To think tech on OC16, for what is weekly newscast on things that matter to tech, and to Hawaii, I'm Kaui Lucas. And I'm Raya Salter. In our show this week, we'll cover medical aid in dying, also known as death with dignity, a bill pending in the 2017 legislature. The proponents of this bill have been trying to advance it for 28 years, and maybe this is the year it will pass. Medical aid in dying, or death with dignity, would permit the medical establishment to aid dying patients in taking steps to end their own lives. It has been increasingly popular in the rest of the US, and many people feel that it is the humane thing, and should likewise be adopted in Hawaii. Of course, this is a sensitive issue since it effectively enables a terminally ill patient to end his or her life. At the same time, it allows that patient to die in peace, minimize pain and terminal deterioration, and the difficulties and expenses that go along with that. No one ever said that death was easy, or that ending your own life was easy, but for a person who is in the throes of death anyway, and for the family of that person, medical aid in dying can be a much better choice. No one ever said that facilitating the death of a patient was easy for a doctor either. The problem is that the causing your own death, or facilitating the death of another, is against the law in Hawaii. That makes it difficult for terminal patients to end their lives, and it makes it difficult for doctors who wish to help them. And all along the way, over that 28 years, there has been opposition to the bill, led mostly by religious organizations and individuals who see death with dignity as inimical to their own religious values. The church, particularly the Catholic Church, with its enormous resources, has mounted a continuing attack against the bill, and has prevented its passage over all these years. Inter-Senate Bill 1129, the death with dignity bill, now called Medical Aid in Dying, is currently pending in the 2017 legislature. This bill, which is well supported in the medical community, is the enlightened approach that would finally make it possible for a terminal patient to end his or her life, and for a doctor to facilitate the process. This is not the same thing as a right to die. That term applies rather in the context of directing one's own medical care. That is, refusing life-sustaining treatment, such as a respirator or feeding tubes, when permanently unconscious or close to death. You can provide your own health care decisions by completing a Hawaii Advanced Health Care Directive. No fewer than five bills related to assisted dying were introduced in the 2017 legislature. The only bill now alive is SB 1129, originally the Death with Dignity Act. SB 1129 is modeled closely on Oregon's Death with Dignity Act, which took effect in 1997. If SB 1129 passes, a patient requesting aid in dying medication will have to be at least 18 years old, a Hawaii resident, mentally capable of making and communicating health care decisions, and diagnosed with a terminal disease that will result in death within six months. The bill was sponsored by Senators Carl Rhodes, Lorraine Inouye, Michelle Kidani, and Russell Ruderman. The bill received its first hearing in the Senate Health Committee on February 15th, where it passed with amendments on a six to zero vote. On February 28th, the bill passed in the Senate Judiciary Committee, again with amendments on a four to zero vote. A great number of organizations submitted testimony in support of SB 1129 and the Senate hearings, including the Democratic Party of Hawaii, a number of religious and community organizations, unions and civil rights and consumer rights organizations, the Hawaii Psychological Association, and many others. And the Hawaii Medical Association said it would not oppose the bill. Just as the lobbying efforts of the church have been in play on abortion and LGBT issues, the church would like to impose religious principles in these and other areas of our lives, even if we do not subscribe to the religions that drive their efforts. There are many who believe that in opposing these changes, the church is out of its element under the separation of church and state in the Constitution. That is the establishment clause of the First Amendment. There are many people in Hawaii who believe that it is time for enlightenment on this issue. An October 2015 Stanford University poll found that 76.5% of Hawaii residents favor assisted dying as an end of life option. A poll by anthology research likewise found that 80% of residents favored the idea. Clearly, death with dignity or medical aid in dying is an initiative whose time has come in Hawaii. ThinkTech has covered this discussion for some time. We have had various talk shows and done various interviews examining the issues and argument taking place on the subject. Currently, there are laws that would prohibit somebody from taking their own life and rightfully so. But I think, especially for a terminally ill patient, I think there are very limited circumstances where they should be allowed to control their own destiny. So hopefully that they aren't suffering in days and weeks of inextricable pain so that they can actually enjoy a situation and be lucid enough to have those final moments with their family exactly like how you've had illustrated for us and how significant that can be. But a lot of those things can only happen if we make some changes to the current law because what we really need to do is clear the pathway so that physicians feel that they can do this and they are not going to be held legally responsible so that patients are aware that this is an option for them and how they can do it in a way that will be safe and actually will be in a manner that we can ensure there aren't going to be abuses. And so we need to find the laws that can help us get to that objective. The founder of Capital Consultants, John Radcliffe, is terminally ill and he is out in the front on this issue. Correct. What's it like working with John? Oh, John is great. He retired from Capital Consultants so he's no longer with the organization but he's still around. It kind of depends on his health, you know, it goes up and down but he has been a great, great champion and advocate for this issue. We have a situation in which medicine has become better over the years to such a degree that we can be kept alive indefinitely for a very, very long time anyway with nothing else going on than artificial stuff keeping you going. That we can do but we still have a prejudice against allowing people to control their own lives at the end. That is just a prejudice that is in the medical field. I understand it. It comes with the Hippocratic Oath. Do no harm. But, you know, a little common sense would be useful. The legislation, you have to be of sound mind. You have to have less than six months to live and there have to be two doctors that have to say that. You've got to have, you know, two doctors willing to say that they're, go ahead with this. There's all sorts of safeguards in it if you believe that you have a right to determine under certain circumstances your own method of death because of pain and suffering and things that cannot be otherwise prevented. If you believe in that, then you've got to organize and you've got to get down to the legislature and you've got to make a scene.  We all know people who have died long, extended, protracted deaths when they were in agony. They had clearly said to themselves and to others that they've had enough. They don't want to keep on going. And yet consistently, there were no heroic measures were taken and yet they kept on living and living long past the point where there had been endless suffering and sometimes depletion of monetary resources from the family as a result of what had happened. Suicide as you take your own life, when you talk about the difference with that and what's going on with this particular issue, it's that there's a human intervention and the human intervention can either be humane or inhumane and humane is giving the person the medication that they need and if that leads to their death, then that was a merciful thing to do. The inhumane is causing the suffering to go on indefinitely to have all the pain and agony as well as the loss of human dignity which John Radcliffe is very, very concerned about and doesn't want to lose his and then those are the differences between the two. Some human intervention. We married not just because of that, but and then just shortly after we were married, she was diagnosed with what turned out to be terminal cancer. Now when I met you, you were caring for Lenny. Yes, I was her caregiver at home. We did have hospice Hawaii, which was a wonderful thank the good Lord for the hospice systems because Lenny was able to pass in her bed in her little bedroom in our apartment with me holding her hand. So I've seen it all. Was there was was she comfortable with her struggle with his last few? We had heavy meds, IV meds, and she had what's called a pick line, which was a easy way to give an injection in her arm and I was taught the process. So I was because I was there 24 hours a day. She was very comfortable. Now that was unfortunately having that pick line in her at home was after a series of what the doctors call a breakthrough pain attack. And that's when her pain reached such a level that I had to rush her to the hospital screaming with pain and agony. And this was after two major surgeries and chemo and radiation and all of the heroic efforts that if I had to do it over again, I would encourage her not not to have done all that. But I demanded that I be in control of her meds. And that's something that people need to understand. They are in control of the conservative fundamentalist religions, primarily the Catholic Church. They'll fight tooth and nail to stop this. And they are the ones that when we nearly passed the bill in Hawaii in 2002, it was killed dead and I'm not being no pun intended. The bill, the death of Digny Bill was stopped in its tracks. We lost it by three votes in 2002. And that was because the Bishop of Hawaii had a personally written letter hand delivered to all of the Catholic state representatives and senators. And we lost that bill. That, unfortunately, that loss since 2002 has caused tens of thousands of horrible, painful, protracted deaths since 2002. Someone who hasn't been in touch with the family or is living on the mainland or simply has a different, maybe a set of religious values and beliefs, which are different from the patient and the rest of the family. So if anything, by the time the conflict has arisen, though, I'm almost guaranteed that this conflict has surfaced before, right? But they've never really had the time or desire to address it. So by now, though, it just becomes, I would say, one of those opportunities for great courage on everyone's part and an opportunity for great healing and reconciliation. But it takes a commitment on everyone's part to kind of move through some of the differences. It's OK to have differences, but how can we still work together for the well-being, again, focusing on the needs of the patient? They call it the sister in California syndrome. You have people here. No mom has her advanced direct living will and they're following it. Sister comes swooping in from California saying, oh, no. They haven't seen mom since she was. Yes. OK, so now they see her and she's pale and she's incapacitated. They freak out and then it's I know what's best for mom. You guys aren't doing anything. She would never be in this situation if you guys hadn't dropped the ball. I'm taking over now. Excuse my language, but to help with the advanced directive and go straight to the doctor and tell him this is not what we're doing. Doctors are afraid of getting sued. So they'll back up and then you have all kind of things done to this person that was against their wishes. There is a point that I believe each person reaches in her or his life where their health may be degraded to a point where they are incapacitated. They may be in very much pain. And what I think we as a society have as an obligation is to provide them as much comfort as possible during that. Let's talk about that joy and pain and grief and dealing with that. Yeah, that's a I think I ended up in that area because I had that experience of my sister and how that impacted me for her to be cared for but also the pain that I experienced. And we know that there are stages of grief and they're not simply easily laid out. Like you say, well, there's denial, there's bargaining, there's anger, there's acceptance and they don't always flow in order. So what happens quite often is that you have this point of life where now you realize that this person is gone but you don't want it to be real so that denial sets in. Usually that one is right up front that it's like, well, wait a minute, wait a minute. They're not really gone. They're not really gone.  So that's one of the ways you might experience it. And then the other is this bargaining, the bargaining of saying, if I could just do this, then maybe I could heal from this and it won't happen. Every person experiences it differently. I had a very, very close friend of mine who was in the exploring process with you on Sunday one day on Wednesday was in the hospital and never left and did not know that he was ill. And in that process it started to happen, the bargaining with God that, boy, when I get better, I'm going to do this with the church or in the community or, boy, when I've done a lot with God, I don't understand why this is even happening to me. Why would this be? So I think that it's each individual then towards the end, sometimes healing takes place in ways that we don't understand, like healing with family members. Family members come from far away that maybe you hadn't talked to in a while. And in this person's case it was. A family member came, they had a great conversation, kind of a reunion. And they'd been estranged from each other 10 or 15 years. So there's this healing sometimes that takes place that we can't understand. It's not physical. 80% of our Hawaii residents support the measure. And so she did take a poll and she will be hearing this measure. And she's looking at putting on the agenda SB 1129 on Senator Rhodes' bill. However, the discussions that I hope that the community and people who want to see us make decisions this year, please come and support Senator Baker's bills that she is going to introduce. We want people to come out and please send in your testimonies in support, give the senator and her committee an opportunity to hear from your experiences out there and to ensure that something passes for the first time and make sure that we have good discussions and that it passes the Senate. Make sure that there's something that goes over to the House and have their discussions. What this, at least from my point of view seems to allow, which I find, you know, actually quite acceptable is the idea that I can actually not have to starve to death. I can actually die with dignity because it's my choice, however the procedure is. And I'm not going to be just removed from my support. I'm going to actually, you know, get something that'll put me to sleep. To me, you really need a fourth option.  If you look at the side effects on some of the medications that doctors prescribe every day and one of them says death, what in the world, how can they say, well, we take an oath not to do any harm? Doctors are already prescribing as a necessity for health reasons, very dangerous things anyway. And so, but this will not, this does not, your bills or what you're supporting does not require them to administer. No. As a matter of fact, all it, in fact, the doctor has to be, has to agree that you're a terminal. So that's actually a protection. Right, two doctors, two doctors. Okay, so two doctors will say you're terminal and that's all they do. Tell your legislators, those you know personally, whether you see them in the supermarket or anything like that, tell them that, that's the thing that the legislation, that legislation which, you know, choices for the retro is talking about, go with that. I do not want to die, but I'm dying. Until now, the bill has had no success. But this year it appears to have attracted broad grassroots support and notable champions among the legislators. It has had hearings which evidenced abiding interest and support. And there seems to be a fair chance that it can pass, and that's encouraging. SB 1129 was to have been put to a full vote in the Hawaii Senate on Tuesday, March 7th, and that vote will be a turning point in Hawaii's efforts to pass this legislation. You can read the text of the bill on the Hawaii Legislature website. You can also visit the websites of the Hawaii Death with Dignity Society and the Death with Dignity National Center, and for information about appointing a healthcare agent and expressing your wishes for medical care at the end of life. See your attorney or visit NOLO.com, among other sites. Medical aid and dying has been regularly discussed on Think Text Weekly, Navigating the Journey series, where host Marcia Joyner explores the options and choices of end-of-life issues from religious, cultural, medical and legal perspectives. You can see these shows on ThinkTekHawaii.com or on YouTube. They are uploaded as podcasts on iTunes, and you can listen to them here. Of course, it's not over until it's over, and it remains to be seen whether and when the bill will pass and be signed into law. It is in any event an important bill for us to follow, right down to the governor's signature. ThinkTek will be there, so stay tuned for more. And now, let's take a look at our ThinkTek calendar of events going forward. There's so much happening in Hawaii. Sometimes things happen under the radar, and we don't hear much about them. But ThinkTek will take you there. Remember, you can watch ThinkTek on OC-16 several times every week to stay current on what's happening in government, industry, academia and communities around the islands and the world. ThinkTek broadcasts its daily talk shows live on the Internet from 11 a.m. to 5 p.m. on weekdays. Then, we broadcast our earlier shows all night long and on the weekends. If you missed a show, or if you want to replay or share our shows, they are all archived on demand on ThinkTekHawaii.com and YouTube. The audio is on ThinkTekHawaii.com slash radio. And we are now posting podcasts of all our shows on iTunes. See our website for links. Visit ThinkTekHawaii.com for our weekly calendar and live stream and YouTube links, or sign up on our email list and get the daily docket of our upcoming shows. ThinkTek has a high-tech green screen First Amendment studio at Pioneer Plaza. If you want to join our live audience or participate in our shows, write to Think at ThinkTekHawaii.com. Give us a thumbs up on YouTube, or send us a tweet at ThinkTekHawaii. We'd like to know how you feel about the issues and events that affect our lives together in these islands. We want to stay in touch with you, and we'd like you to stay in touch with us. Let's think together. And guess, you can call into our talk shows live. While you're watching any of our shows, you can call in to<PHONE_NUMBER> and pose a question or participate in the discussion. We'll be right back to wrap up this week's edition of ThinkTek. But first, we want to thank our underwriters. That wraps up this week's edition of ThinkTek. Remember, you can watch ThinkTek on OC-16 several times every week. Can't get enough of it just like Raya does. For additional times, check out OC-16.tv. For lots more ThinkTek videos and for underwriting and sponsorship opportunities on ThinkTek, visit ThinkTekHawaii.com. Be a guest or a host, a producer or an intern, and help us reach and have an impact on Hawaii. Thanks so much for being a part of our ThinkTek family and for supporting our open discussion of tech, energy, diversification, and global awareness in Hawaii. You can watch this show throughout the week and tune in next Sunday evening for our next important weekly episode. I'm Kaui Lucas and I'm Raya Salter. Aloha everyone.


Welcome back to Think Tech for the one o'clock show. This is Coronaville. What's next? And Mike, the chief scientist here at Think Tech joins us for a discussion of where we're going, you know, on the numbers. And can we really reopen? Can we really reopen? Let me ask you the third time. Mike, can we really reopen? Eventually. Thank you. That's the problem. You've got to decide how many casualties you're willing to take and how fast you want to take them. I mean, that's kind of dismal math and dismal to think about. But unless we get a vaccine, that's what's going to take. We're going to have a lot of dead people and a lot of crippled people before we get to the other side of this. Well, let's dwell on that for a minute. I mean, it's not as simple as we thought. The disease, I don't want to use the word mutation because I don't know enough about mutation. But the disease is striking now young children, which we thought we knew better that it would not strike young children and doing bizarre things to them, things that it does to the children. I've got to be, I'm in a meeting, Mary. But it doesn't do to other people. And the other thing that's happening is we are learning that it does damage to various organs of the body. And this damage is permanent. Yeah, it makes us disabled, disables you for the rest of your life and makes you a candidate for some serious comorbidities. So we didn't notice it first. I mean, at least the public didn't anyway. We thought, well, you get through it. It's OK. You'll be OK.  But it's not necessarily so. You can go into a kind of special zone where you are being injured in very bizarre ways. And I mean, A, this was not the case before and has become the case because the virus has changed. Or B, it was always the case. But we were not watching carefully enough to know that it was having this effect. And why could be both? Yeah. Yeah, it could be both. And yeah, I had this conversation with a relative in Kansas City. He was saying, look, I'm 58. I'm OK if I die as long as my kids survive and prosper. And I'm like, dude, you can't bargain with nature like that. There's no guarantee your kids will survive.  There's no guarantee they will prosper, even if you both survive.  So I mean, there's this bargaining I'm seeing with people. They think we're not in a high risk group. Or if I'm in a high risk group, I'm willing to sacrifice myself. Well, everybody is in a risk group. Nobody is guaranteed to survive this. Nobody is immune to this. And it's not a small thing. It's not something that you can afford to that will just pass you by somehow. It will have a profound effect on you, even if you do survive. And of course, there are those who have it and pass it along to everybody in view, because they're shedding virus and they don't know it, they're asymptomatic.  This is the strangest virus. But then viruses are strange. Yeah, yeah. And then I know a lot of people who have this, what I call a delusion of insulating privilege, because they're rich and white and they'll be all right. And oh, it's not even your friend, Mr. Trump. Yeah, Trump's not being male is a risk factor. Yeah, right. And he's right in there. I mean, he's probably got co-operatives himself. And he's got people around him who have it. We know that. And he's got habits that are not particularly healthy. Doesn't want to wear a mask or all that. So I really wonder when it's safe. It's that line out of the marathon, man. Is it safe? No, let's go with some numbers. Let's just start looking at some numbers and we can have something to talk to. OK. We go to the first slide that has numbers on it. A lot of people are saying antibody tests will save us. Well, the antibody tests right now have a 5% or so false positive rate, which means that if 1,000 people are tested, 50 who have never been exposed to the virus will test positive. In Hawaii right now, we have less than 1 in 1,000 people actually have had the disease. So for every 50, false positives of one true case. So if you test positive, your odds of having been really exposed or being immune at best are 2%. And every, yeah, right. So this comes under the heading of Bayesian statistics, a Reverend Bayes invented this back in 1800s. And it's not intuitive, but it's the dismal math we're facing. If you have a test that has a false positive rate, the true incidence of the disease in the population has to be much, much higher than a false positive rate for the test to be useful to you at all. That's why they only want to test subset of people's. People show symptoms because that raises the prior probability that you have the disease, say for maybe 1 in 1,000 to 1 in a few hundred or even higher. So in Hawaii, until about 70,000 people have had the disease, a 5% false positive rate test doesn't tell you the population statistics at all. It doesn't tell you whether it's safe yet to open Hawaii, which is really unfortunate. So the antibody test would have to be 99.9% accurate. Have a false positive rate less than 1 in 1,000 to be useful to us. And every time you test positive for the antibodies, they have to stick a swab up your nose and do the invasive test to do the polymerase chain reaction, the PCR test, which is way more accurate, more specific to follow it up. So every true case you find, you'll have 50 people have to go through this testing. So that's not going to save us. And even if you screen tourists, say, we're going to screen every tourist, well, if you come from a place on the US mainland where it's a 1.5%, on average, on the mainland, there's 1.5% of people who've had the disease. That means out of 1,000 visitors, 15 will test positive who have never been exposed. But you've got to test all 15. And then maybe you'll find out of that 15, one or two, actually have truly either had the disease and are immune or still have it in our contagious, which is what you're trying to find. You just don't know for sure. I mean, I can see that's a problem for somebody who wants to come to Hawaii, is struck with a romance and all that, comes here, gets tested, and is sent back, but not with any good cause. Right, right, right, right. Not with any good cause or with a fault or with a false sense of confidence because they didn't have the disease on the invasive of your nose swab test, but they still tested positive for the antibody. It's like, hey, I'm immune. No, you only have a 2% chance of being immune. So that's, yeah. So is it safe? No. So let's go to the next slide where we talk about what it will take to make it safe. So if the lockdowns have bought us a lot of time, when I started looking this in February, I said that by now, with the way the disease was doubling back, then by now we'd have about 800 million cases in the world, about 100 million in the United States, and about 100,000 in Hawaii. Well, we're no or near that. The lockdowns have really bought us time. They bought us a lot of time. They cut their fatality rate by at least 90% so far. I said, cut, I really mean delayed. Because if this disease is anywhere in the world, nowhere is safe until we have a vaccine. Well, there's always going to be somebody out there, patient zero, right, who can start the whole bubble machine up again. Yeah, right, right. So if we go to the next slide, oops, let's see, next slide. I'm not trying to get my computer to work here. So I can say, if it's anywhere in the world, you can say you can start the whole bubble machine again, nowhere is safe. Can we open Hawaii or to be able to brand Hawaii as the safest place in the world, like the protesters or the tourism authority want to do? Well, the thing that would be best for the whole planet would be if all the governments of the world got together and said, we're going to shut down the whole world for 60 days and kill this virus. If they did that and then make sure they follow up with contact tracing and stamp out all the final little flare-ups, we'd be done with this in a couple of months. Tell me how that would work, Mike.  What does that mean? And how do you know that you stamped it out? Yeah, so it would be like New Zealand. They claim they have wiped out the disease in New Zealand or Hawaii, which is almost wiped it out. So we have to do relentless contact tracing to make sure we catch any little traces of transmission. But we did that by social isolation, banning gatherings, keeping them getting together in groups. New Zealand did that. Taiwan seems to have pretty well done that. And America, of course, never had the disease. But all these places have in common the islands. It's easy to control movement of people from place to place. That's what you would have to do globally. I don't think that'll work. I mean, it would work, but it won't happen. The governments of the world will not work out as tragedy. But hypothetically, if I shut a place down for 60 days, then I do tests to make sure that there's nobody there. And I find somebody. I find somebody there. What am I going to do with that person to make sure that I've shut it down? Tracer contacts. Yeah. Tracer contacts, tester contacts. If any of the contacts have symptoms or have any kind of test that turns positive, quarantine them, you just have to be relentless with your contact tracing. Everybody gets quarantined. That's the idea. Yeah, that's the idea. Everybody who's been in contact with a patient when it's down the low level gets quarantined. And then if I find that he has the disease, I treat him. Oh, yeah. And I make sure that the people around him are protected. And then he goes through the disease. And theoretically, he's not going to have it. Well, he's not going to have it again, hopefully. Then I've stamped out every single case that I could possibly find in that 60-day period. Yeah, and it would take a lot of work. But here, we've almost done it in Hawaii. We still have one or two cases a day. They claim to have done it in New Zealand. So it's possible, theoretically, to do this, whether the governments of the world would get together and actually make it happen. I don't think there's enough goodwill. I don't think there's enough trust. There's too much desire to avoid blame or to cast blame. It's unfortunate. So the best option isn't going to be the one that happens. So then the next option is to get it. But at your 60-day thing, you would have to quarantine them all that couldn't go work. Oh, it'd be like here, where we have restaurants closed, movie theaters closed, no gatherings on the beach. Everybody stays home. Everybody stays home. Everybody stays home. No economy. Right. But only for two months. We've already been through that. The whole world had gotten together and decided to do this. Yeah, got it. Right. The whole world had gotten together and decided, we're going to stamp this out.  OK, they let it get out. We're going to stamp it out now. We're not going to wait for any more who did it, who is responsible discussion. They're going to stamp it out. The whole world could have done this. We'd be done now. The whole world could still do this. And we'd be done in July. Well, that's hard as a policy. It's been politicized, so you can't stop it. But let me ask, suppose I insert into this process testing. And let's say that the tests are absolutely accurate. I come up with a test that is absolutely accurate. Forget about antibodies for a minute, just the test. And the problem is, so I test you on Monday. I don't know who you saw before we got to Tuesday. So I have to test you at a certain frequency. Now, if I want to make it safe, I've got to test you at a certain frequency, or else I'm shooting my foot again. So how frequent is that, Mike? That's a good point. In the latent period of the disease, it's like four or five days. So that's probably what you have to do, maybe weekly. I don't know for sure, because I'm not a doctor. I'm not a physician. But yeah, so it seems like you have to test weekly. So there's a company of a brother in Kansas City who's going back to work today. And they tested every one of the antibody tests today. That was a condition for being able to allow to work. You take the fingerprint antibody test. And if in a few minutes that shows positive, you get the nose swab, and you stay home until that swab result comes back. That's kind of the thing you would have to do. Now, the antibody test is, like I said, has a false positive rate. It's way more accurate than a lot fewer people are unnecessarily given the invasive test. And you have to do this maybe every Monday. Everybody gets tested. Why do I have to have both, Mike? Why do I have to have the antibody test? Well, that's true. Well, the other thing, the swab thing is really invasive. If they came out with a simple spit test or something like that that would give you an answer in a few minutes instead of a couple of days, then we could greatly speed up this process. That would be ideal. But, well, the idea would be wiping out the virus. The next thing is do these tests, come with something fast, noninvasive, effective, and then just test everybody. That's what it's gonna take for companies to really reopen. But then to go to my point, you have to take everybody every day or every four or five days within a fairly short time. You have to keep repeating the test. That's why I do not understand when the White House and so many others say, well, we've tested 5,000 people, 20,000 people, 100,000 people. Well, that's cumulative. And maybe a lot of those were tested a month ago or more. Then it's all this time has passed where they could have been infected again. So to say that you have a static number of tests, even a cumulative static number of tests is non-probative. You have to have them frequently. So we need that to be in the formula. You have to test everybody so often, I mean, ever so often. Oh, you have no level of confidence that a lot of those people got the disease after they were tested. Right. And I know you saw in the news yesterday that now that the White House is requiring everybody to be masked and to be periodically tested. So even the White House themselves are requiring periodic retesting ever, but it goes to the White House. So, you know, the recognizing reality, you know, the late, but the thing is, it's right. It's gotta be done for everybody in the United States. It's gotta be, we're gonna be doing millions of tests a day, not millions of tests cumulatively. Well, it's very troubling if the White House can do all these tests, but the average person cannot. Not right.  What would you do? It's not so easy. In fact, it may not be doable at all. It might not be doable right now. Right now it might not be doable, but we need to get there. But well, the next best thing to, you know, world shutting down and wiping out the disease by, you know, stopping the transmission from person to person would be a universally safe and effective vaccine. Now, we would have to have six billion doses of that. And we had to distribute it widely and cheaply. No, just because somebody's poor, they gotta be vaccinated because otherwise everybody else is at risk still. Because sometimes vaccines don't take. Sometimes people can't be vaccinated because of a suppressed immune system. So we need a safe effective vaccine that's universally available. The earliest that could probably happen is still a year, year and a half off. So we're gonna have to have the economy shut down until then, or we can try to open up the economy and allow a steady rate of cases to happen. You could achieve herd immunity by getting to 60% of the population, maybe 80%, but let's say 60% to be easy. In Hawaii, we'd have to have had a million people infected with the disease to achieve herd immunity. And that's the only way to be safe to have unfettered tourism here. And that is presuming that your immune or almost everybody who gets it is immune for a good long time after that. Well, let me ask you some questions about herd immunity, which troubles me on a logical basis. That is, okay, so 60% of the people in the community, whatever community it is, have had it. And then you achieve herd immunity. But of the 60%, a certain percent, and that is especially the case for elders are going to die. Yes, absolutely. So pay a price for herd immunity, people die. So you're almost asking for more cases, more deaths, and then you have immunity. But query, 40% of the people in the community have never had it. Are they not exposed? Well, they're less likely to be exposed because if they get sick, 60% of the people around them are immune. Or if you wanna be more conservative, say 80% of the people around them are immune. So that reduces the transmission. So right now this thing, on average, they think three or four people get it for every person who has it. So every person who has it gives it to three or four other people unless you take these masking, quarantine, isolation measures. So, but if 80% of the people around you are immune and you were gonna infect four people, now there's only one left, well, now you've got that infection rate down to one. Or maybe lower, just naturally, because of the herd immunity. If it's below one, the epidemic peters out. If it's at one, people get infected at a steady rate, which is what they're trying in Sweden, to keep them infected at a steady rate to maybe manage it in the healthcare system. So let's look at the numbers. But it doesn't mean you can't get it if you're in the 40%, you certainly can. You have no immunity whatsoever. It just may be a slow and steady thing where a certain number of people can get it and infect others. And maybe somebody, well, maybe people will still die. It's just that it won't be considered a multiplier epidemic, that's all. Yeah, yeah. The immunity is the wrong word for that, isn't it? Yeah, I would say that what's gonna happen. So that's what you're hearing from a lot of people say, re-open the economy. They're saying it's inevitable that we're gonna have all these people die. So let's just rip the bandage off and let them die sooner, so we can re-open the economy. That's not gonna work. Let's go to the numbers on the next slide. So I show, so 60% of Hawaii, and maybe it should be 80%. Let's go with 60% because there's even million people. Fatality rate in Hawaii right now is 2.7%. New Zealand is 1.3%. So let's just say that the true fatality rate we can get down to the New Zealand rate, well, it's still 13,000 people dead in Hawaii to achieve herd immunity. And our normal fatality rates like 7,000 a year from all causes. So we're like twice as many people will die of this as dying a normal year of everything. Here in Hawaii, serious cases, about 12% of the population because we're older population or have other risk factors. So that means 120,000 people have to be hospitalized. And if they're in a hospital for an average of 11 days, that's 1.3 million hospital bed days. Well, if you wanted to be done on this in a year, you take 1.3 million people divided by 365 days, that's 3,600 beds just for COVID-19 cases. That far exceeds the capacity of our healthcare system now. We should be maybe be ramping up to that, but there's no way we can achieve herd immunity in a year with what we have now. We would collapse the healthcare system and there'd be a lot of other people dying of other things. There would be no transplants happening, heart disease wouldn't get treated, cancer might not get treated. We've got people dying of other things. So according to the Star Advertiser March 18th, we have maybe 800 beds in Hawaii total that we could devote to COVID-19 patients. So if you take that 1.3 million and 800 beds, you get to four and a half years. So if there are existing capacity, we might achieve herd immunity in four and a half years if we allow a steady state rate. And that rate's about 600 people a day. We have 600 people a day get sick of this disease in order to not overwhelm the hospitals. And we'd still lose 13,000 people, but we wouldn't have the knock on effective, not treating cancer, not treating heart disease, not treating these other things. So... Well, I just come back to the basic question, Mike. Is it safe? No, it's not safe. So all this talk about, we're gonna open the shopping center. We're gonna have people come in. We're gonna do this very magical thing about how we're gonna put all the tourists on quarantine. I don't know how you do that. And all that social distancing is gonna be modified because you can go to a restaurant. I don't know what else they're opening up, but these things are gonna get us in trouble. And have you done any thinking about what kind of a resurgence we would have with Rio? Right, so here's the point I wanna make, that there is a risk to the lockdown. The risk is that the suicide rate will go up, marital violence will go up, spousal abuse will go up, hunger will increase, homelessness will increase, all the things that will kill you that comes with homelessness will increase. So we have a public health risk on that side. What I would like for the people who say, reopen Hawaii to do is to tell us how many deaths the lockdown is causing. And then we can say, okay, that sets the bar for how fast we want the COVID-19 to hit us. We want the collateral effect of the lockdown to be less than the disease itself. But I've heard nobody actually go calculate these death effects, these morbidities from the lockdown itself. They're all talking about money. Well, don't talk about money. Talk about the impact on public health and people's lives.  Because we can estimate how many will be sick, crippled and die from the disease and the numbers are staggering. So, I guess we're asking 13,000 of our fellow citizens to die of this in order to reopen the economy. So what's on the other side of the ledger? Right, I haven't heard anything like that before and it's totally correct. You have to identify and track and attract may not be the right word, but you have to identify all the deaths that take place as a consequence. And let me say, for this discussion, a direct consequence or perceptible consequence of the lockdown. And that means, correct me if you feel otherwise, that means you have to identify the kinds of things that happen with being cooped up. The kinds of illness and deaths that result from a lack of hospital beds, right? For the ordinary things, are we including that? Well, we can include that, but it's also, so the doctors right now are scared. Like I have a colleague, a friend who has cancer and he has more than one tumor and they need to do a biopsy of the other tumors. See if they're metastases or de novo and new cancers. They're afraid to have him come in for the biopsies because they're afraid of the hospital of exposing him to COVID or getting COVID themselves. So we have that. Now that's not a consequence of the lockdown as a consequence of the COVID-19. But well, it's sort of a consequence of the lockdown. There's a hospital's lockdown. So we have these, but when we talk about the lockdown itself, the consequences of the lockdown itself, independent of the COVID-19, talking about like, right now, I can't go get my cataracts in my right eye fixed. Okay, that's not a morbidity. It's just an inconvenience for me because I have one good eye. All right, but there are other people who have more serious things that can't get fixed because of the lockdown. But there's also people who will turn to drugs or alcohol because they've lost their jobs. They are having problems in their home because everybody's cooped up together and everybody's cranky. You'll have people who have heart attacks because of the financial stress because they don't know how they're gonna pay their bills. How do we estimate those things?  Well, first of all, it's hard to define exactly what this category is, what should be in the category, what should not be in the category. And then so often, it's gonna be a question of degree where the lockdown could be a factor. Maybe the guy was gonna have a heart attack anyway, but the lockdown accelerated it. How do you make a direct connection? You really can't? Well, you can do it statistically. You can say like, well, on average, like last year in Hawaii, we had about 7,000 cases of all-cause mortality. So now we look at month to month and compare what last year's mortality rate was or the average for many years was. So we can say, we're having this many extra deaths now that compared to historical average. And you can say, well, some of this is attributable to the lockdown because you can say you can probably tease out the ones that are attributable to the disease itself. But right now in Hawaii is negligible. We got down to one case a day, a new case a day. So we've squashed that. So now we can look at the mortality we're getting and attribute the rest of them to the lockdown. So... But isn't there, there's a factor working. The longer I lock down, the more I'm gonna have of these co-morbidity of these other factors killing people. And you can't just make a blind comparison from before till now. You have to somehow crank in the dynamic of the lockdown taking longer time and thus having greater damage. Right. So you have to come up with a model they say on the Great Recession maybe or even the Great Depression. How many people died excess from the Great Depression? Because that's the kind of economy we're in right now. A Great Depression level economy. So if we can estimate how many excess deaths that were from the bad economic times in the 30s and try to correct for things that were better now or worse now than back then, we can estimate how many people are gonna die from the current depression.  But I see nobody try to do that. I mean, all I hear is arguments about money and business. I don't hear arguments about deaths from other causes that are caused by the lockdown. And that's what I would like to hear, I think. Yeah, absolutely. And it's doable, as you say. It's doable. You can use statistics, you can use AI, you can use comparative analysis. There's a lot of ways that a trained scientist that trained statistician can do this. And then we can have an index, you know. And is this index, the index of people dying from the lockdown versus the index of people dying from the COVID, and you can see them right there. You can balance them and make public policy choices. But we're not doing that now. And frankly, I totally agree that if you don't do that, you really don't know where you are on the moral curve. Right, right. You don't know where you're on the moral curve. Right now, they're putting money against lives. I want to see lives against lives. Then you have a chance to do the moral calculus in a way that actually sort of makes sense. It sort of is your main. Right now, I don't see anybody really doing that. Yeah, well, maybe somebody watch this video and get the idea of how much we're missing when we make these sort of blind analyses. Right now, it's a blind analysis. We can't tolerate a depression. Therefore, we have to let X people die. It's not scientific at all. Right, right. It needs to be 1930s. We had this many excess deaths per year on average. This is what we can expect out of this depression. Okay, now that means we can allow up to X number of COVID-19 cases a day to develop because we'll have a mortality rate then from COVID we can predict. And as long as that rates, in balance with the number of people that would have died if we had kept the economy locked down, we can make the moral case to open up the economy. Yeah. Well, unfortunately, I mean, I think the science community would understand this. Maybe some people in the public policy community would understand this. The medical community would certainly understand this. But the political community, I'm not so sure, and the White House, and the White House, I don't think they will understand this. Yeah, I think in Hawaii, at least Lieutenant Governor, I think, would understand it. Yeah, yeah. Because he's a doctor, he's in the emergency in things. I can't say anything about the other politics. I haven't really observed them so much. I'm sure the White House doesn't sell though the beginning to get a clue now because two people in the White House aids to Trump and Pence, got it.  On the other hand, the political pressure from the powers that be, the lobbyists, you know, the multinational corporations, those pressures are all the stronger every day because you're losing so much money. Well, you and I have to continue to talk about this, Mike. And we have to take snapshots going forward. And we have to see how it really works and how it is working because it's a moving target on all sides. Oh, for sure, for sure. Yeah, yeah. Thank you, Mike, to our Chief Scientist here at Think Tech Hawaii. We so enjoyed talking with you. We'll talk to you again soon. Thank you, Jay. Appreciate it. Bye-bye.


The Nigerian Association of Resident Doctors, NAD, says the federal government ignored its two-weeks ultimatum. The association had threatened to embark on strike if the government was unable to meet its demands. Speaking during a press conference on Tuesday, Innocent Orgy, NAD president, said the government neither reached out nor made any significant move while the ultimatum lasted. He said the association's National Executive Council considers the development embarrassing for the country. The issue that ultimatum. And nobody called us. So what we are there expecting that will continue to, you see, we have a government in place. Whether this government is living in less than two weeks or not, we have a government in place. They should not just fold their arms and wash things, go back. In the many years we had a hard time controlling our members because many of them were pushing for an indefinite strike. But the point is that, at the end of the day, we just considered the incoming government. We have a president-elect, Senator Bola Ahmed, we know that he is watching. We know that his people are watching. We decided to give them a soft landing because it may not be good for them to take over when there is crisis in the health sector. And that was why we had to restrain our people to still continue to exercise these patients they are known for. To limit this to just five days. And after that five days, we will review the situation. And if nothing has happened, nobody should blame the Nigerian doctors. If after that five days, we come back to a meeting and take stock and we see that nothing has happened and we decide to proceed an indefinite strike.


Good morning, my name is Dr. Ravel, I am from Krishna Institute of Medical Sciences, Karahat. So today my topic of discussion is MRA Imaging of the Sinovial Dissolve the Knee. So in this first introduction, as you all know that knee is one of the largest and most complicated joints in the body and this is Sinovium line joint. So Sinovial Dissolve does often affect knee joint and they are the common cause of mobility. So early imaging is highly important and it is very helpful in the early detection to avoid the incidence of irreversible joint injury. So what are the available investigations are like conventional radiography, ultrasound and MRA which will be helpful in the diagnosis and even in the follow-up also. So main aim and objective of my presentation is to determine and differentiate the uncommon Sinovial Dissolve associated with the knee joint. So materials and methods in this retrospective cross-sectional study was performed of the Sinovial Dissolve in our department and MRA knee was performed on Siemens 1.5 Tesla. Nineteen cases of knee pain and swelling were taken into our study in which some impact to Sinovitis, rheumatoid arthritis, pigmented rheumatoid arthritis, Sinovil contomatoces, Lycoma absence and so on. Sinovil hemangiomas were identified. First coming to rheumatoid arthritis. This is a common chronic and a progressive inflammatory disorder primarily affecting the Sinovia. So the main early feature will be the Sinovitis and it is a strong predictor for the future erosive changes. So on the radiography you will be seeing bony changes when it is in the chronic surgery it stills. So in MRA it will be mainly helpful to see the earlier or other changes of RA. So what are the features of RA on MRA? So this is Sinovil hyperamia, penis formation, degree thickness of platelet and subcondar cysts and erosions. And juxta-articulate bone marrow edema and joint affluence can also be seen in the rheumatoid arthritis. So in the, in our case now, coming to our case, in the T1 serratal, PD serratal and PDFS serratal, you could see that there is a diffuse Sinovil screen along the Sinovil, which is more a better evident on the PDFS. And in the PDFS coronal, you could see that there is a cartilage loss in the subcondar marrow edema. This patient afterwards went for Sinovil biopsy and it turned out to be rheumatoid arthritis. So in the, in the, of the same patient you have, we have also this radiograph in which if you are showing this bone erosive tables and the marginal osteophytes also can be seen. So next common close differential for the rheumatoid arthritis, that is rheumatoid arthritis or inflammatory arthritis is infected to Sinovitis. In this patient, we have another patient in which it was a child who came with the patient in complaint of knee pain and so on. And in this, you can see T1 serratal, PDFS serratal and PDFS serratal, you could see that this joint effusion was seen as associated with diffuse Sinovil's thickening, diffuse Sinovil's thickening was seen holding. And on post contrast images, you could see that there is diffuse Sinovil enhancement, every post contrast enhancement, which was more evident on the axial scans. This patient turned out to be infected to Sinovitis. So pigmented willow root of Sinovil. This, this benign process characterized by hyperplastic Sinovil proliferation either within the joint or along the tendonsics and within the bursa also can be seen. So wherever the bursa and tendonsics that is lined by Sinovil, will be affected with this, with this pigmented willow root of Sinovil. So this is of two types, localized form and decreased form. Localized form is most common disease and usually extraordinary. So MRA typically shows mass-like Sinovil proliferation with low belated margins. So signal characteristics, what are the signal characteristics are? P1 it will be low to intermediate signal and on post contrast, which will be showing variable enhancement. On T2, low to intermediate signal with some areas of high signal will also be seen and on GRA sequences it will show blooming. That is main characteristic feature of pigmented willow root of Sinovitis. So in our case, how coming to this our case, PV sagittal, T1 sagittal. PV sagittal you can see at the high point as mass in the robust fat pad. And on T1 sagittal you could see some other low signal mass in the robust fat pad, same mass. And on PDF it is also low signal and on very sequence it is showing blooming. And in post contrast images you can see that hetero Jesus post contrast enhancement is seen. So these are the features of suggestive of localized pigmented willow root of Sinovitis. This is MRI need to perform which was showing ill-defined nodular masses all around the knee joint in the interim. Even it was extending into the intramuscular plane also which was not shown here. You could see that the PV sagittal, T1 sagittal, PDF sagittal you could see there is heterogeneously hyper intense mass in hyper intense areas also we can and for showing which blooming also here, which will be blooming also. And on post contrast it is heterogeneous post contrast enhancement is seen. So after its patient went for arthroscopy and it turned out to be the Sinovitis. The joint at the end can also be seen which is showing the supra-patternization. This is Sinovial contromotor system. Sinovial contromotor system is here in benign condition which the Sinovium lining develops Chondral or Osteopontal nodules. So if it is Osteopontal nodule it can be easily diagnosed on a radiograph as it is bony. But if it is a Chondral condition that is cartilage it can be easily treated for us to diagnose on a X-ray. So as if an MRE can be helpful in this diagnosis although it may be a non-specific features will be there like T1 hyper hyper T2 hyper will be there and it will be associated with joint definition. Advanced cases generally will be associated with Osteopontal nodule around the knee joint. And the symptomatology is often similar to that of a patient sampling with osteoarthritis. Next this one case T1 sagittal, T1 exter, T1 coronal you are seeing a hyper intense mass. The hyper intense mass all around the knee joint here also you could see. And as I have mentioned as a star mark here this one is that with the one which was seen predominantly in the posterior aspect. And on PDFS you are seeing that this is the hyper intense hyperintelsization which this is suggestive of Sinovial contromotor system. And this is of another patient. Out of this patient you are showing multiple loose bodies in the knee. So this is suggestive of Osteopontomatosis to Osteopontomatosis. Next Lypoma herbicides. Lypoma herbicides is a real condition affecting the Sinovial linings with a front like deposition of fatty tissue due to non specific react to Sinovial proliferation. This knee joint is the most common set of environment. Other joints will be like shoulder, elbow, ankle, wrist. And MR is the modality of choice for this diagnosis. In this there will be a front like Sinovial mass which will be characteristic appearance always associated with joint. In T1 it will be a high signal as we know that appears T1, T2 high signal which will add certain types of red sequences. On the gradient they go sequences we can see sometimes these fads immediately resist. So in our case of coming to our case patient came with knee pain patient came with knee pain. In this there is a front like mass in the Suprapatellar region which was appearing hyper on T1, PD and the hyper on PDFS and on the post contrast you are showing the post contrast. This is suggestive of ligoma or presence. So next is Sinovial hematoma. This is rare pain in vascular malformations that occur most commonly in relation to the joint. So most commonly this will be seen out of this knee joint and sometimes associated with the femoris also. In that MR8 can be typically lopulated interarticular mass will be seen. Sometimes that lopidation can be seen or sometimes diffuse we can also be seen. So signal characteristics include T1 it will be used in the joint which include T1 it will be usually of intermediate signal or iso also sometimes and T2 it will be markedly hyper intense background because of the cold blade within the vascular spaces and sometimes if it is a high flow vascular malformations you could see the flow voids also and on T1 post contrast you could see marked enhancement. So even suggestive here you could see a iso intense mass which is in the superior to the opus fat fat and in the PD it is also iso on T1 hyper on PD hyper on PD address and in the pre contrast image you could see there is T1 net as hyper and on post contrast you can see slight enhancement and on post contrast deliered T-blast you will see rich enhancement which is suggestive of low flow venous malformation as it is being better well seen on the deliered images. So this is a piece of information. So based on this based on our MRA teachers and Sinoval biopsy teachers and arthritic followers have divided the patients into based on the Sinoval pathology. So most common pathology we found is the impact to Sinovalitis as we got the 6 patients and atleast last work like Lycoma Abysses and Sinoval Hemp, which were like one one case of each. So next conclusion 19 cases were followed and segregated according to the MRA findings. Among them 6 were of impact to Sinovalitis, 4 were of arthritic, 4 were of Invented Velo nodular Sinovalitis, 3 were of Sinoval gonobitis and each case of Lycoma Abysses and Sinoval Hemp. So based on the my MRA teachers we are suspecting some Sinoval pathologies what are the sequences we will be taking of T1, T2 or PD player sequences and even the gradient sequences and post contrast delieres also can be needed as well. So in this MRA imaging is really helpful for modality for the differential diagnosis preoperative assessment follow up of Sinoval disease. So MRA along the Sinoval biopsy is the best possible diagnosis. So based on this we have prepared a diagnostic algorithm with thickened and irregular synomium mass present in mass also when masses are offset periarticular erosions, subcontrances marrow edema, joint effusions these are all there then we have to suspect inflammatory or infective pathologies and if masses are present solitary mass forming or multiple mass forming this solitary mass forming it will be like Lycoma Abysses and localize the congenital Sinovalitis in plopoma Abysses there won't be any loose bodies but bone erosions are blooming but in localize the congenital Sinovalitis bone erosions blooming and loose bodies can be seen multiple mass forming you will be seeing diffused congenital Sinovalitis blooming. In Sinovalic congenital Sinovalitis you won't be seeing any blooming. So this will be associated with intervetorotial infections these are my references. Thank you.


So today, we're going to talk about education. And this is based on a book by Murray Rothbard called Education Free and Compulsory. It's a bit difficult to translate into French because free has a double meaning, freedom, or free of charge. And you can't really do that in French. But nonetheless, I try to convey the essence of this book rather than a blow-by-blow account of every single paragraph. And I will try to not preach to the choir, I'll try to aim for a normie. So this person is a normal person. A normal person is a person who has not taken the red pill. This is the red pill and the blue pill here. So if you take the blue pill, which the normie has taken, then you can't believe in what you always believed. And if you take the red pill, which is this one here, then you see how far deep the rabbit hole you can go. And maybe you end up in a boardroom at this conference. And just to make my life even harder, I will try to convey the essence of Murray Rothbard's book to a French normie. So it's very difficult to do that because public education is very much a sacred cow in France. You can't actually criticize the very existence of public education in France without being kicked out of the dinner party, basically. So tough challenge. So to get started, this man was the prime minister of France. And on June 2, 1997, he made a calculation mistake.  And we know socialists cannot calculate. So I'll go back to that in my third section. But what was the mistake? The mistake was that he appointed, as minister for public education, this gentleman. So you can see right there the mistake. This man has bookshelves. They're filled with books. He's actually read these books. These are scientific books. He actually even wrote some of them. And more than that, he actually wrote some articles that were cited 500 times. Typical article, basalt, basalt weathering laws. The guy is a real scientist. And you should never appoint a real scientist or a real university professor as minister of public education because he may have some ideas. You have to make him minister of transport if you want, but definitely not education. So obviously, the mistake was consummated. What was unavoidable happened 22 days after the appointment. And Claude Alegre, the minister, pronounced this phrase, which has become absolutely famous in France, which is, the mammoth has to slim down. The mammoth has to slim down. That's the only thing he said. Well, obviously, from the context, you can tell what the mammoth is. The mammoth is the national education in France. Indeed, when I was a hostage of the French national education when I was young, there was he saying that public education in France was the third largest employer in the whole world after the Red Army and General Motors. Not sure if it was true, but it was what people thought. And so the French public education has a lot of resources visibly, but does it employ them well? To do that, we can take the purest product of French public education. And his name is Laurent Laforgue. So that's him. He is just receiving the Fields Medal, which is the highest decoration in the field of mathematics. As you know, there is no Nobel Prize in mathematics, supposedly because Alfred Nobel's wife slept with a mathematician. Not verified. It wasn't me, certainly. And so the Fields Medal is as close as you're going to get. And it's actually pretty good. It's more like the Nobel Prize in chemistry, physics, or medicine.  It's pretty serious stuff. So obviously, when you have such intellectual royalty in France, you want to appoint him to the High Commission for Education. The High Commission for Education. And this is what he did. He did a paper on the Drinfeld Stuckas. You can't make that up. It's pure mathematics. The Drinfeld Stuckas. When he was young, when he was at school, when he was a teenager, this guy would actually lock himself up in his parents' bathroom because it was the only room in the house in the apartment that had no light. And then he would turn off all the lights, and then he would roll a towel underneath the little crack of the door to make sure that the light doesn't even go through the crack in the door. And there, in the dark, he'd do algebraic topology in his head for hours. So that's sort of what he takes to get the fields metal. And that's not in his official biography, but I actually know it. So he got appointed to the High Commission for Education. And Lafogue is a serious guy. He actually took his job seriously. He said, well, I'm going to approach this in a scientific method. So I am going to read all the programs for French public education. Since 1881, when it was instituted by Jules Ferri, all the way till the present, I'm going to decide which is the best program. So he did all this analysis, took a lot of time, a lot of work. And he concluded the best programs were from 1923. So that means from 1923 from 80 or 90 years onwards, it's all been going downhill. Every single reform has been horrible. So that's his conclusion. And he was appointed to the High Commission on November 8. He gave his report on November 16. And he was fired on November 17. That was pretty quick. Which starts to beg the question, is the French state, or any state for that matter, the right institution to educate children? Is it capable of introspection? Is capable of maybe finding its own limits in the field of education? Is capable of reforming itself? And the bigger question is, rather than look for the next reform, maybe we should just question the premise. Maybe the nation state was never the institution that should have been taking care of education. So that's the question I want to ask. And there is no better guide to ask this question than the book by Murray Rothbard, Education Friend Compulsory. So there'll be three parts. One part on history of public education, how education became to be a public affair. And economic, there'll be some sort of more general philosophical considerations. I'll finish with an economic analysis of the provision of education services by the state. So start with the history. Today, it's actually almost impossible to imagine a system of education that would not be run by the nation state. So we just sort of assume it has to be done like that. However, that cannot possibly be true, because the nation state was instituted by the Treaty of Westphalia in 1648, as we know it. Generally, that's really the basis of everything. And clearly, there was education before 1648, at least since the days of Karl Der Gross or Charlemagne. There was education and lots of philosophers, thinkers, mathematicians, scientists. So they must have been educated somehow. So clearly, that predated the nation state. You could have other institutions in the state producing education. It could be the maybe local institutions, the religious institutions. It could be charitable institutions. The families, small groups of families could get together by affinity. There are many ways to think about that. You could have professional leagues of carpenters teaching carpentry, for example. You could have outside a big university that could be a microcosm of preparations for the entrance exams. Many things you could do. And nowadays, you could have homeschooling and the Khan Academy. So the Khan Academy is on the internet. So basically, you can learn everything you want from there. And it's very, very good. So the possibilities are limitless. And indeed, before the state took over education, the variations were infinite. So there's one thing that I want you to remember today from this talk is that all the features of public education that you are familiar with, they're actually not very natural at all. They come from the Prussians. So if you think that the public schooling in France is a bit authoritarian, there's a reason for that. Because it was invented by the Prussians and copied later on. So what happened is that, obviously, now the message is changing. You don't teach God and the King as the message. Now the message is more about the environment and human rights. But the technique for teaching it is still exactly Prussian. In October 14, 1806, the French emperor Napoleon I inflicted a vicious defeat upon the king of Prussia at the Battle of Yenna. And the generals of the king, rather than admit that they had fallen to a superior strategist, put the blame on the little guy, on the soldiers. The soldiers were not sufficiently willing to sacrifice themselves for the king. So that was a theory. And then the solution then was to start a program of youth education to instill Germanic values into the German children before they go into battle. There's a Chinese saying, which is that you have to twist the cucumber when it's young. So that's what they did. And so I'm citing here from Rothbard some of the appalling things that they did were they abolished semi-religious private schools. All education was placed under the authority of the Ministry for Interior. There was a state exam that was made compulsory. All teachers had to be vetted by the state. And there was a sophisticated bureaucracy was put in place to manage schooling in all the cities and in the countryside. And then in order to get into the civil service or into university or into the professions, you had to take some state-administered exams. So all these things, which we take for granted now, that's really the way education is organized, they were actually completely unnatural. And they were invented by the Prussians. OK. So once they had taken control of education through these authoritarian means, they organized the school exactly like the army by age cohorts. So that's a bit unnatural also. To put me with, if I'm 16 with other 16-year-olds, maybe I'd be better off with 17-year-olds or with a variety of people. But in the army, you're all the same age. And there was obviously a lot of propaganda about national pride. And there was also a real effort to prevent children from learning the languages of the enemies. So that, for example, in France, we say, oh, no, no, no, you cannot learn any language until you're at least 12 or 13 or 14 because it's too complicated. And now we know obviously from linguistics research that it's easier to learn a language when you're two than when you're 12. And certainly, if you look at the aristocracy before the French Revolution, they all spoke many languages. And maybe they had private tutors who teach them in languages from the earliest age. So that was the technique that was used by the Prussian model. And well, did it work? The answer is, unfortunately, yes, it worked really well. So this is the revenge. So Yenai was 1806. It was a revenge. It's 1871, the Franco-Prussian war. And to the left, we have the defeated Napoleon III at Sedan, where he was caught. And to the right, we have Bismarck having a little friendly chat with him. So it worked really well. And the soldiers from the Prussian army were very willing to get shot in order to save the homeland. Indeed, Leon Gambetta, who was a Parisian politician who was famous for getting away from Paris in a hot-air balloon while it was encircled by the Prussians, he said, it is not the Prussian general who won the war. It is the Prussian schoolmaster. And it will be up to the French schoolmaster to win the next war. That was in 1871. So it's very prophetic. So after the defeat, what did France do? France, the cradle of human rights, democracy, the republic. What are we going to do? Well, we're going to do it Prussian style. Just copied everything from the Prussian schoolmaster. And they started the French public education in 1881. The big offender there was Jules Ferry. I don't like his beard. He's really a bad person. Even at the time, in 1888, there was a Parisian counselor named Louis Fiot who wrote a book saying, Jules Ferry, a malphiteur publique, so a public malefactor or public criminal, so first class criminal. So what was his crime? And basically, a crime of Jules Ferry was that he pretended he liberated the minds of the little children by educating them. But he wasn't really doing any of that. He just replaced propaganda for monarchy and for Christianity or Catholicism, which was really very deeply embedded in the school system prior to him, with propaganda for the republic and for atheism. So he just replaced one type of propaganda by the other. That's really what the whole book here is saying. And so it's not exactly liberating. The worst offender from this era was this little book here, Le Tour de la France par 2 Enfants, means Going Around France by 2 Children. And it's the story of two little boy and his sister who are from that part of France that is basically Germanic speaking. And they eat, sort of like Germans eat, that was taken over by the Prussians in 1870, 1871. So it's Alsace and Lorraine. So you have two children from there. And obviously, they get kicked out by the Prussians. And they go all around France, in all the regions of France, to see their relatives.  And then at the end of the book, they look over the border. And they see the little village over there, but they can't go back because it's Prussia now, or it's Germany now. So this is the book where most children learn how to read. So the first thing you read is you have to get these pieces of land from the Germans back. That's the first thing you read. Millions of copies were printed, I think, 8 million in total. And we have some modern French philosophers, Jacques Monazouf, who said this was the little red book of the French Third Republic. And my grandmother learned to read in this one. But she wasn't aware there was going to be a propaganda unit. So did it work? Did it work? Well, yes, it worked quite well. Certainly, we had World War I. So in 1914, everybody really went out fighting. In French, we say la fleur-au-fusie means they put flowers in their guns because they were so happy to go fighting. So that really worked. It was very effective. And so here we have the first lesson about free public education because Jules Ferri sent these teachers into all the little villages in France. And they were free. Come, give us your sons. We're going to teach them how to read and write and count for free. It's great. It's free, paid for by the taxpayers. But it wasn't really as free as advertised because after 1914, in every village, there was a monument to the dead of World War I, like this one. So it wasn't exactly free, it was paid for by the blood of your sons and grandsons. Nobody told them that initially. And so that goes under that there's no such thing as a free lunch kind of thing. Or another saying would be that sometimes it is those things in life that are free that are the most expensive. So that's the history part. Now we're going to go to more philosophical considerations about can we trust the state to educate our children? And clearly, if you look at the original history of the Franco-Prussian War and World War I, that sort of starts as a no. But maybe things are better now. It's the current year. It's 2016, maybe we can trust the state. So let's think about that. And the first remark that I would like to make on this point is that prior to the takeover of the education by the state, there was what is known as a division between the spiritual power and temporal power. So temporal power is the power in this earth. And spiritual is more in the next life or more of the power of the mind. The spiritual power was in the hands of the church and the temporal power was in the hands of the state. So there was a bit of counterbalance which worked in favor of the little people. But just logically, once you start to educate the children, then you put ideas in their minds. And the mind is spiritual. So now we have a fusion of the spiritual power to educate and of the temporal power to basically as a person who has the guns. So as a result, the state says, not only will I tell you what to think, but if you disagree with me, I can throw you in jail because I've got the guns and you don't. And you're going to think, well, it cannot happen here. We are in democracy. This is the current year. No, it's not possible. Let's just give you one example from Germany. Hans Professor Hoppe is German. So in Germany, the statistics are that from 2001 to 2010, according to the Office for the Protection of the Constitution, it's a bit of evil sounding kind of name, but it exists, there were 140,000 criminal investigations for thought crimes. So thought crime is not just something George Orwell's book. It's actually in the books of the reports of the Office for the Protection of the Constitution. And this is sort of the number per year, 140,000. I'm not saying all of them were thrown into jail, but they had to answer some pretty tough questions. And some of them were thrown into jail. And this particular data, I probably shouldn't say that, but I will not name names, was collected from the official report of the Office for the Protection of the Constitution by a German thought criminal who spent 2 and 1 half years in jail for writing chemistry thesis on the properties of prosaic acid. So you have to be very careful what you study when you're a chemist. So that was my first remark. The second remark would be that the kind of education that the state wants to produce has one tendency, tendency towards uniformization and equalization. It's always going to be like that. Certainly if you open your eyes in France, you see equality is really the objective here. And I can do no better to comment on that than to cite directly from the book by Murray Rothbard. He says that since abilities and interests are naturally diverse, a drive towards making people equal in all or most respects is necessarily a leveling downwards. It is a drive against the development of talent, against the development of genius, variety, and reasoning power. And since it negates the very principles of human life and human growth, the creed of equality and uniformity is a creed of death and destruction, death and destruction. Murray Rothbard does not mean words, but fully agree with him. And my third remark in this chapter will be that trusting that the state has very noble intentions when it comes to educating your children, that's a little bit naive. And you do not even need to be a hardcore austral libertarian to believe that. You can take Noam Chomsky, who is a linguist from MIT and very left-wing. He's very left-wing. And he gave a conference on the world after 9-11. He said, it is only in folk tales, children's stories, and the journals of intellectual opinion, so I think he means New York Times or something like that, that power is used wisely and well to destroy evil. The real world teaches very different lessons, and it takes willful and dedicated ignorance to fail to perceive them. So I really like this quote because he speaks about willful and dedicated ignorance. So to remain naive, you have to make a real effort to remain naive. And this, again, from George Orwell in 1984, has a name. It's called Stop Crime. So Stop Crime is the ability that when you get to the frontier of thought crime, you have a spider sense. You're getting close to there.   And so you stop yourself from thinking before you commit a thought crime. So I think that that really describes a lot of normies out there. And I will, my last citation in this section will have to be from Professor Block because we have honored with his presence here. He wrote an article with Andrew Young, and he says that the individuals entrenched in position of power in the state are those with control over what the children learn in history, in government theory, economics, and so forth. So the result is that you have citizens who are educated by the operators of the state into how to choose the operators of the state. So I think it's very clear that we have a logical loop here. And to conclude this section, I will say that I have come to the conclusion, and I hope you follow me on that one, that asking the state to educate our children is exactly like asking the Khmer Rouge to be in charge of the High Commission for the Promotion of Human Rights. And I'm glad you find this funny because it's actually not mine. It's not my quote. It's from Laurent Laforgue, who's the guy who got fired after 10 days. So I go to the Khmer Rouge, taking over Pnom Penh in Cambodia, not friendly. So now I have probably a few minutes to finish. And the last section will be, is the state even capable of educating? So even assuming that it would want to do a good job, is it technically feasible? And the answer comes from the mentor of Khmer Rouge, Bart Ludwig von Mises, in his article entitled Economic Calculation in the Socialist Commonwealth, published in 1920. He showed that if the state wants to produce a good, it's not, his paper is not about education, but it does apply in this case. The problem with public education is that it's free so that the parents, the consumers, the families, the end users, do not vote with their wallets, so they do not produce signals, which would be, well, this teacher I'm willing to hire at that price to teach that particular subject in that school. So the only way that you can see the teacher and the subject satisfy the families is if the families actually pay some money for it. So in the absence of such signal, it is impossible to organize the production of education. So the public education is about 13% of government spending in France, but how is that money spent? How is that planification going? Well, you can't really answer that because the signals, which is the satisfaction of the parents paying for education, is not produced. The school buildings are scarce. The school books are scarce. There's not an infinite number of school books. There's not an infinite number of teachers either. So how are you going to organize them into a production plan, knowing that the number of production plans is infinite? The only way to do that would be if, at the end, the parents were to signal what production meets their objectives, and because they don't, then you have chaos, or as Mises would say, you have planned chaos. The analogy here would be that the French state is no more capable of producing education than the Soviet Union was capable of filling up the supermarkets with groceries. So when Khrutchev on the left visited the US in the 60s, that's him with John F. Kennedy, he said, oh yeah, I just want to see a supermarket. So he went out with his entourage and they showed, well, there's a supermarket right there around the corner. He looked up and down, and it was full, full of tomatoes and salt and eggs and everything.  It's a Potemkin village. I want to have a real supermarket. I want to, I thought he went to like a few of them. After the third or fourth, he could realize that they couldn't actually stock up the shelves fast enough for him, so it must be real. And when he compared that with the typical supermarket, this is a historical picture from the Soviet Union. No, not really. That's what comes out when you have Soviet supermarkets on Google images. The groceries he returned in English. So clearly it's a bit of an error here. But yeah, you get the point. And the basic idea was that in the same way, the Soviet Union could not organize the production plans and allocation of scarce resources of production because it was not a capitalist economy and people in the end wouldn't pay the fair price. So communism doesn't work at producing things. So you could say that if this argument were correct, then it would also imply that the state is not capable of producing public health, public health care. You could say that. And you could even go further. You could say that the same argument implies that the state is not capable of producing security. And we have the book from Professor Hopper just out there on the myth of national defense, for example. So yes, you could say that and you would be right. But given that this is aimed at the normie and we're only going to take one red pill at a time. So I'm just going to focus on education today. Okay, so nice. I think my time is almost over. So I will conclude, and I hope I have convinced you that the circumstances under which the state to control of education in the 19th century were extremely dodgy. And they had no qualms about it. They actually admitted it black and white back then. Now if you say that, put it clean, correct. But they were pretty happy with explaining their reasons. Also, I hope I've convinced you that the state does not want to do a good job of educating your children because it is not in its own interest to have citizens who are able to think by themselves. And finally, I hope I've convinced you that even if the state wanted to do a good job, it still couldn't because in the absence of the price signal generated every time a parent pays for education of his or her child in a certain way. In the absence of the signal, you can't actually organize production in an economically correct way, okay? So my conclusion will be that just as we have a separation of church and state, we also need separation of school and state. Thank you.