Mass assault of bullshit

You knew it would happen. The headline on the CBS News web site this morning: "Is the violence in Iraq Obama's fault? The worsening fallout from the Iraq war Obama ended is casting a long shadow over his foreign policy." NPR this morning featured Vali Nasr of the Johns Hopkins School of Advanced International Studies arguing that the partition of Iraq would be a disastrous failure for U.S. foreign policy and that "we" have to take responsibility for maintaining the Shiite government's control over all of Iraq. (NPR didn't bother to mention that Nasr grew up in Iran. Relevant?) And similar dreck is all over the place, coming from Republican politicians of course but also as the unexamined assumption of the corporate media. The Iraqi government that the U.S. installed, and the Iraqi army that the U.S. armed and trained, are a fortiori U.S. allies and assets and we have to continue to back them and defend them.

Funny thing -- Iran is already sending Revolutionary Guards to Iraq. Wait a minute, I thought Iran was the bad guys? Now we're supposed to fight alongside them? What's going on here?

Here's the truth. The United States has absolutely no national interest in preserving the arbitrary map of the Middle East that was drawn by departing European colonial powers. Iraq is an artificial creation, and its territorial integrity is already fictitious. Iraqi Kurdistan was de facto independent before the U.S. invasion. The Kurds have taken advantage of the current chaos to expand their own territory. If there ends up being a Sunni Arab state in part of what is now Iraq and Syria, why would it matter to the United States in the slightest? It wouldn't. This has nothing to do with us, there is no national interest at stake, and there is no conceivable reason why it should be a goal of U.S. foreign policy to prevent it or a failure of U.S. foreign policy if it happens.

ISIS is bad guys who we don't like. True. But the population of Anbar and Nineveh provinces also feels the same way about the Iraqi government, and they won't defend it. We don't know how the political situation within the breakaway Sunni region will evolve -- it may well be that ISIS, having spearheaded the secession fight, will ultimately be unable to maintain political control. Or it may be that Iraqi and Iranian forces will be able to re-exert some degree of control over the territory. But whatever happens, it is not our problem, and there is nothing constructive we can do about it except stay the hell away.

Obama was right to get out of Iraq. The Iraqi people didn't want the U.S. military there, and the government would not allow it. So they left. What happens next is just something for us to watch.

Understanding Iraq

The corporate media, and for that matter U.S. politicians of all stripes, are fundamentally misunderstanding what is happening in Iraq. The collapse of the Iraqi army in Mosul and cities to the south along the Tigris is not essentially about the rise of ISIS (aka ISIL) as a powerful extremist force; it is fundamentally about the sectarian misrule of Iraqi Prime Minister Nuri al-Maliki and his allies in political Shiism. Former U.S. diplomat Wayne White (oddly appearing here in an Iranian web magazine), has a sharp analysis. ISIS is successful because the largely Sunni population of Anbar and Nineveh provinces hates the government more than they fear the extremists; and because ISIS has allies of convenience in Baathist revanchists and other Sunni militias and vigilante forces. As White says:

Maliki’s refusal to capitalize on Sunni Arab assistance brokered by the US was a missed opportunity of vast importance. Back in 2007-08, most Sunni Arabs were profoundly war weary after several years of bruising combat with US forces. As a result, a community previously determined to resist US forces and a government dominated by Iraqi Shi’a and Kurds, reluctantly accepted new realities. In exchange for ending their resistance and helping to battle AQI, Sunni Arabs expected a fair share of Iraq’s political pie, more government employment, and an appropriate slice of the country’s revenues. This, however, was not to be.

Securing a freer hand to deal with Iraq’s Sunni Arabs more harshly appears to have been one reason Maliki and his Iraqi allies backed away from the immunity agreement needed to allow a limited US military presence to remain behind after the American withdrawal. Both the Bush and Obama administrations tried and failed to secure this. Then, within 48 hours of the departure of the last US troops in mid-December 2011, Maliki had an arrest warrant issued against Iraq’s most senior Sunni Arab official, Deputy Prime Minister Tariq al-Hashemi, charging him with alleged involvement in “terrorism.” .. . .

The Kurdish army (peshmerga) has taken advantage of the chaos to seize control of the city of Kirkuk, disputed between Arabs and Kurds. The ISIS advance toward Baghdad is unlikely to get far -- despite the mass desertion in Mosul, the Iraqi army outnumbers the insurgency by an order of magnitude, has vast superiority in heavy weaponry, and has helicopters. Worryingly, however, Maliki is raising Shiite militias to join the battle, which will only intensify the sectarian character of the conflict. The peshmerga, a formidable and disciplined force, also do not like ISIS and will probably help succor the Maliki government if it comes to that, although for now they are taking care of Kurdistan. There is also concern, however, that Iran will enter the fray and their are reports that Revolutionary Guards have already gone to Iraq.

All of this creates a likelihood that the relatively few Sunni Arabs in the Iraqi army and other security services may defect, and that full-scale civil war will erupt, perhaps drawing in the Sunni Gulf monarchies to confront Iran. Should the U.S., at this stage, intervene to rescue Maliki and the Shiite government of Iraq? Doesn't seem like it to me, but whatever the U.S. does, the situation is very dangerous. Oh yeah -- fill up your tank, gasoline is about to get  lot more expensive.

Update: Emirates News has a much more detailed factual report  than you'll get from U.S. media. Apparently ISIS has managed to get a couple of captured helicopters into the air, which definitely suggests defection by Iraqi army personnel. They also see it as going without saying that this is essentially a sectarian civil war. 

March Hauser: The Denoument

I missed it at the time, but it turns out the Boston Globe obtained Harvard's internal investigative report a couple of weeks ago and it's about as ugly as can be.

To whit:

The 85-page report details instances in which Hauser changed data so that it would show a desired effect. It shows that he more than once rebuffed or downplayed questions and concerns from people in his laboratory about how a result was obtained. The report also describes “a disturbing pattern of misrepresentation of results and shading of truth” and a “reckless disregard for basic scientific standards.”

In a pistachio shell, when his experiments didn't get the results he wanted, he changed the data.

I find this very difficult to understand. Post docs competing for the dwindling share of faculty appointments, assistant professors desperately striving for tenure, frustrated non-entities seeing no chance for glory, yeah, they have motives to cheat and you can make all sorts of arguments about how academic culture, the social organization of science, the competition for grant funding as public support for science yo-yos, all contribute to scientific misconduct.

But none of this applied to Hauser. He was already tenured at Harvard, already famous, already positioned to suck up all the funding he needed. He had no discernible motive for fraud. And his general program of research does not appear to be a tissue of fraud; it's just some particular experiments that didn't go his way. People often write that an experiment "failed." There's no such thing. If it's well done, then the result is informative, no matter what it is. Maybe it turns out that your idea for a warp drive won't allow you to travel faster than light after all, but now you know something that you didn't know before. Maybe your monkeys can't figure out how to do division, but now you know. It still counts, and it has the virtue of being true.

Evidently Hauser is out on Cape Cod somewhere working with at risk youth. I hope he isn't purporting to be a role model.

Isn't there anything we can do about this shit?

I'm guessing you're probably like me, and you're starting to get a little bit tired of wackos committing random acts of mass murder. Yeah, it's a bad thing.

So everybody's got a diagnosis and a prescription. Better mental health services. Rooting out misogyny and delusional extremism from the culture. Making it harder for nutcases to get guns. All that sounds good, if not necessarily evidently possible, but . . .

Here's the problem, looking at this from a public health perspective. We really don't know how to predict that somebody is going to be violent. Well, that's not quite true -- past violent behavior is a useful predictor of future violent behavior. There is an elevated risk of violence among people who are simultaneously seriously and persistently mentally ill, and also have substance abuse disorder, but even there it's only a minority. But being mentally ill, as a general category, is not predictive of violence. Most people who commit bizarre acts of violence against strangers could be said after the fact to have a diagnosable mental disorder, but that's really tautological. Whether you want to say that people who behave in extremely deviant ways have a disease or not is really just a semantic argument, it doesn't mean anything. The point is, we can't predict.

And that's really nut. We aren't about to start restricting political speech in this country, and we shouldn't. Direct threats of violence can be against the law, but Glenn Beck's conspiracy theories and George Will's endorsement of rape and Bill O'Reilly's provocations against abortion providers -- you just can't draw the line. If the culture is full of angry, hate filled people with ideas that they use to justify violence, there isn't any law you can pass against it.

And, we can't start taking rights away from people who get a diagnosis of mental illness, that we extend to everybody else. In case you didn't know it, the vast majority of people qualify for a psychiatric diagnosis at some point in their lives, if not all the time. Getting a psychiatric diagnostic label is pretty much a random event that doesn't mean anything.

Finally, by now, the U.S. is saturated with firearms. We're never going to recall them. I'm all for reasonable regulation, just like we regulate cars and drivers, but that's not going to stop a nutjob.

So, if we could improve our ability to predict who's going to go postal, we might be able to do something. But until that happens, I despair.

Campaigning against motherhood and apple pie

Republicans are still insisting that the Affordable Care Act is a disastrous failure, and they still plan to build this year's congressional campaign around repealing it. But a funny thing happened on the way to the trainwreck. As Krugzilla shows, it's working just fine, thanks, in fact at the high end of expectations. The number of uninsured people in the U.S. fell sharply after the main provisions of the law went into effect, and gains in employment jumped at the same time.

But, most voters still don't know what's in the act, how it works, and why it works the way it does. They just know they're supposed to hate it, but they don't know why. I actually don't think it will be a winning issue for Republicans, but that it isn't yet a winning issue for Democrats is largely because of our dysfunctional corporate media, that dutifully transcribes politicians' fact free commentary without bothering to explain the reality. Until that changes, the long decline of the United States will continue.

PETA Bait

You'll often see people who I agree with about a whole lot of important subjects defending the importance of animal research to the advancement of medicine and the relief of human suffering and disability.

The picture most people, including scientists have of the typical course of biomedical research is that you first create an animal "model" of human disease; you study the animals to try to understand the disease better; then you test treatments in the animals. Ones that seem promising then get clinical trials in humans. According to this putative reality, If PETA gets its way, and we can't do this any more, we will never find cures for multiple sclerosis and Alzheimer's disease and pancreatic cancer and all those other horrors. It's too bad for the animals, but human welfare and survival are more important.

According to Pandora Pound and Michael Bracken, writing in BMJ, not so. In order to make the best judgments about what treatments work in humans, we do systematic reviews and meta-analyses to pull together information from all the available studies, assess its quality, and combine the highest quality information to generate conclusions and assess  how confident in them we can be. Lately, investigators have worked hard to overcome the problems of publication bias, cherry picking of results and other flaws in the scientific enterprise that often lead to overuse of treatments without good evidence. We have a long way to go, but we're getting better at it.

In animal studies, however, there is far less accountability for quality and synthesis of results. Pound and Bracken cite one survey that found only 12% of animal studies used random allocation and only 14% had blind assessment. Selective analysis and publication bias result in distortion of "entire bodies of research," according to another reviews. Meta-analyses are rare.

When treatments enter clinical trials in humans based on animal research, they are overwhelmingly likely to fail. P&B also note that decades of research have failed to yield a single treatment for stroke, ALS, and other conditions.

Not only are there problems with research quality, reporting and synthesis, but it is questionable how useful animal models are for understanding human health or predicting human responses to treatment in the first place. There are just too many differences between humans and rodents, or even other primates, for treatments to translate in most cases.

There is an enormous vested interest in animal research, and you know these claims will generate massive yelling and screaming. Note, of course, that this is unrelated to the conduct of basic research intended to understand the animals themselves. We're talking about biomedical research purported to ultimately benefit humans. That relationship is far more tenuous than most people believe, and the effort generates enormous waste and massive failure much more often than it generates anything useful. That's what Pound and Bracken are arguing. This is a debate that people need to approach with an open mind.

About those carbon emission regulations . . .

How important are the proposed EPA regulations on power plant emissions? Actually not too shabby, I would say. Ben Adler at Grist runs down the content of the proposal, which is more than your average newspaper or talking head has bothered to do. The regulations bind the states to reductions based on their (2005) baseline, defined as emissions per megawatt hour of generation, however they want to do it. The 2005 baseline is cheating because emissions are already down from that year, due to abundant natural gas and the recession, mostly. So there's a head start, and the target -- a 30% reduction by 2030 --is considered unambitious by environmentalists.

But -- this will establish a national policy and give the U.S. more credibility in international negotiations. That is if and only if a Democrat is elected president in 2016, of course, because the regulations probably won't even be implemented until then. As Ezra Klein explains, Republicans were actually for controlling carbon emissions until recently. In fact, John McCain and Sarah Palin ran on a platform of a cap and trade system that would reduce emissions by much more than Obama's proposal. Really. In 2008, John McCain said this: "Whether we call it 'climate change' or 'global warming, among environmental dangers it is surely the most serious of all." But then the Koch brothers purchased his withered soul.

The proposed EPA regulations are far too little by themselves to save us from catastrophe. But they will force a substantive public debate, for a change, and at least we're starting to do something. Dangerous and costly warming is inevitable, but we can still keep it to the low range of awful.

Highly Misplaced Fear and Trembling

It's been amusing (I guess that's the word) watching Republican politicians freak out over the exchange of 5 Taliban prisoners for a U.S. soldier. Yes, these guys were high ranking -- actually they were mostly civilian leadership of the Taliban government. They are described as "hardened killers" but that's because the Taliban regime was violent. The only people they ever bothered were Afghans. They can't be prosecuted because they haven't violated any U.S. laws. They were prisoners of war, which means they have to be released some day.

The U.S. has been trying for some time to arrange a peace deal in Afghanistan, as has the Afghan government. Qatar has been acting as intermediary all along. This is just part of that process, a necessary clearing of one obstacle which may help get to a result that will end the violence in that long-suffering country. Meanwhile, there are thousands of Taliban fighters. Adding five old guys to their numbers isn't going to suddenly make the Taliban more dangerous. It's inconsequential.

But we seem to view "terrorists" (which they actually aren't) as having supernatural powers. It's ridiculous. And oh yeah, whether Bowe Bergdahl deserted or was derelict in his duty is completely irrelevant. Get a grip, folks.

Progress report

For anyone out there contemplating arthroplasty of the thumb,  I can tell you that after nearly 8 weeks I am slowly regaining good use of my left hand. Wednesday and today I used the weed wacker, which actually doesn't require a contribution from the left thumb -- you pretty much grab the handle with the fingers -- but even so, that would have put unbearable pressure on the sore spot not long ago. I also used a chainsaw, briefly, yesterday and today, but decided not to resume major combat operations just yet.

So yeah, I'm hopeful that this will work in the long run. Still, it's a really violent intervention. They remove the trapezium -- the bone at the base of the thumb -- and stuff the cavity with tissue harvested from a wrist tendon. There has got to be a better way, but I'm guessing they figured out how to do this by experimenting with trauma reconstruction. You would never inflict it on someone with a useable hand, no matter how painful, purely on spec. That means they started out with people whose trapeziums were destroyed, so that's what they know how to do. There is, obviously, no animal model for the human hand so PETA will be glad to know that's out.

There are some slightly different approaches to this surgery but they've never had head-to-head trials. My surgeon does it his way and that's that. Unfortunately, this is true of many medical interventions. That's why there's a lot of emphasis these days on comparative effectiveness research but we have a decades long agenda ahead of us. I expect few people are really aware of how much we are still struggling with an insufficient evidence base for medicine. Obviously, we've learned a lot and medicine is getting more effective, but we still don't know, in many cases, how to make the best use of the technology we already have, nor do we necessarily understand what we're doing.

In the case of osteoarthritis, why is bone-on-bone contact painful in the first place? There are no nerve endings in bone. Yet we can only fix it by removing and replacing entire joints. I think we're missing something here.

Then, Now, and Yet to Come

The invaluable Brad DeLong and the invaluable George Monbiot today present us with bookend essays that define our essential -- our existential -- crisis.

DeLong tells the story of humanity. The human population was probably about 4 million in 10,000 BC, at the dawn of civilization; 170 million in Year 1, the crest of the Roman Empire; and 720 million in 1750. Then, boom goes the dynamite. 1.8 billion in 1900, and more than 6 billion today, just 100 years later. Wait, there's more: until 1750, nearly everyone lived at a bare level of subsistence, their growth stunted by chronic malnutrition. Based on plausible assumptions and definitions, GDP per capita remained unchanged from 100,000 BC to about 1500 AD at about $400-500, then increased very slowly to a little over $1,000 in 1900, then once again, Kaboom! to more than $6,000 today.

Monbiot explains:

Economic growth is an artefact of the use of fossil fuels. Before large amounts of coal were extracted, every upswing in industrial production would be met with a downswing in agricultural production, as the charcoal or horse power required by industry reduced the land available for growing food. Every prior industrial revolution collapsed, as growth could not be sustained. But coal broke this cycle and enabled – for a few hundred years – the phenomenon we now call sustained growth.

It was neither capitalism nor communism that made possible the progress and the pathologies (total war, the unprecedented concentration of global wealth, planetary destruction) of the modern age. It was coal, followed by oil and gas. The meta-trend, the mother narrative, is carbon-fuelled expansion. Our ideologies are mere subplots. Now, as the most accessible reserves have been exhausted, we must ransack the hidden corners of the planet to sustain our impossible proposition.

But, this cannot continue. As Monbiot also points out, with a growth rate of 4.5% per year, one cubic meter of fixed capital would grow to the volume of 2.5 billion billion solar systems in 3,000 years. We don't have to wait that long, however, to hit the absolute limit of economic growth. Maybe we have 50 years. As Monbiot concludes, "The inescapable failure of a society built upon growth and its destruction of the Earth’s living systems are the overwhelming facts of our existence. As a result they are mentioned almost nowhere. They are the 21st Century’s great taboo, the subjects guaranteed to alienate your friends and neighbours."

Well, we need to break the taboo. Loudly. Now.

What gets our attention

Mass shooting incidents account for only a small fraction of gun violence, but they become big news, while the everyday drumbeat of domestic and ordinary criminal violence fades into the background. I stopped by a couple of the popular blogs today and the postings on the mass murder in Isla Vista have attracted hundreds of comments. Viz PZ, who copies much of the killer's manifesto.

Not surprisingly, Myers uses this as an occasion to condemn his arch enemy Men's Rights Activists, but the comments don't have any particular discernible central concern or pattern, they seem all over the place. A lot of the argument is over whether we should blame mental illness, which I suppose just comes down to the semantic argument over whether you want to call whatever was wrong with the guy a disease.

Anyway, Mother Jones provides a handy dandy guide to mass murder in the U.S., of which they count 70 incidents in the past 30 years. (Definition: 4 or more dead, not counting the shooter, in one incident.) Most of the weapons used were obtained legally, almost all of the killers were male, and the venues were generally schools, workplaces or public places. But you probably knew all that just from your overall impression. Most of the weapons were semi-automatic handguns, which would not be affected by an assault rifle ban.

So, if we aren't going to eliminate routine sale and ownership of firearms, which we aren't, other than banning testosterone I'm not sure what to do. There always have been, and always will be, the occasional guy who goes amok. If he has a gun, the consequences will be worse than if he doesn't. That's the world we live in.

It's in the New York Times!

The Times does occasionally make mistakes (I know, I know, this news must come as a serious blow), but identifying Noam Chomsky as a professor at Harvard Divinity School has to be the weirdest ever. (Can't link to it because they've already corrected it on the web version.)

Equally weird was an ad that appeared therein today, from these folks. It's actually quite common for raving psychotics to have enough money to buy half-page or full-age ads in the Times. It's not a surprise that they exist, but how do they get rich? But the more important point here is that this drivel is actually indistinguishable from religion in general. It's no more meaningless than any theological language, just less familiar. No statement about God is meaningful, because the concept is nonsensical to begin with. I happen to know that Noam agrees with me.

Les Izmore

A couple of interesting, or should I say egregious items in this week's medical journals. (You'll probably just get the abstracts, if that.)

Barnett and Linder proffer a research letter to JAMA which quite frankly baffles me. We have known for decades that antibiotics are not effective for acute bronchitis. CDC and others have been working to reduce antibiotic prescribing for acute bronchitis, and the leading quality measurement system, the Healthcare Effectiveness Data and Information Set metric is that antibiotic prescribing for acute bronchitis should be zero. Zip, zilch, nada. Don't do it, doc!

And yet, and yet . . . Based on the National Ambulatory Medical Care Survey and the hospital equivalent, which includes emergency departments, from 1996 to 2010 the rate of prescribing went up. It's nearly 80% -- that's right, 80% -- in primary care and about 70% in emergency departments. And physicians are prescribing broad spectrum antibiotics which are a) expensive and b) contributing widely to antibiotic resistance. Also, too, antibiotics are bad for you because they kill your symbiotic microflora. Why on earth is this happening? Beats the hell out of me.

Meanwhile, over at the New England Journal of Medicine, members of the Swiss Medical Board explain why they recommend abolishing routine mammographic screening. It seems that based on survey data, U.S. women estimate that if 1,000 women 50 to 60 are screened every year, deaths from breast cancer will be reduced from 160 to 80. Seems worth it, no?

Here's the cold truth. Based on the best available data, the actual reduction in breast cancer mortality would be from 5 to 4. And it's quite possible that the one death averted would be replaced by death from another cause. At the same time, "For every breast-cancer death prevented in U.S. women over a 10-year course of annual screening beginning at 50 years of age, 490 to 670 women are likely to have a false positive mammogram with repeat examination; 70 to 100, an unnecessary biopsy; and 3 to 14, an overdiagnosed breast cancer that would never have become clinically apparent." "Overdiagnosed breast cancer" likely means surgery, radiation, chemotherapy, and terror. Maybe not so worth it?

Any time somebody makes an assertion of this nature, screaming vengeful hordes descend upon them, accusing them of not valuing women's lives and basically committing murder and mayhem. Oncologists and surgeons and radiologists and drug companies make big bucks off of this. But women should make up their own minds.

Oh yeah, that'll work

President Obama's chief counterterorrism advisor has written to the deans of schools of public health saying that the CIA has abandoned the practice of using vaccination programs as a ruse to collect intelligence. As you may recall, this is a response to the shitstorm over the fake vaccination program in Abbotobad they used to try to confirm that Osama bin Laden was living there.

The fake vaccination program didn't work -- they failed to get ObL's DNA -- but it did result in numerous vaccination workers in Pakistan being murdered, contributing to the resurgence of polio in Pakistan and putting the world in peril.

But that's okay now, if the director of the CIA says something, then clearly everybody in the tribal regions of Pakistan will believe him. They never lie, after all.

In case you're interested . . .

"Some guy's faculty page" in the sidebar has an updated link. This was a major technical enterprise that took two years and as far as I can tell didn't result in any improvement but what the heck.

This is a major peeve of mine. They keep updating software, from Windows to G mail to Word to EndNote, you name it, and it just gets harder to use and doesn't do anything it couldn't do before. It works just fine, leave it alone.

That is all.

News of the Day and various items

A reader asks if I have discussed prescribing Xanax to elderly people here. Actually I don't think I have, although I have discussed antipsychotic prescribing to elderly people. Advanced age is definitely a counterindication for benzodiazepines, one study even finding an increased risk of dementia, although this study is small and I haven't seen a meta-analysis. Still, elderly people metabolize benzos more slowly, so they get higher plasma concentrations, and they are therefore at higher risk for the usual side effects such as drowsiness. However, I also tend to think that belonging to the species Homo sapiens is also a counterindication. Finally, benzos have considerable potential for producing dependency.

As for searching my blog, I can do it myself with my credentials but I don't know if there's a way for the general public to do it. But if you have any requests, I'll consider them.

In other news, tomorrow is the 10th anniversary of the first legally recognized same sex marriage in the U.S. At the time, many of us were concerned that it had been brought about by judicial fiat, not the legislative process. However, as soon as people noticed that in fact, nothing bad happened -- fire and brimstone did not rain down upon the Commonwealth, other people's marriages were unaffected, and restaurants and caterers made more money -- it suddenly became fine with people. And that's what's been spreading all over the place. Once it's familiar, and all the horrific consequences manifestly fail to appear, what the heck, why not?

In less happy news, former New England Patriots tight end Aaron Hernandez has been indicted on 2 more murder charges, unrelated to the murder for which he is already awaiting trial. Why do I bring this up? He played the entire 2012 season after he allegedly murdered 2 strangers out of mild pique, apparently, over an interaction in a bar. Here's what he said to a reporter 11 days after the murders:

“Aaron, was your summer as crazy as Gronk’s?
“Um, more private,” Hernandez said to the delight of the crowd surrounding him. “But I still had some fun.”
Like what? Can you give us some examples of the fun you had?
“That’s still private but…” Hernandez said to more laughter. “Next question.”

 As it happens, he had already shot at least one guy, non-fatally, while he was on the Florida team, and there was a whole lot of other crap the Florida coaches new about, but they hushed it up. The guy's a total psycho thug but it's okay, he's a star athlete. We have some serious warpage in our culture.

Finally, it so happens I have met Jill Abramson, she is married to my buddy down the street while I was growing up. (Haven't seen Henry for years now.) Billions of people are discussing this, causing a serious depletion of electrons, but I will just say that in case you didn't know it, the NYT is owned by a hereditary dynasty and while no doubt working women face similar crap at all levels, another lesson here is that this is what you get when you live in a plutocracy.

Man bites dog

Specifically, that would be U.S. Postal Service public affairs officer Mark Saunders. Well, only metaphorically. He writes to remind us that it's not a myth or a funny cartoon scenario: 5,581 postal employees were attacked by dogs last year. That may sound like a lot but it's only a bit more than 1/1,000th of the 4.5 million people who were bitten by dogs in the U.S., half of them children. Sayeth the CDC,885,000 people required medical attention for dog bites, and 27,000 people needed reconstructive surgery.

We don't like to acknowledge this because most people love dogs and feel like their dogs love them. They probably do, whatever that means to  dog, but they're still wolves and they are also dangerous. Most people do not take this seriously. From CDC:

• Spay/neuter your dog (this often reduces aggressive tendencies).
• Never leave infants or young children alone with a dog. Seriously folks -- not a joke! You could really, really regret it. No matter how well you think you now Fluffy.
• Don’t play aggressive games with your dog (e.g., wrestling).
• Properly socialize and train any dog entering your household. Teach the dog submissive behaviors (e.g., rolling over to expose the abdomen and giving up food without growling).
• Immediately seek professional advice (e.g., from veterinarians, animal behaviorists, or responsible trainers) if the dog develops aggressive or undesirable behaviors.

Teach children basic safety tips and review them regularly:

• Do not approach an unfamiliar dog.
• Do not run from a dog or scream.
• Remain motionless (e.g., "be still like a tree") when approached by an unfamiliar dog.
• If knocked over by a dog, roll into a ball and be still.
• Do not play with a dog unless supervised by an adult.
• Immediately report stray dogs or dogs displaying unusual behavior to an adult.
• Avoid direct eye contact with a dog.
• Do not disturb a dog that is sleeping, eating, or caring for puppies.
• Do not pet a dog without allowing it to see and sniff you first.
• If bitten, immediately report the bite to an adult.

 

Ha ha!

I got an e-mail from Avalere Health:

According to a new Avalere Health analysis, 17 of the 26 states that did not expand Medicaid in the first three months of 2014 still reported growth in Medicaid enrollment, ranging from 0.1 percent in Texas to 10.1 percent in Montana. Since these states had decided not to expand Medicaid eligibility levels under the Affordable Care Act (ACA), these numbers show the impact of the “woodwork effect,” which is when individuals who were previously eligible, but not enrolled in Medicaid, newly sign up as a result of increased outreach and awareness. These enrollees may place a strain on state budgets, since states are required to contribute to the cost of their coverage based on traditional Medicaid matching rates. . . .

These states would have gotten 100% federal reimbursement for newly eligible Medicaid beneficiaries, had they chosen to accept the expansion. But they only get 50-70% reimbursement for these folks, who were already eligible. So their hospitals and docs won't get all that federal money, but they'll still have to cover more Medicaid beneficiaries. Lots of people left out in the cold, of course, but this is a good side effect.

Call me intolerant . . .

. . . if you will.

Last Sunday I was channel surfing toward the news when I saw the victor in that weekend's golf tournament getting interviewed. The teevee guy asked him the standard question, why did he think his game had been so good?

It turns out it's because this particular golfer has "gotten closer to God." He realized he couldn't do it on his own so he started relying on God to guide his swing.

Here's what I think, punk. You are a malignant narcissist. You are actually claiming, before a national television audience, that the immortal, omnipotent creator of the universe of billions of galaxies, each of billions of stars, gives a flying fuck on a rolling doughnut where your golf ball goes? That God favored your victory over all the other poor schmucks who aren't close enough to him?

At the same time, your God is petty and banal enough to fix your golf game while he's otherwise occupied burying people under land slides and afflicting children with malaria. You are actually worse than the people whose neighbors are killed by a tornado and thank God for sparing them. Your religion makes me want to barf.

Disease eradication

World Malaria Day was a couple of weeks go, and I missed posting on it due to my recent indisposition. Yeah, yeah, I don't usually pay much attention to these artificial occasions --- National Pickle Week, Administrative Assistant's Day, yadda yadda -- but the WHO and the Global Fund used the day to push hard to get attention and maybe raise some dough. Here's the UN Special Envoy's statement on the day, which was April 25. Malaria matters because it is a leading killer of children and because endemic malaria is a major factor that holds down poor regions of the world. With lots of people debilitated, economic welfare suffers.

And malaria is eradicable. It won't be easy, but it can be done. It's technically possible because the parasite needs a human host for part of its life cycle. If infected people can be cured, and the chain of transmission stopped, malaria can be gone forever, like smallpox. which was declared eradicated in 1980. Polio should be gone from the earth by now, but it isn't, because of civil conflict and religious fanaticism. Eradicating malaria faces some of the same problems -- many of the places where the disease remains are very difficult to work in. But these are potentially incredibly powerful investments. However, the eradication of smallpox followed a previous unsuccessful campaign to eradicate malaria.

These efforts require more social science, community organizing, business management, and political negotiation than they do biological science. They have the potential to strengthen civil society in poor countries, and international cooperation, but done wrong they can damage both. (See the last link.) Will we have the wisdom as a species to pull it off? 

Thumb arthroplasty

Well, the cast did come off yesterday and the pin came out. Both were big wins -- cast means I can use the hand more effectively, no pin means less pain. It sure looks ugly -- wrinkled skin, surgical scar, atrophied forearm. But, I'm typing with both hands so that increases my productivity big time. It used to be, when people asked me what I do for a living, I'd say I'm a medical anthropologist. But I realize now a more accurate job description is typist.

However, it ain't over. The hand is weak and stiff. I have to do rehab exercises every day, and it will be a month before I'm allowed to put any real stress on the hand and maybe three months or  more before I'm allowed to do heavy lifting. That cramps my style big time -- can't dig up the garden or use the chainsaw. I do plan to try guitar in a couple of days however.

So this is a big investment, a big ordeal. I'm not sure whether I'd do it again -- I was in pain and becoming more and more disabled as it was, so I guess it was necessary. But I don't know that it's for everybody. And I don't think the surgeon really gave me adequate warning of how difficult this would be. On the other hand, if he did, would anybody do it? Maybe a little soft pedaling will turn out to be good for me in the long run. This is a difficult question for me as moral philosophy. I'll have to ponder it.

Actively Dying

That's a strange term of art I have recently come across in the field of hospice care. I'm not sure how you would define it -- we're all actively dying, it seems to me, it's only a matter of degree. But, hospice care means we aren't working at prolonging life or trying to treat underlying disease, but rather at making a dying person as comfortable as possible. The WaPo wants me to steer you to this investigative report that finds, based on billing records and supported by anecdote, that some Medicare hospice providers are taking the money, but not really doing that.

My colleague Joan Teno is quoted as endorsing their deduction that a hospice that claims no skilled nursing care and zero hospitalizations is skimping. Yes, we aren't trying to prolong lfe, but some painful crises do require active intervention for palliation.

The reason is financial incentives, apparently. Lower level care is more profitable. Medicare could try to fix this by realigning reimbursement or more active oversight, but meanwhile if you have a loved one in crisis be a squeaky wheel.

Cast comes off Tuesday and hopefully I'll get back to more regular posting. In other personal news, you might be interested in this article of mine that just went open access on PubMed central. Federally funded research has to be publicly available after one year. The publishers, who make billions, don't like that and they're trying to overturn it. Don't let them.

Could reality possibly matter in the end?

It seems Rick Scott went looking to rile up some seniors about the horrors of Obamacare and it turns out they're fine with it, nothing bad has happened to Medicare after all and isn't it nice that their younger friends can get insurance?

And now a story the likes of which we'll be bearing more and more of, about a rugged individualist who wouldn't have no truck with that soshulist Obamacare until he did, and it saved his life:

He's a self-employed, self-sufficient logger who has cleared his own path for most of his 57 years, never expecting help from anyone. And even though he'd been uninsured since 2009, he especially wanted nothing to do with the Affordable Care Act. "I don't read what the Democrats have to say about it because I think they're full of it," he told his friend Bob Leinhauser, who suggested he sign up. . . . "We argued about it for months," Angstadt said. "I didn't trust this Obamacare. One of the big reasons is it sounded too good to be true." January came, and Angstadt's health continued to decline. His doctor made it clear he urgently needed valve-replacement surgery. Leinhauser had seen enough and insisted his friend get insured. . . . Angstadt's plan kicked in on March 1. It was just in time. Surgery couldn't be put off any longer. On March 31, Angstadt had life-saving valve-replacement surgery. "I probably would have ended up falling over dead" without the surgery, Angstadt said. "Not only did it save my life, it's going to give me a better quality of life."

I don't see how it's possible that between now and November people will fail to notice that there aren't any death panels, there aren't any government bureaucrats sitting in the doctor's office, and more people are getting the health care that they need. No trainwreck. But apparently they're still going to vote for Republicans. Please tell me why.

Taking time off from the blog has helped me appreciate . . .

why Tom Lehrer retired from public life. The goings on lately are beyond the power of commentary. A guy becomes a conservative hero by refusing to pay his bills, on the grounds that "the federal government does not exist," while his armed supporters ostentatiously wave the flag of the non-existent United States. That he's an ignorant racist lunatic is pretty much beside the point. But everybody expects the Republicans to gain control of the Senate in November.  I'm baffled.

Anyway, my personal update is that I'm still in the cast and it's hard to type, but the pain is much less and I'm off the ibuprofen. Cast comes off May 6, I'm counting the days. Meanwhile, back at the ranch, I got one of the rare e-mails from a publicist I actually want, a report by a coalition of progressive groups on the National Restaurant Association. No, it isn't the corner diner, it's Coca Cola and McDonald's and  KFC and the like. They spend huge bucks on lobbying and political contributions, and they're major opponents of minimum wage laws, other labor protections, and public health regulation. Selling junk food to children is one of their biggest priorities. Coca Cola, by the way, is not food, it's poison. How we can organize to fight and beat these scum is not clear to me, but it should be a top priority for progressives and everybody who cares about their children.

Sorry, typing is still a real pain . . .

and probably will be for the next two weeks till I get the cast off. So if I'm light on blogging, you know why.

Anyhow, the first anniversary of the Boston marathon bombing has pretty much displaced recognition of other anniversaries this week, perhaps mercifully including Columbine. What most people probably still haven't caught up with is that it wasn't about bullying or jocks and nerds or anything to do with high school culture or politics. Eric Harris was a psychopath who just wanted to kill as many people as possible for the fun of it, and Dylan Klebold was a tool. That's all. it doesn't really mean a whole lot except that such people exist.

And they could easily get guns, I suppose, although their main intention was to kill people with propane bombs, which fortunately did not go off. But they could have with better wiring skills.

I think this is more or less true of the marathon bombing as well. It doesn't have much to do with Jihad or radical Islam. Tamerlan was a violent lunatic, probably schizophrenic, and Islam was just the particular fantasy around which his violence coalesced. And his brother was also a tool, like Klebold. Don't look for more meaning than there really is, I say.

Medicine Triumphs

You know that a lot of my thinking revolves around the proposition that we spend too much on medical intervention and it really doesn't do all that much good. Type 2 diabetes is one of my best examples. If we could all just skip the processed food and sugar water, and get some exercise, we'd never need the doctor in the first place.

Maybe so, but we haven't been doing that. So, doc to the rescue. CDC investigators have found that even though the prevalence of diabetes has gone up, complications are way down. Why? Because we've figured out that we need to concentrate on preventing the cardiovascular and kidney complications that maim and kill most diabetics, and we have better drugs. I'd feel better if people were losing weight and eating whole grains and legumes instead  of white bread and soda, but they aren't.

In spite of fraud by pharmaceutical companies, underinvestment in public health, overtreatment and all the other constant complaints you read here, medicine does gradually get better. So let's have universal access, as a fundamental right.

I'm baaaaaack . . .

It was just too painful to type for a few days so I decided not to bite the bullet. People ask me what I do for a living and I say I'm a medical sociologist, but now I realize that a better job description is typist. Anyway . . .

Millions of people are locked up for shoplifting and smoking pot and shooting dope, but if you steal $20 billion you're cool. I don't know how much of this you can read, but the new BMJ has a theme issue on the latest fraud of the century. The story is that in 2006, one Tom Jefferson led a Cochrane review* of neuraminidase inhibitors -- these are drugs to treat influenza, most notably oseltamavir (brand name Tamiflu, manufactured by Roche).  He concluded that it can prevent hospitalizations, shorten the course of influenza, and save lives. Accordingly, during the flu pandemic hoax of 2010-2011,** governments stockpiled huge amounts of the drug and doctors handed it out like lollipops.

Then Jefferson got a heads up from a Japanese researcher that there was a lot of unpublished data that might change these conclusions. He fought for years to get the drug companies to cough it up. They resisted every step of the way, but backed up by BMJ and powerful (mostly British) physicians, he finally got the data. What do you know? The full clinical trial data finds that the benefits of the drugs don't outweigh harms. Says BMJ International Editor Kamran Abassi:

Worryingly, the welfare of patients seems a secondary consideration for all stakeholders. Drug company executives champion their work for the benefit of patients. Regulatory authorities are responsible for protecting patients. Politicians make decisions for the public good. Yet, when faced with the sudden threat of pandemic H1N1 flu, a threat that ultimately did not materialise, each party behaved opportunistically and irresponsibly. Drug companies exploited a window for rapid sales. Regulators approved drugs with insufficient scrutiny, exposed now by the forensic approach of the Cochrane researchers. And politicians were desperate to act, to do something in the face of a perceived crisis, whether it was based on evidence or not. Patient welfare didn’t matter, although it
was the excuse for these decisions.

Hey indeedy.

*The Cochrane Collaborative is an international non-profit that publishes systematic reviews of medical treatments. It's used a gold standard reference for what works and when and with whom.

** In order to find that there was a pandemic, the WHO was forced to change the definition of pandemic flu such that we actually have one every year. 2010-2011 was a milder than usual flu season.

Just so you know . . .

I'm as well as can be expected, under the circumstances. Still kind of hard to type, which slows down blogging. but . . .

This is kind of disturbing, but while driving me home my brother, who is no fool, said that he knows what happened to that Malaysian airliner. Since 2007, Boeing commercial aircraft have been equipped with a supposedly anti-hijacking system that allows a ground facility to seize control of the aircraft. Yesterday, I did some Googling and found numerous references to this. Today, only this, the patent information. Yes, it's real. Great if you really are hijacked, not so great at all if somebody hacks into it. And no, they obviously wouldn't talk about that possibility.

We'll see if men in black show up at my door.

Vivisection

That would be on me. I'm getting surgery today on my left hand. Specifically, they are going to remove the bone at the base of the thumb, called the trapezium, and stuff the space with tissue harvested from a wrist tendon. Grotesque, isn't it?

The reason is osteoarthritis. I have no cartilage left between the trapezium and the metacarpal bone, that is the shaft of the thumb. It hurts all the time - it hurts to take money out of my wallet, it hurts to button my shirt, it hurts to take a paper cup off the shelf. The proximate stimulus for taking this step is that my cousin-in-law talked me into buying a guitar, and I just can't play for more than a few minutes. I studied up on it carefully, and this surgery has an excellent record of long-term outcomes. However, it will be an ordeal. I'll be in a cast for six weeks, I'll need weeks of physical therapy, and it will be months before it's fully normal. But, then I'll have the rest of my life to be glad I did it.

I don't blame evolution -- we weren't supposed to live this long. But most of the world's people, obviously, have no access to this kind of intervention. If they develop osteoarthritis, they just have to live with it. It's the price of stayin' alive. So just think about it -- being in your fifties or sixties, and taking it for granted that you have many productive years left and shouldn't be, and don't have to be, disabled, is a very recent, very unusual version of the human condition. And maybe it won't last much longer.

Art Criticism

It seems war criminal George W. Bush is taking advantage of his impunity to exhibit his portraits of world leaders at his "presidential" library.

I think it would be more appropriate for him to paint mangled and burned corpses, disfigured children, shattered cities, and maimed veterans. Those are subjects much more relevant to Mr. Bush than world leaders.

Excitement in Mudville

As far as I know, the University of Connecticut is the only school to have won the men's and women's NCAA basketball championship in the same year, which I believe was 2004. (I'm not going to look it up because it isn't that important.) This year, UCONN can do it again.

The women's team, which won last year, was rated number one all season and was expected to be the team to beat. They play their semifinal match tonight, against Stanford, who they already beat easily earlier in the season. The men's team, however, is a surprise. They went into the tournament as a 7th seed, having been trounced by Louisville in the American Conference final. They survived and overtime scare to get through the first round. Then they went on to beat number 4, 3, 2, and finally 1 seeds, the latter being Florida, the consensus pick to win it all, who they trounced to make the championship game on Monday.

So, I have some fandom in the game when it comes to the controversies about the NCAA. As a matter of fact, long-time UCONN men's coach retired under a cloud last year with the program on probation over poor academic performance. The men's team has always had a poor graduation rate, and it's not because they are going on to riches in the NBA, for the most part. (The women, on the other hand, do really go to college and graduate.) This year, however, under new coach Kevin Ollie, things seem to have changed. In fact their superstar point guard Shabazz Napier is expected to graduate in May, fulfilling a promise to his mother, after a solid academic career. And yes, NBA riches await him, but he deferred for the full four years.

But we've seen situations like Kentucky, in which playing on the basketball team obviously has nothing to do with going to college and nothing particularly to do with the University of Kentucky. The players do one season and it's on to the pros. I suppose if that's your chosen career path you don't have a strong argument to be paid, but you don't have much of an argument for an athletic scholarship either. Much worse, of course, are the kids who play on the team, help the coach and the athletic director earn millions, never get an education and never make it to the pros either. The ratio is even worse in football, and they risk traumatic encephalopathy in the process.

At my place of employment, in contrast, athletics has its place and we even produce the occasional NFL player. But the Ivy League does not give athletic scholarships. You get an edge on admission if you're a talented athlete but you still have to fulfill the academic requirements to stay on the team and stay enrolled. We don't offer a Rocks for Jocks course or a phys-ed major. I won't say that the top athletes don't get a break or that none of them suffers from the entitled jerk complex associated with male athleticism. I don't know about that. But college sports as a community building exercise for the university, fun and good exercise and character building for the participants -- that isn't entirely mythological, at Brown or at the other colleges and universities I've been associated with.

What I think we need to do is create two separate categories of college athletics. Top division football and basketball programs a) should pay their players and b) should give athletes the opportunity to get a college education but they can also take a pure athletic track in which their official career ambition is to be a professional athlete or coach and that's what they're studying to do. And yes, if they aren't meeting requirements to credibly stay on that track, they're off the team and out of the program. That's only fair to them, as a matter of fact. And if they have a career-ending injury, they get a full scholarship, tuition and room and board, to get a degree in something else. And if they can't cut it at the university, the university will pay for vocational training.

So no, there won't be a level playing field, any more than there is for the New York Yankees and the Milwaukee Brewers. Colleges that want to sponsor a pro sports team should do just that. There can be a limit on salaries, but the athletes should be paid. Colleges that want to have collegiate athletics should play in a completely different league, and should not provide scholarships to people just to play games. Take our pick, but don't pretend that one thing is the other.

A reflection on the climate change problem

Specifically, not climate change itself, but the failure of the political system to respond to it. Eric Chivian, one of the founders of International Physicians for the Prevention of Nuclear War, has some thoughts about this in BMJ. (Not sure if this is open access.)

He makes the usual points: scientists are always cautious and hedge their conclusions -- "high degree of confidence," that sort of thing -- whereas the denialists speak with what sounds to lay people like greater clarity; the media finds that controversy sells so they give the denialists equal time and stature; and there's big money behind denial.

But he embeds the deepest point in another -- burying the lede, I would say:

We were, and are, up against the richest, most powerful, most rapacious adversaries on the planet, who since the industrial revolution began have controlled what powers almost everything we do, whose products are the engine for the economies of all industrialized countries and the fuel for the rapid growth of developed countries.

The real issue is not the powerful, rapacious adversaries. They are a by-product of the fundamental reality. Our world, our entire civilization, exists only because of fossil fuels. The human life span, the conditions of life for the overwhelming majority of the world's people, the accumulation of wealth and the pace of technological change were essentially stagnant since the first ape that spoke. Then came James Watts steam engine in 1781, fueled by coal. Everything since then would have been impossible without it. The human population would be maybe 1/50th as large. Maybe. We'd still need more pasture for our horses than farmland, which would absorb the daily, grinding labor of 90% of us. It would take two months to cross the Atlantic, and the only way to get a message across would be to carry it.

We can't undo this world, but finding acceptable ways of fueling it is the hardest thing we will ever do. It's like chewing your own leg off to get out of a trap. But, chew we must.  

A couple of bookmarks

Do check out:

Democracy: A Journal of Ideas

and uh

The Baffler.

Without a doubt, both offer some of the best free content (or any content, for that matter) out there.

Can't figure out how they pay for it, these are well-known professional writers, but you might as well take advantage.

While they ignore the IPCC report . . .

the corporate media are getting all excited about Ebola virus, which ABC news is now telling us may come to the U.S.

Puh-leeze. People contract Ebola virus from wild animals in remote places in Africa. It is highly unlikely any of those people are going to get on an airplane, and if one of them were to do so, even more unlikely that she or he would be headed for Kennedy Airport. Ebola virus is a problem for people who live where it is likely to be encountered, but it doesn't have to be our problem for that to be true.

Here are the true facts, from the WHO.

Yes, it's a really awful disease. The case fatality rate is 90% and there is no effective treatment or vaccine. And people can be contagious during the incubation period in which they are not symptomatic. But . . .

The virus is transmitted only through direct contact with bodily fluids. If somebody sitting next to you on the plane happened to be infected asymptomatically, you would be very unlikely to contract it. The virus spreads when health care workers take insufficient precautions -- gloves and gowns and masks and all that -- and through funerary practices in which people come into contact with the corpses of victims. People in the acute phase of the illness bleed through every orifice, so yes, there are plenty of bodily fluids to avoid, but they aren't walking around and they definitely aren't flying on airplanes! (And, it is present in semen.)

What all that means is that we will continue to see these isolated outbreaks, but unless it somehow mutates to become more contagious, this is not going to become the next Black Death. And don't worry about it coming to the U.S.

Why the "journalists" just can't avoid these temptations is beyond me.

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!

Whizdumb

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.

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?)

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.

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.

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.

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.

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.

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.

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.

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. 

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.

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.

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.

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.

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.