Map of life expectancy at birth from Global Education Project.

Monday, April 20, 2015

Pay no attention to the man behind the curtain

No doubt you have heard about the physicians who wrote to Columbia University's  dean of the medical faculty demanding that the school fire Mehmet Oz. The university responded with some banalities about academic freedom.

The physicians who wrote the letter seem a bit dodgy; some of them have ties to the GMO industry and the letter seemed to focus inordinately on that subject. But that's neither here nor there. The question is, should Columbia remove Oz from the faculty.

Honestly, I'm of two minds about this. It is generally against my religion to see professors fired because of controversial public statements. Free inquiry is the raison d'etre of the university and our bedrock value is that the cure for error is open investigation and debate. That said, there is a respectable argument that the Oz affair is not about academic freedom.

Oz does not do research on the fraudulent products and useless practices he promotes on his television show. He does not debate them at conferences or in the pages of medical journals. And there often no scientific or ethical controversy, as in this case or numerous others. I mean come on, a "psychic" who communicates with the dead?

No, what Oz does is lie to people, for money. I'm not saying he is paid by the hucksters and charlatans whose products he pushes, but he is paid to host his TV show and he evidently figures that this trash is what attracts viewers. He abuses the prestige of his medical degree and the Columbia faculty in order to make money by lying to people, potentially causing them substantial harm. That's contrary to his oath as a physician and yes, you can fire people from the faculty for egregiously unethical behavior.

Still, there is a real problem of slippery slopes and drawing lines and hard cases making bad law. There are some defensible claims that nevertheless deeply offend many physicians, whose own reputations and livelihoods depend on practices that are attacked by people out of the mainstream. For example, Robert Whitaker claims that there has been a massive epidemic of mental illness caused by psychiatric medications. He's not in academia, but suppose he had a supporter who was on a medical faculty and had a radio show promoting Whitaker's ideas? Could the school fire the the supporter? They might make the same accusations against him or her that I make against Oz, but I don't think the situations are comparable. Whitaker might not be right about everything, but he's not a nut. He does have some points worth pondering, and the challenge he presents to psychiatric practice deserves consideration and can potentially improve it.

So Columbia doesn't want to open a can of worms. I can understand that. But they should at least disassociate the school from Oz's worst frauds.

Thursday, April 16, 2015

Upper class twit of the century

I have no idea why Robert Kennedy Jr. can't let go of his obsession with the utterly false claim that vaccines cause autism, especially since he apparently doesn't know any autistic people and doesn't associate with the families of autistic people or their advocates. Dig this recent quote:

"They get the shot, that night they have a fever of a hundred and three, they go to sleep, and three months later their brain is gone. This is a holocaust, what this is doing to our country."
Then, in attempting to apologize, he said this:

"I want to apologize to all whom I offended by my use of the word [holocaust] to describe the autism epidemic. I employed the term during an impromptu speech as I struggled to find an expression to convey the catastrophic tragedy of autism, which has now destroyed the lives of over 20 million children and shattered their families."
Many people with autism are severely disabled, but others are not, nor are their families shattered. And of course, vaccines have absolutely nothing to do with autism.  He's been on this jag for years, since writing an article for Mother Jones, since retracted, claiming that the CDC and pediatric establishment were engaged in a conscious, malicious coverup.

So okay, we know he's a destructive nut. But here's what we should not have to put up with. Last week, I got a fundraising mailing from the Natural Resources Defense Council. It purported to be from Robert Kennedy Jr., whose name was featured prominently on the envelope and who signed the letter inside. As far as I know, he is still the NRDC general counsel.

The NRDC does good work which I would support. But. They don't just employ this malignant clown, they seem to be proud of it. Apparently his name trumps his loathesomeness and stupidity. So no, I cannot support, endorse, or encourage the work of the Natural Resources Defense Council. Until Kennedy no longer has any association with them.

Wednesday, April 15, 2015

This time, it's personal

The Government Accountability Office finds that 1/3 of people in nursing homes with dementia are prescribed anti-pscyhotic drugs -- and that is excluding people who actually have psychoses for which these drugs are indicated.

Why is this wrong? Because these drugs are prescribed essentially to put people into a stupor who would otherwise be a problem for the staff. The term for this is "chemical straitjacket." And, they present a high risk for premature death and other side effects.

Why is it personal? My father spent a long time in a nursing home, with dementia. Once my mother found him slumped over in a chair, nearly unconscious, and drooling. It turns out they'd given him seroquel (which is heavily advertised on TV by the way, as a treatment for depression, which also should be against the law, but that's for another day) because he had wandered into the kitchen. They couldn't be bothered just to have somebody watch him.

I drafted a letter for her to give the nursing director, stating that he was not under any circumstances to be prescribed antipsychotics. The ND said okay. A few months later, it happened again.

There is  a black box warning on the label for these drugs, saying that they are not approved for symptoms of dementia and are dangerous and harmful to elderly people with dementia. But the nursing homes continue to use them. This is the sequel of an illegal, off-label marketing campaign which apparently has burrowed so deeply into the culture of nursing homes that it has so far been impossible to eradicate. Lots of awful things happen in those places, but this must stop.

If you have a loved one with dementia, make sure the Nursing Director knows your wrath will descend should this crime occur.

Monday, April 13, 2015

More on Republican governors who hate their own consitutents

Brad DeLong could use a copy editor, but the point is well worth taking. He discusses info-graphics from Price and Evans about the geography of Medicaid expansion.

Medicaid expansion has a powerful positive impact on state level economies, as well as (obviously) on the well-being of the beneficiaries. Delong tells us that on one dollar of federal money coming into the state leads to a six dollars increase in the regional economic product. Among other effects, it puts money into the pockets of physicians, who used to be big contributors to Republican politicians. Sayeth DeLong:

The only way I can find to understand the pattern of Medicaid expansion nullification is a truly extraordinary unconcern on the part of Red State politicians with their poor–whether working or non-working–and substantial insulation as a result of the rise of right-wing billionaires from financial pressures put on them by the doctors who used to be the financial fund-raising bedrock base of the Republican Party. Plus remarkable unconcern with the the health of their state-level economies. But even if they do not care about the well-being of their citizens, they should care about competing for the votes of the non-working and the working poor, shouldn’t they? Or do they just think that the poor are low-information voters, and that those who pull the lever for the Republicans will not be unhornswoggled by looking across the Missouri-Illinois or the Tennessee-Kentucky or the Mississippi-Arkansas or the Texas-New Mexico state line and thinking: “Hmmmm…”

The ineffectiveness of the voice of the doctors I just do not understand. It goes against all theories of rational-choice political economy, it does.

I have expressed similar bafflement here in the past. How can you screw over your own state, hurt working poor people and health care workers -- who include both low wage and highly affluent people -- and harm your state's overall economy, and get elected and re-elected? One despairs for democracy.

Friday, April 10, 2015

Land of the Free and Home of the Benighted

I don't know if you've heard of mitochondrial replacement therapy (MRT), but it's legal in the UK and not in the US. Why is that?

So, first a bit of biology. This will make more sense to you if you are not a creationist. Somewhere back in the mists of time -- long before the universe was created 6,000 years ago -- actually somewhere around 2 billion years ago, it seems that 2 (or possibly 3) simple prokaryotic cells entered into an endosymbiotic relationship. We don't know exactly how this happened. Prokaryotic cells don't have a nucleus and are otherwise relatively simple in their internal structure. There are two major kinds, called archaea and bacteria. The most straightforward explanation of the origin of the eukaryotes is that an archaeal cell somehow engulfed a bacterium, but didn't digest it. Instead, the bacterium reproduced and its progeny started living happily within the cytoplasm of the archaea and its descendants. The endosymbiotic bacteria gradually lost most of their DNA -- they didn't need it because their environment was properly managed by the archaeal DNA, which is now our nuclear DNA -- and they settled down to a few jobs, including the production of adenosine triphosphate (the cell's fuel) and some other essential functions.

The eukaryotes went on to evolve and produce the metazoa -- that's the animals, including us -- and plants, which evidently absorbed another prokaryote, which happened to be photosynthetic, and is today the chloroplast of the plant cell. Anyhow . . .

Some people have defective mitochondria. These can only be inherited from the mother, because the cytoplasm of the ovum becomes the cytoplasm of the zygote. Got that? The sperm don't contribute any mitochondria to the embryo. Having defective mitochondria can be a real bummer. Because mitochondria perform various functions in various tissues, and at different times of life, the manifestations of mitochondrial disease are myriad.Anyhow . . .

These diseases aren't curable, but it is now possible for a woman with defective mitochondria to give birth to a healthy baby. There are actually two ways to do it, not much to choose between them really. Method A is that you produce an ordinary zygote by standard in vitro fertilization, then you take a donor oocyte from a woman with healthy mitochrondria, remove it's nucleus, and insert the nuclear from the zygote. Presto, you have mommy and daddy's nuclear DNA in cytoplasm containing healthy mitochondria. Note that the only characteristic the baby will inherit from the egg donor is healthy mitochondria. Otherwise, the baby will be just like any other baby of those two parents -- each of them has contributed half of the DNA that makes us who we are.

The other method, which as I say is six of one, half dozen of the other, is to replace the nucleus of the donated oocyte with the nucleus of an oocyte from the mother, and then fertilize it. Doesn't matter.

It turns out that people in the U.S. find this ethically unacceptable. Some of them don't get past the "three parents" weirdness factor. That really isn't true, but lot of corporate media reports just say it is because the reporters are ignorant.

The other reason is because people seem to think that method A constitutes abortion. Really. I mean, you have a zygote, which as far as they are concerned is already a baby. Note that it isn't even a blastocyst. Part of it -- the cytoplasm -- is destroyed, even though the nucleus goes on to make the baby that otherwise would have happened, only healthy. They would rather have a sick baby than toss away that microscopic bit of slime. Because Jesus said so.

Ponder that.

Wednesday, April 08, 2015

The Affordable Care Act: Greatest Thing Since Oxygen

Sure seems like it anyway. Urban Institute calculates that:

  • The projected cost of expanding Medicaid under the ACA is now $94 billion less than the forecast made at the time the ACA became law.
  • The projected cost of providing subsidies to consumers to help purchase health plans in the marketplaces is now $125 billion lower than the forecast made at the time of the ACA’s passage.
  • In total, CMS projects $2.5 trillion less in public and private health care spending between 2014 and 2019 compared to projections made in 2010.

     Now, as you may recall, Republicans predicted several different disasters including destruction of jobs, ballooning federal budget deficits, exploding costs .. . oh yeah, death panels. In fact, the act has succeeded beyond the wildest dreams of its proponents, and the news just keeps getting better. But . . . 

    It continues to be underwater in popularity. People just don't know what's going on around them. That is the fault of 1) Democratic politicians who are too chicken shit to stand up and forthrightly brag about the success of their own policies and 2) the corporate news media who merely act as stenographers and take dictation from Republicans. It's getting really old.

Monday, April 06, 2015

Cutting off your nose

From the Robert Wood Johnson Foundation:

States that expanded the number of people eligible for Medicaid are seeing big budgetary savings without reducing services, a new report shows. Prepared by researchers at Manatt with funding from the Robert Wood Johnson Foundation, the report identifies $1.8 billion in budget savings and revenue gains across eight states by the end of 2015—a direct result of Medicaid expansion. Researchers say the savings come from less state spending on programs for the uninsured; more federal dollars coming to the state for newly eligible Medicaid enrollees—including funds to cover typically expensive beneficiaries like pregnant women and the disabled; and increased revenue from existing insurer and provider taxes. In some states, budget savings should offset the cost of expanding Medicaid through 2021.

The eight states studied are Arkansas, Colorado, Kentucky, Michigan, New Mexico, Oregon, Washington and West Virginia.

The report highlights specific sources of savings for each of the states. Across the eight states, for example, $68 million will be saved through 2015 as a result of more pregnant women now being covered with enhanced federal funding. States are also seeing savings from behavioral health programs. The highlighted states will save $472 million through 2015 on mental and behavioral health care spending, now that more state residents with mental or behavioral health care needs are covered by Medicaid.

“States that expanded Medicaid are finding that it was a win-win proposition. More people have health insurance, which reduces the states’ costs for caring for the uninsured. Savings to state budgets are in the hundreds of millions of dollars,” said John Lumpkin, MD, senior vice president at the Robert Wood Johnson Foundation. “When states expand who is eligible for Medicaid coverage, they see the federal government cover more of the costs of caring for patients who historically have been expensive to care for.”

Meanwhile, Rick Scott Flip-Flops, Opposes Obamacare's Medicaid Expansion. Obama could discover cold fusion and Republican governors would refuse to allow the electricity to be used in their states.

Thursday, April 02, 2015

Well, Stayin' Alive

In Democracy (which you should bookmark) Diane E. Meier has a review of Atul Gawande's "The Way We Die Now." The irony, if that's the right word, is that the central issue is how long we live.

In 1900, life expectancy at birth in the U.S. was 47.3 years. Alzheimer's, cancer, heart disease, osteoarthritis and osteoporosis, chronic kidney disease, frailty and infirmity -- very few people had to worry about all of that. And if you did get cancer or heart disease or dementia or kidney disease? At least the good news is that you didn't have to live with them for very long.

So our problem is that we have created a new stage of life, a decade or two or more of ever elaborating co-morbidities and physical and mental decline. Not everybody's fate, to be sure. Some of us are fortunate enough to keep the wonderful one-hoss shay together and then just not wake up one morning, but most of us are not. 

Gawande's main complaint is that nursing homes and other services for the elderly are designed to emphasize safety and medical management; but when we're sick and old, we're still people, and environments built with those goals foremost are not pleasant places for humans. We need to stop making a fetish of longevity and instead make life about living.

It seems weird, then, that quantity of life seems to be the highest value, indeed a trump card over every other value, for so many deeply religious people. This position, which to me is ethically inexplicable and just weird, is causing all sorts of problems and frankly, in the long run, it's completely unsustainable. Like burning fossil fuel. But they don't believe that either.

Monday, March 30, 2015

The Angel of Death

There is plenty of vapid speculation going on about the possible motives of Andreas Lubitz. Lots of people are depressed, and people sometimes kill themselves, but it's obviously uncommon to take a lot of other people along for the suicide ride. Not, however, unprecedented. These researchers found 24 cases of "aircraft assisted suicide" in the U.S. from 1993 to 2012. Most of them were private planes and probably were solo ventures; however the story recounts 4 cases of commercial airline pilots deliberately crashing planes and killing passengers. In no, case, however, did they leave behind an explanation. (One pilot survived, and he was clearly psychotic.)

A somewhat different, but possibly related case, is that of Harold Shipman, a British general practitioner who is estimated to have murdered 236 of his patients, and likely more, by means of fatal injections of diamorphine, which is the name the British give to prescription heroin, which is a thing there. He was convicted of 15 murders and sentenced to multiple consecutive life sentences. He eventually killed himself in prison. Even though they had him dead to rights, he never confessed and never offered any explanation for his actions.

Unlike the murderous airline pilots, self-destruction was evidently not originally on Shipman's agenda. However, though we can only speculate, it is possible that the murder half of the motive was related. Shipman is no the only medical professional who was into murdering patients. Michael Swango is an American internist who murdered as many as 60 patients and colleagues. He murdered his colleagues by poisoning their food, but he murdered his patients much as Shipman did, with drug overdoses. According to an essay by Joseph Geringer (at the link),

Forensic Psychologist Dr. Jeffrey Smalldon (who has examined many serial killers, among them John Wayne Gacy) believes that Swango's drive is "a preoccupation with control and manipulation," including a feeling of control over life and death itself. Sans a formal examination, Smalldon says Swango displays the common threads of a narcissist. . . .

The most chilling evidence was Swango's own diary in which he said he killed for pleasure. He loved the "sweet, husky, close smell of indoor homicide." He claimed that these murders were "the only way I have of reminding myself that I'm still alive." How does one explain a man going through the arduous path of getting a medical degree and then using it to launch a career of murder and assault on the people who entrusted their lives to him? One can almost understand the attributed motivation of serial killers of murdering to have complete power over an individual. But killing for pleasure?
Lubitz, of course, didn't get to savor the pleasure of killing after the fact, but he did take several minutes to enjoy it -- he could have just pointed the plane straight down. I suspect that he wanted to go out with a feeling of power and control. Alas, we will never know.

Friday, March 27, 2015

Don't breathe the air

If you're among my 4 1/2 readers, you've heard about air pollution before. Exposure to indoor air pollution is the fourth leading risk factor for disease worldwide. That's mostly in poor countries where people burn wood or dung indoors for heat and cooking. But outdoor air pollution is the ninth leading risk factor worldwide, and that's not just because of China.

Here in the U.S., the highest exposures occur to people who live near major highways.
There is a very large body of evidence showing that in the United States, non-white and low SES people are more likely to live in proximity to local sources of pollution, including high traffic roadways. We already knew they are at high risk for cardiovascular disease and heart attacks. But now the new BMJ has two papers, one a meta-analysis confirming a high risk of stroke associated with exposure to particulate pollution, the other an observational cohort study finding that exposure to air pollution is associated with anxiety.

You may find the latter observation odd, but it's well controlled. Exposure to particulate pollution is associated with systemic inflammation, and it may be that there is a link to mental health. There are even indications that short-term variation in air pollution is associated with suicide.

Of course, it might be that there are factors such as traffic noise or lack of open space. Nevertheless, whatever the mechanism, this once again is probably the most salient problem of environmental justice in the U.S. When you push a ton of metal at 70 miles an hour down the highway by burning the residue of ancient plants, you are poisoning the unfortunate people who live and work along the route. Maybe we should do something about it.

Tuesday, March 24, 2015

The Inbox

I don't know what I did to deserve it, but I am under a continual bombardment of e-mails from publicists who would have to be out of their minds to think I have any interest other than scathing, boiling contempt for their scumbag clients. The latest is a clown who claims to be the "immediate past president of the Arizona Homeopathic and Integrative Medical Association, and the clinic director of Integrative Medicine of the American Medical College of Homeopathy." He wants me to read his book about how I can detoxify myself from heavy metals through chelation therapy.

The mystery is why these con artists aren't prosecuted for fraud. If you take people's money under false pretenses, that's a crime, right? That certainly applies to homeopathy, which is utterly absurd. If you tell me you can improve my gas mileage by attaching magnets to the fuel line or some such, and accept payment in exchange, you have stolen from me and you are a criminal. If you tell me you can cure my diseases by giving me a small vial of water, or by giving me chelation therapy even though I do not, in fact, have heavy metal poisoning, you are trying to steal from me. In fact, you are risking my life and my health, sayeth the FDA:

There are serious safety issues associated with chelation products, which can alter the levels of certain substances in the blood.  Even when used under medical supervision, these products can cause serious harm, including dehydration, kidney failure, and death.  
“These products are dangerously misleading because they are targeted to patients with serious conditions and limited treatment options,” said Deborah Autor, director of the Office of Compliance in the FDA’s Center for Drug Evaluation and Research. “The FDA must take a firm stand against companies who prey on the vulnerability of patients seeking hope and relief.”
The agency advises consumers to avoid non-prescription products offered for chelation or detoxification. The only FDA-approved chelating agents are available by prescription only and are approved for use in specific indications such as lead poisoning and iron overload. Procedures involving these agents carry significant risks and should be performed only under medical supervision.

This guy is a flat out criminal. He should be prosecuted. That is all.

Monday, March 23, 2015

Happy Anniversary!

to the Affordable Care Act, signed into law 5 years ago. (Has it really been that long?)  The blogosphere is all aflutter with the topic, so above is my value added. There were huge disparities in the rate of uninsurance prior to the ACA. They still exist, but they are much less, especially for African Americans. (Latinos who are not citizens, alas, don't benefit.) So this is real progress in the long struggle for health equity. (Numerically, by the way, most beneficiaries are white, non-Hispanic.) Hopefully all these people will vote, and will vote their interest, which means voting for Democrats.

(click on the chart to enlarge)

Friday, March 20, 2015


Sidney Wolfe (Nader's health care raider) in the new BMJ tells the outrageous story of rosuvastatin. As you undoubtedly know, there are several medications in the statin class, very widely prescribed for the primary and secondary prevention of heart disease and stroke. They lower LDL ("bad" cholesterol) and probably have anti-inflammatory properties that contribute to their effect.

There is controversy over whether these medications in general are overprescribed, but that's beside the point here. Rosuvastatin was approved much later than other drugs in the class, it's still under patent (I won't mention the brand name) and it is also the most widely prescribed statin in the U.S.

Oh yeah -- according to Dr. Wolfe, it's also the one with the worst risk/benefit profile. It is a associated with a much higher risk of diabetes. Obviously, if you're trying to prevent heart disease, causing diabetes is not helpful. It also appears to present a higher risk of rhabdomyolysis -- destruction of muscle tissue -- and kidney damage.

So why is it the most commonly prescribed statin? Quoth the good doctor:

A prescient answer can be found in an October 2003 Lancet editorial, “The statin wars: why AstraZeneca must retreat.”20 It stated that AstraZeneca’s chief executive, Tom McKillop, “has pledged to do whatever it takes to persuade doctors to prescribe rosuvastatin, including launching an estimated $1 billion first-year promotional campaign. ‘We’ve got to drive the momentum’, he [McKillop] said at a recent investors meeting. ‘You get one shot at launching a major new product. This is our shot.’” 

But McKillop responded with denial, and an advertisement in the Washington Post claiming, utterly falsely, that "The scientists at the FDA who are responsible for the approval and ongoing review of [Brand Name]  have, as recently as last Friday, publicly confirmed that [Brand Name]  is safe and effective; and that the concerns that have been raised have no medical or scientific basis." The FDA wrote a letter to AstraZeneca stating that the ad was false, with no basis in reality, and that the agency had substantial concerns about the product.

Dr. Wolfe concludes, "The patent for rosuvastatin expires in 2016, and with it AstraZeneca’s need to promote it. But for the sake of the public’s health, we must hope that the drug’s disadvantages will lead to a sharp decline in its use before next year."

I conclude, however, that the pharmaceutical industry appears to be largely run by psychopaths. We are talking about people's lives here, which McKillop and other pharmaceutical executives are perfectly happy to destroy for the sake of their insatiable greed. This has tremendous repercussions in undermining public trust in science and medicine, and we must constantly struggle against that mistrust. It's getting very old.

Wednesday, March 18, 2015

Boston's Trials

The city itself, of course, has endured the most snow since record keeping began, which was trial enough. But concurrently, two criminal trials have been runner-ups for local news attention. Both are ritual enactments of substantial civic significance, although otherwise in no way similar.

Dzokhar Tsarnaev's lawyers have already declared that he is one of the two perpetrators of the marathon bombing, along with his brother, although he has not as far as we know confessed himself to law enforcement. That's pretty much of no consequence because his guilt is beyond question. Yet we are having a full trial to prove guilt, complete with witnesses' unbearable, inexpressible pain and the most horrific of images. The reason for this technically is that a plea of guilty cannot be accepted in a capital trial. But the prosecutors could get to a guilty verdict with much less theater of cruelty. The real reason is that they want to kill the defendant and they believe that putting the jury through this ordeal will help them achieve that.

Those witnesses who have said anything in public away from the witness stand appreciated the opportunity to confront the defendant and tell their stories, although most have not spoken out of court. So prosecutors can use that as justification. But Tsarnaev's lawyers have indicated that they will accept life without possibility of parole, which is the only other possibility given a guilty verdict, and the Department of Justice will not agree.

Why is it so important to snuff out Dzokhar Tsarnaev? Will it fix anything?

Former New England Patriots tight end Aaron Hernandez, in contrast, is charged with a tawdry murder over what appears to be a trivial slight of some kind, although the motive is so far not publicly known or even suggested. His lawyers are trying to get an acquittal or a lesser charge, but presumption of innocence granted, so far the matter does not look good for him. He has also been charged with another pointless murder of two strangers, is subject to a civil suit for a non-fatal shooting, and it's been pretty well demonstrated that he never left behind the small-time hoodlum culture of Bristol, Connecticut from which he emerged in spite of his fame, glory, and millions of dollars.

This trial, while it's obviously about guilt and innocence from the point of view of the defendant, is about our culture of athlete worship from the standpoint of the rest of us. If the prosecutors are painting a true picture, this guy is a sadistic psychopath whose natural athletic endowment let him get away with a total lack of self-discipline or serious effort and whose only purpose in life is immediate gratification. But 10 year old boys were wearing his name on their backs. 

Monday, March 16, 2015

A puzzling incident

While in the hypnagogic state recently, I recalled something that happened as I started my freshman year in college. A recent Harvard graduate got accepted to Swarthmore, telling the admissions office that he had been in the army to account for his years after high school. (I'm not sure how he dealt with letters of recommendation and what might have seemed a strange transcript request to his high school. Evidently it didn't occur to them to ask for his service record.) He lived in a dormitory and attended classes for a few weeks before they discovered the ruse. Alas, I don't remember the dude's name.

I actually met him during freshman orientation. We were on the sidelines of an event we both obviously found bemusing, specifically folk dancing, so I tried to strike up a conversation. He was aloof, understandably. I mean, he doesn't want to get to know people and then have them start asking him about army life, of which he is utterly ignorant. People who had classes with him remarked that he seemed exceptionally well prepared.

There was no e-mail back then, which is what colleges use today to inform the community about weird shit like this. The deans issued a statement of some sort and there was a brief item in the student newspaper -- necessarily brief because how much is there to say? The grapevine had it that his explanation was that he wanted to write a book. That would be impossible, I should think, without massively violating people's privacy and trust, and demonstrating himself to be an asshole.

I imagine we all fantasize about going back and doing it over knowing what we know now. He probably imagined himself impressing the freshman girls with his maturity and erudition, acing all the courses, dominating the dormitory bull sessions. But surely he didn't expect to follow through on this for four years, graduate summa cum laude and be the commencement speaker, while having to keep his secret from everybody he knew. How he swung this financially in the first place is also a mystery. He must have had a trust fund.

Presumably Swarthmore and Harvard communicated about this, which would create a problem for him if anybody requested his Harvard transcript. That would no doubt keep him out of graduate school but would probably not be a problem for employment. In my life, no employer has ever requested a transcript from me at any level, and that includes my current position as university faculty, no less. So he probably pretty much got away with it. I don't think they tried to prosecute him.

Anyway, it was strange. Anybody have a clue what was in the guy's mind?