Map of life expectancy at birth from Global Education Project.

Tuesday, October 27, 2015

The flesh of tetrapods

There are many good reasons not to eat meat -- something I have not done for 40 years, by the way. (I do eat some seafood.) But I'm a little nonplussed, if that's the word, by the massive global flapdoodle over this new publication by the World Health Organization saying that eating procesed meats (and probably any red meat) is associated with an elevated risk of cancer.

My nonplussedness is because we have known this for decades. All they are doing is restating epidemiological evidence that has been emerging since the 1980s. This is not a "study" as most reporters have been calling, but a systematic review of what we already know.

The truth is the absolute risk is pretty small, although it certainly pertains to amounts that carnivores do commonly consume. A steak or two strips of bacon a day is the kind of dosage they are looking at, and if you aren't a DFH you probably eat at least that much. This represents something on the order of a 1% lifetime increased risk of cancer. It's far more important not to use tobacco in any form, not to drink to excess, and to maintain a healthy weight. Steering clear of formaldehyde and nuclear waste are also good ideas but you're probably already doing that.

I think the public should be informed, of course. The problem is keeping things in perspective and in proportion. The meat industry is destroying the planet because it produces immense carbon outputs. Making a pound of beef takes 8 pounds of feed. If people ate the vegetable products directly, we'd multiply the product of our farmland, fertilizer, and machinery 8 fold. And we'd cut our risk of cancer by 1 or 2 percent.


Monday, October 26, 2015


My hotel is at the corner of Bourbon and Canal St. and I have to say, I haven't had an opportunity to do any extensive exploration, but I'm disappointed so far. It's incredibly tacky around here, nothing but CVS, McDonald's, store selling junky tourist crap, and yes, strip clubs. Not the New Orleans  I expected at all. I'm sure I'm just in the wrong place.

Anyway, everybody here thinks like I do, which means so far I don't have a lot of revelations for you. But I will say this -- modern medicine is very complicated and it is legitimately difficult for doctors and patients to get on common ground, understand what's important from each other's perspective, and understand each other's explanatory models and reasons for feeling how they feel. And yes, doctors do have feelings -- yes they mostly do care about their patients but not necessarily in a good way from the patients' point of view, because they take it personally when people don't do what they want. Also, when that happens, they usually don't try to find out why.

I'll have more to say soon. At least it's stopped raining.

Friday, October 23, 2015

Jacamo Fina Ne

And I'm off to N'Orleans tomorrow for the International Conference on Communication in Healthcare. Never been there before, glad I'm getting a chance to go before it's under the ocean.

I'll be presenting some of my research on physician-patient communication. Long story short, and probably not a news flash, but doctors still aren't doing a lot of the stuff they should be doing to help us understand and remember what's going on, and make decisions together that work for us.

The way a medical visit ought to go is first, set an agenda. What do you want to accomplish today? And here's what I want to accomplish. If it's too much, what is the priority and what can wait? Then go through it in an organized way. The doctor should ask open questions to invite the patient to express concerns or ask questions of her own. The doctor should explain that there are alternatives, not just say what he or she thinks is best without explaining why. Patients should have a chance to say why they might find it hard to follow advice. They should have a chance to state their own relevant values and goals. The doctor should ask the patient to repeat back, in his or her own words, any important information and instructions. ("Do you understand?" is a waste of oxygen.) And there should be a wrap-up at the end that reviews the important points.

Doesn't sound too hard! Also hardly ever happens. Doctor visits are a disorganized mess and doctors just tell people what to do. And people only remember half of it without prompting. Even with prompting, if there are too many things to remember, people remember fewer of them.

Have you ever been frustrated by a visit with a physician? Why?

Wednesday, October 21, 2015

The Profoundest Evil

Yes, this will be the hottest year globally in recorded history, and it's accompanied by widespread drought in Africa, drought in Australia, a heat wave in India and Pakistan that likely killed several thousand people. It's already here, and it's just going to get worse.

Sorry Atrios, but your "worse humans in America" awards trivialize the real worst humans in the world. They are fossil fuel industry executives, including the executives of Exxon who have known since 1977 that their industry would eventually destroy much of civilization, and who chose to spend millions to cover up and deny this fact so they could keep getting richer.

You know what? That may actually be worse than Hitler.

Monday, October 19, 2015

I guess I shouldn't be so puzzled . . .

by the ability of serial sexual abusers and harassers to get away with it over many years. I have personally seen little of it at my own workplaces. Once a woman I supervised came to me with a complaint about a co-worker, but he was a low status employee and our executive director dealt with the guy quickly and decisively. We also had an executive who behaved inappropriately toward women but they fired him, mostly because of more general incompetence, I think.

I've been in academia full time for 10 years now, and part-time for 10 years before that, and I have to say that tales like that of Geoffrey Marcy and Colin McGinn came as a bit of a surprise. (Here's PZ on Mcginn, and we are talking about a world historical creep here.) So astronomer John Johnson, who had the opportunity to hear stories from many of his female colleagues, helps by explaining the enormous power senior academics have over junior colleagues, and the elements of human nature that make us reluctant to tell others when we have been conned or betrayed. There's a shame that goes along with it, we feel as though it's our own fault. Psychos like McGinn and Marcy know that, and they also know who the deans value more if it does come down to a she said/he said.

It seems this behavior is actually very widespread. If you read the comments on Professor Johnson's post on the Women in Astronomy blog, you'll get the impression that it's the norm in astronomy departments. I don't think I'm so obtuse that it's going on all around me in the School of Public Health, but I am certainly unaware of it. I don't think it's nuts to think that we have a somewhat different culture -- we aren't nearly so male dominated, there are lots of women in top faculty positions in public health. But I'm not so sure what's going on at the medical school . . .

Wednesday, October 14, 2015

Tuesday, October 13, 2015

Yet another one of those campus free speech/political correctness flapdoodles ...

...this time at an Ivy League university in Providence, Rhode Island which shall remain nameless. It seems a student whose real name is Emma Maier wrote two opinion pieces for the student newspaper, the [redacted color] Daily Herald, under the pseudonym (for some reason) M. Dzhali Maier. One of them, which apparently said the native Americans should be grateful for the European invasion, I have not been able to read because the Herald took it down, claiming they did not intend to publish it in the first place, but didn't get the word to the printer in time.

The other, which you can read here, accompanied by an editor's note repudiating it, recounts some largely (though not entirely) accurate history of how technological advances in southwest Asia and Europe led to Europeans being able to conquer distant lands. However, it puts a spin on this history which seems to endorse or justify colonialism and genocide as the privilege of the more technologically capable "race." You actually have to read it carefully to get that, it's not a blatant racist manifesto, but that does look to me like the subtle point.

So, there has been a lot of complaint about the diversity of the Herald editorial board and whether it is proper to publish stuff like this. It so happens that Columbus Day (or Dia de la Raza as others call it) was the occasion for Scott Lemieux to note that the late Christopher Hitchens made the same argument about how the Injuns should be grateful for the European conquest, and published it in The Nation magazine (which also was happy to run his aggressive promotion of George W. Bush's imperial conquest of Mesopotamia).

Of course, The Nation's editors didn't have to publish anything they didn't want to, nor does the Daily Herald, and one may rightly complain. However, once something is published I think the best response is to write your answer. The various statements and proclamations, from the university president and other senior officials, and from various campus organizations, don't really answer these essays so much as just condemn them by labeling them as racist, and insisting that racist statements should not be permitted at the University.

I don't actually agree with that. Racists don't think of themselves as evil, or mistaken. They have what appears to them to be a coherent world view. Not permitting them to express it on university grounds or within the formal means of communication characteristic of the university won't make their beliefs go away, it will just prevent anybody from explaining why they are wrong. So were I the university president, I believe I would have responded somewhat differently. I find this personally offensive, and many others do as well. Let them speak out. But we must be very clear that we don't suppress what we find offensive.

There are lines not to be crossed, of course, including gratuitous insults to specific people, and threats of violence. E.g., don't call people offensive names, don't hang up nooses, that sort of thing. But telling people they aren't allowed to express specific stupid ideas is counterproductive, not to mention a slippery slope. (No, the First Amendment does not govern the policies of a private university. But the rationale for it does apply here.)

Friday, October 09, 2015

Yet another smack down of libertarianism

Brad DeLong presents a quotation from Daniel Kahneman which evokes one of the deep problems with the idea of liberty. I want to dig even a little deeper. Go ahead and read the whole thing, it's just three paragraphs, but here is a snippet:

For behavioral economists, however, freedom has a cost, which is borne by individuals who make bad choices, and by a society that feels obligated to help them.
With respect to this observation, I have previously remarked on motorcycle helmet laws. If you suffer a traumatic brain injury in celebration of your individual liberty and personal responsibility, we the taxpayers are going to pay for your life-long institutional care. You have therefore deprived us of a bit of our liberty. If you have children, it's even worse. This, in a nutshell, is why we sometimes need the nanny state to make us more free, not less.

But it goes deeper than that. We obviously can make choices that we later regret. We want to save the biker from himself because, as Kahnemann points out, we will be obliged to take care of him if we do not. His personal misfortune is still left as his own problem.

But consider. A tobacco addict would be freer today had he never chosen to smoke that first cigarette. Many people with diabetes would have more liberty had there not been a soda machine in their high school, even though it gave them the liberty to drink soda at the time. (Let us presume they can pay for their own health care.) One can endlessly invent such examples. We often appreciate somebody saving us from ourselves, so why not the state?

The simple fact is it is always a tradeoff. There is no such thing as liberty. The universe always limits our possibilities. Granting me one liberty inevitably deprives me, and other people, of others. Whatever freedom I am granted to choose unwisely may cost me less freedom tomorrow.

You see? Moral philosophy is hard. That is why some people never seem to outgrow Ayn Rand.

Wednesday, October 07, 2015

The Nut Party

While Republicans are completely wrong, about everything, one of their weirdest wrongnesses has been the refusal of Republican-led states to accept the Medicaid expansion. While this obviously leaves a lot of vulnerable people unable to obtain medical care, it also does substantial economic and institutional damage to their states. That physicians and hospital owners and executives, who are well-to-do and often Republican, have been unable to howl loud enough to overcome the mindless ideological opposition to the Affordable Care Act, is disturbing.

Reiter et al, in Health Affairs, give us an idea where this might be going. States that refused the Medicaid expansion have a disproportionate number of poor, and rural residents. Since the ACA presumed that all the states would accept the expansion, it reduces federal funds that used to go to hospitals that served a disproportionate share of uninsured people. This means that those rural hospitals in the red states are coming under increasing financial pressure. They are financially vulnerable, often losing money, and may start to go our of business. As the authors write, "Policy makers need to formulate strategies for maintaining
access to care for rural populations residing in nonexpansion states."

Do yuh think? But that would mean, you know, spending money. Which Jesus specifically said not to do for the benefit of poor people. It's right there in the Republican Bible. But then what happens when the rich people who live in the same area lose their hospital?

Monday, October 05, 2015

The Ruling Class

I haven't posted here for a few days because I've been busy with events in Afghanistan, which have been quite outrageous. Anyway, I'm back here now with a different outrage.

You may recall a whiff of corruption affecting my employer, which I recounted a week ago. Well, the ever reliable BMJ is back with the subject for this Monday's post. It seems, according to Anderson et al, that of 442 publicly traded health care industry companies in the U.S. for which information on their Board members was available, 180 had at least one director who was affiliated with academic medicine. That includes 19 of 20 top NIH-funded medical schools. They include 8 medical school deans as well as 121 professors and 15 university presidents or provosts.

Oh yeah -- their average compensation was $193,000 per year. As far as I'm concerned, this is completely unacceptable. As David Rothman says in an accompanying editorial, if the companies want advice from these people they can get it without putting them on the board of directors and matching their academic salaries in exchange for attending a few meetings a year. This is bribery, and it has to stop.

Thursday, October 01, 2015

A mighty wind

The current National Hurricane Center forecast puts the bullseye for hurricane Joaquin precisely on my ass. Fortunately for me, though possibly not for some other people, the meteorological blogger Jeff Masters at Weather Underground (no link because this is so ephemeral) explains that this is just splitting the difference between models that take it out to sea, and models that bury it in the mid-Atlantic. It's far too soon to know what will happen, but regardless they are predicting a lot of flooding rain and onshore wind.

That will cause a lot of damage, and maybe kill some folks, but it would be a lot less if congress didn't spend your money to encourage people to build houses in places where they will inevitably be destroyed. The National Flood Insurance Program is incredibly stupid for many reasons. Here, according to the General Accounting Office, is the first one:

The National Flood Insurance Program (NFIP) is a key component of the federal government’s efforts to limit the damage and financial impact of floods. However, it likely will not generate sufficient revenues to repay the billions of dollars borrowed from the Department of the Treasury (Treasury) to cover claims from the 2005 and 2012 hurricanes or potential claims related to future catastrophic losses. This lack of sufficient revenue highlights what have been structural weaknesses in how the program is funded. While Congress and the Federal Emergency Management Agency (FEMA)—the agency within the Department of Homeland Security (DHS) responsible for managing NFIP—intended that NFIP be funded with premiums collected from policyholders and not with tax dollars, the program was, by design, not actuarially sound. As of December 31, 2014, FEMA owed the Treasury $23 billion, up from $20 billion as of November 2012. FEMA made a $1 billion principal repayment at the end of December 2014—FEMA’s first such payment since 2010.
Another reason it's stupid is that it uses private insurance companies as intermediaries, rather than administering the program itself, and like all corporations, insurance companies are evil and they screw claimants even as 40% of premiums go to administrative expenses, most of that paid "to private insurance intermediaries who sell and manage flood insurance policies on behalf of the federal government but do not bear any risk."

Finally, of course, the sensible thing to do would be to retreat from the rising seas and allow salt marshes and barrier beaches to replace the shore front developments which keep getting wiped out and rebuilt with taxpayer dollars. That would also be good for the marine ecosystem, since the destruction of those regimes has meant loss of spawning grounds and marine biomass production. In the long run, it's inevitable.

But you know, people are stupid.