Tuesday, November 30, 2004

Dinner Conversation

At the Madras Masala (an excellent restaurant, by the way), on Maynard street, in Ann Arbor:

j7uy5:  You know, it is possible to start with some basic chemicals, containing carbon, oxygen, nitrogen, and so forth, and create DNA with any sequence you want.

Kevin: Yes.

j7uy5: So, what if you made a complete set of human chromosomes, took the egg cell from any animal -- it doesn't matter which -- and substituted the synthetic DNA for the DNA that was there already.  Then implant the egg and have it develop.  Would the resulting person have a soul?

Kevin: Well, to the extent that the soul exists, then yes. 

j7uy5: And would there be some magic moment at which the soul came into existence?

Kevin: No, there would be no magic moment.  But it would still happen. 

j7uy5: And at what point in the process would you say that the construct had attained the potential for life?

Kevin: The potential is there already.

j7uy5: Would you like one of these rice cakes?

Monday, November 29, 2004

How to Prepare for Bird Flu Pandemic

Google News lists 41 articles on what has been termed the "inevitable" bird flu pandemic.  Some excerpts:

Tens of millions could die from flu
By Keith Bradsher The New York Times 
Tuesday, November 30, 2004

HONG KONG A global pandemic of avian influenza is "very, very likely" and could kill tens of millions of people worldwide, a top World Health Organization official said Monday. [...]  Deaths associated with the rapid spread of a new form of influenza would be high, he said. "We are talking at least 2 to 7 million, maybe more - 20 million or 50 million, or in the worst case, 100" million, he said.  [...]  A few analysts have suggested that the death toll could be considerably higher. Dr. Henry Niman, a medical researcher in Pittsburgh who criticizes the World Health Organization as being too conservative, said that with more than 70 percent of the human victims of the disease dying so far, the death toll could exceed one billion if the disease were to spread rapidly among people. [...]
HK May Restrict Bird Slaughter to Combat Flu
Sun Nov 28, 2004 10:37 PM ET

HONG KONG (Reuters) - Hong Kong said on Monday it may ban shopkeepers slaughtering poultry after world health experts issued strong warnings that the deadly bird flu virus may trigger the next pandemic.

Hong Kong scientists have been fighting to end the widespread practice of killing live chickens in markets since 1997, when the H5N1 virus first spread to humans and killed six people in the territory.

But strong opposition from the poultry industry has prevented the government from stopping stall holders from selling live chickens and ducks and slaughtering them in front of customers. [...]
The World Health Organization has a web page that provides the latest information.  They explain why the poultry control is so important:
A new laboratory study of domestic ducks infected with several 2004 H5N1 viruses shows that, when compared with infections caused by viruses from 2003, domestic ducks are shedding more virus for longer periods. The majority are doing so without showing symptoms of illness.

Findings from this study also show that, compared to highly pathogenic avian influenza viruses from previous outbreaks, the recent H5N1 viruses survive several days longer in the environment.

The study found that the quantities of virus excreted by healthy-looking ducks approach those excreted by diseased – and visibly very ill – chickens. This suggests that domestic ducks might now be acting as a “silent” reservoir for the H5N1 virus, which is highly pathogenic for chickens.

In terms of preventing further human cases, it is of public health concern that ducks may be infected and shed virus for long periods, yet issue no “warning signal” in the form of visible signs and symptoms that alert people to take precautions. The concern is greatest in rural areas of affected countries, where free-ranging ducks and chickens often mingle, frequently sharing the same water supplies.

The WHO also has a page with recommendations for preparedness.  The recommendations are generic, in that they have to apply to all countries of the World.   Therefore, the Corpus Callosum has taken the initiative to prepare a set of guidelines specific to the United States of America:

Recommended Status
Actual Status
High percentage of population should have good health insurance
The percentage of uninsured persons is at a record high
High percentage of sanitary living conditions
Number of homeless persons is at an all-time high
Reliable vaccine supply
Vaccine supply recently demonstrated to be susceptible to disruption
Solid economic reserves
Federal deficit is at an all-time high, and the exchange rate for the dollar is declining
Close working relationship with international organizations
Current administration displays disdain for UN and many important countries
Highly visible and responsive national leadership
President spends record amount of time on vacation, gives very few press conferences, and spends too much time reading about pet goats.

I would say that we have a bit of work to do in order to get ready. 

Cool Photo Blogging

Martian Moon Phobos in Detail
November 11, 2004

These images, taken by the High Resolution Stereo Camera (HRSC) on board ESA’s Mars Express spacecraft, are Europe’s highest-resolution pictures so far of the Martian moon Phobos.
These HRSC images show new detail that will keep planetary scientists busy for years, working to unravel the mysteries of this moon. The images show the Mars-facing side of the moon, taken from a distance of less than 200 kilometres with a resolution of about seven metres per pixel during orbit 756.

Sunday, November 28, 2004

The History and Philosophy of the Ownership Society

Those who do not read and understand history are doomed to repeat it. 
-- Harry Truman

I have read history, and I understand it, but I seem to be doomed anyway.
-- j7uy5
Ownership Society: noun,(nr-shp s-s-t) 1. A society in which, if you do not own anything, you are not a part of the society; 2. A form of social organization patterned after the popular board game, Monopoly ®, as promoted by members of the faith-based community.  See also: the rich get richer and the poor get poorer.

Read The History and Philosophy of the Ownership Society at The Rest of the Story

Saturday, November 27, 2004

Life at 4800 Baud

I've been dinking around with the computer, installing SuSE 9.2, trying to get it to dual-boot with 9.1, so that I would not risk messing up the installation that already works.  Now both of them work, no problem.

Except, there seems to be a problem with my Internet connection.  Often, it will not connect at all.  When it does, it connects at a very slow speed.  Right now, it is 4800 baud. (Usually, I get over 32000, often over 42000.)  And the connection rarely lasts for more than a few minutes.  Which is why I have not been posting so much lately. 

The problem also afflicts my wife's computer, which is an off-the-shelf Hewlett-Packard box, running Windows XP, using a built-in modem, and a different phone line.  So it has to be a problem somewhere in the phone system, or with the ISP.

This might be what finally gets me to sign up for satellite Internet access. 

Friday, November 26, 2004

Maternal Health: Suicide is a Major Risk

As we, in the USA, reflect on our good fortune, and our preoccupation with family values, it is good to pause for a moment and think of the global perspective:

Iraq has one of the highest maternal mortality rates in the world - 53 per 1,000 live births, compared to the UK's six per 1,000.

Given the fact quoted above, plus the fact that the United States of America has assumed responsibility for the well-being of Iraqi citizens, plus the fact that the current administration has proclaimed life-affirming values, one naturally would expect that the US government would be doing something about the dreadful maternal mortality rate in Iraq.  Read the rest at The Rest of the Story.

Thursday, November 25, 2004

Saturday Morning Medicine Blogging

From the University of Michigan Health System press release site:

‘Virtual surgery’ simulations help train tomorrow’s surgeons
November 23, 2004

ANN ARBOR, MI  -The rigors of medical school teach the information required to become a physician, but when it comes to surgery, the greatest teacher is experience. Traditional training is done through a type of immersive apprenticeship, with experienced surgeons teaching residents in the operating room over a period of years.

At the University of Michigan Medical School, 21st century educational technology has caught  up with 21st century medicine with the development of the Clinical Simulation Center. Here, doctors-in-training can practice their skills on extremely realistic procedural simulators, including those designed  for developing surgical skills. These sophisticated simulators mimic the look – and even the feel – of performing an actual surgical procedure, allowing surgical trainees to practice techniques before they ever reach the operating room. [...]
The actual press release (link above) includes a link for a video of the process.

Finally, technology leads to a real advance in medical teaching.  I suspect that the patients will appreciate this, too, even if they never know it.  One problem in surgical training, in any large medical center, is that junior trainees don't get very much hands-on time in the O.R.   The senior residents and fellows get to do the most interesting stuff; first- and second-year residents do most of the mundane stuff, and medical students -- if they are "lucky" -- might get to do some suturing at the end. 

The idea of using computers to simulate surgery is not a new one.  However, it is only recently that it has become feasible to get really high-resolution graphics that run fast enough for this kind of simulation (at a reasonable cost).  That, and the development of tactile feedback, were necessary for this technology to be really useful. 

Now, if we could just develop something similar for psychiatry...

Wednesday, November 24, 2004

No Comment Necessary

Election brain gain?
Some scientists think Europe can entice scientists away from the US after the Bush victory | By Ned Stafford
November 23, 2004

Germany and other European countries should make the most of the results of the US presidential election to woo back researchers from America, a leading stem cell researcher has suggested.

Last Tuesday (November 16), the German business daily Handelsblatt quoted Hans R. Schöler as saying that Germany now has a "unique opportunity to keep scientists in Germany and recruit top scientists from around the world" because of the current "not exactly rosy" research and political situation in the United States.

Schöler, head of the Department of Cell and Developmental Biology at the Max Planck Institute for Molecular Biomedicine in Münster, told The Scientist that he had talked to more than 20 American researchers who were worried about the direction of American science, especially embryonic stem cell research, in the coming years under a Bush administration.

"After the election, the people I have been talking to are just in shock," Schöler told The Scientist.

Schöler believes that Germany and other European nations should try to recruit top scientists by improving the research atmosphere, which would include increased funding and loosening of restrictive embryonic stem cell laws.

Monday, November 22, 2004

Before Thanksgiving

I think it was the lateness of the hour, combined with the notion of family festivities, that reminded me of the third worst day in my life.  Perhaps there were other things, too, that caused me to remember that particular event, at this particular time.  One would not expect, under more typical circumstances, that a happy event, such as a wedding, would bring to mind such an unpleasant memory. 

Yesterday, about 7 PM, I put on the yarmulke that was handed to me by a young boy.  About 11:30, the wedding party almost over, I headed back home.  The house was dark, and quiet.  My wife had gone to bed already.  She hadn't come to the wedding, because her leg was sore.  (It was broken several months ago, and hasn't quite healed yet.)  So I was a bit lonely, too; perhaps that also was a reminder.  I put the yarmulke down on the kitchen counter. 

Thanksgiving is coming up in a few days. 

When I was a second-year resident, I spent a couple of months on the Neurology service.  There was a lady there who had had a small stroke.  She also seemed rather depressed, so I was chosen to be the one to take care of her.  I talked to her about her depression.  She had low energy, loss of interest, had psychomotor retardation, poor appetite, and basically just seemed kind of down all the time.  What I noticed, though, was that she was not particularly sad.  Yes, she had had a stroke.  Yes, she was in the hospital, a couple of days before Thanksgiving.  It was snowing outside, though, and she had a nice view of the newly-redesigned hospital courtyard.  Actually, the view was quite nice.  She appreciated the view, with a richness that one ordinarily would not expect to see in someone with clinically-significant depression.  All this made me suspect that there was some kind of underlying illness that was causing the symptoms that looked like depression. 

I was on call the day before Thanksgiving that year.  I told my mother that I could come over for dinner, but I could not be sure what time I would get out.  Having been through this before, she understood. 

Some tests came back.  The person who had had a stroke had a little bit of blood in her urine.  Her body temperature when up a little bit each evening, then came back down.  Stroke, hematuria, and daily fever suggested that she might have a source of infection somewhere, causing little blood clots that could break off and travel in the bloodstream, causing a bit of damage to various organs.  Oh, did I mention, she had an artificial heart valve?  I drew blood cultures.  She might have endocarditis.  That would explain all of the findings, including the listlessness.

Thanksgiving came the following day.  There I was, getting ready to go for Thanksgiving dinner.  Everyone was waiting for me. 

People who have been through medical training already know what happened next.  My pager went off.  I looked at the number on the display:the microbiology lab.  Those who have not been through this need to know a little background in order to understand.  I was on call the day before Thanksgiving, not on the holiday itself.  But the tradition is, that if one of your patients is in the midst of an acute problem, you stay and take care of it.  You can't hand the problem off to the person who is just coming in, especially if that person does not know the patient and is not up on the latest developments.  If would be bad form to do so, not to mention being dangerous for the patient. 

There was only one reason for the micro lab to page me.  The blood cultures were positive.  I would not be able to leave for several hours, at least.  The lab informed me that the culture was positive for micrococcus.  That was significant for two reasons.  One, it was a known cause of bacterial endocarditis, particularly around prosthetic heart valves.  Two, it could not be a contaminant.  Sometimes, blood cultures have false positives, if bacteria from the skin contaminate the blood when the blood is drawn.  But that would not explain the micrococcus, so there was no chance that the result was a false positive.  It was real, the woman had endocarditis, and I was not going to be getting out of the hospital anytime soon.

In any other circumstance, this would be exciting, in a mildly perverse way.  It would have been a "good case."  Good cases are good because they are rare, and good teaching opportunities.  Only rarely is it good for the patient.  (See A Great Case, by Dr. Jerome Groopman, for a perspective on this.  He found out, on a Fourth of July weekend, that his son had intussusception.)  

A surgical resident in the emergency room began taking the history. Suddenly, an intern in scrubs burst into the room. "What have you got in here? What is it? A good case?"

I fixed on the intern's expectant eyes and lost control. "Who the hell are you? My son is not a "good case!'"

The intern stood frozen.

"Get out of the room!" I bellowed. "Out!"

I called the Infectious Disease fellow, who was very nice, despite having been called on a holiday.  He told me that I should call the thoracic surgery fellow, since a prosthetic valve was involved.  The surgeon was obnoxious.  First he told me it probably was a contaminated blood culture.  Then I told him that it was micrococcus.  Ruined his Thanksgiving, too.

Then came the inevitable turf struggle.  It was clear that the patient no longer should be on the Neurology service.  But should she go to the Internal Medicine Service, or to Thoracic Surgery?  More phone calls.  Medicine won this time, so I had to call the the intern for the medical service that would take her.  We met and I gave a quick rundown of the case, wrote a sign-off note, and finally got to leave.  There was heavy snow by then, and it took a while to get to dinner.  The dinner had to be reheated, but I was glad to be there. 

Families are good; diseases are bad. 

Yesterday, I was present at the forming of a new family.  In a few days, I will be with my own family, as we get together again for Thanksgiving.  By, then, hopefully, I will have forgotten about that day, 16 years ago, when I almost missed the whole thing. 

Sunday, November 21, 2004

Let's All Be Friends Now

U.S. Treasury Secretary John Snow, left, and his German counterpart Hans Eichel, shake hands during the G20 conference of finance ministers and central bank governors in Berlin on Saturday, Nov. 20, 2004. (AP Photo/Stephanie Pilick, pool)
Normally, I do not agree with the foreign policy of the Bush Administration, not do I typically agree with their fiscal policy.  Today, however, I find myself in the doubly peculiar situation of agreeing with both. 

The picture shows our Secretary of the Treasury shaking hands with Hans Eickel.  I'm not sure what the handshake was about, but it occurred after the US and Germany agreed to forgive Iraq of a significant fraction of their international debt.  It is nice to see some altruistic spirit on the part of our leaders.

France is on record as expressing reluctance to go along with the deal, stating that Iraq has oil and "development potential," such that they should be able to repay the debt. 

This was an incredibly shrewd move on the part of Mr. Snow.  Presumably, the move either was prompted by -- or, at least, approved of by -- President Bush.  It shows a remarkable degree of foresight.

Foresight generally is lacking in the current Administration.  This time, I have to give them credit: the really are on top of this one.

After all, it may not be long before the United States of America is unable to repay its international debt; Mr. Snow may very well have to jet around the world, begging for the same kind of deal that was granted to Iraq.  I guess I understand the handshake now. 

Saturday, November 20, 2004

Ripped Off From the New Yorker...

Click for Cartoon Bank

NAS: Don't Politicize Science

The nation is in need of exceptionally able scientists...

So ends the most recent report by the National Academy of Sciences (NAS).  The beginning is quoted here:
The security, economic well-being, and safety and health of the United States depend on the strength and vitality of the nation s science and technology (S&T) enterprise. Almost every aspect of modern public policy is touched by S&T, including those involving national security, economic development, health care, the environment, education, energy, and natural resources. The US research enterprise is the largest in the world and leads in innovation in many fields. For these reasons, it is critical to attract scientists and engineers into the highest levels of public service, either as political appointees in top leadership positions or as members of the many advisory committees providing scientific and technical advice to executive agencies.
The entire report can be read online, at the National Academies Press site (link above); a 12-page downloadable PDF summary is available as well.  Or, if you want, you can pay forty-five dollars for a real book.  Or, you can just read this blog post and trust me to convey to you the issues that are most important for you to know.

No, don't do that.  I did not read the report.  Reading an entire book online is not my idea of a fun Friday night.  Rather, I read the summary, and an article posted on www.the-scientist.com.  I selected those parts that suit my political inclinations.  Read the rest at The Rest of the Story.

Wednesday, November 17, 2004

Outline for a Revolution

What the Knight's Tour Problem Doesn't Teach Policy Wonks

This essay is long and boring.  I almost did not have the patience to write it.

One of my favorite ways to teach complex subjects is to use analogies.  Start out by talking about a simple subject, then compare it to the more complex topic.  The Knight Tour problem is good for this.  The problem is this: take an empty chessboard, place it on the table in front of you, situated such that there is a white square in the right-hand corner closest to you.  Put a knight on that white square.  Do not put any other pieces on the board.  Using the traditional way of moving a knight, is it possible to move the knight such that it lands on each square on the board once and only once, and ends up on the corner diagonal to the starting point?

There are three ways to solve this problem.  You could try out each possible sequence of moves.  That is a bad idea, because you will not live long enough to try them all.  You could program a computer to run through all the possibilities for you.  That is feasible, at least, but still, it will take a while.  The first two methods are called "brute force" methods, because they require a lot of effort, but are guaranteed to solve the problem.  The third way, which is the way most people do it, it to try to find some kind of short cut.

In case you have not figured it out yet, I will reveal the answer here.  After that, I set out on a zig-zag tour of my own, trying to see if math or science can teach us how to have a better government.  Read the rest at The Rest of the Story.

Medical Mystery Solved...Sort Of

The authors of one of the oldest Linux distributions ("distros") is Patrick J. Volkerding.  He has made significant contributes to the open-source community, and now he is ill.  He also is having trouble getting the right medical treatment.  For an interesting story of medical detective work -- he found the probable diagnosis using Google -- read his letter here

This all began quite some time ago, perhaps as long ago as May of 2001. I was preparing Slackware 8.0 for release and working really hard. A pain developed in my shoulder, and (too busy to do anything about it right away) I ignored it and continued to keep working. It got to be pretty bad and one afternoon in early June I was rushed to the emergency room at a hospital in Concord, California. I was sweating, feverish, with a weak pulse of around 50, experiencing chills and seeming to be on the verge of passing out. The doctor who saw me did a chest X-ray and didn't think it was too unusual. I was told it was probably bronchitis and was sent home with a prescription for ciprofloxacin which mostly cleared up the problem. Still the pain in my shoulder seemed to vaguely remain. By mid October of 2001, I was in bad shape again. [...]
Mr. Volkerding thinks he has figured out the problem, and the treatment, but he appears to be having trouble getting appropriate medical care.  He's asking for help. 

Tuesday, November 16, 2004

Political Capital and Moral Development

President Bush stated, in a well-publicized speech, that he has "earned capital" and that he intends to "spend it." 
Ebullient over his re-election and increased Republican majorities in the Senate and the House of Representatives, he [Bush] made it clear he saw the vote as a mandate for his manifesto.

"This week the voters of America set the direction of our nation for the next four years," he said. "I earned capital in the political campaign and I intend to spend it."
Of course, capital comes with a price, and now we are seeing the price.  It appears that those who elected him expect a return on their investment:
Conservative and religious leaders who led the pray-in protest said elevating Specter could jeopardize their support of GOP senators, including Frist, who are eyeing a White House run in 2008.

"It is a betrayal and a slap in the face to millions of pro-life Americans who helped re-elect this president," said Patrick Mahoney, director of the Christian Defense Coalition. "Don't turn to us in four years when you want to run for president ... and expect us to contribute millions of dollars."
Of course, that is business as usual, from a political perspective.  But what of the psychological perspective?  Reciprocity is an important part of any culture.  If one examines the culture, certain rules governing reciprocity become evident.  Of course, different people have different ideas about the rules.  Read the rest at The Rest of the Story.

Monday, November 15, 2004

A Clarification

It has come to my attention that one of my recent posts has caused some hurt feelings. In Questioning Potential Suitors; The Difference Between Accuracy and Precision, the portrayal of the person doing the questioning might have been interpreted as innacurate, given the stature and character of the actual person. The post is a work of fiction, and as such, is not intended to be an accurate portrayal of any specific individual. To set the record straight, the actual person was an extremely talented individual, made substantial contributions to his community, and was a perfect gentleman as well as an excellent role model. The world would be a better place if there were more people like him.

Sunday, November 14, 2004

The Circle of Life

The quality of the environment of Earth is going to get much worse.  Therefore, it is good to remind ourselves, from time to time, of the tremendous costs that this will entail.  Although the study reported here may not seem like a major study, it serves as a reminder that everything on the planet is linked together.  It may be inconvenient to acknowledge that fact, and it will cost money to act on it, but we cannot afford to ignore it. 

Declining Fish Supply Linked to Land Animal Extinctions
Scientific American
November 12, 2004

An analysis of nearly 30 years of data on African wildlife has uncovered a link between declining fish stocks and increased hunting and bushmeat trade. The results suggest that when fish sources of protein wane, people turn toward illegal hunting on land, which can lead to species extinction.

Justin S. Brashares of the University of California at Berkeley and his colleagues studied animal census information collected between 1970 and 1998 by park rangers in Ghana and compared it to information collected about the fish supply in the region over the same time period. The researchers found a 76 percent drop in overall abundance for the 41 species studied, which included buffalo, antelope, jackal and lion. In particular, the team discovered that in years with a below average fish supply, there was a greater decline in the land animal populations. In addition, some smaller game reserves experienced local extinctions of nearly half the studied species.

The team also studied the sale of bushmeat in 12 rural markets throughout Ghana in 1999 and found that poor fishing seasons were inversely related to both the price of fish and the amount of bushmeat available for sale. “Our study present very strong evidence showing how human food supply can be directly related to conservation of wildlife,” Brashares says. “We need people working together across disciplines to look at how losses of marine resources are impacting land resources and vice versa.” --Sarah Graham
The extinction of a species may not seem like a big deal, if you think of plants and animals as replaceable raw material.  But that is only one aspect of the problem.  The loss of a species also means a loss of one component of the ecosystem, which can be expected to have a negative impact on everything else.  It also represents the loss of irreplaceable genetic material. 

Ardent proponents of industry are prone to dismiss such things are irrelevant.  They look at a study of something obscure, do not see why it is important, and assume that it must not be important.  The next study illustrates this nicely.  Scientists studied the top layer of mud at the bottom of the ocean.  That certainly is obscure, and admittedly, it is not obvious right that it is important...

Extinction in ocean's mud presages key ecological changes
Science Blog
Posted on Friday, November 12, 2004 @ 5:00 PM PST by bjs

The loss of seemingly inconsequential animal species in the marine benthos - the top 6 inches or so of mud and sediment on the floors of the world's oceans - is giving scientists a new look ahead at the consequences of the steady decline of the world's biological diversity.

In new work published today in the journal Science, an international team of scientists describe work in which the ocean mud and the many animals that live there are used to forecast how the extinction of species alters important ecological processes that sustain life at the bottom of the ocean. [...]

And while the creatures that inhabit the mud at the bottom of the ocean may seem remote and unimportant, Cardinale pointed out that oceans cover 70 percent of the Earth's surface, and that the productivity of the sea is intricately linked to sediments that generate nutrients and food for other organisms such as fish. In places where human activities have disrupted marine sediments, such as the enormous ''dead zone'' in the Gulf of Mexico - where excess fertilizers are dumped by the Mississippi River - nearly all life has vanished.  [...]

When a species becomes extinct, there is another loss.  We loose -- forever -- the scientific knowledge that would have come from the study of that species, and from the study of how that species interacted with other components of the ecosystem.  Again, it may not be obvious, to some, just how big of a loss this is.  Remember: scientific knowledge has to be understood in a broad context to be meaningful.  Anytime you loose part of the context, that which remains has lost some of its value. 

Wednesday, November 10, 2004

The Best Health Care in the World

The election campaign is not over.  It is just beginning.
CHENEY: Our nation has the best health care in the world and President Bush is making it more affordable and accessible to all Americans.

BUSH: Our health care system can provide the best care in the world and ensure more Americans have access to care.
The first quote is from Cheney's acceptance speech at the Republican National Convention' the second is from the GeorgeWBush.com reelection site. 

<aside>The Bush reelection site also contains the following snippet:

 Health Care Endorsements will be announced soon. - Check back for updates...

The election was last week.  Exactly when are we to expect all those endorsements? </aside>

Back to the topic: The following is from Medscape News, reporting on the 132nd annual meeting of the American Public Health Association (APHA).
Medscape Medical News 2004.
© 2004 Medscape

Nov. 10, 2004 (Washington) — After years of steady progress toward improved health in the U.S., there are signs of a downturn that may soon translate into movement in the wrong direction, according to a new report released here at the 132nd annual meeting of the American Public Health Association (APHA).

The report, "America's Health State: State Health Rankings," uncovers three key troubling trends: the first rise in infant mortality rates in four decades, the rapidly increasing prevalence of obesity in all age groups, and the number of uninsured individuals, which increased in 38 states between 2003 and 2004.

Most disturbing perhaps is the big-picture finding that the health improvements of the 1990s, during which overall health improved at an annual rate of 1.5% for a total gain of 17.5%, is headed for reversal. Since the start of the millennium, health improvement has been a negligible 0.2%, a finding that should set off alarms, APHA Executive Director Georges Benjamin, MD, told Medscape.

"Despite the significant improvement in our nation's health over the last 15 years..., the trends we're seeing now — especially this dramatic slowdown in the rate of improvement — are not encouraging," Dr. Benjamin said.

In particular, he cited the increase in infant mortality from 6.9 to 7.0 births per 1,000, a statistic that puts the U.S. 28th internationally in infant mortality, as well as the finding that 14 states have preterm birth rates that exceed 13%. That alarming statistic is likely associated with the fact that 12.6 million American women of child-bearing age are uninsured.

"Clearly, there is a connection there that cannot be ignored, and this is something we must address as a nation," Dr. Benjamin said. "Prematurity has many factors, from poverty to inadequate prenatal care and infections, but for the clinicians who treat these women, this [increasing prevalence of preterm births] is clear evidence of a healthcare system in crisis," he said.

To put that infant mortality statistic into perspective, there are about 1,100 births each day in the USA.  This means that increasing the infant mortality rate from 6.9 to 7/1000 results in one extra infant death about every 10 days.  If infant viability is directly proportional to moral values, then the USA has the 28th best moral values in the world.

Tuesday, November 09, 2004

Bush Was and Is Wrong

I suspect most readers have seen this news by now, perhaps in other outlets.   Still, it is worth noting that two significant reports, both based upon large studies, agree that there will be a huge environmental impact of global climate change in the next 100 years. 

New Scientific Consensus: Arctic Is Warming Rapidly

REYKJAVIK -- The Arctic is warming much more rapidly than previously known, at nearly twice the rate as the rest of the globe, and increasing greenhouse gases from human activities are projected to make it warmer still, according to an unprecedented four-year scientific study of the region conducted by an international team of 300 scientists.

At least half the summer sea ice in the Arctic is projected to melt by the end of this century, along with a significant portion of the Greenland Ice Sheet, as the region is projected to warm an additional 4-7 C (7 to 13 F) by 2100. These changes will have major global impacts, such as contributing to global sea-level rise and intensifying global warming, according to the final report of the Arctic Climate Impact Assessment (ACIA).

The assessment was commissioned by the Arctic Council (a ministerial intergovernmental forum comprised of the eight Arctic countries and six Indigenous Peoples organizations) and the International Arctic Science Committee (an international scientific organization appointed by 18 national academies of science).

The assessment’s findings and projections are being released today and will be presented in detail at a scientific symposium in Reykjavik, Iceland, November 9-12, 2004.  [...]

Published online: 09 November 2004; | doi:10.1038/news041108-4
Michael Hopkin
Global warming alters US wildlife
Report warns of damaging changes in animal and plant habits.

Climate warming is influencing the lifestyles of animals and plants right across the United States, a report has warned. The changes are bringing rival species into contact with each other and could upset entire ecosystems.

Over the past few decades many plants have begun flowering earlier in spring in response to rising temperatures, and animals have migrated north or moved to higher altitudes, reports Camille Parmesan of the University of Texas at Austin, one of the report's authors.

One example is the red fox (Vulpes vulpes), which is already widespread across North America but is now pushing north, threatening the weaker Arctic fox (Alopex lagopus), says Parmesan. Other more subtle effects may occur as, for example, birds altering the timing of their arrival at breeding grounds find themselves with less food or space. [...]

It will be an interesting test of his honesty, to see if he now can identify at least one mistake that he has made.  He has insisted that there is no scientific consensus on climate change, that we need to wait until more conclusive evidence is available, and that the damage to the economy would be too great to implement the Kyoto agreement.  Wait until we find out how much it is going to cost to move Washington DC to Kansas, just to keep the Washington Monument from being used to make shipping lanes. 

OK, maybe that is an exaggeration, but the point stands: the Arctic ice cap is melting, and coastal areas are going to be in big trouble by 2100.  And by then, the federal deficit will be so large, that we will not be able to afford to do anything about it.

Nice Picture...

Monday, November 08, 2004

It Is Good to Eat Fish, But...

If you like to eat fish, but are afraid of mercury, then you have a problem. On the other hand, if you are one of the people who thinks that mercury is ok, that it is more important to prevent gay marriage that to prevent brain damage in children, by all means, go ahead and eat all the fish you want. I suppose another way of putting that is the old saying: 'Give a man a fish, and he will eat for a day. Teach a man to fish, and he and his family will have brain damage for a lifetime.'

I am trying to get back to writing about science. Really.
Omega-3 Fatty Acids: Good For The Heart, And (maybe) Good For The Brain

New York, NY (November 1, 2004) -- There is mounting evidence that a diet containing omega-3 fatty acids, already known to help prevent cardiovascular disease, may also prevent depression. In light of the Food and Drug Administration (FDA)'s recent ruling that antidepressants will be labeled with a "black box" warning about the drugs' higher potential suicide risk in children, NewYork-Presbyterian Hospital/Weill Cornell Medical Center nutrition experts call for further study of the mental health benefits of omega-3 fatty acids.

"Given recent findings of serious risks linked with antidepressants, we should prioritize the study of natural antidepressants contained in dietary sources -- specifically, omega-3 fatty acids, found most abundantly in fish and seafood," says Dr. Barbara Levine, associate professor of nutrition in clinical medicine at Weill Cornell Medical College and director of the DHA Information Center at NewYork-Presbyterian/Weill Cornell. Dr. Levine has been studying DHA (docosahexaenoic acid -- a component of omega-3s) and its effects on lowering triglycerides and raising HDL (high-density lipoproteins) in overweight and obese patients with metabolic syndrome.

"Omega-3 consumption in the U.S. is lower than in any other country; the U.S. also has one of the highest depression rates in the world," says Dr. Jeffrey Borer, chief of the division of cardiovascular pathophysiology at NewYork-Presbyterian/Weill Cornell and Gladys & Roland Harriman Professor of Cardiovascular Medicine at Weill Cornell Medical College. "New research has linked omega-3 consumption inversely with incidence of neurological and immune disorders. However, further research among all age groups and populations is necessary in order to confirm these findings and to further educate the public." [...]

The article goes on to recite the reasons to think that fish oil may be helpful for persons with some degree of clinically-significant depression. Based upon my casual observations, it does seem to help some people. The size of the benefit is not very great, compared to the usual treatments; but for persons with mild depression, it might do enough. The other situation, where it seems to help, is in patients with treatment-resistant depression: those who may get some benefit from standard treatment, but do not attain remission. For them, anything that can help, even a little bit, is worthwhile.

As the title of the article (..."And (maybe) Good For The Brain") implies, the evidence for benefit is not really conclusive yet. I would not suggest that people go out and spend a lot of money, or worse, abandon those treatments that have been validated empirically. But fish oil really does appear to be one of those things that might help and can't hurt.

Sunday, November 07, 2004

Questioning Potential Suitors;
The Difference Between Accuracy and Precision

In the summer of 1974, as I rode with my family in a new Ford Galaxy 500 station wagon, the air conditioning was on.  It was on because we were in New Mexico, and it was Very Hot.  We came over the Organ mountains, approaching Las Cruces.  My sister cried out: "wow, they have a lot of sky here!"

Organ MountainsIndeed, they do have a lot of sky.  My parents got us a membership at the NMSU swimming pool, because, although there is a lot of sky, there is not much for teenagers to do.  When I was not at the pool, I was at the local library.  In fact, I read all the books in the library's psychology section that year.  I learned about the principle of psychic determinism.  That is the notion that everything that is going on in your brain, at any given moment, is a product of what was going on in your brain the moment before, plus whatever sensory input is occurring at the time. 

According to the principle of psychic determinism, there are no non sequiturs.  Sometimes people say things that do not seem to fit with the topic at hand.  But, in the mind of the speaker, there always is a connection between what was said a moment ago, and what is being said now.  Apparent non sequiturs can be annoying.  Usually, though, one merely has to wait a few moments in order for the connection to become clear.

One day, at the pool, I met a young lady.  We became friends.  One other day, I think she was trying to impress me, because she made me lunch.  I was at her house, she opened the refrigerator, and asked me if I wanted a steak.  I, like almost any 15-year old boy, when asked if he wants a steak, did in fact want a steak.  Honoring my mother's direction to be honest at all times, I said "yes."

She cooked the steak.  I ate it.  It was very good.  I didn't think about it again for several weeks.  Later, I went to the young lady's house again.  Her father was there.  He looked up at me and asked, rather gruffly, "Are you the guy who ate my steak?"

"Uhhh, yes, I am."

White Sands Missile Range MuseumHe looked down at the table for a moment, as though to soften the impact of what might have been perceived as a rude way to introduce yourself to someone you just met.  He then asked, "What is the difference between accuracy and precision?"  I did not know it at the time, but he was a civilian engineer at the White Sands missile range.  He was involved in the design and testing of missiles.  (The military is interested in the accuracy of its missiles.)

The alert reader will have deduced that I was a bit of a bookworm, at the time, so I happened to know the answer.  I also knew about the principle of psychic determinism, so I knew that if I were patient, the rationale for the apparent non sequitur would become apparent.  I replied something like this: "Accuracy is how close a measurement is to the real value, whereas precision is how close repeated measurements are to each other."

He threw his hands in the air, and said, "I can't believe it!  I've been trying to get the US military to understand the difference, and they can't get it straight.  But here's some teenage kid who knows!"  He was nice after that.

What was the connection? I had eaten his steak, and dated his daughter.  Apparently, those two things were OK, since I knew the difference between accuracy and precision.  It does not matter if you get two strikes, if the third swing results in a home run.

Ever since then, I have understood the importance of the ability to make a distinction between two related concepts. 

There was more discussion of accuracy and precision.  "Accuracy means truth.  Precision means repeatability."  If missiles are perfectly accurate, then all missiles launched at Target A will hit Target A.  If missiles have perfect precision, then all missiles launched at Target A will hit the same spot, which may or may not be the target.  Thus, it is possible to have perfect precision, but no accuracy; whereas perfect accuracy always is accompanied by perfect precision.  People get mixed up about this all the time. 

It is tempting, of course, to think that if you measure something several times, and come up with the same value every time, that the measurements indicate some kind of fundamental truth.  But is someone hands you a ruler that is not really a foot long, all the measurements you make with that ruler will be wrong.  The errors you make will be systematic errors.

Likewise, if you listen to someone talk, and he or she always says the same thing, it is tempting to think that what they are saying reflects the truth about what is going on inside their head.  It follows from the principle of psychic determinism, that what they are saying is related to what is going on in their head.  The thing is, the relationship between what is going on in their head, and what they are saying, may be systematically distorted.  Thus, the fact that the person always gives the same answer does not mean that the answer is correct. 
Phrenological Map
When you listen to a person talk, you are trying to get a measurement of what is going on inside their head.  Of course, this is a bit like trying to size up your daughter's suitor.  If the person is honest, what he says is a good reflection of what he is thinking.  But if he is systematically dishonest, you cannot believe anything he says, never mind that he always gives the same answer to the same question.  In fact, the precision with which he speaks may be a part of his effort to deceive.  Like the person who handed you the fake ruler, the pathological liar knows that if he always gives the same answer, you will be tempted to mistake precision for accuracy.

Taking the measure of a potential suitor is sort of like taking the measure of a potential president.  It is reassuring if he or she always says the same thing, but that does not mean that that the truth is being spoken.

Saturday, November 06, 2004

Things Found while Looking for Other Things

Vast Right Wing Conspiracy

sponsered by Right Wing News, A Small Victory, and the Letter W.

Like people say, you can't make this stuff up.  Hooray fer morel values!

Cool Thing About Linux

I haven't posted much lately. Partly that is because I was so morose about the election. Partly it's because I trashed my operating system. As I've learned more about Linux, I decided to try to compile a customized kernel. Ooops. The cool thing about it is that I was up and working again very quickly. I keep a copy of Knoppix nearby. I put the CD in the drve, booted from the CD, and was back in business. Although I still don't have the complete system back, I have access to all my files, and Knoppix has enough applications that I can still do about as much as I could with the complete SuSE installation. That kind of quick recovery is just plain impossible with Windows. Of course, I supppose, people don't go around compiling their own Windows kernels, either, but the point still stands: recovering from a Linux crash is really really easy.

Horse Ethics:
Moral Values Revisited

I have watched horses.  When a horse first becomes active in the morning, after it is done sleeping, or whatever it is that horses do at night, the first thing it thinks is: "I think I'll eat some hay today."

About ten months ago, my wife and I both were injured, such that we could not take care of our horses.  The vet recommended a lady who would come and take care of the feeding, etc. 

It worked out pretty well.  She had two working legs and two working arms, and she needed the money; neither of us had a full complement of working limbs, but we had money.  I won't mention real names here, but let's call the horse feeding person "Abigail."

She turned out to be a nice human being.  Sometimes she would come up and have coffee.  After a couple of weeks, I was able to return to work, but my wife was still stuck at home.  One day, I came home from work, and my wife said that she though she and Abigail might become friends.  The thing is, Abigail did not come up for coffee very often after that. 

A couple of months ago, my wife told me of a couple of conversations she had had with Abigail.  Shortly after they first met, over coffee, Abigail mentioned that she was a Christian, and that moral values were very important to her.  My wife responded by saying that she is an atheist, but moral values are important to her, too.  She went on to explain that she believes strongly in honesty, faithfulness, fairness, helping the disadvantaged, etc.  Abigail was perplexed.  She said something like 'But you must believe in god if you have values like that.'

They did not turn out to be friends, really.  After a few weeks, Abigail came up to the house a little more often.  Eventually they starting having coffee together again.  They talked some about social issues.  As my wife started to heal somewhat, the two of them started doing some work in the barns, or with the horses, together.  Working and talking together like that, Abigail started to get a sense of my wife's character.

A few weeks ago, Abigail said, seemingly out of nowhere, "You know, you really are a good person."

Horses do not really have a developed sense of ethics.  They just want to eat hay, stay away from the wolves, and make more horses.  I think, though, that horses could teach us a thing or two. 

Or maybe, possibly, if people of different political perspectives would spend some time, mucking out barns together, they might learn to respect one another.

Thursday, November 04, 2004

More Good News From Iraq

While we all are celebrating the outcome of the recent election in the USA, let's all increase our joy by reading the good news out of Iraq, from a soldier stationed there.

Just follow this link to warm the cockles of your heart.

Dreaming of a Better World

A series of troughs and layered mesas in the Gorgonum Chaos region of the Martian southern hemisphere appears in the chaotic terrain. Gullies proposed to have been formed by seeping ground water emanate from a specific layer near the tops of trough walls, particularly on south-facing slopes. Such a layer is called an aquifer, and this one appears to be present less than a few hundred meters (few hundred yards) beneath the surface in this region. This image was taken by the Mars Global Surveyor camera on January 22, 2000.

Wednesday, November 03, 2004

Results of Latest Election
(From Netscape News)

Top News
Wednesday, Nov. 3, 2004
'The Grudge' Stays at No. 1; 'Ray' Second
That says it all. Anger wins over class.

Monday, November 01, 2004

Threat to National Safety; Leader from Texas Steps Up

The United Nations is the goat of the Republican Party. After all, who needs the UN???? What are they good for???? When there is a real threat to the US, look to the Leader from Texas to step up to the plate.
Flu threat to be discussed

The World Health Organization has called a summit of flu vaccine makers and nations to iron out a coping plan as threats of a flu pandemic grow.

BY MARILYNN MARCHIONE Posted on Mon, Nov. 01, 2004 Associated Press

WASHINGTON - The World Health Organization has called an unprecedented meeting of flu vaccine makers and nations to prepare plans for dealing with the growing threat of a flu pandemic.

Sixteen vaccine companies and health officials from the United States and other large countries have agreed to attend the summit in Geneva on Nov. 11, said Klaus Stohr, influenza chief of the United Nations' health agency.

''We believe that we are closer to the next pandemic than we ever were,'' Stohr said in an interview before a speech at an American Society for Microbiology meeting in Washington.

Flu kills about 36,000 people in the United States and a million worldwide each year by conservative estimates, Stohr said.

The current vaccine shortage in the United States, caused by loss of one of the country's two major flu shot suppliers, reveals how vulnerable the world is and serves as a ''dress rehearsal'' for the kind of rationing and emergency measures that would be needed in a pandemic, said Dr. Wendy Keitel of Baylor College of Medicine in Houston.

''The ability to respond with the production of billions of doses of vaccine is quite limited,'' Keitel said. ``We need to think through these problems now.
There you have it: the Leader from Texas stepping up to the plate. Who needs the UN???

Of course, the only thing the President of the US has to say, is that he will forego his own flu shot. Here there is a real threat to the security of the USA, and who is actually doing something about it? The UN.

Maybe Bush will get the flu. No great loss. Maybe he finally will have the time to finish The Pet Goat.