specific terms. I.e., variations on: Of course we didn't bow to political pressure, and the story was just not ready yet.
    • Amanda Bennett, a long-time editor and reporter with experience in China (she was co-author of Sidney Rittenberg's book, The Man Who Stayed Behind), promptly resigned as head of Bloomberg's investigative unit. She did not explicitly address the controversy but made her feelings clear in her resignation statement. It said: "I am totally proud of the work of the Bloomberg Projects and Investigations team over the past five years....  I’m also most proud of the groundbreaking June 2012 story that the team led, that for the first time exposed the wealth of the relatives of China’s top leaders. I’m proud of the courage it took from top to bottom in Bloomberg to make that happen."   
    • Michael Forsythe, the Bloomberg reporter who had worked for decades in China and was involved in these corruption-investigation stories, was quickly suspended by Bloomberg. He later joined the NYT staff.
    • Bloomberg continued to deny the allegation of knuckling-under but refused to address any specifics. The story that reportedly was underway has not yet appeared.
      Soon after the flap broke, I received several calls from people inside Bloomberg, all of them insisting that I say nothing that could identify them, or even about the fact that we had talked. One was from a person who warned me that it would be a big mistake to put too much faith in what this person said were competitively motivated attacks by Bloomberg rivals. The other calls were from Bloomberg reporters or staffers, who said that the NYT and FT reports were essentially accurate. I wrote to the man who reportedly gave the spiking order, editor-in-chief Matthew Winkler, and did not hear back.
    • Then, last week, the chairman of Bloomberg L.P., Peter Grauer, seemed to confirm the original accounts by saying that it had been a mistake for Bloomberg ever to deviate from its business-oriented coverage. 
    Ben Richardson,
    from Bloomberg.

    All this is prelude to the latest news, which is Ben Richardson's resignation as a Bloomberg editor. Jim Romenesko had the story yesterday, followed by this from Edward Wong of the NYT, who also had the story about Michael Forsythe back in November.  

    After I saw the item on Romenesko, I wrote to Richardson asking if he would say more about the situation. He agreed. What follows are my emailed questions to him and his replies:

    James Fallows: Four months ago, during the Mike Forsythe episode, Bloomberg officials contended that his stories just "weren't ready," and that the accounts in the NYT and elsewhere were misleading or incomplete. What was your understanding of the episode and whether the company's claims were correct?

    Ben Richardson: I was one of the two editors on the story that was spiked last year, and one of three who helmed the 2012 stories on the hidden wealth of China's Communist Party leaders, so I have a pretty intimate knowledge of what happened. Unfortunately, I am bound by a confidentiality agreement that prevents me from disclosing the details. That said, much has already become a matter of public knowledge. 

    I felt the NYT and FT articles were a fair account. As often happens in news coverage, the stories painted the picture in stark black and white when in reality it was more nuanced. However, the contention that the story "wasn't ready" is risible: the only proof of readiness is publication. The real question is whether the story had any merit, and if it did, how could we get it to press?

    That's a simple question. So if Bloomberg felt the story had no merit, then why has the company not explained its reasons? Four seasoned, veteran journalists (with help from many others on the periphery) laboured for months on this story. Were we all wrong? All of us deficient in news judgment?

    JF: Amanda Bennett left the company at that same time. I know you can't speak for her, but should outsiders see her departure and yours as similar reactions to a trend in coverage?

    BR: Amanda Bennett must speak for herself on this. The only comment I can make is that her departure coincided with the decision to spike the China wealth story and the effective dismantling of her Projects & Investigations team -- along with the sacking of a number of seasoned and award-winning journalists. At the same time, the company is shifting ever-more resources into the short, bullet-point end of the news spectrum. That trend isn't unique to Bloomberg and is undoubtedly sound business, but the overall direction is clear.

    JF: What happened, now, in March, 2014 to persuade you to leave the company, versus the controversy in November, 2013? 

    BR: Time. Like most Bloomberg staff, I have a family to support, credit card bills, taxes and a mortgage to pay. I timed my departure to the company's annual bonus. 

    JF: Is the main change that is afoot here on the Chinese side, in decreased tolerance for any investigation into (especially) leading-family corruption issues? Or is it on the Western-press side, in decreased willingness to run these risks?

    BR: It's hard to say. I'm not aware of any reporting of this nature up until Bloomberg and the New York Times stories of 2012, so there's little to gauge the government reaction against. Those stories were published against the backdrop of a power transition, the purge of Bo Xilai and incoming president XI Jinping staking his legitimacy on cleaning up graft. And on top of that, growing inequality and soaring home prices are stoking public resentment of corruption -- making the government even more sensitive.

    As for the international press, there are many reasons for crimped ambitions. The first is that these stories are immensely expensive to execute. Even if a news organisation has the money, it may not have enough people with the right skills. And then it needs the will.  I don't know whether it was bravado fueled by ignorance or true cold-steel nerves, but Bloomberg stood up to intense bullying by the Chinese government in 2012. Last week in Hong Kong, Chairman Peter Grauer made it clear that China is just too big a market to miss out on. The jury's still out on how most other big organisations would handle a similar situation.

    JF: If you were in charge, how would big Western news organizations set this balance? To be more precise, Bloomberg is in a different situation from NYT or WSJ, in that its main business is not reporting but financial services. How should Bloomberg set this balance? 

    BR: I'll combine this with your next question, "What is the main thing you would like people without experience in China to know about your situation and decision?"

    Bloomberg has to act with the interests of the majority of its employees at heart. The company provides a good living for thousands of people. The vast majority of its news is untainted by the kind of constraints you see in China. If that's the kind of news its clients want, give it to them. The world is full of news organisations that feed different parts of the spectrum -- including many trade and specialist publications that never write critical articles of any kind. I think the debate should now move beyond Bloomberg.

    Business and political power are inextricably linked everywhere. That's especially so in China, where both are largely in the hands of a single, unelected political party that forbids the free flow of information and ideas and operates behind a veil of secrecy. Lack of transparency and accountability fuel rampant corruption, human rights abuses and environmental crimes. As China goes global, those values and practices are in danger of gaining currency elsewhere.  

    The question is a bigger one for society as a whole. What value do we place on investigative journalism? If the world's best-resourced news organisation leaves the field, who will fill the gap?

    I'm grateful to Ben Richardson for his quick and forthcoming answers. This may be the time also to share something I received from a person inside Bloomberg at the time the news first broke, which is a useful complement to what Ben Richardson says. This Bloomberg employee said:

    There is a bigger contradiction for the company than most people perceive. Outsiders think the worst explanation for this controversy is that it's concerned about selling terminals within China. It's bigger than that. Really it's about continuing sales all around the world, if Bloomberg can't promise having the fastest inside info from China.

    Everyone knows that it's a company that exists on the terminals. But now that they have saturated the US market, all of the growth will come from areas with these deep contradictions between the company's financial-business interests and its journalistic aspirations. 

    Until very recently, the very fact that Bloomberg was not principally a journalistic company seemed to be its greatest strategic asset. It could use the stream from those financial terminals to bankroll ever-expanding coverage, while companies that were mainly or only in the troubled journalism biz kept cutting back. 

    From Citizen Kane onward (and beforehand), it's been obvious that these extra-journalistic business ties can complicate news coverage. It's time for someone with standing-to-speak for Bloomberg values—Winkler, Grauer, or the mayor himself—to address these concerns directly. 

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  • William of Occam, Thomas Bayes, and the Fate of MH370

    Some postings that begin to put the mystery in perspective.

    Thomas Bayes wondering whether a customer has said "I want four candles" or "I want fork handles" ( A Bayes Tutorial )

    Three perspectives worth mentioning this morning. 

    1) Mysterious disappearances were once the norm. A reader who runs a tech firm writes:

    It's interesting to remember that this sort of mysterious disappearance was completely normal until comparatively recently. I'm not sure, but I think theTitanic (1912) may have been the first shipping disaster that played out in the press in nearly real time. Before 1899, the first news of a ship lost at sea was likely to be no news at all.

    2) Eponyms of logic, Occam and Bayes. Most people easily grasp (though often stray from) the logical concept known as Occam's razor. It's the idea that, other things being equal, the simpler explanation for an event is more likely to be true. For instance, early in the MH370 mystery, one popular conjecture was that something terrible had gone wrong that impaired the pilots' ability to control the plane. And another popular one was that those pilots had found a way to sneak up underneath another plane, hide in its "radar shadow," and then peel off undetectably and land at a secretly arranged rendezvous site in Pakistan or Iran. Knowing nothing else, by Occam's razor sheer complexity made the second far less likely to be true. 

    I find that people have more trouble with the concept of Bayesian statistics or probability, or simply the name, even though the simplest version of its implications makes common sense. That simplest version is the idea that probability estimates can be continually improved and refined if they are adjusted to reflect past experience or new evidence.

    Thus the image at the top of the page (taken from here, as is the example that follows).  Acoustically, the phrases "I want four candles" and "I want fork handles" are practically identical, and if you listened to a recording with no other info, it would be 50/50 which statement the speaker had in mind. But if you're hearing this in a candle store, the probability changes in one way -- having nothing to do with the actual sound -- and in a cutlery store it changes the other way. There's much more to the concept, but that is the main idea. [Mea culpa! I did not know about the "Two Ronnies" episode on Fork Handles, but now I do.]

    My reason for bringing this up is to point toward an interesting short book I read last year, which is all about this history of Bayes's approach and its modern implications. (Plus, why it probably should have been named not for the English clergyman/mathematician  Thomas Bayes but for the French mathematician Pierre Simon Laplace.) The book is The Theory That Would Not Die, by Sharon Bertsch McGrayne.

    3) Clear thinking about MH370. Here are two examples. One is an article by Les Abend, a long-time 777 pilot whose sane-sounding judgments I have praised before. On the CNN site today he gives a chronology that discards some wild implausibilities and explains how a mechanical problem could have led to the evidence we now have.  

    The other is an update from Chris Goodfellow, who ten days ago offered the first plausible-seeming discussion of why mechanical/electrical error --rather than hijacking, terrorism, or suicide -- was the least-implausible explanation for what went wrong. His views got a churlish early dismissal from Slate and some TV pundits, but I think they have held up better than some other theories. Today he explains how the latest evidence affects his interpretation, and mentions the Les Abend post. (This is on Google+ rather than a normal blog so you may need to prowl around a little.)

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  • The Vermont Lake Monsters, and Other Updates From the Road

    Are people in smaller towns "nicer" than cosmopolitans? No. But their political structures are working better.

    Approaching downtown Greer (James Fallows)

    The photo above is from the small South Carolina city of Greer, which is midway between Greenville and Spartanburg and whose downtown-revitalization efforts I mention briefly in my article in our current issue. I will be reporting on Greer soon, and I mention it now as segue to three updates:

    Inside Marriage Special Report bug
    Reinvention and resilience across the nation
    Read more

    1) Are small towns "virtuous"? Not really. But they can be effective. Most of this article is about the specific ways in which some cities we've visited have addressed their civic problems, improved their economic prospects, and overall made themselves more attractive places to live. Those specifics matter, and as a relative newcomer to the thriving and crowded field of city-improvement studies (of which Atlantic Cities is an excellent chronicler), I've been fascinated by the ways in which successful tactics spread.

    But there is a general point I consider increasingly important, so let me hammer it home once again. It's this, which contrasts our willed, structural paralysis in presidential-congressional politics which what is feasible elsewhere:

    Once you look away from the national level, the American style of self-government can seem practical-minded, nonideological, future-oriented, and capable of compromise. These are of course the very traits we seem to have lost in our national politics.

    The sappy version of appreciating smaller-town effectiveness is the idea that away from the metropolis, people are nicer, more generous, godlier, and so on. I don't buy it. People are people. Romanticizing small-town virtue is like imagining that the reason Western research centers produce so many Nobel prize winners, and Chinese ones so few (none), is that Americans are more "creative"—as these same Chinese researchers miraculously become when relocated from Tsinghua to Berkeley. The real explanation in these cases, I think, is institutional: incentives reward people for getting things done at a local level, and often for not doing so at the national level.

    As another smaller-town mayor I quoted in the story, Don Ness of the (wonderful) town Duluth, Minnesota, put it:

    “Being a mayor, especially in a ‘strong mayor’ city system, gives you tremendous opportunities... It’s a job that requires—and allows—you to create and implement a tangible agenda. You can carry that out in a way that most positions in American politics just don’t permit.”

    That's true. And since we also need a functioning national government, it raises questions about how we could change the rules and incentives there.

     2) Greenville City, Greenville County, and Martin Luther King. I mention in my article that Greenville County was the last one in South Carolina, which itself was the last state in the union, to observe Martin Luther King's birthday as a holiday. I also quoted this reader on its racist past—and since have heard from many current residents, black and white, about changes since then. The longtime mayor of Greenville, Knox White, who is one of the protagonists of my story, writes in with this clarification about the holiday:

    I see that a former county council's public foot dragging on MLK came up. The City long, long ago declared a holiday and when the county council did not follow suit the perpetrators were all swept from office in the next election. Most were defeated in the GOP primary.

    Indeed there are important political and demographic differences between the city of Greenville and surrounding Greenville County. Like most cities compared with their rural areas, the city is politically more liberal. For instance, Mitt Romney trounced Barack Obama county-wide in Greenville, but the race was very close within the city. I take the mayor's point.

    3) Lake Monsters and Reds. My article points out that civic leaders in Greenville made a big push to build a downtown stadium for their minor-league baseball team, the Red Sox-affiliated Drive. (Named, it appears, for the local BMW and Michelin plants.) And Senator Bernie Sanders, in his days as a crusading mayor of Burlington, Vermont, made a big push to get a stadium for their minor-league team, which was then Cincinnati Reds-affiliated and was called the Vermont Reds. They have since left and are now known as the Akron Rubber Ducks.

    As anyone who has been to Burlington knows, the team that plays there now is called the Vermont Lake Monsters—logo below. Through an in-house jumble, we said that the local team "is called" the Reds, rather than "was called," thus presenting the name of the team Sanders brought in as if they were still there under current mayor Miro Weinberger.

    Sorry for the mix-up. Mayor Sanders cheered for the Reds-affiliate Vermont Reds; Mayor Weinberger, for the A's-affiliate Lake Monsters. Go team(s). 

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  • After the Latest MH370 Report, How to Think About Speculation

    Weeks of wall-to-wall coverage offer lessons in cable news's dealings with the unknowable.

    A pilot looks out onto the southern Indian Ocean while searching for flight MH370 this weekend. (Reuters)

    Once again I am spending most of today in transit, and the doors of a (commercial) flight are about to close. So this is a placeholder note about today's announcement from the Malaysian prime minister about the fate of Malaysia Air flight 370.

    The most urgent concerns about this flight are of course those of the families affected. Next come questions about this airline, this model of aircraft, the air-traffic-control and air-safety operations in this part of the world, and any other potential source of longer-term systematic problems. 

    And then there is the question about how our news media deal with the unknowable. The human fascination with the fate of this flight is understandable and natural. So far it has been a mystery with no obvious precedent in the world of modern air travel.

    Structurally, these past few weeks have also reinforced an obvious point about 24-hour cable news. Its basic premise is that what is happening right now is more important and compelling than whatever may have been regularly programmed on some other channel—or in the other aspects of your life. Thus it is natural that CNN, in particular, has gone wall-to-wall with coverage even on days with no development resembling actual news. This is the war-style coverage that gave CNN its start, applied to a different situation.

    In terms of the content of news-while-waiting-for-news, I've come to value the analysts, panelists, "experts," and others who display two traits:

    * They have emphasized the unknowability of the entire situation, the contradictory nature of much "evidence," and the tentativeness of assumptions about what could and could not have happened with MH370.

    * At the same time, they have helped the public separate the possible-but-unconfirmed from the FantasyLand-wild improbabilities. The clearest indication of this last category is the "radar shadow" hypothesis, which I'll link to later. Or a prominent official's straight-faced assertion that the plane might be headed to Israel on an attack mission.

    Two of the panelists who consistently met this test were Les Abend, a former commercial pilot, and Miles O'Brien, a TV veteran and (Cirrus) pilot. There may have been others, but they were the ones I saw most consistently talking sense.

    Now, on the general phenomenon of speculating about the improbable, I give you this note from several days ago from reader T.J. Radcliffe, a scientist. He writes:

    Your observation "modern airlines are so extraordinarily safe that when something goes wrong, the full story is usually by definition unusual" is precisely why speculation ahead of the data is so utterly irresponsible in this case.

    The famous dictum "when you hear hoof-beats, think horses no zebras" only works because horses are a single, fairly common source of hoof-beats in everyday life.

    For any given effect, good Bayesians are bound to focus their speculations on things that are about as probable as the most common cause. But in the case of modern air disasters, due to the amazing gains in safety in recent decades, the most common cause is always wildly improbable, which means there are an almost infinite number of alternatives of equally low probability. So speculation is pointless, and the people who do it are being flagrantly non-Bayesian, which never ends well.

    Speculation, like imagination generally, is not a particularly effective tool for deciding what is true. We can and do imagine impossible things (perpetual motion machines, political violence that actually achieves its purported end) and we fail to imagine things that actually exist (evolution by variation and natural selection, creative non-violence as a viable strategy for political change). The human imagination is many things, but as a tool for knowing it's about as good as a hammer for tightening bolts.

    For low-probability events when very little data is available, our ugly tendency to fall back on our imagination comes to the fore on all sides, as it has in the past two weeks with MH370. While my heart goes out to the loved ones of the passengers, that some of them cannot imagine how difficult it is to find wreckage in mid-ocean does not justify their harassment of public officials, who are no-doubt struggling with feelings of inadequacy due to their own lack of understanding of the laws of probability.

    There is a Kuhnian revolution going on right now in our understanding of the world in terms of probability distributions rather than mechanical, binary, cause and effect. It will take decades or centuries for this to percolate through society, but the foolishness of non-Bayesian speculators in the case of MH370 is one more example of how the old ways fail all of us in times of crisis and heartbreak.

    He has a related post on his own site, here

  • The Use and Misuse of Information Technology in Health Care: Several Doctors Reply

    One of them writes, "There is a very American tendency to look for technological fixes for significant problems.  In general, technological fixes only work in the context of appropriate institutional structures."

    Our new issue has an interview with Dr. David Blumenthal about why it has taken the medical system so long to adopt electronic record-keeping, and what it will mean when the switch occurs. (Blumenthal led the Obama administration's effort to encourage that change.) On Friday several technology experts and doctors weighed in with responses. Here are a few more.

    1) "Give us a cotton gin." Creed Wait, a family-practice doctor in Nebraska does not like the mandated shift to electronic records, at all. [I've added his name, as he sent permission to use it. Also he has moved from Texas to Nebraska.] For now, I am sharing his detailed complaint in full, rather than interspersing comments or "Yes, but" queries:

    The saying is, “Build a better mousetrap and the world will beat a path to your door. “

    The saying is not, “Build a different mousetrap, pay out nineteen billion dollars in incentives to use the mousetrap, mandate its use by law and punish those who fail to adopt it.  Then shove the world kicking and screaming against their will through your door.”

    So far, doctors have been paid $19B in incentives to buy EMRs [Electronic Medical Record systems].  No one had to incentivize the cotton gin.  It was simply a better product.

    The current EMR system is a mess because the current EMR systems in use by the majority of physicians were written in the Rube Goldberg School of Software Design and work poorly.  There is no ‘asymmetry of benefits’ as proposed by Dr. Blumenthal.  Unless, of course, what he means by this is that only the software companies are benefitting from these federal mandates.  Then, I would agree with him.  Yes, the benefits are asymmetrical.

    Build a better mousetrap and we will use it.  DVDs came out and they were better than VHS tapes.  Overnight the whole world invested in new electronics, we bought DVDs and we threw out our VHS tapes.  There was no need for $19B in incentives because DVDs were simply a better product.  Flat screen televisions came out and we stopped buying cathode ray tube televisions.  Why?  Because they were a better product.  Laws mandating the use of DVDs and flat screen TVs, bonuses for using them and punishments for failing to do so, were not needed.  The market chose the better products.

    Mandated EMR adoption requires carrots and sticks consisting of massive incentives and concomitant penalties because the products that are available work so poorly and are so severely user-unfriendly.

    Using the VA system, Kaiser, and Geisinger as examples of the successful use of EMRs is disingenuous.  These are massive systems with massive budgets and massive around-the-clock onsite IT departments.  The vast majority of physicians are not in these megalithic systems.

    Most of us are in much smaller practices.  We have IT departments but the salesmen and software engineers who sold us these magic beans are already down the road looking for the next unsuspecting rube and cannot be reached.  Our IT departments are swimming upstream trying to implement and maintain software that they do not understand while mandated changes to this software are being released before we can get the last update debugged and working.  The doctors are always screaming because the systems are down, we can’t work until the system is running and the IT guys have the harried and glazed look of caged prey.

    For the federal government to mandate the use of EMRs by every physician out there just because it works at the VA would be like telling the entire world, “OK, we made it to the moon.  Now it is your turn.  Any country that has not put a man on the moon within the next five years will be bombed.  Every country that complies with this mandate will get a check for $1B.  For those countries who fail to comply with this mandate, shelling will begin at 1:00AM, five years from today.”

    What the federal government can do with a bottomless supply of tax dollars cannot be used to reasonably mandate what happens in small offices constrained by budget limitations.

    One year ago in private practice I could see eighteen patients per day.  A transcriptionist typewrote my notes. These were typically three pages long, concise, complete and extremely useful.  Then our group bought an EMR.

    After one year I was seeing fourteen patients a day, my notes were twelve pages long, the vital signs alone required a half page and the notes bordered on being useless.

    My reimbursement per visit had increased, my face-to-face time with the patient was shorter, I was doing a poorer job, patients were less satisfied, and I was completely frustrated by trying to build each note out of dozens of pages of drop down menus.

    Before implementing an EMR I had approached each patient encounter with an attitude of, “What can we do today to improve your health, happiness and overall satisfaction with life?”  The patient and I would have a meaningful conversation about the pertinent issues.  Once an EMR was implemented, a subtle change began.  It was so gradual that at first I did not even recognize the poison.  But after a few months I realized that the visit had slowly evolved into, “Just a minute, we need to be sure that we have checked off every box on every screen and we need to be sure that a narrative of some sort has been entered into every required field.”  Then there were realizations like, “Oh, look.  If we add one more point to the Review of Systems then we can raise the billing code one notch.  Hold that thought while I click, ‘wears glasses’ under the ROS field!” 

    Well, time’s up!  The fields are all now completed and all goals have been met!  Next!

    The EMR had become the primary influence in the interview.  The dynamic had changed.  The patient and I were now both in the room to feed the hunger of the software.

    Don’t even get me started on CPOE (computer-based physician order entry systems).   Physicians used to write their orders and clerks would enter these data into the computer.  Under the new mandates, the physician is now a data entry clerk.  What’s next?  Is each hospital CEO going to be required to spend two hours a day manning the switchboard?  It is claimed that CPOE systems reduce errors.  In the real world, this is nonsense.  It is all in how one collects and reports the data.  Data collectors refuse to attribute errors to the CPOE system. Rather than blame the software, the physician is blamed for not understanding how to use the system correctly.  Just like with office-based EMRs we refuse to admit that the Emperor is naked.  I have seen physicians get past mandatory stop points during system entries, when the correct input was not an option, by inputting obviously erroneous answers so that they could keep working.  Then the physician would call the pharmacy and verbally correct the entry.  There are dozens of ‘back door’ fixes of this nature that allow physicians to keep working when a CPOE system locks up or cannot meet the needs of a unique patient.   In my own experience I estimate than a CPOE system adds 1-3 hours of work to each day.  

    I am not a typist, I never have been a typist and I never will be.  I can dictate a beautiful note.  A typist can then create an excellent document from that dictation.  There is no reasonable excuse for the government to mandate an end to this system when no one has a better product.  There is no reasonable excuse for the government to mandate that I will now be a typist.

    Now, on to the VA system.  They have a great and highly integrated information management system, with one glaring flaw.  As long as the patient stays completely within that system, it works.  As long as the patient never sees a physician outside of the VA, it works.  As long as the patient never gets a test, x-ray or is hospitalized outside of the VA, it works.  But the VA does not integrate well outside of their own system.  By the time non-VA physicians and hospitals can get records, reports or anything of value out of the VA, the patient is generally dead or cured.

    But this is exactly the problem that integrated EMR systems were touted to cure.  If the best EMR in the nation has not yet solved this one simple problem, why is the entire concept being shoved down our collective throats?

    So, you want to revolutionize data management in healthcare?  The starting point is a product that works.  Give us a DVD, a flat-screen television.

    Give us a cotton gin.

    2) The latest snake oil. More skepticism about the coming changes:

    I've been a clinical psychologist for many years, and it's long been clear to me that few patients are likely to benefit from the adoption of expensive, labor-intensive technologies, which do, indeed, make it easier for managers and other third parties to do their jobs.

    In recent years we've been seeing increasingly aggressive attempts by a variety of self-interested parties to insist that a certain change in how health care services are provided or paid for - a change which, coincidentally, would have salutary effect on their company's bottom line or their own career - is precisely the snake oil which is needed to "cure" the present system of its ills.

    Rather than making changes which would, in fact, be most likely to result in "the greatest good for the greatest number," what we've been seeing - and are almost certainly going to continue to see - are changes which reflect the outcomes of intense behind-the-scenes political maneuverings among "stakeholders," each of whom is trying to make sure that, when all is said and done, he will be among the "winners."  

    3) What the VA's experience shows, and doesn't. From a doctor in the upper Midwest: 

    I'm a practicing physician with significant experience in the VA system and at an institution that recently adopted a new EMR.  There are some significant qualifications about the potential of EMRs to improve care in the USA.

    1) The precedents of the VA system and systems like Kaiser are a bit misleading.  A very good criticism of EMRs generally being adopted in the USA is that they are fundamentally built on billing systems.  This is an inevitable consequence of the fact that the incentives to introduce EMRs are driven by reimbursement.  Systems designed to maximize patient information would be somewhat different. 

    The older, clunky but functional VA system is better in this respect than the modern EMR I use at my academic institution.  Dr. Blumenthal and his colleagues are inadvertantly partially responsible for this situation because the legislation incentivizing use of EMRs had to be built around reimbursement incentives-penalties.  In our fragmented system, I don't see that alternatives were available to Dr. Blumenthal and his colleagues but realism about the results is necessary.

    2) EMRs should, as they do in the VA system, reduce costs by reducing duplication of tests and services.  This occurs only, however, in the context of relatively large, integrated systems.  I routinely waste money by ordering tests that may well have been performed previously by other physicians because I don't have access to patients' medical records.  Big Data isn't big unless it can be aggregated and used broadly.  There may well be considerable consolidation among health care providers in the near future but any market or semi-market based system like ours is an obstacle to consolidation because it encourages inefficient winner take all behavior.

    3) An analogous point is that ostensibly data-driven changes in clinical practice will not emerge without someone or something to actually analyze the data and develop optimal care approaches.  We need something like the British National Institute for Health and Clinical Excellence (NICE), probably on a more ambitious scale, to push appropriate reforms in clinical practice.

    There is a very American tendency to look for technological fixes for significant problems.  In general, however, technological fixes only work in the context of appropriate institutional structures. 

    4) The good, the bad, and the worse. From a reader in Jerusalem:

    Good:  I'm a long-time software engineer and was recently talking to my hematologist about computers and medicine.  She was very grateful for the change.   She remembered patients coming in to the ER that the staff recognized, but they'd have a terrible time looking for the medical records.   Multiple staff searching through mounds of folders and not finding the right one.  Previous diagnosis helps a lot in figuring out what to do in an emergency.

    Bad: On the other hand, my GP spends more time facing the computer screen than his patient.  Prescriptions come out of the computer via his laser printer, which cranks away all day.  But all the Rx are in the system, anywhere I go.

    American docs used to leave the room in the middle of the visit to look things up, rather than turn away from the patient.  Bedside manner.  Uh, deskside manner.

    On the third hand:  Hacking. 

    I have new respect for the complexity and difficulty of this change. More to come.

    Previous post

  • When a Man Is Tired of Wingsuit Videos, He Is Tired of Life ...

    The world is big and interesting, chapter 438.

    ... as Samuel Johnson might have sayeth, if he had gotten a look at these things.

    We've previously explored the wonders of wingsuit-flying in China and assorted sites in Europe (plus underwater). Now I give you Switzerland, via Epic TV* and our friends at AOPA:


    And in case you missed the flying-and-diving video the first time around, here it is again.

    Plus, for some terrifying/riveting wingsuit video. check out this.

    I love flying airplanes but would never dare try one of these wingsuit stunts. I also never get tired of seeing them. They have a dream/nightmare quality that is immediately recognizable though hard to define.

    * Tech note: Sometimes this video displays an annoying Epic TV banner announcement across its upper half through its whole duration. If that happens, try refreshing the page and viewing the video again. That seems to thwart it.

  • On the Ramifications of High-Tech, Big-Data Medical Care

    As more of medicine comes into the info age, will we get better sooner? Or simply have a more detailed idea of why we're sick?

    As mentioned this morning, in our new issue I have an interview with Dr. David Blumenthal about the paradox of modernization in the American health care system. We all know that everything about medicine is becoming technologized, in ways good and bad. On the good, see previous interview with Eric Lander about the genomic-knowledge revolution. On the bad, see Jonathan Rauch on the industrialized process of dying. But we also know that nearly every visit to a medical facility begins with the tedium of filling out forms by hand.

    David Blumenthal was in charge of the Obama administration's effort to speed the adoption of electronic medical records, and in the interview he explains why that has been hard but will be worthwhile.

    Now, responses from readers in the tech and medical worlds. First, from David Handelsman, of a health-related data company in North Carolina:

    One of the things that Dr. Blumenthal didn’t include in his response was that the health care industry needs to continue to create a culture of evidence-based medicine, beyond the activities at those organizations that are further along the maturity curve regarding electronic health records and healthcare technology. 

    The reality is that much of healthcare is administered to patients based upon the practitioner’s experience (patients he or she has seen with similar conditions), the practitioner’s ability to accurately recall the appropriate care for the patient being seen and, where time has allowed, the opportunity to stay current on healthcare research and able to then apply that research correctly to the patient at hand.

    While I have the utmost respect for health care practitioners, there’s an awful lot of room here for what I’ll call non-optimized care.  The practitioner’s experience may be incomplete – he or she may not have seen a patient “like this patient”.  They’re ability to recall the best care options for “this type of patient” may be unreliable given the vast numbers of patients in their care.   They may be lagging behind in current research and recommendations because there isn’t enough time in the day, and if they are current, they may still have the same issue of recall regarding complex health decisions.

    Evidence-based medicine aims to provide optimal recommendations regarding patient care.   When electronic data is available, the patient’s current situation can be electronically compared to other similar patients AND their respective healthcare outcomes.  At that point, a recommendation for care for “this patient”, whose profile is aligned with “all of those similar patients”, can be made based upon the recorded outcomes.   Please note that this should be considered a recommendation – the responsibility for providing care ultimately falls on the practitioner, and not an algorithm, but that practitioner should always have the best information at hand to determine the best course of care.

    From a retired MD:

    There is a rub [among many, I suspect] as seen in our personal records from digitized offices.

    To respond to insurance company demands for documentation of visits, physicians can simply cut and paste the previous visit data onto the current visit, making such changes as are necessary. Every visit looks remarkably complete!

    The volume of material viewed makes finding anything new difficult.  The record becomes a document for the insurance company, barely useful for physician's own use or physician to physician communication.

    From the academy:

    I'm a PhD student in statistics working on prediction and causal inference using health data. I'd like to comment on a quote from your (great) interview with David Blumenthal about the promise of Electronic Medical Records: 

    Dr. Blumenthal says: "This will move us into a field that is taking shape right now, that of analytics. It will help us take these data and turn them into diagnostic information—into recommendations a physician can give a patient or that patients can get directly, online."

    He seemingly conflates 'diagnostic information' and '[treatment] recommendations'.  But they actually pose fundamentally different problems from a statistical perspective, and I think EMRs will play a much more transformative role in diagnosis than treatment. This is because diagnoses live in the realm of pure prediction, while treatment decisions live in the realm of causal inference. EMR data will be observational. Using observational data for pure prediction is completely valid, but using it for causal inference is only valid under strong assumptions of no unobserved confounding.

    A common fallacy of Big Data Hype is the assumption that gathering boatloads of observational data will enable us to solve problems that are fundamentally causal in nature. There will certainly be special situations where EMR data can reliably drive treatment decisions (and this will be a big deal!), but such cases will be the minority.

    By contrast, statistical algorithms should be able to almost always make excellent, reliable predictions about what conditions a new patient is likely to have or acquire given her own health history and the health histories of millions of other patients. These predictions, which are probabilistic diagnoses in themselves, can also guide decisions about which diagnostic tests to perform on which patients.

    From someone in the tech industry:

    This question in particular interested me:

    "JF: In the broadest sense, what difference will better information technology make in our lives and health?"

    And this part of the answer:

    "DB: This will move us into a field that is taking shape right now, that of analytics. It will help us take these data and turn them into diagnostic information—into recommendations a physician can give a patient or that patients can get directly, online."

    That’s where the future lies, and of course people want the benefit of it right now. Before, there was no market to make this sort of analytic product. Now that we have a growing electronic infrastructure for health information, there is a surge of traditional capitalist interest in turning that information into valuable knowledge, and selling it back to patients and doctors. That will happen. But it could never have happened until we got the data into digital form.

    To which I would add three things:

    1. Put simply, the short-term benefit is efficiency (easier/cheaper management of data for existing processes). The long term benefit is effectiveness (making people healthier)

    2. YCombinator (the #1 tech incubator, based in SV) yesterday put out their 'Request for Startups -- Breakthrough Technologies', which included a section on health, notably:

    "We’re especially interested in preventative healthcare, as this is probably the highest-leverage way to improve health.  Sensors and data are interesting in lots of different areas, but especially for healthcare."

    So certainly corroborating the "surge of traditional capitalist interest in turning that information into valuable knowledge." More here:

    3. I share YC's view that preventative care holds huge potential returns. In general, I see "Health Care" being too focused on the "care" (e.g. I can get an appointment with an expert at John Hopkins within a week;  they have all the latest equipment;  the hospital is a nice building). And not focused enough on "health" (e.g. sixty year olds being in good enough shape to enjoy traveling and grand children; young people not being taken out of the work pool for a lack of basic medicine). Using data for preventative care could be a key component to redressing this - of course, it could also exacerbate it...

  • Why You Still Have to Fill Out All Those Paper Forms at a Doctor's Office ...

    ... and whether that might ever change.

    David Blumenthal MD

    In the new issue of the magazine (subscribe!) I have an interview with Dr. David Blumenthal. He is now head of the Commonwealth Fund, but during the first few years of the Obama administration he was in charge of moving America's medical-records system away from tedious paper-based filing to the digital age.

    I am biased, in that David Blumenthal and I have been friends since we were teenagers, but I think he does a very good job of explaining why it has taken so agonizingly long for medical records to catch up with the rest of our digitized life -- and what the payoff will be when the impending switch takes place.

    Please check it out. I've already received some retorts from other doctors (and insurance-company people), and will post in due course. 

  • The Glamorous Life of a Journalist, Couples-Getaway Edition

    Addressing America's infrastructure crisis, while people are staying right in the infrastructure.

    Downtown Winters, California, today. (James Fallows)

    For previous Glamorous Life installments, check here and related links.

    Inside Marriage Special Report bug
    Reinvention and resilience across the nation
    Read more

    As my wife Deb and I have traveled around the country, we've stayed with friends, in daring motels, and once in a windowless, converted shipping container, which fortunately had a ventilation system. It's all worth it for the cause.

    Last night in Davis, California -- closest place with a hotel to our recent target-city of Winters -- we enlarged our experience by staying in a place while, unannounced in its online literature, it was in the middle of being demolished/ improved. The arrow points to our strategically positioned room.

    Fortunately, if there had been some emergency in the night, quick access to a dive for safety was just outside our door. All we had to do was leap.

    Ah well.  On the other hand, a few miles away the agricultural scenery around Winters was of surpassing beauty. These are nut trees.

    Orchards outside Winters, California, on March 20, 2014.

    More about the place and its people tomorrow. If you want tips on where not to stay in Davis, come to us.

  • Greenville, Burlington, and American Futures

    "I loathed it with the heat of a thousand million suns."

    The Reedy River in Greenville, S.C. a few weeks ago (James Fallows)

    The new issue of the magazine is out. (Subscribe!) Among the articles is one by me on some of the cities we've seen on our American Futures project. These include Greenville and Greer, South Carolina, and Burlington, Vermont, all of them -- despite their obvious differences, and including Duluth, Minnesota -- illustrating parts of American public life that actually work, despite the general paralysis of politics at the federal level.

    In the Okefenokee Swamp early this month (J Fallows)

    Through the past month, Deb Fallows and I have been traveling a lot, through writing and broadcasting very little, as part of this project. We've been in southernmost Georgia -- Saint Marys, Kingsland, the Okefenokee (right), and adjoining areas of Florida -- and just now, via United Airlines rather than our Cirrus, in the fertile-but-troubled Central Valley of California. 

    Over the weekend, we met a group of California mayors and city-council members to hear about their stories, and since then we have been to, and will report on several, including Fresno, with extremely serious downtown and other problems but with people trying to cope with them, and tiny Winters, outside the university city of Davis.

    Inside Marriage Special Report bug
    Reinvention and resilience across the nation
    Read more

    Here is a marker for the next series of posts my wife and I plan to put up about these cities and their lessons. There are many traits that distinguish communities that seem alive, in the broadest, sense, from ones that don't. Locally based wealth, as I've mentioned before. Inventive approaches to schooling, as Deb has described in several cities -- and as we'll discuss for both St. Marys and Fresno. A civic self-image, or public narrative, that gives shape to the successes (and failures) in the city's past and guides people to useful decisions for the future.

    And, very significantly, a sense of "us"-ness in the city -- a form of what I've called local patriotism, and which is one of the most strikingly repeated notes in our travels around the country. This evening, in pop-7,000 Winters, California, we heard people explain why this was the only place they'd ever wanted to live, and how it had a magic they wanted to preserve. It was the more touching because we'd heard things so similar three thousand miles away in Eastport, Maine, and in between in Holland, Michigan, and in Greenville and Burlington and Redlands and Sioux Falls and elsewhere.

    The world of Bowling Alone has nothing in common with what we've seen and heard.

    But: any us implies a them. Someone told us this afternoon that "the best thing about Winters is also the worst, which is that everyone knows everything about you." Best: people watched out for one another. Worst: life in a fishbowl.  

    Very popular Buckhorn restaurant in Winters, Ca.

    Balancing the positive of community (the mutual responsibility, It's a Wonderful Life) against the negatives (constraint, conformism, Babbitt) is a long-term challenge for a society that tries to be both dynamic and rooted. We've kept stressing the community we've found, because so much American diagnosis of the moment assumes that we're a rootless, atomized culture.

    But in awareness of the balance, we've tried to remember the other side. After we'd mentioned all the good, community-minded projects that were underway in the small western Michigan town of Holland, several former residents weighed in about the claustrophobic effects of that same, tight community. And on the day when an article largely admiring of Greenville and upstate South Carolina appears, I should similarly quote a dissenting view. After reading a number of upbeat reports on "the upstate" of South Carolina, a former Greenville resident wrote:

    I've never been to Sioux Falls, SD, but I had the misfortune to live
    in Greenville, SC [for four years in the 1990s].

    Here's what I bet won't happen to you in SD, but did happen to a close
    friend of mine in SC. She's a white woman, a native of Ireland who
    speaks English with no appreciable accent of any kind except she
    doesn't sound Southern.

    She walked into a Post Office to inquire whether they would be open on
    the following Monday, which happened to be MLK day. The white postal
    worker, after glancing around to see if he was within hearing distance
    of any one black said, "we're closed, it's Martin Luther King day.
    Maybe if we kill more niggers we'll get more time off."

    I was told nearly every week by a white woman of a certain age --
    usually the wife of a colleague of mine at [a university in the region]  -- that
    Greenville was "the buckle of the Bible Belt," said with an accent
    that dripped honeysuckle and magnolia and a great deal of pride.

    A few very brave students started a [P]FLAG group, and had t-shirts
    made. I was told in all seriousness by the Chair of my department, a
    Greenville native, that I ought not wear the shirt around town or I
    might be shot... 

    This wasn't in 1950 or in 1960 or in 1970 or in 1980. This was in the
    early 90s.

    I loved my students a lot. The Catholics who wept in my office after
    their peers had explained, sincerely and with pity that they weren't
    really Christians. The Northerners who stumbled in shell-shocked by
    the blatant racism they'd never heard or seen before. The handful of
    black students who were fortunately primarily from the South so had
    seen and heard it all before.

    I loathed Greenville with the heat of a thousand million suns. I'm
    grateful beyond measure I was able to get out.

    I have no illusions about the fact of Northern and Western racism (and
    all the rest). I maintain, however, that it matters that white people
    in Greenville think they're immune from censure when they speak as the
    post office worker did. It matters that religious prejudice spoken
    aloud is acceptable. It matters when slurs count as polite public
    conversation. There are pockets and places outside the South where
    this is true, no doubt, but it's not the default assumption anywhere
    else. Not then and not now.

    It will take more than Michelin and BMW and whomever else comes to
    town to rid the town of its toxicity.

    As I note in my article, Greenville was the last county, in the last state, to recognize Martin Luther King's birthday as a holiday. But when I asked people in Greenville, black and white, about this analysis, most of them said: Things have changed.

    I don't presume to wrap up the topic right now, late at night. I will say that the good parts of American community-consciousness seem, in many places, stronger and better than we anticipated. And we are asking and reporting about the other parts too. More to come: for now, I hope you'll check out this issue.

    Previous post

  • As the Australians Announce Their (Possible) MH 370 Finding

    A clue that offers less hope for a safe recovery of passengers and crew, and possibly more hope for understanding what went on.

    Australian Search Map ( SBS Australia )

    Main point: sympathies for the tremendous strain on the families involved -- Chinese, Malaysian, and others from around the world.

    Secondary point: as I write it's not clear whether the Australian satellite sightings actually involve this flight. Short of the passengers being found live and safe, which unfortunately is hard to imagine nearly two weeks in, the most useful news would offer certainty about what actually happened. Let's hope that this sighting, unlike some previous ones, offers a real clue.

    Insanity watch: I hope someone will look back on this and similar episodes for revealing lessons about individuals' and institutions' reactions in the face of mystery and uncertainty. Terrorism experts have immediately traced this to terrorism; Rupert Murdoch said one day after the flight's disappearance that the episode "confirms" a new jihadist attack on China. Last night Michael Oren, who until recently was Israel's ambassador to the United States, was soberly warning on CNN that the plane could well be headed for Israel on an attack mission. Cable news experts have been absolutely sure of one explanation one day, and sure of another the next.

    When I noted yesterday that Oren's theory could be a mark of peak nuttiness about this flight, I got a stream of huffy messages like this one:

    My original suspicion, which seemed to be quite obvious by last week, is that MA 370 was stolen by Iranian operatives (They don’t seem like terrorists, they’re just Iranians spending huge money flying all over the world on stolen passports, nothing terrorist-like there.) to take home to Iran. Of course, those agents would have needed to get access to the cockpit, assuming they didn’t have at least one pilot compromised, how could they gain access? Oh yeah, these pilots have a rep for letting pretty girls into the cockpit. Some pretty girls flirt with pilots at the airport, get in the cockpit, pilots incapacitated and agents in that fast.

    Iran needs export controlled guidance parts from the 777 for their nuclear missile program.  The 777 was fueled up enough to get to Beijing, which means it had plenty to fly across the Indian ocean cut north and land in Iran, not go to the Andaman Islands. The only country who might have noticed, once the satellite transponder was cut, would have been Oman. I’m sure you’re aware Iran was visiting Oman just last week. I think it will also be clear that a certain number of high level officials in Malaysia were bribed/ ideologically motivated to help this along. The interesting question is what Iran intends to do with 220 or so Chinese citizens (and assorted others). The default would be for the bodies to never be found.

    BTW. As you harrumph. It just happened. You also harrumphed about the idea of jets being flown into buildings before 9/11. Don’t deny it , you did. [JF note: News to me.]

    2nd BTW. As I understand the guido parts in question, they wouldn’t be for the nuke headed towards Tel Aviv, they would be for the nuke headed to NYC. Why anyone thinks Iran’s second nuke isn’t for NYC just baffles me?

    Meta-point #1: responses to a mysterious episode constitute a sobering reminder that only so much "debate" or "discussion" involves what you could think of as evidence or facts. People see what they're going to see.

    Meta-point #2: modern airlines are so extraordinarily safe that when something goes wrong, the full story is usually by definition unusual. It is probably too much to expect that this will have a happy outcome, but I hope the outcome is known soon, among other reasons for quelling the nuttiness.

    I will try my best to make this the last dispatch on the subject in this space, until something is known for real.

    Previous post                                                                            Next post

  • Why Cities Work Even When Washington Doesn't
  • Why Doctors Still Use Pen and Paper

    Why Doctors Still Use Pen and Paper

    The healthcare reformer David Blumenthal explains why the medical system can’t move into the digital age.

  • Are Transponders the Main Problem? In a Word, No

    On my list of aviation safety- and security- measures, this reform comes pretty far down.

    Data blocks reporting transponder info on an Air Traffic Control screen ( From Don Brown's 'Get the Flick' site )

    My friend and colleague Gregg Easterbrook has an op-ed in the NYT today saying that one big lesson of the 9/11 attacks, which should be re-learned because of the Malaysia 370 mystery, is that pilots should not be able to turn off the transponders in their planes.

     (I suspect that most people have no idea what a transponder is or what it looks like. Here is an image of the same kind I have in my Cirrus SR-22. What you'd find inside an airliner would look different but is functionally the same. You enter "squawk codes" via the number keys along the bottom, and you control the other functions via the other buttons you see, including the one that says "Off.")

    As Gregg knows, because I've told him, I think that focusing on transponders is mis-directed effort, Ms. Emily Litella-style. Here is why.

    1) Does turning off a transponder make a plane invisible to radar? No. It means that that the plane still shows up as a "primary radar return" -- the famous blip, on a radar screen -- rather than reporting detailed information about its identity, altitude, and destination. As you might imagine, military radar system in particular are designed to track planes even when they don't want to be detected. And even when they're on, transponders are far from foolproof -- controllers often report that they can't pick up transponder reports when you're over mountains, too low, or too far away. 

    2) Why would you switch a transponder off, in the first place? Because every bit of electric equipment in an airplane is designed to be controllable, with a switch or a circuit breaker, so a flight crew can shed load selectively during an electric failure, or isolate the rest of the system if one piece of equipment acts up. Worldwide, we've had two episodes out of the millions of flights through the past dozen-plus years in which turned-off transponders arguably created a problem. Electric problems that potentially threaten flight safety are vastly more common.

    3) Would an always-on transponder make a big safety difference? NO, it wouldn't. To understand why, let's take a minute to review how transponders are used.

    Before you take off on an instrument flight plan, or at other moments in flight, as a pilot you get this instruction from an air-traffic controller (ATC): "Airplane 1234, Squawk 3547." When you hear that, you enter 3547 in place of the 1200 shown at the top of this page. And from that point on in your flight (until you land, "cancel IFR" or "cancel Flight Following," or are given a different code), ATC uses the "Mode C" reports from transponder 3547 to calculate airspeed, altitude, position, etc, and match that with information for the airplane assigned that code. 

    Suppose you were a hijacker, or a pilot bent on sabotage. If all transponders were replaced with new models, you might not be able to turn them off. But nothing could keep you from entering a code different from the one you're assigned. You could enter 3457 instead of 3547. Or another special code indicating that a plane has been hijacked. Or 1200, meaning a generic visual-flight-rules plan. Or any number at all. Or change them as frequently as you liked.

    So if you wanted to thwart detection, the absence of an "off" switch would barely slow you down. Unless, of course, all civilian planes were re-designed to be controlled, like drones, from ground installations, which would create security and safety issues at least as bad.

    All this is why, on my own list of safety and security improvements for air travel, removing "off" switches for transponders would not be in the top 10 and probably not in the top 25. Money and effort spent here would have bigger payoffs elsewhere.

    What we're really looking for here is improvements in and faster adoption of a technology known as ADS-B. This is essentially a way for each airplane, with a unique identifier, to broadcast information constantly to ATC and to other planes about its location, direction, altitude, and other traits.  I'm in favor of that -- for safety, efficiency, and security reasons (as I explained in Free Flight). I'll join Gregg in a pro-ADS-B rather than an anti-Off Switch campaign.

    Meanwhile, check out Gregg Easterbrook's The King of Sports, which I gave my sons for Christmas.

    Previous post

  • Malaysia 370, Day 10: One Fanciful Hypothesis, and Another That Begins to Make Sense

    Did the airplane hide in a "radar shadow"? Probably not. Did the flight crew act like heroes? Possibly so.

    Tintin and a disappearing airplane ( Tintin Wikia )

    I rejoin the Internet after a day away to find no additional hard evidence about the fate of Malaysia Air flight 370, but a number of new rumors and possibilities. To run through a few:

    1) The "Radar Shadow" Hypothesis. Many, many readers have sent in links to a post early today by Keith Ledgerwood. He suggests that the Malaysian plane might have avoided radar detection by sneaking up on and deliberately flying right next to another 777, so that radar operators would see only a single blip from this ad-hoc formation flight.

    You can read the intriguing details for yourself, but the crucial points are:

    • The other plane, a Singapore Airlines flight en route to Spain, would not have known the Malaysia flight was right behind it, because its onboard collision-warning system (called TCAS) senses other aircraft by their transponder signals. Since MH 370 had its transponders turned off, the Singapore TCAS system would have nothing to work with -- and would get no warning from ground-based radar operators, who would not realize they were looking at two planes.
    • Meanwhile, MH 370 could creep very close to the Singapore plane without crashing into it, because the Singapore transponders were still working, and would broadcast its position to the Malaysian plane. (Plus, in the night sky the Malaysia pilots could see the other plane's green, red, and white navigation lights as it flew along ahead of them.)
    • After going as far as it wanted in the Singapore airplane's shadow, MH 370 could peel off at some point and head toward its intended destination.  

    Is this possible? At this point, when no normal expectations have panned out, I suppose almost any conjecture must be entertained.

    Is it likely? Or even plausible? Neither, in my view.

    Apart from the general rococo-ness of the plotting, this interpretation rests on a piece of evidence that I view in a very different way from what's implied in the post. Keith Ledgerwood notes that the two planes followed exactly the same course across a series of aerial way points ("intersections" with 5-letter names like IGREX and VAMPI) at very close to the same time. Isn't this suggestive of something strange?

    Actually, not. On many heavily traveled air corridors, planes will be sent along exactly the same sequence of way points at intervals of a few minutes. (If you listening to Air Traffic Control near a major airport, you'll hear one plane after another receive the same routing instructions.) I view it as routine rather than exceptional that planes might have crossed the same sequence of intersections.

    So maybe this will turn out to mean something -- and if so, all respect to Mr. Ledgerwood. My bet is that this will be another interesting-but-fanciful interpretation, and that the cause will prove to be something else. 

    2) The Pulau Langkawi possibility. Over the weekend Chris Goodfellow, an experienced pilot, offered via Google+ a very different sort of explanation. Far from carrying out an elaborate scheme, he says, the pilots may have been caught by surprise by an inflight fire, a major systems failure, or some other genuine emergency. At that point they called on the reflex nearly all pilots develop: the constantly updated awareness of where the nearest airport is, if they should suddenly need to get back to the ground. As he puts it:

    We old pilots were always drilled to always know the closest airport of safe harbor while in cruise. Airports behind us, airports abeam us and airports ahead of us. Always in our head. Always. Because if something happens you don't want to be thinking what are you going to do - you already know what you are going to do.

    When trouble arose, Goodfellow says, the pilots tried to head for what they knew to be the nearest very long runway, with an unobstructed over-water approach, on the Malaysian island of Pulau Langkawi. (Pulau means "island.") Here's the Google Earth idea of how the Langkawi runway might look in daylight, although the plane was of course approaching at night. That runway is 13,000 feet long -- enormous.

    But they never made it. Before getting the plane down, Goodfellow suggests, the pilots could have been incapacitated -- and the plane would fly on until it ran out of fuel. This view is notable for the light it casts on the MH 370 flight crew. Far from being villains, schemers, or the objects of a hijacking plan, he says they were in fact heroes, struggling until the last to save their aircraft, themselves, and the 237 other souls on board. Referring to the senior pilot, he says: 

    This pilot did all the right things. He was confronted by some major event onboard that made him make that immediate turn back to the closest safe airport.... 

    Fire in an aircraft demands one thing - you get the machine on the ground as soon as possible....

    Smart pilot. Just didn't have the time.

    Goodfellow says he is certain this is what happened: "No doubt in my mind."  I think there's doubt about everything concerning this flight. But his explanation makes better sense than anything else I've heard so far. (And he has updated it in light of developments since his original post.) It's one of the few that make me think, Yes, I could see things happening that way.

    3) Flight 714. Many readers have written in to say that the best fictional reference for the mystery of this plane is not Thunderball, nor You Only Live Twice, nor any other part of the James Bond oeuvre. Instead it's Tintin, as a reader in Los Angeles explained:

    I can go the Thunderball reference one better…the comparison I make is to the plot of the Tintin story “Flight 714”, in which a rich man’s jet is hijacked by part of the crew and crash landed on a deserted island in the java sea. 

    The numerous parallels are quite interesting…it’s a crew takeover, they drop out of sight of radar, it all takes place in the same general part of the world…and the scene in which they show how the plane lands (on a hastily constructed airstrip, which is then dismantled) could explain a lot.  Frankly at this point, you’d be better off reading Flight 714 than watching the cable news reports.

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