Penny Wise, Pound Foolish

The cost to American science and healthcare of the administration’s attack on legal immigration is hard to quantify.  Maybe it will prevent a terrorist attack, though that’s hard to say.  What is certain is that American faculty are suddenly no longer able to hire the best researchers from the seven countries currently affected by the ban.  Numerous top scientists suddenly cannot travel here to share their work with American colleagues; or if already working here, cannot now travel abroad to learn from experts elsewhere… not to mention visiting their families.  Those caught outside the country cannot return, hurting the American laboratories where they are employed.

You might ask what the big deal is; it’s only seven countries, and the ban is temporary. Well (even ignoring the outsized role of Iran, whose many immigrant engineers and scientists are here because they dislike the ayatollahs and their alternative facts), the impact extends far beyond these seven.

The administration’s tactics are chilling.  Scientists from certain countries now fear that one morning they will discover their country has joined the seven, so that they too cannot hope to enter or exit the United States.  They will decide now to turn down invitations to work in or collaborate with American laboratories; it’s too risky.  At the University of Pennsylvania, I had a Pakistani postdoc, who made important contributions to our research effort. At the University of Washington we hired a terrific Pakistani mathematical physicist. Today, how could I advise someone like that to accept a US position?

Even those not worried about being targeted may decide the US is not the open and welcoming country it used to be.  Many US institutions are currently hiring people for the fall semester.  A lot of bright young scientists — not just Muslims from Muslim-majority nations — will choose instead to go instead to Canada, to the UK, and elsewhere, leaving our scientific enterprise understaffed.

Well, but this is just about science, yes?  Mostly elite academics presumably — it won’t affect the average person.  Right?

Wrong.  It will affect many of us, because it affects healthcare, and in particular, hospitals around the country.  I draw your attention to an article written by an expert in that subject:

http://www.cnn.com/2017/01/29/opinions/trump-ban-impact-on-health-care-vox/index.html

and I’d like to quote from the article (highlights mine):

“Our training hospitals posted job listings for 27,860 new medical graduates last year alone, but American medical schools only put out 18,668 graduates. International physicians percolate throughout the entire medical system. To highlight just one particularly intense specialty, fully 30% of American transplant surgeons started their careers in foreign medical schools. Even with our current influx of international physicians as well as steadily growing domestic medical school spots, the Association of American Medical Colleges estimates that we’ll be short by up to 94,700 doctors by 2025.

The President’s decision is as ill-timed as it was sudden. The initial 90-day order encompasses Match Day, the already anxiety-inducing third Friday in March when medical school graduates officially commit to their clinical training programs. Unless the administration or the courts quickly fix the mess President Trump just created, many American hospitals could face staffing crises come July when new residents are slated to start working.”

If you or a family member has to go into the hospital this summer and gets sub-standard care due to a lack of trained residents and doctors, you know who to blame.  Terrorism is no laughing matter, but you and your loved ones are vastly more likely to die due to a medical error than due to a terrorist.  It’s hard to quantify exactly, but it is clear that over the years since 2000, the number of Americans dying of medical errors is in the millions, while the number who died from terrorism is just over three thousand during that period, almost all of whom died on 9/11 in 2001. So addressing the terrorism problem by worsening a hospital problem probably endangers Americans more than it protects them.

Such is the problem of relying on alternative facts in place of solid scientific reasoning.

39 responses to “Penny Wise, Pound Foolish

  1. Wouter van der Wijngaart

    Yep, having the same problem with our staff and students here in Sweden. They can’t travel to conferences in the US any longer, and US based students cannot travel to conference outside the US because they would not be able to return to work.
    Furthermore, this put immediate strain on conference organizers that see some 10% of participants suddenly disappear, which results in a 10% increase in conference fees expected to be able to cover the (fixed) conference costs.

    • 10% of participants are from the 8 blocked countries? That sounds impossibly high. Do you mean 10% of participants are from countries where they’re afraid they *might* be blocked?

  2. Certainly makes our Brexit look a bit trivial. Thanks for continuing to put the word out Matt.

  3. Such foolish and thoughtless actions.

  4. It feels like the world’s gone mad..

  5. It’s pound foolish, but it’s not even penny wise.

  6. An interesting perspective. But this problem is nothing new – it is a truism that the finest health insurance in the world is worthless if you can’t find a doctor. And I have yet to see any health care proposal that gives incentives to go into the health care field. Consider: graduate from college at 22, 4 years of medical school, internship, residency – you’re 29 with a quarter of a million in debt before you’re making a penny. I’ve run those figures by the CEO of a large hospital chain and he confirms them; one of his biggest admin problems is helping his doctors with their debt. Three of the last four doctors which I’ve had in the last 25 years have been Filipino (and very good ones, by the way). Until we figure out a way to incentivize young people to want to be doctors, the problem will only get worse.
    Trump-bashing is fashionable among The Establishment these days, so if it makes you feel any better, I guess it’s OK.

    • I was with you until your last sentence, which is missing the point. I’ll call a policy bad if it’s bad, no matter who makes it. And I would be much more supportive of Trump if he would focus on “incentiviz[ing] young [Americans] to want to be doctors”, instead of keeping out ones we need. We’d not need so many immigrants as workers if we did a better job of training Americans (and incentivizing Americans to want the training — which is part of the problem too.) Neither the president nor any in Congress seem to be focused on this issue — or the problem of automation which is eliminating low- and middle-skill jobs faster than we can create them.

      • Sorry you took it that way; I’ve had eight years of it and it didn’t really bother me.
        You are right about the question of automation – we’re in the middle of a revolution comparable in some ways to the agricultural and industrial revolutions. Revolutions are never fun to those in the middle of them. I know one state senator who maintains – I think rightly – that we need to stop thinking K-12 and start thinking K-14. But I also don’t think anyone really knows the way out; certainly every time “the best and the brightest” get ahold of a problem, they really botch it up. “Muddling through” seems to have worked best in the past; hopefully it will again.

      • Awesome comment, Matt. Just what you describe are key elements to the issues at hand: people want to earn as much as a very good doctor, or a very good engineer, or a very good physicist, but do not want to go through the pain that involves the training required (so many years of practice after so many years of study!) to be a very good doctor or a very good engineer, or a very good physicist.

  7. I just posted one of your key paragraphs on my FB page. About the number of folks dying from medical errors vs the number dying from terrorism. Thanks for speaking out Matt. We all are doing this now, there being no alternative [to be distinguished from “alternate”, as in “alternate facts”]

  8. Torbjörn Larsson

    Hear, hear!

    And here I thought Trump’s continuing conspiracy theories (this time about inauguration images and the press and park services) would take the cake. No, not only does Trump constitute a religious ban, he does so with the *exclusion* of the nations that historically birthed most US terrorists. But he would not move against Saudi Arabia and US – like presidents before him – demonstrating that there is method to his madness.

    I am not sure I will go back to visit US any time soon – I worked in Texas for two years – but the worst thing is that I cannot help my Swedish countrymen that just happen to be born in the Seven nations. But our government will leave/has left a protest of course, and combined with Brexit this has made Germany seen as the new de facto leader in this corner of the world. I am sure China is nipping on the bit to proceed from economic leader to leading in climate change and foreign politics as well. Trump will – to his own satisfaction, no doubt – go down in history for his resounding ‘Make America Small Again’.

  9. I liked this website much more when it was all about physics. I’m already bombarded by anti-Tump sentiment from sunrise to sunset, unfortunately its now time to delete this bookmark. Thanks Matt for all the great science, but I’ll pass on the rest.

    • Sorry to see you go, but thus website was NEVER all about physics. Check past links. And in any case, damage to physics as an enterprise is certainly about physics. The notion that science and politics have nothing to do with each other is naive; consider what happened to scientists in Germany during the Nazi era. If they’d had science bloggers then, would they have remained silent as half of Germany’s best scientists fled the country?

      • “The notion that science and politics have nothing to do with each other is naive;” I feel like bookmarking this blog again and again.

  10. Matt: I liked your previous post on “Alternative Facts”, Thanks for making the point so eloquently – I think scientists have the ability to look at the issues that Trump raises dispassionately and call b/s when we need to without getting polemical and you do it really well.

    • Warm water freeze faster than cold water. Former has more room to rearrange. ?
      So Fossilized informations are very persistent illusion – what we call as reality. At higher energy alternative fact is possible ??

      Unnaturalness invokes the holographic universe. The persistent needs will – in 1940s there was not !

  11. Once again you are preaching to the choir and so a waste of time. Do something effective. Analyze how to effectively thwart Thump’s policies in the near term and get out the vote in 2018.

  12. Saudi Arabia has a travel ban for atheists. What’s wrong with Trump? He doesn’t care. Who does? The smell of caprice is everywhere.

  13. I am studying English. Knowing less about the west and the political or policy as well as laws.

    I know there be are nature scientists or natural philosopher whose ability of language are better than native speaker.

    Debating is a piece of cake.

    How to vote them to be president?

    Trivia, why physics? Physician? I’m about to say if physics is more than nature science or natural philosophy, it is same to my level, high school, whether or not it does research in treating body?

  14. Ah, now I can. Yes, a technical glitch. Apologies.

  15. I would warn that the comparison between medical-error and terrorist deaths, along with the “Penny Wise” part of the title, seem to suggest that this executive order should be considered a legitimate and effective way of “addressing the terrorism problem”, which it is not.

  16. On the 15th of March this year 31 parties are competing during new elections. The number of trumps, clintons etc. is an all time high. Can we chose a new President? No. Can we chose a new Prime Minister? No. Can we chose new Mayors? No. Election time means that we are allowed to vote. What a wonderful Bananamonaechy we have!

  17. I believe the Presidential Decree’s adverse impact was exaggerated by the incompetence of the people who prepared it. If they had bothered to plan it, review it, and inform those supposed to carry out the instructions, most of the mess we are witnessing could have been avoided.

    This makes me wonder, will the Trump White House team nuke Norway by mistake when they decide to start a war?

  18. I think its blown out of all proportion by scare mongering press and newspaper, media hype . All there doing is extra vetting , if you have the correct papers and visas ect I don’t think there is going to be a problem, just an inconvenience ? Am I wrong ?

  19. I agree we are in automation revolution ( similar to agricultural and industrial one ). The pbm is really huge. Automation already made many jobs obsolete. Soon even drivers will be un-necessary. I imagine what will happen with the job market then.
    But does anyone remember that during his election campaign Trump promised to heavily invest in the developing of infrastructure of US. A pgm similar to FDR’s Great Deal. So far he keeps his election promises, he is just too fast to keep them. That would solve the pbm of Rust Belt and most of the working class people who voted for him in this belt.
    I agree with Matt that research in physics is underfunded in this country. It began with cancelling by Congress of a Chicago collider, and EU is ahead of US b/c of it The motivation of the Congress was very simple: it would take so much money that even US can’t handle such a huge project alone, So a combined effort of many countries was needed for a project of such magnitude. And precisely that was done. We already “got” Higgs boson as a result.
    The pbm with Healthcare in this country is actually much bigger than lack of good doctors. In EU this system is much cheaper and more effective b/c after the end of ww-2 when most of Europe was in ruins, its Healthcare
    system was actually recreated from scratch, with a huge help from Governments. In this country, however, still Big Pharma companies compete with each other in Healthcare market. This system is less efficient
    than in EU, and the cost of this system keeps rising and rising.
    Out of ~ 33 millions completely un-insured people in this country Obama Care insured ~ 22 millions, but ~ 11 millions “are still there ” . The major
    pbm again: Who’s gonna pay for this ? as FDR once put it. Intensely competing among each other companies of Big Pharma do not look like capable of fully doing this job, and Gov’s help looks like very much necessary. So again the pbm is where and how get the money. One of the
    solutions of the pbm would be to develop the system of PREVENTION of illnesses, that is to pay Doctors not only for cure of patients, but for keeping them healthy as well, Otherwise new innovations will always make the whole system too expensive, The cost of all medical plans go only up and up, never down. Only in Europe after the ww-2 they went down.
    So accent on PREVENTION, rather then on more doctors may greatly decrease the lack of doctors.
    As for terrorists,. I think this pbm is solvable by Trump’s approach, it just have to be fine tuned. What is important that he is already trying to do it
    just being 10 days in office. It means that his promises during election campaign are not just promises as we had in many election cycles before,
    It means that “he means it”, not just talks, but acts though may be just too fast. But at least he tries, many before him never even tried and that makes
    a huge difference.
    Thanks for attention.
    Yours, bob-2

  20. Guido Dinkerschmidt

    Have you been equally agitated about those same countries denying entry to people with as little as an Israeli stamp in their passport let alone Israeli citizenship? Didn’t think so. As far as I’m concerned the list should include ALL such hellholes out of solidarity with Israel because cave-dwelling primitive antisemites should be opposed. And frankly, I’m much more concerned about losing Israeli science talent than missing out on Somali particle physics developments…

  21. I’m in the medical field can testify that your scary statistic is a true fact that I see in action almost every day. I’m glad you brought it up because I think the comparison between the medically caused deaths and terrorist caused deaths highlights that we need to put things in perspective.

    I personally like Obama way better than Trump. Who doesn’t? But, it’s equally absurd to be upset about the few lives that have been temporarily delayed by Trumps actions, if you have not been outraged at Obama’s foreign policies failures in Syria, and to a lessor degree Iraq, which have allowed the worst humanitarian disaster of this century to occur. Which, coincidently, caused the need for Trumps action. Was it a perfect order? No. Should it have been rolled out better? Yes. No one argues that. But, let’s get some perspective.

    New grads are only part of the problem with your local Dr. When I talk personally and off the record with MD’s they tell me that they want out of the business because of the changes that have forced on them by Obama care. They are working for 3-5 hours more a day than they used to due to electronic medical billing, for less pay, and have to see more patients than before it went into effect. They are quitting and retiring early to get away from it. I lost my MD because of it. It gets almost no press and no reaction. When Trump does something to try to fix it I’m sure there will be a huge over reaction to that too.

    The deficit is almost 20 trillion dollars. That’s $167,000 per tax payer. The republicans and democrats in Congress and to a lessor degree Bush and Obama are to blame for that. Does any body care about that any more? Let’s get some perspective.

  22. Two comments. First on “K-12 and start thinking K-14.” That’s wrong.
    It really should be start thinking about getting 5-14 info
    into 5-12. We need to upgrade standard universal school. Virtually
    everybody can learn at age 18 what they can at 20. What us needed,
    as in Asia and Germany, is ruthless tracking. Turn community colleges
    into trade schools modeled on some other countries, or think of
    things like music conservatories, which do have some non-trade
    college-like courses, not think of them as low grade remedial as now.

    Second, and it is coming, the great elephant in the room: robots with
    real intelligence. That is the big upheaval; we have seen only a trace
    of it yet. We need fewer people. We cannot expect to finance things
    forward (pensions, etc) through exponential growth in human
    population. Population yes .. but not human.

  23. Population, Automation, Global Markets over saturation, trade wars, soft wars, hacking / spying, , hot wars, property revolutions, religious wars ideological wars, weapons propagation, further militarization, Nuclear proliferation, Military Industrial Complex-ization ( remember Eisenhower farewell message to the Nation ? ) and Global Competition in it.,

    Coming Anti-rockets protections against it, looming re-division of the world,
    all against the background of warming of the Planet, environment pollution, orange, purple, and other multi-color in all other respects multi-cultural revolutions both in Old and New World …..

    WHO can name the complete list of the problems WE confront ???
    IT’s A MAD, MAD, MAD WORLD as one old movie of the 1960-s said

    And that’s happening when nearly EVERYBODY stands for Peace !!!
    I wonder what an extra-terrestrial AI would report in iT’s message to its
    Sender(s) about the state of development of Intelligence ??? on this Planet.

    And most in scientific community ( Matt is a rare exception ) don’t want even to hear anything about this MAD MUD, looking happily down from their IVY TOWER of Big Science. Folks, by chance do you have your own personal bunkers ? If you do I have no QQ-s to you.

    bob-2

  24. If it is matrix, things are getting simpler day by day. It will be important who you are and how fossillized (condensed matter) you are – rather than how much Informations you Stacked recently, how much good your school and your teacher ? – or which high energy particle you was bombarded with ?

  25. May be you have some specifics instead of switching to personalities ?
    Historical context is not just fossils but also key to understanding present and sometimes even future.
    bob-2

    • Yes it is Kantian (Immanuel Kant) ?
      Physical reality exist outside personalities (Anthropic) ?

      But this reality (mass) was due to bouncing of other universe on our one (at event horizon) – creating diffeomorphism ?

      In condensed matter the physical laws became different – by spontaneous symmetry breaking.
      So Diffeomorphism also create such symmetry breaking in our Holographic projection ?

      In natural sciences, Nature has given us the world, and we just discovered its laws. In computers, we can stuff the laws into it and create the world. Experiments in quantum physics are now creating artificial physical systems that obey the laws of quantum mechanics but do not exist in nature under normal conditions.
      An example of such an artificial quantum system is a quantum computer.

  26. If we squeeze a rectangle grid to square, the small grid squares would not much deformed. For a correct square we need fine tuning or correct rhythm – but with no mass no gravity – the dead naturalness.
    But at large scale, the Diffeomorphism creates mass and gravity – the space has conservation energy – try to settle from metastable (unnatural) to stable ?

    The dance stops locally with a “correct step (Naturalness)” is an individual Apocalypse – the Death – and continues again catching with a “wrong step” – the “flip” in EM !

    But its Cosmic connection is gauge invariance – an almost nonRepeating pattern – also away from Natural Laws (wrong Rhythm) – evident in radio activity ! ?

  27. I enjoyed your musings. But what do they have to do with the problem that
    prof. Strassler posted for discussion here. You do not care ?
    bob

  28. George Bush pulled the plug on the dike, Obama watched as it grew to a flood and who knows what Trump will do. Sorry for the political statement. Two of the worst presidents ever, my opinion.

  29. In Physics it is believed that there is no such thing as empty space, perhaps, we need the qualifier, between the ears of some politicians…….

  30. In Physics there is such a concept as Quantum Vacuum which is supposedly “filled” with an infinite Ocean of energy. Being Quantum it can sometimes on a random basis pop out a huge Quantum of Energy into our familiar “visible” World.

    It well may be that Our President is such a Huge Quantum
    from the deeper Ocean to all of US in U.S.

    Prof. Strassler may correct the physical part of my statement, and
    all political analysts will no doubt ignore the second part of my statement
    as being just plain foolish, but I still hold firm as an invitation to discussing possible links between Big Politics and Big Science.
    bob