Map of life expectancy at birth from Global Education Project.

Monday, April 21, 2014

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.

Thursday, April 17, 2014

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.

Monday, April 14, 2014

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.

Thursday, April 10, 2014

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.

Tuesday, April 08, 2014

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.

Monday, April 07, 2014

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.

Sunday, April 06, 2014

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.

Friday, April 04, 2014

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.  

Thursday, April 03, 2014

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.

Tuesday, April 01, 2014

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.

Monday, March 31, 2014

Obviously only one blog post worth making today . . .

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

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

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

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

Friday, March 28, 2014

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.

Wednesday, March 26, 2014

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


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

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

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

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

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

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

Tuesday, March 25, 2014

What fools these mortals be


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

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

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

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

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

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

Sunday, March 23, 2014

Grifters gotta grift

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

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

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

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

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