Wednesday, December 26, 2012
As Noah says to the Lord in the famous Bill Cosby routine. As I may have mentioned before, I'm a lifelong -- well, since age 13 -- subscriber to Scientific American, which is probably why I'm such a know-it-all, even though they've been assiduously dumbing it down for the past few years.
Anyhow . . .
Michael Dettinger and Lynn Ingram this month tell us that once every couple of hundred years, California has been visited by the real, diluvean deal. Starting on Christmas eve in 1861 it rained not for 40 days and 40 nights, but for 43, after which the Central Valley was "an inland sea 300 miles long and 20 miles wide." Sacramento was 10 feet under. It took 6 months for the water to drain.
The most incredible fact about all that is that I had never heard of it before. Cal was relatively sparsely populated at that time, nevertheless thousands of people died. If that were to happen today . . .
Guess what. It will. They've been able to trace the record of such events in the sediment going back to 1150 or so, and they have convincing evidence of 5 of them. It turns out that great rivers of water vapor form in the atmosphere and west coasts generally are vulnerable to these events. And of course you know the kicker . . .
Global climate change should make them more frequent, by increasing the amount of water vapor in the atmosphere. If you thought Katrina and Sandy were exciting, well now. Words fail. A simulation of a lesser event -- only 23 days of rain -- found that 1.5 million people might need to be evacuated, with total economic costs of $700 billion. Given that nobody's getting 1.5 million people to high ground very quickly, again, well now. You figure it out.
That's why I'm not making any predictions for the New Year. Shit will happen.
Monday, December 24, 2012
Really. I believe I posted many moons ago about Richard Dawkins's idea to make "Atheists for Jesus" T-shirts.
I was just talking to a friend yesterday about the ascendancy of I-got-mineism in our politics, and the delusions that come with it -- that everything you have you deserve, nobody and nothing outside of yourself contributed to your deserved fortune, and every penny you pay in taxes is stolen to give to lazy parasites. That's not so weird in itself, but the alliance of this philosophy with the predominant form of Christianity in the U.S. is pretty strange.
My uncle was a preacher -- the pastor of Trinity Church on the Green in Branford, Ct, which is a national historical landmark. My mother was a Sunday school teacher. I got several perfect attendance medals for Sunday school, and I was talking about getting confirmed when I got old enough to figure out for myself that religion is bunk, i.e. thirteen years old.
But, the Christianity they taught me was the exact opposite of Rich Warren and Pat Robertson and Franklin Graham. They claim to interpret the Bible literally, and live by it. So how do they interpret this?
31 “When the Son of Man comes in his glory, and all the angels with him, he will sit on his glorious throne. 32 All the nations will be gathered before him, and he will separate the people one from another as a shepherd separates the sheep from the goats. 33 He will put the sheep on his right and the goats on his left.
34 “Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. 35 For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, 36 I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’
37 “Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? 38 When did we see you a stranger and invite you in, or needing clothes and clothe you? 39 When did we see you sick or in prison and go to visit you?’
40 “The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’
41 “Then he will say to those on his left, ‘Depart from me, you who are cursed, into the eternal fire prepared for the devil and his angels. 42 For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, 43 I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.’
44 “They also will answer, ‘Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?’
45 “He will reply, ‘Truly I tell you, whatever you did not do for one of the least of these, you did not do for me.’
46 “Then they will go away to eternal punishment, but the righteous to eternal life.”
13 Later they sent some of the Pharisees and Herodians to Jesus to catch him in his words. 14 They came to him and said, “Teacher, we know that you are a man of integrity. You aren’t swayed by others, because you pay no attention to who they are; but you teach the way of God in accordance with the truth. Is it right to pay the imperial tax[b] to Caesar or not? 15 Should we pay or shouldn’t we?”
But Jesus knew their hypocrisy. “Why are you trying to trap me?” he asked. “Bring me a denarius and let me look at it.” 16 They brought the coin, and he asked them, “Whose image is this? And whose inscription?”
“Caesar’s,” they replied.
17 Then Jesus said to them, “Give back to Caesar what is Caesar’s and to God what is God’s.”
And they were amazed at him.
16 Just then a man came up to Jesus and asked, “Teacher, what good thing must I do to get eternal life?”
17 “Why do you ask me about what is good?” Jesus replied. “There is only One who is good. If you want to enter life, keep the commandments.”
18 “Which ones?” he inquired.
Jesus replied, “‘You shall not murder, you shall not commit adultery, you shall not steal, you shall not give false testimony, 19 honor your father and mother,’[c] and ‘love your neighbor as yourself.’[d]”
20 “All these I have kept,” the young man said. “What do I still lack?”
21 Jesus answered, “If you want to be perfect, go, sell your possessions and give to the poor, and you will have treasure in heaven. Then come, follow me.”
22 When the young man heard this, he went away sad, because he had great wealth.
23 Then Jesus said to his disciples, “Truly I tell you, it is hard for someone who is rich to enter the kingdom of heaven. 24 Again I tell you, it is easier for a camel to go through the eye of a needle than for someone who is rich to enter the kingdom of God.”
Now, I know that the scammers have all sorts of arguments as to why these passages don't actually mean what they appear to mean. But why don't we ever hear from other Christians who do believe in the words attributed to Jesus in the Gospels? Why do they cower under the pews? Just askin'.
Thursday, December 20, 2012
Via Balloon Juice, I came across this essay by Mark Ames, who apparently is something of an expert on rampage murder. His main focus in the linked piece is on the NRA, and I recommend it for that reason. Basically, he argues that by being batshit crazy, the NRA actually insures intense loyalty and passion on the part of its members, because it reinforces their tribalism and paranoia.
That's worth thinking about, but the point I want to make for this post is that the Newtown tragedy was not typical, in that the perpetrator had no evident connection to his targets. I have mentioned previously the socially isolated men who shoot up their workplaces when they are in one way or another robbed of their only source of dignity through their employment. The kids who attack their own schools also typically, in one way or another, feel humiliated or socially excluded.
Now we find the question of access to mental health services entering prominently into the post-Newtown debate. I'm afraid that while I agree we have problems with mental health services, that's largely an irrelevant distraction. The typical workplace or school shooter would not have contemplated getting mental health services. Workplace shooters often erupt after being fired, or disciplined, or having a conflict with their supervisors. There is seldom any indication in advance that they ought to get mental health treatment, and even if somebody thinks there is, there's no way to make them do it. Similarly, the school shooters are generally entirely unpredictable.
Now, it just so happens that Jared Loughner and James Holmes were recognized in advance as having serious mental illness, in both cases as it happens by school authorities. And their respective institutions reacted by expelling them and washing their hands of the matter. Loughner already has an official diagnosis of schizophrenia and obviously, Holmes will get one too. The Newtown shooter was also manifestly somehow wrong in the head, although we'll never get to slap a specific label on him. It's this run of bad luck which has apparently made mental health a big player in the current debate.
However. None of these people sought treatment. Putting a free psychiatry kiosk on every street corner would not have helped. The only thing that would have helped is making it impossible for them to acquire large capacity ammunition clips.
Update: An armed society is a polite society, right Mr. LaPierre?
Tuesday, December 18, 2012
Jeffrey Sachs is of course correct. The amendment has to do with an archaic debate about federalism. It protects the state militias, not some bozo who wants to walk around the shopping mall with a gat on his hip so he can shoot any black kid who looks threatening, or a bunch of louts who think they can resist "tyranny" by taking on the United States army. The state militias are now the National Guard. That's the well-regulated militia. Back in the day, the militia members owned their own muskets, and kept them at home, which is why the amendment reads as it does.
The Supreme Court, in decreeing that a) this has anything to do with a "right" that pertains to individuals and b) has any application at all in the United States post about 1800, is legislating from the bench. This "interpretation" has nothing to do with conservatism or "original intent" or even jurisprudence. It's just a fraud. There is no such thing as gun rights, or gun owners rights, or a right to bear arms, deriving from the Constitution of the United States.
None. It's all nonsense.
Monday, December 17, 2012
It's not exactly a revelation that you get a huge political advantage from attaching a label with positive associations to your cause. Rights, liberty, life, freedom,choice -- who could be against any of those? Respecting the right to bear arms gives us more liberty, more freedom, more choice, and we can defend our lives and our property. If you want to restrict that right, you want to take away my freedom. Obviously.
What's wrong with this picture? I shouldn't even have to point it out, yet somehow our public discourse can't arrive at the obvious.
People walking around with guns on their hips may feel that they have liberty and freedom, but they diminish the freedom of others. Who would dare to offend a belligerent character with a gun in his hand? Are the people of Newtown, and every other school district in this country, freer because their neighbors own high powered rifles with 30 round magazines? Of course not. They are forced to take all sorts of measures that restrict freedom in order to protect themselves. They have to make their schools, libraries, town halls and court houses less accessible. They have to tax themselves more to pay for police and security systems. Even so, sometimes their children get murdered.
I could play this argument out at greater length but others have done so better. The point is, liberty is always a problem of balance. Whatever liberty is granted to one person may take away from the liberty of another. Your liberty to dump your waste in the river deprives me of the liberty to swim in it.
Here's another powerful example. Banning smoking in public places turns out to have a huge effect on the incidence of heart attacks and acute respiratory distress. Huge. A twenty-one percent decrease in hospital admissions for acute myocardial infarction. That means smokers aren't poisoning other people, and the rest of us don't have to pay as much to take care of people who have heart attacks.
Libertarianism is sophomoric nonsense. Rand Paul and Ron Paul and everybody associated with the Cato institute are mindless. We must root this delusional thinking from our political discourse.
Sunday, December 16, 2012
Connecticut is a relatively small state in geographic extent, but Newtown is pretty far from me in Connecticut terms. I have never been there, and I had to look it up on a map. As it turns out, though, my brother-in-law's niece attended Sandy Hook, and her baby sitter's daughter was killed. And seeing my governor and senator on TV talking about it makes it seem somewhat close to home anyway.
As for why the guy did it, the answer to that is easy: he was batshit crazy. Nobody is worried about asking Jared Loughner, for example, why he shot the congresswoman and all those other people, because we know he can't give a meaningful answer. As this story by AP's Helen O'Neil discusses, we can't say there has been an increase in these rampage killings recently. The first one I remember was Charles Whitman, who climbed a tower at the University of Texas in 1966 and shot 45 people, killing 13. I was 12 years old at the time. When I was in college, a woman in combat fatigues shot up a nearby shopping mall, and 16 year old Brenda Spencer shot up a school yard in San Diego in the "I don't like Mondays" assault. Usually they're men of course: the Luby's cafeteria massacre, the McDonald's in San Diego, that Vietnam vet who attacked children in a schoolyard, the epidemic of postal service massacres, and more recently Columbine, Virginia Tech . . .
(As I write this, my neighbor is emptying a 12 round magazine. He needs to do that every morning.)
So these keep happening. The distribution in time may not show any obvious pattern, but the distribution in space does. The U.S. seems to be where it happens most often. Sure, there have been massacres in New Zealand, Scotland, and Canada in my memory, but each of them is unique in its particular country. (I'm leaving politically and economically motivated crimes, such as the Mexican drug cartel massacres, for another day. I'm just talking about rampage killings by unconnected individuals.)
Is it something in the culture? I don't really see any evidence of that. Charles Whitman, on autopsy, was found to have a brain tumor. Many of the perpetrators, including Loughner and James Holmes, are manifestly psychotic. We don't understand psychosis well at all; it isn't clear how the zeitgeist influences psychotic fantasies. Obviously you have to know that the CIA exists to believe it has implanted a chip in your brain, or to have heard of Alpha Centauri to believe that extraterrestrials are beaming messages at you from that particular location, but otherwise the form of the delusion is probably sui generis, in other words you could believe you were possessed by a demon. Same idea. So whether violent movies or video games actually make psychotic people violent is far from proven.
There is a pattern of workplace rampages by socially isolated men whose work is their only claim to dignity and who react when something goes wrong there, but I don't know that that is unique to the U.S.
But we all know what is unique to the U.S. The only time I have fired a rifle was at boy scout camp. The weapon had a bolt that you pushed up and pulled back to open the chamber. Then you inserted a single cartridge, pushed the bolt forward and down, and took your one shot. Guess what? If you're hunting deer, that's just as good as a semi-automatic Bushmaster with a 30 round magazine. You only get one shot and if you miss, and try shooting again at the fleeing animal, you are an irresponsible idiot. There is absolutely no reason for people to own semi-automatic weapons or large capacity magazines. They have nothing whatsoever to do with hunting or sport of any kind. They are designed for exactly one purpose, and that is to kill humans. That is the only purpose they are good for.
The arms which the well-regulated militia had the right to keep and bear were muzzle loading muskets. You'd pour black powder down the barrel from your powder horn, then shove a wad of paper down the barrel with a rod, then drop in a ball. Then you could aim and fire, once.
If I want to shoot the chuck that's eating my garden, or bag a turkey for dinner, the most I need is a double barreled shotgun. Break it at the breech, put in two shells, and you're good to go. If I had one, and I lost my marbles, I could maybe shoot two people. Not 26. It's that simple.
Thursday, December 13, 2012
An on-line app from the Guardian that let's you look at death rates globally or regionally, by age, from various causes, in 1990 and 2010.
Worldwide, heart disease and circulatory disease are by far the leading cause of death. No surprise there, but you might be surprised by the importance of chronic respiratory diseases in carrying off the old folks. Unintentional injuries -- falls -- aren't way up there in the rankings but they're pretty important. A broken hip is very often the beginning of the end.
There have also been some big changes since 1990. HIV of course has jumped way up, while other communicable diseases have tended to go down in rank.
Anyway, you get to visualize it all sorts of different ways -- try it, it's very informative.
Jonathan Chait has justly won a wanker of the day award or two, but I'll give him props for this. (No endorsement of the Puffington Host implied or intended.)
I'll put a slightly different spin on it, but the basic idea is correct. The reason the weeping orange man won't specify the spending cuts he's demanding in return for the revenue increases he also won't specify is that he cannot. The United States has a far less generous social safety net than other wealthy countries, our infrastructure is crumbling, our regulatory agencies are underfunded (and they spend little money anyway) -- the one place where we can actually find substantial savings is in the bloated military, while the Republicans have been running around screaming that it's dangerously underfunded since Obama took office. They also campaigned against Obama for cutting Medicare, and now they're complaining that he doesn't want to cut it enough. Not that simple logic ever mattered in political discourse but . . .
The fact is that at some point, Congress is going to have to sit down and pass appropriations bills, and reauthorize the major entitlement programs. Fiscal cliff or not, debt ceiling or not, Orange Julius's House of Representatives is going to have to specify how much the federal government will spend on each and every one of its functions. They can cut funding for stuff they don't like, such as the EPA, but that will have a trivial impact on the budget deficit. They can cut spending on Medicare, but there are only two ways to do that:
- Payment reform and cost-effectiveness guidelines. They claim that is equal to "death panels," so they won't do that.
- Reducing benefits. That's not going to win them any love in 2014.
And they can cut the military budget, but they won't do that.
So they're stuck. The low IQ members may not understand that, but Boehner does. He knows it perfectly well.
Wednesday, December 12, 2012
Our new article in Patient Preference and Adherence is now available open access. (I try to publish open access when I can, but don't always have the funding.)
I really like this piece because we gave voice to people who have been through really tough times and in most cases, overcome. But it required fundamentally changing how they thought of themselves and how they related to the world.
This is one of the consequences of a chronic disease diagnosis -- in this case HIV, but it happens to some extent with heart disease, chronic kidney disease, cancer. The doctor pronounces the word and the world changes. You are still the same person, but in a sense your identity is altered, where you are in the world is different.
Most of these folks, ultimately, made the most of it. But I don't know what the magic pixie dust is that can get people to successfully incorporate the new reality and move ahead courageously. Nor can they say what it was. At some point, it just happened.
Monday, December 10, 2012
While it is true that only a few people are convinced that the apocalypse will occur on a specific, known date, it is tragically also true that there are a lot of people -- I don't specifically remember the polling on this and maybe somebody can come up with a number, but it's close to half of Americans -- believe that it will happen sometime soon, they just can't say exactly when.
You may be old enough to remember that Ronald Reagan's Secretary of the Interior, James Watt, believed that, and said so publicly. He said that environmental conservation was pointless because the environment wasn't going to be around much longer anyway. Yes, that really happened. And maybe that's one reason among several that the looming catastrophe of climate change is largely ignored.
The failure of the Doha climate conference ought to be the top headline in every media outlet. It was buried in a small item inside the NYT this morning and is basically nowhere to be seen on the web sites of the major news networks. But the Reuters story (linked above) gets it right.
At the end of another lavishly-funded U.N. conference that yielded no progress on curbing greenhouse emissions, many of those most concerned about climate change are close to despair. . . .
The conference held in Qatar - the country that produces the largest per-capita volume of greenhouse gases in the world - agreed to extend the emissions-limiting Kyoto Protocol, which would have run out within weeks. But Canada, Russia and Japan - where the protocol was signed 15 years ago - all abandoned the agreement. The United States never ratified it in the first place, and it excludes developing countries where emissions are growing most quickly.
Delegates flew home from Doha without securing a single new pledge to cut pollution from a major emitter. . . . A series of reports released during the Doha talks said the world faced the prospect of 4 degrees Celsius (7.2F) of warming, rather than the 2 degree (3.6F) limit that nations adopted in 2010 as a maximum to avoid dangerous changes. According to the World Bank, that would mean food and water shortages, habitats wiped out, coastal communities wrecked by rising seas, deserts spreading, and droughts both more frequent and severe. Most impact would be borne by the world's poorest.
No, this is not the end of the world. It's not the end times. The universe will go on. But it will be hard times indeed, harder than we have ever known, and that includes World War II and the Dark Ages. Wake the fuck up.
Saturday, December 08, 2012
. . . in just a couple of weeks, my curiosity has again been awakened about why so many people believe in this particular category of balderdash, continually through the ages. This story about the followers of Harold Camping casts a bit of what little light there is to be found, but leaves me unsatisfied. (The on-line magazine Religion Dispatches, from which this is taken, is a good resource, BTW. They write about religion from the outside, without hostility but with appropriately critical thinking.)
As you may recall, Camping was the radio preacher who convinced thousands of people that the apocalypse would occur on May 21, 2011. They quit their jobs, spent their savings promoting the truth to the world, left their kids without college funds, abandoned their homes . . .
Spoiler alert: It didn't happen. The universe sailed on as serenely or tumultuously as ever. But why did they believe this? They weren't just betting on it. They were absolutely certain, as certain as the sun would rise on that day, the earth would be devastated by massive earthquakes, and then the rapture and the end of the universe would occur in October. Which also didn't happen, by the way.
It turns out that many of them are engineers or otherwise mathematically trained. They figured it out, by elaborate reconciliation of scriptural passages. The numerological and textual relationships they found in the Bible could not possibly have been coincidences, they were irrefutable evidence of the truth of the prophecy. Well, okay, but you really have to try very hard to get to that conclusion. Confirmation bias can't happen until you already believe. There's still a piece missing here.
But come to think of it, the same can be said of all religious belief. It's just that much of it doesn't smash to pieces against observable reality quite as hard. Anyway, I'm puzzled.
Thursday, December 06, 2012
As you have no doubt heard, while Americans tell pollsters they like various specific provisions of the Affordable Care Act, the act as a whole still gets less than 50% approval.
Maybe this is why. (PDF -- scroll down to page 8.)
Two and a half years after the law’s passage, six in ten Americans either believe that the health care law establishes a government panel to make decisions about end‐of‐life care for Medicare beneficiaries (39 percent) or are not sure whether or not this is a provision of the ACA (22 percent). The numbers among seniors are very similar: 32 percent of seniors believe the law sets up such panels, 28 percent are not sure. Two in three seniors say the law cuts benefits for people in the traditional Medicare program. In fact, there are no actual cuts in benefits for beneficiaries in the traditional Medicare program, though those enrolled in Medicare Advantage plans may see fewer supplemental benefits once reimbursements to those plans are reduced.
A lie is half way around the world before the truth gets its boots on. The Republicans have succeeded in lying to people, and the corporate media have enabled their lies. This must end, or there is no hope for us.
Tuesday, December 04, 2012
The new policy at NIH is that all publications resulting from NIH funding have to be posted to a repository called PubMed Central for open access after one year. Here's one of mine, that went live today.
Many people -- both doctors and patients -- complain that there isn't enough time in a standard medical visit. In order to make their boat payments, doctors typically average 12 to 15 minutes for regular outpatient visits. In fact, there isn't much evidence that visits used to be a lot longer, but medicine, and life, have gotten more complicated, and that amount of time seems less adequate than it used to. Of course a higher percentage of patients are older and sicker than in the past, and of those who are sick, there's usually more to be done. In addition, we're managing diagnoses that didn't used to exist - "pre-diabetes," high LDL, and so on.
The people in our study all had HIV, and they were visiting HIV specialists, but for these patients, as for most people with HIV, the HIV doc is also their primary care doc. Most of them were doing reasonably well, so these visits, on average, weren't a whole lot longer than 15 minutes. But, they varied a lot. Using a coding method of my devising, we found that longer visits tended to appear to be more "patient-centered" -- less physician verbal dominance (i.e., doctors normally talk more than patients but it was more even in longer visits), more patient questions, more patient expressive utterances, that sort of thing.
As you will often find with me, there's a "but" -- when we looked directly at the really long visits, many of them seemed more patient centered because a lot of what went on wasn't really medicine. In one, the patient spent most of the time griping about his siblings who were squabbling with him over his mother's estate. In another, the doctor spent several minutes teaching the patient about the history of South Africa. In another, the doctor tried to recruit the patient to go to church with her.
So it's not that simple. We're there on business. Most of us expect efficiency and likely value quality over quantity when it comes to interacting with our doctors. In fact, my own mother happened to volunteer to me the other day that she really appreciates how her ophthalmologist concentrates on business and doesn't get into a lot of chit chat. She adores him, but it's because she trusts him to take care of her eye (she only has one), not because he's all up in her stuff. That makes sense to me.
Monday, December 03, 2012
Okay, this study, partly paid for by the National Football League, has gotten a lot of attention. The NYT has a more lay-friendly discussion, but the Times coverage, like most media reports on this, is a bit misleading. Let me first unskew it, and then discuss it.
In a nutshell, the researchers sliced up the donated brains of a bunch of football and hockey players, and some combat veterans (many of whom had played football) and found most of them had brain damage that looked kind of like Alzheimer's disease. They were able to correlate what they saw under the microscope with reported symptoms that they maintain define four stages of traumatic encephalopathy.
Now to unskew. This is actually what we call an existential or phenomenological study. It does not give us information about the prevalence of this sort of damage among football or hockey players. True, this sort of damage was not found in the (fairly small) number of controls they looked at, but these guys' brains were donated in the first place because the families were worried that something was wrong. What this study is telling us more about what can happen to people who suffer repeated blows to the head, but it does not mean 68/85 of football players (or hockey players or combat veterans) actually have this sort of damage.
We still don't know that number, and we don't know a whole lot about the details of what puts people at risk. Maybe some people are more susceptible for reasons of underlying physiology. Maybe particular patterns of injury -- with respect to frequency, age of occurrence, severity and specific physics of the blows, etc. -- are much more dangerous than others. Conceivably, growing awareness among coaches and policies to prevent repeated concussions in a short time have already reduced the risk. We don't know . . .
But. Clearly there is a risk. It seems based on casual observation at least to be quite substantial for professional football players but it also seems to be more than most parents would tolerate even for high school, and certainly for college players. This is quite unpleasant for me to face up to because I am a lifelong pro football fan. They're giving us cheap entertainment and yeah, some of them get fame and fortune but a lot of them only last a couple of years and end up with battered bodies, little in the way of marketable skills, and a few bucks to show for it. Then this disease -- first headaches and depression, then personality changes including angry outbursts, then loss of ability to plan and motivate, then dementia.
You can argue that grown men who take on this risk voluntarily can do what they want. Maybe. But if mothers won't let their sons play, the game will fade away. What other people think doesn't matter. That will be the end of it.