Map of life expectancy at birth from Global Education Project.

Monday, March 31, 2014

Obviously only one blog post worth making today . . .

That's of course the new release from the Intergovernmental Panel on Climate Change. All the available material is at the link but you might want to start with the Summary for Policymakers, which is only 44 pages long.

The report made the upper right hand corner place of honor in the NYT, but in the smallest possible guise, one column wide. The TV news web sites are still leading with the missing airplane and the mudslide. These are obviously more important than:

i. Risk of death, injury, ill-health, or disrupted livelihoods in low-lying coastal zones and small island developing states and other small islands, due to storm surges, coastal flooding, and sea-level rise.34 [RFC 1-5]
ii. Risk of severe ill-health and disrupted livelihoods for large urban populations due to inland flooding in some regions.35 [RFC 2 and 3]
iii. Systemic risks due to extreme weather events leading to breakdown of infrastructure networks and critical services such as electricity, water supply, and health and emergency
services.36 [RFC 2-4]
iv. Risk of mortality and morbidity during periods of extreme heat, particularly for vulnerable urban populations and those working outdoors in urban or rural areas.37 [RFC 2 and 3]
v. Risk of food insecurity and the breakdown of food systems linked to warming, drought, flooding, and precipitation variability and extremes, particularly for poorer populations in urban and rural settings.38 [RFC 2-4]
vi. Risk of loss of rural livelihoods and income due to insufficient access to drinking and
irrigation water and reduced agricultural productivity, particularly for farmers and pastoralists with minimal capital in semi-arid regions.39 [RFC 2 and 3]
vii. Risk of loss of marine and coastal ecosystems, biodiversity, and the ecosystem goods, functions, and services they provide for coastal livelihoods, especially for fishing
communities in the tropics and the Arctic.40 [RFC 1, 2, and 4]
viii. Risk of loss of terrestrial and inland water ecosystems, biodiversity, and the ecosystem goods, functions, and services they provide for livelihoods.41 [RFC 1, 3, and 4]

Followed, of course, by resource wars, massive refugee crises, and global famine. Ah, no biggie, there's a giant sinkhole in Detroit!

Friday, March 28, 2014


I haven't had anything to say about that missing airplane, for the obvious reason that I don't have anything to say about it. But, as you know, that hasn't stopped the teevee news from talking about nothing else. That's actually good, because it has distracted attention from Crimea and thereby prevented World War III. If not for the missing plane, the past two weeks of teevee news would have consisted exclusively of Republicans taunting president Obama for being a girly man.

But, even though there was at most a scrap or two of new information each day, none of which added up to answers, the 24 hour data free mindless blathering attracted a big audience. CNN is in the business of selling eyeballs to advertisers, and saying nothing meaningful for hours on end worked very well for the purpose. I actually find this interesting.

Interesting aspect number 1: This event is actually not very consequential in the grand scheme of things -- many more people have died in ordinary car crashes in the past two weeks than died in the airplane, just for starters, and obviously there are innumerable other matters that are much more important. Commercial flying is still very safe. But when many people die at once, in a single event, we pay attention. For some reason we particularly seem to like to pay attention to aircraft-related catastrophes, which is why Al Qaeda is always trying to blow up airplanes even though it's easier to blow up other stuff and could also kill more people.

Interesting aspect number 2: The fact is, we Homo sapiens are hard wired to be very interested in out of the ordinary happenings, and we are driven to understand them. That was essential to survival back in the African savannah days. Our ancestors relied on the predictability of their environment to find lunch and avoid becoming it. When something wasn't where it was supposed to be or did something it wasn't supposed to do, they paid attention, and they tried to figure out why. And indeed, this is a bizarre mystery and it's certainly intriguing. I can't help thinking about what might have happened, and I can sort of understand how people might end up riveted to the TV hoping to get a new piece of information that they can fit into their solution structure for the puzzle.

The information which has been publicly stated doesn't actually fit very well with any of the three plausible broad hypotheses: catastrophic electro-mechanical failure of some kind; a hijacking gone awry; or pilot suicide. (Actually, I'm sorry to say, it probably fits best with the latter, but I shouldn't speculate.) Of course the information we have been told could be wrong. But the strangeness of this event makes it all the more intriguing.

The ultimate conclusion is that television news is not for the most part designed to inform, but rather to entertain. Always keep that in mind.

Wednesday, March 26, 2014

Sonja Henie's tutu, wait till the Bible thumpers start cogitating on this . . .

At some unknown day in the next couple of weeks (most likely) surgeons in Pittsburgh will put a human into a state between life and death, I suppose you could say. An undefined state. Heisenberg's cat. I don't know what to call it.

Right now, if your heart isn't beating and you don't have any measurable brain activity, Jack you dead. But . . . this is because a person in that state, ordinarily, has had ongoing metabolic activity while the brain was deprived of oxygen. Brain cells can only survive a couple of minutes in that situation. But, if the body is really cold, metabolic activity slows way down. You may have heard of seemingly miraculous cases of people falling through the ice, being pulled out after an hour or so, and recovering. (Follow the link if you want a fuller explanation.)

So, a few years back Dr. Hasan Alam in Michigan did some experiments with pigs. (If you are a PETA member or sympathizer, you might want to round up your posse right now.) He sedated them and then gave them horrific injuries, equivalent to multiple gunshot wounds. Then he drained all of their blood and replaced it with cold salt water. Then he fixed the injuries. Then he gradually reperfused them with blood. They recovered.

So, next chance they get, a team in Pittsburgh will try this on a human being, who comes in with massive blood loss and cardiac arrest. They figure they'll have as much as two hours to operate and fix all the bleeding points, during which time the person will have no heartbeat, no blood, and no measurable brain activity. But, their brain cells will still be alive, just operating at a greatly reduced metabolic level, as will their other cells. Heating them up slowly enough will avoid injuries, presumably.

Now, let's be clear. People who are currently ruled to be brain dead really are dead because you can't do this. It's too late, their brains have been deprived of oxygen for too long while they were warm. But this does somewhat complicate the definition of death. Oh yeah -- suppose these people report all sorts of hallucinatory experiences, which I expect they will, at least some of them. I don't even want to think about the idiotic discussions we are about to have.

(If you got the people even colder, could you stow them away for years while they journeyed to the stars? You'd need some sort of antifreeze but if that could be worked out, maybe, sure why not?)

Tuesday, March 25, 2014

What fools these mortals be

I've written about this phenomenon before -- people building their houses and farms on the slopes of active volcanoes, eroding barrier beaches, forests that burn every few decades . . .

It turns out geologists have known for decades that hillside in Snohomish county was going to collapse. Geomorphologist Dan Miller, who filed a report for the Washington Department of Ecology in 1997 predicting the disaster that just happened,

could not believe what he saw in 2006, when he returned to the hill within weeks of a landslide that crashed into and plugged the North Fork of the Stillaguamish River, creating a new channel that threatened homes on a street called Steelhead Drive. Instead of seeing homes being vacated, he saw carpenters building new ones.“Frankly, I was shocked that the county permitted any building across from the river,” he said. “We’ve known that it’s been failing,” he said of the hill. “It’s not unknown that this hazard exists.”

Yet one local homeowner, who happened not to be home at the time, said:

“That’s like saying the river is going to flood,” Wood said. “If the hillsides were going to slough away, they were going to slough away. That’s kind of what happens around here.”

Well yeah. But does that mean you shouldn't care about it happening to you? It's a mystery.

Sunday, March 23, 2014

Grifters gotta grift

You may have heard of Joel Osteen, a Houston preacher with a really big congregation. And you may have heard that his church was recently the victim of a $600,000 theft. What you may not have noticed is that the stolen loot was the take from the collection at a single, ordinary church service.

Do the math. He's taking in more than $31 million a year. Just from the collection plate. Who knows what he gets from people who send in money after watching him on TV. I pity the fools who enrich this fraud. Well, a little bit anyway. That's the essence of religion - it's a con game. And it's a good one. Nobody ever comes back from the dead to tell the pigeons it's all a lie.

Here's what he told Piers Morgan about his obscene wealth:

"I don't ever feel guilty because it comes from – it's God's blessings on my life. And for me to apologize for God's – how God has blessed you, it's almost an insult to our God."

Well okay then. If I call him a thief and a liar, I'm insulting God, who after all made him a thief and a liar. Fine with me. I insult thee.

Thursday, March 20, 2014

An "Invisible" World

I just heard a talk from guys with Project Weber, a program here in Providence for male sex workers. This is not a phenomenon that most people even know exists. I'm not talking about high price rent boys like Jeff Gannon, I'm talking about street workers.

According to Project Weber founder Rich Holcomb, most of them identify as heterosexual and they do it out of desperation, usually because they are addicts. It's a horrible, degrading life. Unlike female street workers, who are usually readily identifiable and attract the ire of neighbors and the attentions of the police, they are unrecognizable to most people and get little or no police attention. But they are obviously at very high risk for HIV and other STDs, do cycle in and out of jail due to drug offenses, and are also at high risk of being raped and murdered. In fact Project Weber is named after a kid named Roy Weber, who was murdered in Providence in 2003. The crime has not been solved.

The project hands out condoms and exchanges needles, has a drop-in center, and helps people get into treatment and out of the life if and when they want to. These guys are as down and out as it gets. I expect most people pass moral judgment on them, but the fact is they were typically abused as children, and a lot of them started out as "throwaway kids," kicked out by their parents at a young age, who got into sex work to survive. The addiction may have come before or after.

Most people don't care about them, but the public health response -- as opposed to the Christian response of threatening people with damnation -- demands treating people with compassion and respect. Stigma and shame equal invisibility and just drive people deeper into the shadows and away from hope and help. Thanks to the clean needles and condoms they get from Project Weber, a lot of the guys manage to stay HIV negative until they get clean. And if they do become infected, they can get into medical care and if HIV is treated effectively, the person is not infectious. That's a big win for us all. Caring about the people who are least fortunate is a nice bonus.

Tuesday, March 18, 2014

Science Journamalism

Wow. Just wow.  One Marcy Darnovsky, executive director of an institution called the Center for Genetics and Society, doesn't know anything at all about genetics.

Here's the story. Shoukhrat Mitalipov, a Soviet emigré scientist, has figured out how to insert the nucleus of a human zygote (a fertilized ovum) into the cytoplasm of a donor ovum. The reason for doing this is to make it possible for women who have genetic mitochondrial disorders to have healthy biological offspring.

For those of you who need the background science, it's actually a very interesting fact about our deep evolutionary history. The eukaryotic cell, which is what we are built out of along with all the plants and animals, is the product of a very ancient event in which primitive bacteria became endosymbionts within larger cells, probably archaea.* It may be that the archaeal cell ingested a bacterium, but failed to digest it. The DNA of the archaeal cell is now (apparently) essentially the DNA in our cell nuclei, what we call our genome. (It's possible that some of it derives from the endosymbiont. Some of it also derives from retroviruses. It's a long story. But anyway . . .

Those symbiotic bacteria are now what we call mitochondria, organelles within our cells that generate the energy the cell needs to fuel its chemical machinery. They have a very small genome of their own, just enough to keep them alive and functioning within the highly specific environment of the cytoplasm. And their genes do not determine anything about us, whatsoever, other than how well our mitochondria function. We get 100% of our mitochondrial genes from our mothers, the father's genome has nothing to do with it, because the mitochondria in all of our cells are descendants of the mitochondria in the ovum from which all of our cells descend. In other words, the mitochondria do not reproduce sexually and they have their own, independent line of descent which is exclusively maternal.

So here's what Marcy Darnovsky says:

His research has brought persistent criticism. “If these procedures are carried out, it crosses a very bright line,” said Ms. Darnovsky of the genetics center. She said that the current goal, mitochondrial replacement, may be narrow, but that Dr. Mitalipov’s genetic techniques could lead to broader applications and eventually to a situation in which scientists or governments “compete to enhance future generations,” such as producing soldiers who never need sleep.

No. Completely wrong and astonishingly ignorant. Dr. Mitalipov isn't even using genetic techniques at all. He isn't going near the human genome and what he is doing cannot create enhanced future generations or affect people's sleep or anything else about them. The only thing it can do is create a baby with healthy mitochondria. Period. End of story. One would think that the executive director of the Center for Genetics and Society would know the first thing about genetics. Sadly, no.

The additional problem is that the New York Times science journalist who wrote this story doesn't understand this either, and didn't bother to ask anybody who could explain it to her.

* Archaea and Bacteria are two different kinds of single-celled organisms, which are considered separate "kingdoms," which diverged very early in the history of life on earth. They appear superficially very similar but have large differences in their cellular machinery.

Sunday, March 16, 2014

Re-reading The God Delusion

Not sure why I picked it up again -- not much in there I don't already know and haven't thought about myself, really. But there is one chapter I don't find satisfactory.

That's chapter 5, where Dawkins tries to explain why religion is so pervasive. His main theory is that a) children are indoctrinated early and his evolutionary psychology hypothesis is that we're wired to believe what our elders tell us with great solemnity. E.g., don't swim in the crocodile infested river, do say the correct mumbo jumbo on Sunday; and b) he invokes his beloved meme theory and notices that religion is full of memes that are well tailored to insure their own survival, such as you will be tortured for all eternity if you so much as doubt this out loud.

Well, yeah, but I was indoctrinated as a child. My uncle by marriage was the pastor of a fancy High Episcopal church in an affluent Connecticut shoreline town, which we attended until I was 7 or 8 years old when we moved to another town and started going to a Congregational church, where I participated in all the youth activities and the choir. My mother was a Sunday school teacher. When I got to be 13, I started talking with my uncle about confirmation.

I attended Phillips Academy Andover, where they made us go to church three days a week with of course a big whomping service on Sunday. One day I was sitting there next to my roommate, and we looked at each other, and I said, "This is completely fucking ridiculous." He said, "Yep." From then on we didn't stand up for the hymns or kneel for the prayers, we just sat there and endured it.

Is there anything super special about us? Dave, my roommate, grew up in a Catholic orphanage, and no, he probably didn't tell me everything about that, but he told me enough that I can guess it might have led him to see through the fraud. But for me, it was perfectly simple. I was old enough to think for myself, and it was immediately obvious that the whole thing was transparent nonsense. I had the advantage of having actually read the Bible, unlike most Christians, just because I was a reading fool as a kid.

But I mean, come on. There were only two people in the world and God told them not to eat a piece of fruit but a talking snake persuaded the woman to do it anyway, therefore all of humanity was cursed throughout the generations until God got a woman pregnant with himself, and then had himself tortured to death, but nothing actually changed, life was still a bitch only now we were forgiven? I mean, I don't really give a shit if God forgives me for having a remote ancestor who ate a piece of fruit, but if he wanted to do it, he didn't have to get himself tortured to death. I could go on, but the point is made, I hope. This is batshit insane, all of it.

How anyone can exist who doesn't see that is baffling.

Saturday, March 15, 2014

After decades of struggle . . .

. . . I have finally surrendered. It is impossible to cook dried beans. I'm sticking with canned from now on. It's sad, but one must bow to necessity.

Thursday, March 13, 2014

Conservatism is synonymous with ignorance

I first saw this on Balloon Juice. It seems the Fox affiliate in Oklahoma City found the single, fleeting reference to human evolution in the first episode of Cosmos so offensive that they censored it.

Obviously, Cosmos, as it continues, is going to whip the refugees from the 12th Century who constitute the Republican base into screaming, barely articulate rage. Maybe, just maybe, it will help to move their atavistic idiocy out of the acceptable mainstream.

Wednesday, March 12, 2014

I have no idea whether Herbalife is a pyramid scheme . . .

. . . but it's a scam anyway. (Legal disclaimer: In my opinion.)

The company is in the news because a short seller is trying to knock the share price down with a campaign to show that it doesn't really make money from selling it's snake oil, but from roping in new distributors. Whatever, the products are a fraud.

Here's a typical example. This garbage "Supports the body’s absorption of micronutrients and promotes cellular energy production.*" The asterisk is to tell you that, no it doesn't. "Supports" is the favorite verb for peddlers of fraudulent nostrums, because it doesn't really mean anything. Are you not absorbing your micronutrients? Highly unlikely. Does your cellular energy production need promoting? Only if you have a mitochondrial disease. And no, antioxidants do not "support" healthy aging. As innumerable studies have shown (much discussed here) there is no evidence whatsoever that any antioxidant supplement is associated with any health benefit whatsoever -- and some of them appear to be harmful.

This is 100% crap. It wouldn't surprise me if the whole thing is a pyramid scheme but on the other hand, people do buy similar junk in the CVS, which is not ashamed to sell it. Congress has basically made it impossible for the FDA to regulate this market so they keep getting away with it. Also note the false advertising on TV -- people wearing tinted contact lenses to make their eyes all shiny, telling you to buy special items to "support" eye health. Special vitamin formulations for women, old folks, people who do crossword puzzles, whatever. It's all a con job. 

Monday, March 10, 2014

A weird but interesting natural experiment

The European conquerors of what is today the United States have elected to make reparations to the original inhabitants in a very weird way: specifically, to allow them to open gambling casinos. Whatever you may think of this policy in general, for those tribes lucky enough to get a casino, it has undoubtedly brought economic benefits, or at least free money.

I think you'll only be able to read the abstract of this piece by Jones-Smith, et al but that's okay. They used data on Native American children in California from 2001 through 2012, and they compared kids based on the number of slot machines per capita in their school district. (Really!) Slots per capita correlates with the income of the Native American people.

It turns out that getting a new casino on your territory makes your kids less likely to be overweight or obese. This is pretty strong evidence that poverty causes childhood obesity. You can't do a randomized controlled trial of giving money to half the families and not the others, but this is almost as good -- it's what we call and "instrumental variable," a natural event of some kind that produces quasi-randomization of a population. Now, it's barely conceivable that some other factor is correlated with casino revenues that really explains the observation, but it's hard to think of what that might be.

Okay, why would having adequate income make kids more physically fit? It's easy to think of reasons: better nutritional quality, more recreational opportunities, less stressed out families. Maybe you can think of others.

Anyway, this is just one more brick in the ever growing wall of evidence that poverty can hurt kids for life. Once you are an obese child, you are very likely to end up as an obese adult, and that limits your economic potential as well as your life. I think we owe the Indians something better than the erratically awarded opportunity to run a casino, but at least we have learned something from this. Are you listening Paul Ryan? No, I didn't think so.

Saturday, March 08, 2014

No, I'm not Bartcop . . .

. . . whose death was announced today, in case you were worried  Back when people actually read this blog many people thought I was. (The name I use real life makes the connection, but actually, his name was not Bart, whereas mine is.) However, I did correspond with him, around the time he was first diagnosed with cancer. I also had some correspondence with his friend Marc Perkel.

Bartcop was one of the most important liberal bloggers to emerge early in the reign of Chimpoleon the First, Emperor of Mesopotamia, AKA George Bush II. His palpable anger was always fully justified, his wit was sharp, and his reading immense. Eventually Bartcop faded into the blogosphere as it grew vastly larger, but he was seminal in getting the whole thing started.

Thursday, March 06, 2014

Where I'm at

I'm in DC for a grantee meeting of the Patient Centered Outcomes Research Institute (PCORI). I may have had a bit to say about PCORI before, can't quite remember, but it's important for the masses to know about.

PCORI is the product of a little-noticed provision of the Affordable Care Act. More specifically, along with the Medicare Independent Payment Advisory Board, it is one of two Death Panels. (Ha ha.) Actually, it has been characterized in that way, as being a way of "rationing" health care. What it really does is fund research, specifically comparative effectiveness research. In other words, the mandate is to learn what medical interventions work best for what people. The "patient centered" in the name means that PCORI has to define outcomes in terms of what matters for patients, and the way they do that is by involving patients as collaborators in all stages of the research process. By law (and very unfortunately), PCORI is not allowed to calculate cost effectiveness or even use Quality Adjusted Life Years as an outcome measure. Still, if you find out that intervention A costs more but intervention B is more effective and gives you less pain along the way, presumably you'll choose B and we will save some money.

PCORI is funded by a surcharge on health insurance premiums. Yes, a tax. Since it will presumably help insurers save money, they ought to be for it, but so far they haven't been talking. PCORI is a private non-profit, congressionally chartered corporation, not a government agency. So congress can't defund it by inaction. As long as the Dems have at least one house of Congress or the presidency, it should continue on. But it sunsets in 2019, and will have to be reauthorized before then.

With NIH funding being steadily reduced, this helps a bit to fill the gap in health care research. But the focus is very specifically work that NIH does not fund so much of. We aren't about making new biomedical discoveries, we're about using the technology we already have wisely. We're about making it easier for patients to understand what's going on and make decisions in their own interest. How that's rationing or death panels I can't quite figure out, you'll have to ask a Republican.

I'll say more about this, including my own work, anon. The challenge of getting doctors and the medical institution to change course and really be built around serving patients is huge, but that's what PCORI is trying to do. And they're sincere about it. Write your congressritter.

Monday, March 03, 2014

Granny on the ice floe?

There's been plenty of froo frah over people being injured by avoidable errors in hospitals -- back in 1999 the Institute of Medicine reported that at least 44,000 people, and maybe 98,000, died in hospitals every year from preventable errors. That was a famous report and we've been talking about it ever since.

Now the Medicare Inspector General says that more than 1,500 nursing home patients died from preventable errors in August, 2011, with much larger numbers being harmed. Also, this results in preventable hospital admissions costing Medicare $208 million per month.

Skilled nursing facilities vary a lot in quality, but I can tell you from my own experience that a) they are generally physician-free zones; and b) staff are often harried and resort to drugging people to keep them quiet and docile (called a "chemical straitjacket.") There are a few solvable problems here but one is that financial incentives can be perverse. The skilled nursing facility isn't penalized for avoidable hospitalizations. I don't think Medicare reimbursement rates are inadequate, but the same facilities have Medicaid patients (who have exhausted their Medicare long term care benefits and personal assets) for whom they are being paid less. And yes, some operators are unscrupulous.

Unfortunately, there aren't enough beds in the really good facilities and they won't even take Medicaid patients. This isn't my personal area of research but it's something we all need to take personally because we have parents or grandparents who end up in these places, or we will ourselves. We need to do better.

Sunday, March 02, 2014

Killing Kim Jong Un

You may have noticed the recent UN report on North Korea that tells us what we already knew: not a nice government at all. In fact the most hellish place on earth. As I say, not exactly news. But I have an entirely different point to make.

One of the first commenters on the Daily Kos diary about this wanted to know why we don't just send in the SEALS to kill him as we did Osama bin Laden. There are many reasons why that would not be a good idea, the first being that it wouldn't work. Unlike bin Laden, Kim is very well protected by soldiers with guns, and the helicopters would not just sit there unmolested while the SEALS shot it out with them.  But, Kim is not in hiding. He makes public appearances and I presume the locations of his residences and workplaces are known to western intelligence. So he could be whacked with a tomahawk cruise missile. But that would be an equally bad idea.

I'm sure my Dear Readers can think of all the reasons why. But I'll just short circuit that discussion to say that the people outside of North Korea who have the biggest stake in this and know the most about it are obviously not Americans, but South Koreans. And they very clearly would not want the U.S. to assassinate Kim. In other words, it's not particularly our problem.

So let's turn now to Ukraine. We hear all this yammering from the right about how the crisis in Ukraine is somehow a failure by the Obama administration. "We" failed to do whatever it was we should have done to stop Putin from acting aggressively in the Crimea, and "we" have to defend the territorial integrity of Ukraine, and "we" will be disgraced and look like wimps if Obama doesn't do whatever it is he's supposed to do about this, which is not specified.

The fact is, what happens to Ukraine matters to Ukrainians, and to their neighbors, but it really doesn't have anything to do with the United States. That the Crimea is part of Ukraine today is actually the result of a historic oddity. (Kruschev attached it administratively to Ukraine when the whole thing was part of the Soviet Union so it didn't really matter. The Crimea was always a part of Russia and its population today is majority Russian. People of other ethnicities were expelled during Soviet rule but that's water over the dam.) So for Crimea to revert to Russian control would not be an injustice, per se, although I expect most of its current ethnically Russian inhabitants are leery of the Putin regime and the neo-fascist philosophy he has cobbled out of the wreckage of Stalinism. But that's yet another story.

What is at stake here is the means by which intra- and international disputes are to be settled, and borders drawn. The potential for an unfortunate precedent -- well hardly a new one, but one we had hoped was inoperative -- is real. But the cost to Russia would be great. Instead of good relations with a unified Ukraine, they'd have a relentlessly hostile neighbor aligned with a newly enraged Europe, in return for biting off a slice of territory in which they already had a military presence. This would be an unfortunate development, bad for the world, but there is nothing in particular that "we" can do about it nor is it in any way the fault of some sin of omission on the part of the United States.

So, in sum, we have got to get over the mindless reaction of thinking that everything that goes on in the world is all about the United States, that we're responsible for fixing everything, and if we don't, it's a failure by somebody. We should do what we can to make the planet better, but sometimes that isn't very much. Have the wisdom to know the difference.