Map of life expectancy at birth from Global Education Project.

Saturday, November 28, 2015

The first thanksgiving

It's not the story you learned in school. This is an excellent piece of historiography by Charles C. Mann, much of which I am ashamed to say I did not know. But the main point that's most relevant to this blog is that the reason the Pilgrims were able to establish a settlement on the Massachusetts shore where no Europeans had done so before was that the area had been depopulated by a terrible plague. In fact it killed 90% of the Wampanoag who until then had a sophisticated, densely populated and prosperous kingdom. They knew from experience not to tolerate European settlers, but after the catastrophe their chief Massasoit was persuaded to form an alliance with the English at Patuxet (now Plymouth). Even more fascinating was the person who did the persuading, Tisquantum (who is usually today called Squanto). So read it.

The plague was apparently a viral hepatitis imported from England. (The depopulation of natives by smallpox came later.) As Mann concludes, referring to King Phillip's war, in which one of Massasoit's son's tried unsuccessfully to expel the invaders:

The Europeans won. Historians attribute part of the victory to Indian unwillingness to match the European tactic of massacring whole villages. Another reason was manpower—by then the colonists outnumbered the Natives. Groups like the Narragansett, which had been spared by the epidemic of 1616, had been crushed by a smallpox epidemic in 1633. A third to half of the remaining Indians in New England died of European diseases. The People of the First Light could avoid or adapt to European technology but not to European germs. Their societies were destroyed by weapons their opponents could not control and did not even know they possessed.
Can something like this happen again? Yes.

Wednesday, November 25, 2015

Sorry, it's been a while

Partly just that the zeitgeist is too depressing to even comment on. First, I'll cross-post this from Today in Afghanistan.

The U.S. military has released its explanation for the assault on the MSF hospital in Kunduz. Of course it was all just a big mistake. To summarize:

  • Afghan forces requested an airstrike, saying they were under fire. However, they did not provide map coordinates of the building they wanted to be attacked, they just "described its location."
  • U.S. special forces passed on the description to the crew of the AC-130.
  • The plane had been diverted from another mission and its crew was not familiar with Kunduz, and had not been briefed on the location of the hospital.
  • The location description was apparently vague or inaccurate (it referred to an open field), so the crew decided to attack the hospital building.
  • U.S. ground forces were not within visual range of the attack.
  • An on-board targeting computer that might have stored the coordinate of the hospital as off-limits wasn't working.
  • No explanation as to why the AC-130 attacked even though there was no evidence of a firefight. (They would have seen it with infrared surveillance if it was happening.)
  • No explanation of why the crew did not confirm the identity of the target when the information they had turned out to be incorrect.
  • No explanation of why the attack continued for an hour despite frantic calls by hospital personnel to U.S., Afghan, United Nations and Red Cross officials. 
Gen. Campbell says some individuals have been "suspended" from their duties.  I have no further comment on this right now. Oh shoot, I will. If this is true (and that's a far reach) it shows utterly depraved indifference to the people the U.S. is supposedly trying to protect. You don't spend an hour blowing up a building and massacring the people who flee from it without actually knowing what it is you are attacking, unless you are a maniac.

More on other subjects soon.

Friday, November 20, 2015

Proud to be an American

I've never understood those bumper stickers. Is this something you achieved? Did you toil and sacrifice to accomplish the lofty goal of being an American? I really don't think so. In fact,  I think you were born here, in your shiny white skin.

Now suppose murderous maniacs were to take over the country you are so proud to be of, and you were forced to flee with your family for your lives. Would you think people who turned you away and sent you back to your doom should be proud?

But however proud you are, you apparently think that you aren't as proud as you want to be because we need to Make America Great Again, meaning, obviously, that it isn't Great right now.

And it's not just Republican primary voters who feel like you. The man with the dead muskrat on his head is tied in recent national polling in a hypothetical general election with the likely Democratic nominee, who will apparently not Make America Great Again. But muskrat man will, just like that German guy with the funny mustache, who used to shout pretty much the same way.

I am not proud.

Tuesday, November 17, 2015


That Charlie Sheen is HIV+ is not a huge shocker, given his well-known history of drug abuse and patronization of prostitutes. Fortunately he is taking his meds and his doctor says his viral load is undetectable (a term that seems exotic to the reporter, who oddly puts it in quotation marks).

The most interesting moral of this story is not to avoid doing the stuff that can get you HIV infected. I believe we already knew that. It's the decision he finally made to go public, after paying millions in blackmail to keep it a secret. (Assuming this is entirely true. Sheen is crazy so it might be a bit askew.)

Whether or not you think a person should be ashamed for shooting dope (if he did) or paying prostitutes, being HIV+ is not anything to be ashamed of. I have interviewed a lot of people with HIV, and here's what I can tell you. Initially, a lot of people are ashamed, maybe because they regret making a mistake, or because they have internalized the stigma of being gay and/or having a lot of casual sex, or being a drug addict. People often can't incorporate the fact of being HIV+ into their identity so they pretend to themselves it isn't true. They don't see a doctor or take meds because if they take meds, that means they have the thing, and they don't want to have it.

Maybe they do finally start on meds but they don't take them consistently because it reminds them of what they don't want to be reminded of.

But lots of people -- at least the ones who are still around to talk to me -- sooner or later get okay with it. They might see it as a kind of blessing, because the news finally got them to stop doing things they didn't really want to be doing. Many people even take pride in having made changes, and taking care of themselves, and being an example for others. They talk to the young people, they volunteer, they get on track with a career and they don't mind telling anybody. Those are the people who take their meds and do just fine.

I don't know why Sheen thought he needed to pay millions in blackmail to keep the secret. Now that he's come out, I guarantee you nothing bad will happen to him. In fact, he might just overcome his depression and his anger problems and his weird behavior and get back to work and once again fulfill his tremendous talent. And believe me, nobody will hold it against him. What I don't know is how to throw the magic dust on people and make that happen. If anybody has the formula, please let me know.

Monday, November 16, 2015

Update on Death Rates

I noted in an earlier post the surprising discovery that death rates for "middle aged" (i.e. age 45-54 year old) non-Hispanic white people in the U.S. have been rising, against a background of overall decreasing death rates in all other demographic categories.

As it turns out, subsequent analysis by other researchers has modified this conclusion. Here Andrew Gelman explains that in fact, this is true only for women. The death rate for men increased until 2005, then started back down. The reason for the mistake is interesting for those of you who care about ways to lie -- or just make a mistake -- with statistics. It turns out that during the period of analysis, the age composition of white non-Hispanic people within the 45-54 year old cohort increased. In other words, more of them were near 54 at the end than at the beginning. The death rate doesn't go up a lot from 45-54, but it goes up enough to wipe out the apparent effect for men.

This is a version of what is called an error of aggregation. In any case, the result is even more puzzling than the original analysis. How would you explain it.

Sunday, November 15, 2015

Confronting Evil

First, a crosspost from Today in Afghanistan.

I expect that most people contemplating the massacre in Paris last night are puzzled by the motive. The Islamic State can hardly expect to strengthen its grip on territory, or to expand, by provoking a militarily powerful nation to counterattack, as France almost surely will. I commend to your attention this article in the Atlantic by Graeme Wood. It's fairly long, but go ahead and read the whole thing.

He actually makes a mistake at one point by predicting that IS won't carry out attacks on foreign soil (the Charlie Hebdo attack was sponsored by al Qaeda). But the events last night actually do make sense in terms of his analysis. The most important thing we need to understand is IS adherents really do believe that they are fulfilling apocalyptic prophecies, which in fact include their near-destruction at the hands of "Rome," which today mean essentially what we all the West, the European Christendom as it has expanded to North America and elsewhere. They want to provoke conflict, in other words. Here is a key pull from Wood's essay:

In December, The New York Times published confidential comments by Major General Michael K. Nagata, the Special Operations commander for the United States in the Middle East, admitting that he had hardly begun figuring out the Islamic State’s appeal. “We have not defeated the idea,” he said. “We do not even understand the idea.” . . .

Our ignorance of the Islamic State is in some ways understandable: It is a hermit kingdom; few have gone there and returned. Baghdadi has spoken on camera only once. But his address, and the Islamic State’s countless other propaganda videos and encyclicals, are online, and the caliphate’s supporters have toiled mightily to make their project knowable. We can gather that their state rejects peace as a matter of principle; that it hungers for genocide; that its religious views make it constitutionally incapable of certain types of change, even if that change might ensure its survival; and that it considers itself a harbinger of—and headline player in—the imminent end of the world.
 So do read it. This is not an enemy that behaves according to the logic of others.  Its actions make no sense in most people's terms. It is essential to understand its internal logic.

Now, expanding on this, it was a bit odd to hear Francoise Hollande decry the attack as "an act of war." France is obviously already at war with IS, and committing its own acts of war, specifically bombing them from the air, every day. Now, Hollande will make the entirely respectable claim that France (like the U.S. and its other partners in bombing) tries not to blow up non-combatants. Obviously they don't always succeed, but they are engaged in a military campaign, not indiscriminate massacre.

I am also not in the least contrarian about the moral inequivalence of France and IS.  The self-styled Islamic State is a cancer upon humanity, and its existence is intolerable. Principal objectives of the war on IS are to liberate people it enslaves, prevent it from continuing atrocities, and to allow people it has driven from their homes to return. France, in contrast, is a legitimate state with acceptable concern for the rights and welfare of its citizens, and of guests. France does not take visitors hostage and behead them, for example, nor does it crucify religious minorities. France does restrict the religious practice of Muslims, notably by prohibiting the hijab. This may be a legitimate grievance, but a proportionate response would be protest or civil disobedience.

All that said, what is to be done? This is a real quandary. The front line troops against IS, unfortunately, as presently constituted, cannot do the job. The Kurdish peshmerga is capable, courageous and disciplined, and has shown that it can defeat IS on the battlefield with U.S. air support. However, the peshmerga cannot legitimately take on the task of liberating the Sunni Arab heartland from IS, nor do they have any interest in doing so. In fact the reconquest of Sinjar is an irritant to the Baghdad government, as Sinjar is outside of the previously acknowledged Kurdish autonomous region, and the Kurds have announced that they intend to keep it.

The Baghdad government, despite some recent attempts at reform, remains Shiite dominated, has no legitimacy with Sunni Arabs, and has a corrupt and incompetent army. Its most effective elements are Iranian-led Shiite militias, and they would have even less legitimacy than the Kurds moving into Sunni Arab cities. In fact the Kurds and Shiite militias recently clashed in Tuz Kharmato, and the Baghdad government has interdicted arms shipments to Kurdistan. So our allies in this fight are on the brink of war with each other. (Turks and Kurds are also at war, although it's a Kurdish faction which does not have the support of the Kurdistan regional government. Nevertheless it makes the situation very awkward and makes Turkey of little help against IS.)

What IS wants, and what they hoped to get from the Paris massacre, is for Christian troops to come and fight them. This may not make sense to you, but to them it is the point of their existence. They believe they are fulfilling prophecy, and that the battle they are trying to provoke is essential to the fulfillment of God's plan. No, God won't give them the victory, but the spectacle of European and North American armies marching into the Arab heartland is not going to advance the cause of global harmony. That is what Barack Obama has so far done his best to avoid.

Thursday, November 12, 2015

Knowledge is Evil

Certainly it is evil to contemporary U.S. conservatives. This is a particularly offensive example. It seems the Missouri state senate has, get this a "Committee on the Sanctity of Life." The chair of said committee wants the University of Missouri to prohibit a graduate student from continuing her dissertation work, which is studying the effect of the state's 72-hour waiting period for abortions. It's research -- it doesn't have a pre-determined outcome. And, as grad student Lindsay Ruhr says, "The whole point of my research is to understand how this policy affects women. Whether this policy is having a harmful or beneficial effect, we don’t know."

But, of course, the Committee on the Sanctity of Life doesn't want us to know. Just as the Republicans in the U.S. congress don't want NASA to study the earth because they might find out that it's getting warmer, or other bad news about the Free Market. Just like the church fathers who refused to look through Galileo's telescope. But that didn't stop the earth from going around the sun.

Monday, November 09, 2015

A brief history of the world

Here Brad DeLong discusses the history of technology. His particular emphasis is on the past 250 years or so with the sharply accelerating pace of change, but he ranges back to the invention of the spear and the domestication of the horse. His central concern here is on whether machines, having replaced much of the work of our bodies, will shortly replace the work of our brains, and how the economy would then work.

That's a fair enough question, but I will take this opportunity to step back and reflect on the human created world in which most of us humans now live. This is the 50th anniversary of the great northeastern blackout, an even I remember although I was in the fifth grade. We lived in the country so nobody was stuck in an elevator, but we had to go out to the car to listen to the radio in order to find out what was going on. The power came on by morning and apparently people in New York City generally refrained from antisocial behavior, but it was still an impressive event.

Since then I have endured much longer, but more localized power failures -- about a week seems to be the limit for our tropical storms and major winter weather. And they get the hospitals and gas stations and supermarkets back in business first, so it's really just the showers and hot meals that we miss, and maybe TV if you're into it, except for people who do lose work for the period. But that's still pretty miserable.

So think about what would happen if we had another total northeast blackout that lasted, say, two weeks. We'd have a lot of short term fatalities, obviously -- people dependent on electrically powered devices, medications or oxygen that they could not obtain, ambulances running out of gas, people freezing if it's winter, and what not. Maybe some of those people in elevators would never be rescued. But then the power comes back on . . .

Lots of small businesses would go broke, from spoiled goods, or just lack of income leading to unpayable debts. Most people would have lost two weeks of wages but many of them wouldn't get back to work right away, or ever. All sorts of business processes would have been disrupted and it would take weeks to get things running again, with more losses and cascading bankruptcies. There could be widespread social disorder and political turmoil.

One can think of other possible disruptions of the impossibly complex social machinery we have constructed that would have devastating consequences and be very difficult to repair. Now, of course specific predictions such as we hear from Ron Paul and Glenn Beck are nonsense -- there is no reason to expect the economy to evaporate in an explosion of hyperinflation (and if it does, nobody will want your gold, by the way). But I can understand the free-floating unease that many people have that translates into political paranoia. The world is complicated and scary, it's changing much too fast, the conclusions of science are incomprehensible and bizarre. People want clear, simple answers and they want to feel secure.

And that's how we get the Republican presidential candidates.  

Thursday, November 05, 2015

Odds and Odders

I've been extremely puzzled by the Ben Carson phenomenon -- not so much that he polls well with Republican primary voters. They love a fellow religious fanatic, and being a deranged ignoramus is just a bonus. Recent polls show him tied with HRC in the general election, and that is quite weird, but let's chalk it up to most people not really paying attention. No, what's puzzling is the man himself. How can you graduate from Harvard, presumably having studied the science pre-requisites for medical school, and be as ignorant and incapable of critical thinking as a slug? FYI, the Egyptian pyramids were built over a period of about 2,000 years, from c. 2.667 BC - 664 BC. I'll just stop there.

You'll just have to take my word for it that it was pretty obvious to me that GI Joe Gliniewicz had committed suicide pretty much from the beginning. Obviously I couldn't say anything until the official word came down, since he had a family and all that, but we knew right away that: a) This happened in a remote area where there was not particular crime to be committed, even if he did see some guys walking around; b) He was killed with his own gun which was found near his body; c) Even if those guys did have something to hide there was no reason to confront him and kill him since he was on foot a couple of hundred feet from his vehicle and all they needed to do was walk away; and d) There were no reported crimes and no known fugitives meeting the description anywhere in the area.

And just as obviously, the police knew this even before I did. And yet we had to put up with this two-month-long bullshitfest from Fox News and the police unions about how Obama murdered him. Disgusting.

I'll refer you to Erik Loomis commenting on the DoD paying for military tributes at sporting events. This sickens me for several reasons. First, the sports teams get credit with their fans for what appears to be (in their worldview) public spirited support for "our troops," whereas in fact they're just pocketing cash. Second, the glorification of the military is intended not only to lure young people into the ranks of cannon fodder, but also to promote the beauty and romance of war. Third, I have better things to do with the five or ten minutes before the game starts. Let's have some tributes to teachers or social workers instead.

Ha Ha. Study finds children from non-religious households are more generous than children from religious families.

Tuesday, November 03, 2015

Stayin' Alive

I almost wound up accidentally missing the tree for the forest by immediately posting on Ma et al's "Temporal Trends in Mortality in the United States, 1969-2013," in last week's JAMA. (You should be able to read the abstract here.) Fantastic news, it seems. During that slightly more than 4 decades, the age-adjusted death rate in the U.S. fell by 43%. Death rates were down for all major causes except for COPD, a remaining echo of the tobacco epidemic. The biggest killers, cancer and heart disease, showed big declines, although the decline for cancer has leveled off.

But, as it turns out, buried in all the good news is this rather surprising but previously overlooked nugget of ugliness, which is that the death rate for middle aged white Americans, particularly those with no more than a high school education, has been rising. Don't take this the wrong way -- African Americans are still at higher risk of death than white people. But it's quite unusual for any large demographic group in a wealthy country to have a rising death rate recently. (The collapse of the former Soviet Union resulted in elevated death rates, but it's hard to think of another example.)

What's perhaps most surprising is the reason -- suicide, alcohol and drug overdoses, and alcoholic liver disease. Part of this is that people have been reporting more chronic pain of late, and this group -- middle aged white people -- is more likely to get opioid prescriptions than are others. Apparently doctors don't think they are at risk for addiction. But opioid addiction can send people onto a profound downhill trajectory. The group seems also to be at risk for social isolation, economic deprivation, and mental distress. So yeah, it's bummer city out there for a lot of folks. Enough to kill them.

Monday, November 02, 2015

Muslim Atheist President Establishes Death Panels by Executive Order

Yep, he did. In the absence of legislation, the Centers for Medicare and Medicaid Services has promulgated a rule that will provide a billing code and reimbursement for physicians to discuss end of life plans with their patients.

In such conversations, patients could discuss whether and how they would want to be kept alive if they became too sick to speak for themselves. Doctors can advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.

Under the rule, officials said, Medicare would pay $86 for the first 30 minutes of “advance care planning” in a doctor’s office and $80 for the service in a hospital. In both settings, they said, Medicare will pay up to $75 for 30 additional minutes of consultation. These standard amounts can be adjusted for differences in costs in different parts of the country.
What should astonish us all is that this has gone almost completely unnoticed. It turns out that the former half-term governor of Alaska did spew about death panels when she heard about the rule, but she was just about totally ignored. So progress is possible.

The late, unlamented

Willis Carto, of whom I had never heard -- not surprisingly, since he worked behind the scenes and didn't put his name on his publications or organizations. Carto was the insane wizard behind the curtain of the far right racist Liberty Lobby, it's publication The Spotlight, and its radio broadcasts; and the Institute for Historical Review, dedicated to proving that the Nazi holocaust was a lie.

Lest you think he lived beyond the fringe and had no impact on American politics, he was invited to testify before congressional committees numerous times, and, as the Times obit notes, he "helped bolster what became fairly conventional rightist causes: drastically slashing the income tax and blocking a constitutional amendment to guarantee women equal rights. His positions on immigration, globalization and multiculturalism — all of which he loathed — were influential."

We hear the echoes of the Liberty Lobby in the modern Republican party. Holocaust denial and overt anti-Semitism are largely out of fashion on the right, because of the alliance between right-wing evangelical Christians and right-wing Zionism, not to mention Sheldon Adelson's money. But the rest of the program is the essence of contemporary conservatism. While the historical association of these causes is not an argument about their substance, it does help to explain the psychological appeal of contemporary conservatism in terms of its cultural roots. The line we can trace from Carto to Donald Trump and Ted Cruz is very easy to see.

Tuesday, October 27, 2015

The flesh of tetrapods

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

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

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

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


Monday, October 26, 2015


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

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

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

Friday, October 23, 2015

Jacamo Fina Ne

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

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

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

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

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

Wednesday, October 21, 2015

The Profoundest Evil

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

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

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