Recently I read an editorial in the Washington Post that described Howard Dean's ability to engage individuals by using a mixture of the Internet and creative thinking. Dean is demonstrating that he can effectively work as a change agent by effective communication with individuals via a small organization. All other politicians work as change agents by effective communication with the leadership of special interest groups via large political machines. If Dean can effectively harness the Internet and bring individuals back into the political process, then there is hope for new initiatives in the educational world.

The basis for Dean's ability to communicate with a huge following via a minimal staff is based on an insight from Ronald Coase, an economist who started his exploration of industrial behavior at the same time I started my exploration of human behavior. The main idea is that organizational size and complexity is related to the cost of a business transaction. If the cost of interaction with Dean is free, then why bother with either political party's apparatus? If Dean's strategy succeeds, then the market for established political parties will shrink. See:

• An Overview of Ronald Coase's basis of institutional structure
• Ronald Coase Nobel Lecture: The Institutional Structure of Production

I find the notion of "cost of a transaction" as defining the utility of an industrial enterprise appealing and as applicable to the structure of universities and medical schools as it is to industrial organizations. All are producing products from raw materials and there should be similarities. As students find they are able to access information without formal university training, as they discover that they can contribute to society without formal university training, then the market for formal university training will diminish. Explore Coase's ideas and lets continue this discussion.

Thoughts about the Medical Monopoly

I have expressed my views about the constraining influence of the medical school monopoly. I have located others that are adding to this discussion. Below are useful links:

• The Medical Monopoly: Your Tax Dollars Limit Competition
• The Medical Monopoly: Protecting Consumers or Limiting Competition?

A number of folks have talked with me, written about my views etc. Here are some links and PDF files for information related to my life and the development of the Physician Assistant program.

Interviews

• A conversation with J. Willis Hurst and data of editorial alteration - distorting my middle name, Anson. (pdf)

Chinese water torture: All about the PA initiative

Over my career, I have mastered the art of Chinese water torture. If I don't get my way on the first try, I continue to drop water on my target until they either convince me I'm wrong, or they finally get it. The PA program at Duke was my most successful venture and required many episodes of such pressure. The results speak for themselves

• PA History web site at Duke
• A Short Biography of Eugene A. Stead, Jr.
• Bibliography of the PA program development
• Starting the Physician's Assistant Program
• The PA at Duke
• History of the PA program at Duke
• The Physician Assistant: would the US model meet the needs of the British NHS?

References to learning and forgetting

• Theoretical aspects of spaced repetitive learning