Sunday, April 30, 2006

We Cover the News

NYC Protest
Originally uploaded by mollydobkin.

We cover the news, so the MSM doesn't have to.

Also see the Flickr photo pool of the event.

BIG Moose


A junction in the northern part of Sweden, a destination for people all over the world, a monument dedicated to wilderness, nature and the king of the forest. Our goal is for this giant moose to be "born" before the end of 2006.

  • Situated on top of the mountain "Vithatten"
  • 2 legs in the district of Arvidsjaur and region "Norrbotten".
  • 2 legs in the district of Skellefteå and region "Västerbotten."
  • Construction completely made of gluelam wood with steeltubes in the legs and in the "pinetree".
  • Approx. 47 m long, 12 m wide, 35 m on the back, ca 45 m on the antlers. The antlers incl. tines approx. 100 m².
  • The moose will bite onto a pinetree, inside the pine an elevator will lift people up to enter the moose through the mouth. The branches from the pine will serve as an umbrella over the antlers.
  • The exterior will be made from heat-preparated wood, which makes it possible to decide colour by using different temperatures.
  • A track will be made for those who rather want to walk to the top.
  • Inside the moose there will be 3 floors with a total size of approx. 1500 m² and a floor in the throat with a size of 250 m².
  • Done by December 2006.
The interior will contain a concert hall, dining hall, and conference center.  There also will be galleries for artists to sell their creative works.  

Governor Grandholm should take note of this for her "cool cities" concept.  Maybe Ann Arbor could build a huge Wolverine, and put a football field inside.  Next thing you know, Los Angeles will build a giant Trojan Horse.

Saturday, April 29, 2006

Another One Bites the Dust

How many times have you heard a phrase in the form of: "humans are the only animals that X," where X is some kind of cognition or behavior? We hear that a lot less than we did a few decades ago, because scientists keep finding animals that do things that we used to think that only humans did. Now comes a report about yet another presumptive myth:
The Birds and the B’s Challenging Chomsky, Starlings Learn ‘Human-Only’ Syntax Patterns By Inga Kiderra April 26, 2006 The European starling – long known as a virtuoso songbird and as an expert mimic too – may also soon gain a reputation as something of a “grammar-marm.” This three-ounce bird, new research shows, can learn syntactic patterns formerly thought to be the exclusive province of humans. Led by Timothy Q. Gentner, assistant professor of psychology at the University of California, San Diego, a study published in the April 27 issue of Nature demonstrates that starlings have the capacity to classify acoustic sequences defined by recursive, center-embedded grammars. Recursive center-embedding refers to the common characteristic of human grammars that allows for the creation of new (and grammatically correct) utterances by inserting words and clauses within sentences – theoretically, without limit. So, for example, “Oedipus ruled Thebes” can become “Oedipus, who killed his father, ruled Thebes” or “Oedipus, who killed his father, whom he met on the road from Delphi, ruled Thebes,” and so on. Chomskian linguists have held that this recursive center-embedding is a universal feature of human language and, moreover, that the ability to process it forms the computational core of a uniquely human language facility. “Our research is a refutation of the canonical position that what makes human language unique is a singular ability to comprehend these kinds of patterns,” Gentner said. “If birds can learn these patterning rules, then their use does not explain the uniqueness of human language.”
One thing remains unique about humans: We are the only creatures that can raise the price of oil by merely starting a rumor about attacking another country. The original article is in Nature, here.

Klingon National Anthem

I decided to try to translate the Star Spangled Banner into Klingon, but it was too much work, and it would not have been very funny, anway. And it would have been a bear to try to sing it.
Speaking of insolence, the hackers at OnMac.net have succeeded in getting an Intel Mac to triple-boot Mac Os, Win XP, and Linux. I am not sure why, but they did.
Now, this is really insolent: Anheuser-Busch admitted in the Wall Street Journal that it has changed the recipe of Budweiser and Bud Light! Not that I care; I'm one of those people who think that Budweiser is not really beer. But it is America's Beer. Now why isn't Bush complaining about that in the Rose Garden? It's a lot more heretical than a Spanish-version national anthem.

Friday, April 28, 2006

Baloney Detection Kit: Political Version

Regular readers know that one of my pet peeves is propaganda in the mass media.  Since this is Friday, when bloggers traditionally blog about their pets, I thought I would write about my pet peeve.

In this case, however, I am please to report that a journalist was using his Baloney Detection Kit (term © Borac) and actually wrote an article that dispels a common myth that is ensconced in American psyche.  

As a little ironic twist, the author's name is Alister Bull.
Rags-to-riches dream an illusion: study
Wed Apr 26, 2006 11:40pm ET
by: Alister Bull

WASHINGTON (Reuters) - America may still think of itself as the land of opportunity, but the chances of living a rags-to-riches life are a lot lower than elsewhere in the world, according to a new study published on Wednesday.

The likelihood that a child born into a poor family will make it into the top five percent is just one percent, according to "Understanding Mobility in America", a study by economist Tom Hertz from American University.

By contrast, a child born rich had a 22 percent chance of being rich as an adult, he said.

"In other words, the chances of getting rich are about 20 times higher if you are born rich than if you are born in a low-income family," he told an audience at the Center for American Progress, a liberal think-tank sponsoring the work. [link added]

He also found the United States had one of the lowest levels of inter-generational mobility in the wealthy world, on a par with Britain but way behind most of Europe. [emphasis added]
This, of course, is a corollary of the principle that the rich get richer, and the poor get poorer.  Despite all the talk about developing an "ownership society," the fact is that the income gap in the USA is getting wider.

Thursday, April 27, 2006

33rd Skeptic's Circle
And More

The 33rd Skeptic's Circle, a biweekly carnival of skepticism, has been posted by Borac at Science and Politics. It is nicely organized, with an entertaining, whimsical overtone. Running a carnival takes a lot of work; thanks to Borac for putting this together.
Also, I notice that Sine.Qua.Non Journal is collecting what will be a virtual clearinghouse for articles and links pertaining to the US involvement in torture, at Torture, Abuse & Detainee Database. They are looking for contributions, so if anyone has blog posts, or links to articles or other information on the subject, please consider dropping them a line at sinequanonblog [@] yahoo.com. (The email address is obscured as an anti-spam measure; just take out the spaces and the square brackets to get the real email address.

I am hopeful that they can build up an impressive collection to help keep this important issue bright on the American political radar screen.

Banks Won't Make Pizza

I forget where I first saw this sign: "We have a deal with the bank.  We won't cash checks, and the bank won't make pizza."  It probably was in a pizza place, perhaps the Cottage Inn on William St. in downtown Ann Arbor.  If that is where it was, it is not there any more.  But I have seen signs like that elsewhere.  It is still a good idea.  Banks should limit what they do to areas in which they have expertise.

In the latest edition of the medical journal, The Lancet, there is an article about the World Bank and its efforts to address the problem of malaria in developing nations.  
The World Bank: false financial and statistical accounts and medical malpractice in malaria treatment
The Lancet Early Online Publication, 25 April 2006

The World Bank has an annual budget of US$20 billion, and is the largest organisation operating with a mission to reduce poverty worldwide. Malaria destroys about 1 million lives a year; the disease is the leading parasitic cause of death for Africa's children and impoverishment for their families. Here we examine how these factors meet in the new Global Strategy & Booster Program, which is the Bank's plan for controlling that disease in 2005–10.

We believe this plan is inadequate to reverse the Bank's troubling history of neglect for malaria. In the past 5 years, the Bank has failed to uphold a pledge to increase funding for malaria control in Africa, has claimed success in its malaria programmes by promulgating false epidemiological statistics, and has approved clinically obsolete treatments for a potentially deadly form of malaria. Crucially, the Bank also downsized its malaria staff, so that it cannot swiftly execute the restoration it plans under the Global Strategy & Booster Program. We summarise the evidence, show that the Bank possesses demonstrably little expertise in malaria, and argue that the Bank should relinquish its funding to other agencies better placed to control the disease. [...]
The article is made available freely to the general public, something which Elsevier generally is loathe to do; the fact that it is freely available is an indication that the editors think it is a pretty important matter.  And so it is:
The Bank's secrecy and technical errors combine dangerously when we look at malaria treatment. Our investigations suggest that the Bank wasted money and lives on ineffective medicines.
The authors go on to provide abundant evidence of profound mismanagement.  The more you read, the worse it sounds, despite the fact that it was written in a dispassionate and objective style.  If anything, they are too gentle.  After stating that their investigations "suggest" that the Bank wasted money and lives, they document six instances of exactly that.  

Upon reading the article, one is left to wonder what the World Bank is doing.  Is it merely a political showcase, rather that an humanitarian institution?

They would have been better off if they had decided to spend hundreds of millions of dollars making pizza instead of running a medical program.

Wednesday, April 26, 2006

Healthcare Initiatives Fall Short

Massachusetts recently began a program that would expand health care coverage to almost everyone.  Now, U.S. Rep. has introduced a bill (Communities Building Access Act) that would try the same kind of thing.  It would be more modest, but cover the entire country.  
The bill Introduced Tuesday in Congress would set aside $45 million in federal grants over seven years as seed money for communities to design and implement local programs to provide health insurance or health care services to the uninsured. There are 1.1 million uninsured people in Michigan.

"As we all know, there are way too many Americans who do not have access to health insurance and therefore they do not have access to health coverage," said U.S. Rep. Pete Hoekstra, R-Holland, the bill's main sponsor.

"We also know that as we face this issue in health care, there's not a silver bullet to address these concerns. We need to be doing a lot of things in a lot of different areas."

Inspired by Muskegon's Access Health insurance program, the Communities Building Access Act would allow communities to leverage federal grants to create local health insurance cooperatives where the cost of care is shared by the local government, employers and employees.

The money also could be used to create volunteer specialty provider networks, in which providers discount their services to care for low-income members of the network. CareNet of Toledo/Lucas County, Ohio, is the most prominent example of such a network.

Vondie Woodbury, director of the Muskegon Community Health Project, said that these community-based solutions are appealing to the business community, which has been reluctant to embrace national solutions for fear they would be costly and require too much red tape.
As commendable as these initiative may seem, they suffer from a serious flaw.  They rely on an unreliable patchwork of solutions.  The specifics vary from place to place, and change from time to time.  As a result, healthcare providers will have a hard time understanding exactly what benefits are available, where, when, and for whom.  This will make it difficult for providers to formulate treatment plans for their patients.  

I understand what Woodbury said about the business community being reluctant to embrace national solutions.  They are afraid it would be costly and require too much red tape.  The solution is not to create additional programs that add on to the programs that are already available.  It does not make any sense to think that such an approach will reduce costs and avoid red tape.  The opposite is true.  It is inevitable that creating more programs will crate more overhead costs.  The only was to both increase overhead and decrease costs, is to limit the care that is provided.  The thing is, nobody wants to come right out and say the truth.  The truth is, it would cost a lot of money to provide unlimited health care.  The only alternative is to ration the care in some way.  But nobody wants to talk about rationing health care.  

So instead, what we have done, as a society, is to build a massively inefficient, complex system that limits access to health care by being so inaccessible and inscrutable that health care is effectively rationed, without anyone having to say that it is rationed.  

The only sensible approach is to have a universal system that provides basic health care.  If people want more, than what we, as a collective, decide we can afford, then that can go out and pay for it themselves.  If we want to expand what is covered in the basic package, then we have to decide to pay for it.  But the key is to keep the basic system as efficient as possible, with as little paper-shuffling as possible.  

If people want to pay others to move paper from one stack to another, they are free to do so, but they have to pay for it themselves.  There is no reason to use collective funds to pay for that.

Some of these issues are discussed here, specifically regarding the Massachusetts plan.

Tuesday, April 25, 2006

Mozilla RIP

Remember when you had to pay to get Netscape?  I think it was about $25 or so, although I never actually paid for it.  I got it for free when I became an early user of Physicians On Line (POL).  That was around 1995.  POL is gone now (merged with Medscape) and Netscape is not being developed.  The latest version of Netscape (8) is actually pretty nice, but hardly anybody uses it.  

I just learned that the open-source version, Mozilla, is not going to be developed any further, either.  Instead, the offbeat branch is going to become the main branch.  That is, Firefox is going to be the only actively-developed browser out of the original code base.

Netscape used to have a browser, an email client, and an HTML editor, all in one application.  Now, we have the browser (Firefox), the mail (Thunderbird), and the editor (NVu) being developed as separate applications.  I actually preferred the old way, from a usability standpoint.  But I must admit, there has been a lot more innovation using the new model. Having three separate applications does mean more downloading and more disk space being used.  But since downloading is pretty fast these days, and disk space is cheap, that is not much of an issue.

Windows is finally going to introduce some of the innovations we have seen in Firefox, when they release Explorer 7.  But now, assuming it comes out with Vista, that won't be until 2007.  By then, it will be a little hard to think of them as "innovations."

I just fired up Mozilla and used Composer to write this, just for old times' sake.  Still works fine, but how many browsers do we need?  What we need is innovation, and Firefox right now is where the innovation is taking place. 

Monday, April 24, 2006

U.S. Military Orders Human-trafficking Reforms in Iraq

The Chicago Tribune published a series of investigative articles, Pipeline to Peril (free registration required), in October 2005.  Among their findings, they determined that US-based contractors were engaging in illegal human trafficking to supply laborers in Iraq.

Now, the Tribune reports that General Casey has ordered the implementation of reforms, confirming that the abuses did in fact occur.  
The memos, including an order dated April 4 and titled "Subject: Prevention of Trafficking in Persons in MNF-I," or Multinational Forces-Iraq, say the military also confirmed a host of other abuses during an inspection of contracting activities supporting the U.S. military in Iraq. They include deceptive hiring practices; excessive fees charged by overseas job brokers who lure workers into Iraq; substandard living conditions once laborers arrive; violations of Iraqi immigration laws; and a lack of mandatory "awareness training" on U.S. bases concerning human trafficking.
That quote does not make it sound too bad, but the rest of the article details some overtly abusive practices:
Those workers and others suffered from a chain of exploitation that began in their home countries, where families often assumed huge debts to pay fees demanded by brokers, to Iraq. Even after discovering they'd been deceived, workers felt compelled to head into the war zone, or remain in danger for much longer than they desired, just to pay those debts.

The Tribune also found evidence that subcontractors and brokers routinely seized workers' passports, deceived them about their safety or contract terms and, in at least one case, allegedly tried to force terrified men into Iraq under the threat of cutting off their food and water.
I have two things to say about this.  First, it is absolutely disgusting that we would essentially enslave people, all in the service of "liberating" Iraq.  Second, it is unbelievably stupid to import labor, when the unemployment rate in Iraq is so high.  All it does is alienate the local people.  What are they to think, when they see jobs going to foreigners, while their own people are going without jobs?

Sunday, April 23, 2006

Oh. That's Great.

Russia has decided to escalate rebuilding its nuclear arsenal, in response to our nuclear policy. That is really something, isn't it?

Read the article in Foreign Affairs, by Keir A. Lieber and Daryl G. Press, here.

PTSD May Persist in Combat Veterans for Decades

The April 2006 edition of the American Journal of Psychiatry has an article about the longitudinal course of .  The abstract is here; the full version is here, but requires a subscription.  Additionally, there is a Medscape article based upon the original paper, here (free registration required).

In this post, I describe the key findings of the study, then comment on the implications for veterans and civilians.  Contnue reading here.

Saturday, April 22, 2006

Arrrgh! Not Another Online Quiz!

Actually, it is a serious online quiz. It measures a person's implicit bias, with regard to some particular set of concepts. Implicit bias can be measured using, among other instruments, the Implicit Association Test (IAT). You can take this test here. It appears to select a topic for you, either at random, or perhaps according to an internal protocol of some sort.

My results were as follows:
Your data suggest a strong automatic preference for Open-Source compared to Microsoft.
While that is not what I would call an earth-shattering result, it was kind of fun to take the test. Specifically, it was fun to try to figure out why the test works the way it does.

The results of this particular iteration of the test did not result in any new knowledge. I suppose it must happen occasionally that people get results that they don't expect. In fact, before you take the test, you are alerted to the possibility that you might find the results to be objectionable. If that possibility bothers you, you are supposed to stop immediately.
Important disclaimer: In reporting to you results of any IAT that you take, we will mention possible interpretations that have a basis in research done at the University of Washington, University of Virginia, Harvard University, and Yale University. However, these Universities, as well as the individual researchers who have contributed to this site, make no claim for the validity of these suggested interpretations. If you are unprepared to encounter interpretations that you might find objectionable, please do not proceed further.
That would be common sense. My question for tonight is this: What is the opposite of common sense? Is it absurdity?
Having no mental handicap herself, she had to ask George what the latest sound had been.

"Sounded like somebody hitting a milk bottle with a ball peen hammer," said George.

--Kurt Vonnegut, in Welcome To the Monkey House


From a stroll at Country Farm Park in Ann Arbor, Michigan.

Thursday, April 20, 2006

Nichols Arboretum

Pictures from a stroll in , Ann Arbor, Michigan.

A Peaceful Call to Arms?

The New York Times today printed an opinion piece by , who is described as: "a Marine who served in Iraq and a fellow at the , [who] is writing a book about national service and sacrifice."  I found the article by following a link from the new blog, Manging the Atom: Iran News.
A Peaceful Call to Arms

Published: April 20, 2006

THE American public needs to be prepared for what is shaping up to be a clash of colossal proportions between the West and Iran.

President Franklin D. Roosevelt masterfully prepared Americans before the United States entered World War II by initiating a peacetime draft under the Selective Training and Service Act of 1940.

Now, President Bush and Congress should reinstitute selective service under a lottery without any deferments.

This single action will send a strong message to three constituencies in the crisis over Iran's nuclear intentions — Iran, outside powers like China and Russia and Americans at home — and perhaps lead to a peaceful resolution. [...]
Last year, when I first noticed the propaganda that seemed to be preparing the US public for war with , one of my first thoughts was 'There would have to be a draft.  The American Public would not stand for that.'  I suppose I was trying to reassure myself.

I also tried to reassure myself myself by remembering that Bush promised, I think during the third debate, that he would not institute a draft.  I knew, though, that such a promise is worth nothing.  In the current Administration, war seems to be an all-purpose excuse.  

Resurrecting the draft is a terrible idea.  The only way it could contribute to peace is if it so enraged the population that people would threaten an uprising or a general strike in response to the draft.  Kane is right about one thing.  The American public does need to be prepared for a clash of colossal proportions.  But the clash would be a clash between sensible persons, who see that Iran still does not have the capacity to threaten us, and a subset of sensless persons who fail to see that we cannot simultaneously prevent and prepare for war.

To add a little of that most unwelcome spice -- nuance -- I would add that there is a difference between maintaining a credible deterrence, and actually preparing for war.  The question is, where is the line between the two?

Rove Question

In some ways, this is a routine, expected news item, but it does raise one question.
Rove Is Giving Up Daily Policy Post to Focus on Vote

Published: April 20, 2006

WASHINGTON, April 19 — The overhaul of the White House staff intensified on Wednesday as Karl Rove, one of the president's most powerful and feared advisers, gave up day-to-day control over the administration's domestic policy to concentrate on the midterm elections. Scott McClellan, the White House press secretary, said he was stepping down. [...]
What I want to know is this: if this guy's job is to "concentrate on the midterm elections," then why is he drawing a government salary?

Monday, April 17, 2006

Attention CPAP Slackers!

It has come to my attention that there are many people out there who have CPAP machines, but are not using them.  

Remember, there is no shame in wearing a mask at night.  Even Tom Cruise wore a mask at night, in Eyes Wide Shut.

Granted, his was a little more stylish than the ones used for CPAP.  But really, medical devices are gaining in popularity.  Within several decades, everyone will be seen on the street wearing some kind of medical device.  You will just be a little bit ahead of the fashion curve.

Plus, there is a good reason to wear it when you are supposed to.  According to Medscape (free registration required):
Sleep Apnea Increases Cardiac Arrhythmia Risk

By Will Boggs. MD

NEW YORK (Reuters Health) Apr 17 - Sleep-disordered breathing (SDB) is associated with an increased risk for complex cardiac arrhythmias, according to a report in the April 15th issue of the American Journal of Respiratory and Critical Care Medicine.

This study, "suggests increased vulnerability for nocturnal cardiac arrhythmias in those with SDB," Dr. Reena Mehra from Case Western Reserve University, Cleveland, Ohio told Reuters Health. However, "the potential relationships of these arrhythmias and sudden nocturnal cardiac death in patients with SDB remain to be determined."

Dr. Mehra and colleagues compared the prevalence of arrhythmias in 228 patients with SDB and in 338 matched controls without SDB.

Atrial fibrillation, nonsustained ventricular tachycardia, complex ventricular ectopy, bigeminy, and quadrigeminy were significantly more common among SDB patients than among controls, the authors report. [...]
Wearing medical devices will be stylish someday, but quadrigeminy never will be stylish.

Sunday, April 16, 2006

Better LEDs, Better Investment

Scientific American reports on a new generation of white LEDs.  Developed at the University of Michigan and the University of Southern California, they produce 25 lumens per watt.  That is 67% better than the 15 lumens per watt we get from incandescent bulbs.  
Electrical engineer Stephen Forrest of the University of Michigan, chemist Mark Thompson of the University of Southern California and their colleagues created the so-called organic LED by combining two layers of phosphorescent diodes--to release green and red wavelength light--and one layer of a fluorescent diode to supply blue wavelength light.
This is a bit of a curiosity: the device uses both fluorescence and phosphorescence.  The article implies that the only remaining technological obstacle is that they have to figure out what kind of coating to put on it, to keep moisture out.  That is not expected to be a big obstacle.  Lighting accounts for 22% of the electricity used in buildings.  These devices would reduce that by 60%.  Savings actually would be greater, in those buildings that are cooled by air conditioning.  

Reducing energy consumption is the best thing we can do to make our country safer.  It almost does not matter what it costs.  We're spending about $150 million on day on the Iraq war.  Getting better lights would be a better investment.

Bush Leaks Cartoons

See this page for a collection of Leaker-in-Chief cartoons.

More Good News

Chris Richards for The New York Times
Since they began six years ago, the Cactus Rescue Crew has rescued over 27,000 cacti and other native plants from road widening, subdivisions, golf courses and shopping malls in Arizona.
The New York Times reports that volunteers have banded together to save cactus plants, by relocating them away from areas of development.  

Friday, April 14, 2006

Does Restless Legs Syndrome Exist?

Those who read the essay on RLS that I linked to yesterday may find themselves wondering if RLS even exists, or if it was entirely made up by a pharmaceutical company.  Curious readers may read about it on the Merck Manual, which is a generally-respected medical handbook.  (Availably freely online here.)
Restless legs syndrome is a relatively common disorder that often occurs just before falling asleep, particularly among persons > 50 yr. The cause is unknown, but >= 1/3 of persons with the syndrome have a family history. Uncomfortable sensations that are difficult to describe are felt in the legs and are relieved temporarily by movement. Patient distress and sleep loss may become severe. Treatment can be difficult and often requires trying different drugs and dosage regimens. The drugs of choice are the dopamine agonists pergolide and carbidopa/levodopa. Other choices are oxycodone, carbamazepine, and gabapentin. Benzodiazepines taken at bedtime prevent awakening but not nocturnal movements.
Although Merck is a drug company, they do not have any drugs for RLS.  Perhaps a more objective source, though, is Harrison's Principles of Internal Medicine.  This is available online, although you have to be a medical doctor to register for it:
[...] Patients with this sensory-motor disorder report a creeping or crawling dysesthesia deep within the calves or feet, or sometimes even in the upper extemities, that is associated with an irresistible urge to move the affected limbs. For most patients with RLS, the dysesthesias and restlessness are much worse in the evening or night compared to the daytime and frequently interfere with the ability to fall asleep. The disorder is exacerbated by inactivity and temporarily relieved by movement. In contrast, paresthesias secondary to peripheral neuropathy persists with activity. The severity of this chronic disorder may wax and wane with time and can be exacerbated by sleep deprivation, caffeine, and pregnancy. The prevalence is 1 to 5% of young to middle-age adults and increases to 10 to 20% in those >60 years. There appear to be important differences in RLS prevalence among racial groups, with higher prevalence in those of Northern European ancestry. [...]

The symptoms of RLS are exquisitely sensitive to dopaminergic drugs (e.g., pramipexole 0.25 to 1.0 mg q8pm or ropinirole 0.5 to 4.0 mg q8pm), which are the treatment of choice. Narcotics, benzodiazepines, and certain anticonvulsants may also be of therapeutic value. Most patients with restless legs also experience periodic limb movements of sleep, although the reverse is not the case.[...]
Medical textbooks are not always the best source of up-to-date medical information, but Harrison's is pretty reputable, and this particular passage at least has face validity.  It would appear that in the geriatric population, the reported incidence is at least as high as that reported by the company that markets ropinirole.  However, it would appear that the company exaggerated the incidence, if one assumes that the rate they report, is a rate that applies to the general population.

Thursday, April 13, 2006

Disease Mongering and the Calibration of Skepticism

The Public Library of Medicine has a collection of essays on the topic of  disease mongering.  The essays were written in conjunction with an international conference on the topic.  There has been a little bit of publicity on the topic; such as these news articles:
Drug firms 'hype up diseases to boost sales'
By RICHARD SHEARS, Daily Mail 08:35am 11th April 2006

Drug companies are inventing diseases to sell more of their products, it has been claimed. Scientists have accused major pharmaceutical firms of "medicalising" problems like high cholesterol or the symptoms of the menopause in a bid to increase profits.

Experts from around the world will meet in Australia today to discuss what they have labelled "disease-mongering". [...]
There are similar news articles here, here, and here.  

There are many points that one could make based upon the eleven "disease mongering" essays.  Today, though, I would like to focus on these, from the essay on Restless Legs Syndrome (RLS):
First, journalists should be very wary when confronted with a new or expanded disease affecting large numbers of people. If a disease is common and very bothersome, it is hard to believe that no one would have noticed it before. Prevalence estimates are easy to exaggerate by broadening the definition of disease. Journalists need to ask exactly how the disease is being defined, whether the diagnostic criteria were used appropriately, and whether the study sample truly represents the general population (e.g., patients at an insomnia clinic cannot be taken to represent the general public).

Journalists should also reflexively question whether more diagnosis is always a good thing. Simply labeling people with disease has negative consequences [21]. Similarly, journalists should question the assumption that treatment always makes sense. Medical treatments always involve trade-offs; people with mild symptoms have little to gain, and treatment may end up causing more harm than good.

Finally, instead of extreme, unrepresentative anecdotes about miracle cures, journalists should help readers understand how well the treatment works (e.g., what is the chance that I will feel better if I take the medicine versus if I do not?) and what problems it might cause (e.g., whether I might be trading less restless legs for daytime nausea, dizziness, and somnolence).
The point I would like to make is that we cannot rely on journalists to do this.  Readers should be able to do this for themselves.  News articles that contain glowing quotations from patients should be taking with the same degree of skepticism as celebrity endorsements.  Likewise, reports of unbelievably high incidence rates should raise some questions.  Plus, it is very dangerous to assume that the mere presence of an illness means that treatment is always appropriate.  Some conditions are best managed by leaving them alone.  

Having said that, I should also point out that it is entirely possible to take skepticism entirely too far.  As it happens, there probably are a lot of people out there who have undiagnosed and untreated RLS.  Many do not really need to be treated.  But in the most severe cases, RLS can lead to serious problems.  Persons with untreated sleep disorders may be at risk for automobile accidents.  They many underperform at work, which can threaten their livelihood.  They many underperform at home, which can lead to relationship problems.  So, it is important that we not ignore the warnings entirely.  The trick is to calibrate our skepticism the way we calibrate a laboratory test: if it is too sensitive, it generates a lot of false positives; not sensitive enough, and it misses real cases of illness.

Tuesday, April 11, 2006

Leaker-in-Chief, Part III

I have been leaving comments around the Internet, saying that there now has been a second leak.   The first was the Libby-Plame leak; the second was the Bush-Israeli Military Intelligence leak.  Now, I have to amend that.  There have been three high-profile leaks that have damaged intelligence operations.  Hat tip to Steven J. at Radamisto, who reminds us that the Libby-Plame leak was the second.  The first occurred in 2004, when the Administration blew a Pakistani-UK operation that had successfully infiltrated Al-Qaeda.  

In the event that the London Times article about the third leak becomes unavailable, I've archived a copy on Newsvine, here.  To me, part of the story hear is that the US media have completely ignored the story.  Despite the fact that the Libby-Plame leak is a top news event right now, nobody in the media is bothering to connect the three leaks together into a comprehensive picture of the Administrations penchant for clumsy handling of sensitive intelligence data.  

I have heard that the phrase "Leaker-in-Chief" is turning out to be rather damaging to Bush.  It is sticking to him just like the "flip-flopper" nickname stuck to a different aspiring politician.  I think it is important, though, for us to reflect on just how appropriate the nickname is in this case.  

Some of the Right have tried to diminish the impact of this, by pointing out that all Administrations use leaks for political purposes.  That is true, but irrelevant.  The problem with the Bush 43 Administration is not merely that it is prone to leaks.  Rather, the problem is that some of the leaks damage our national security in general, and risk the lives of certain intelligence operatives in particular.  It is not just one case.  There are now three cases that have come to my attention.  

Why does this matter?  Consider this: when an intelligence operative goes into the field, he or she does so at the behest of the Administration.  He or She is acting in good faith, that the Administration has a good reason for the operation, and the the Administration will not betray them.  The operative then recruits people to be sources of information.  The sources act on good faith, assuming that the operative will not betray them.  When the Administration leaks sensitive information, it does betray them; both the operatives and their sources are put at risk.  Perhaps even worse, when the Administration blows the cover off of an operation conducted by a cooperative foreign government, the betrayal has three layers: the foreign government, it's operatives, and their sources, are all put at risk.  This is deadly, serious business.  

In the Bush White House, loyalty only goes one way: you are expected to be loyal to the President, but that loyalty gets you nothing in return.

Saturday, April 08, 2006

Leaker-in-Chief Redux
Offered Without Comment

The Sunday Times

April 09, 2006

US leak of Zarqawi letter riles Israelis

ISRAELI military intelligence officials have accused President George W Bush’s administration of undermining their attempts to infiltrate Al-Qaeda’s operations in Iraq by revealing the contents of a secret letter written by Osama Bin Laden’s second-in-command, writes Uzi Mahnaimi.

Israel passed the letter — in which Ayman al-Zawahiri outlined his Middle East strategy to Abu Musab al- Zarqawi, the Al-Qaeda leader in Iraq — to Washington last October on condition of strict anonymity.

Israeli officials were dismayed, however, when John Negroponte, the US director of national intelligence, made it available in both English and its original Arabic on his office web site.

Bush then referred to it during his weekly address. “The Al-Qaeda letter points to Vietnam as a model,” the president declared. “Al-Qaeda believes that America can be made to run again. They are gravely mistaken. America will not run and we will not forget our responsibilities.”

Israeli intelligence sources said officials who had worked on “Operation Tiramisu” inside Iraq took emergency steps to protect their sources, but it was not clear how successful they had been in averting the damage to their intelligence network.

They said Bush’s indiscretion had undone months of painstaking effort.

Friday, April 07, 2006

Candidate's Forum

This is a quick report on the Washtenaw County Democracy for America Candidates Forum, held on April 5, 2006, at the Superior Township hall. The purpose of the Forum was to have Democratic Party candidates for State of Michigan offices answer questions about themselves and their campaigns.  This forum was small; there were three candidates there, two for the Attorney General spot, and one for the Secretary of State (SoS).  They invited three attorney general candidates, but only two agreed to come.  Scott Bowen is the one who did not come. Amos Williams and Alexander "Sandy" Lipsey did come.  Geoffrey Fieger also may be running, but nobody even mentioned him.  Continue reading here.

Wednesday, April 05, 2006

Collateral Damage in the War on Terrorism
Medical Ethics in Inaction

This post is about the case of a patient with Duchenne Muscular Dystrophy, whose life-prolonging medication was intercepted at the border by Homeland Security agents.  The post includes a long excerpt from the Grand Rapids Press.  I would not ordinarily excerpt so much of an article, but I think the article will disappear behind a firewall in a couple of weeks. Continue reading here.

Tuesday, April 04, 2006

Absolutely Blistering

The United States of America is a young country.  So young, in fact, that one may reasonably doubt whether it has any institutions that legitimately can be called "venerable," given that part of the definition of something that is venerable, is that it must must be old.  If, however, one allows that this young whippersnapper of a country can indeed have something that is venerable, then certainly, the New England Journal of Medicine would qualify.  It was founded by Dr. John Collins Warren in 1812 as a quarterly called The New England Journal of Medicine and Surgery.

The history of medicine is replete with time-honored traditions.  Among these is included a certain elusive quality of pretentiousness that is somehow acceptable, despite the air of exclusivity it engenders.  This is true because, as irritating as pretentiousness is, it does not sink to the level of a deadly sin, when it subserves a truly noble purpose.  

A quick examination of their website confirms this nobility of purpose.  There are no advertisements, although it is quite likely that there would be many suitors.  The editors chose to spurn that quick profit, in return for both the perception of impartiality, and some editorial freedom.  Editorial freedom, after all, is a valuable commodity.  It is somewhat surprising, perhaps, that despite that freedom, the authors seem to make use of such freedom only rarely.  It is even more rare, that they turn their editorial blunderbusses toward the federal government.  After all, the Journal is penned by academic physicians.  Federal research grants are their lifeblood, even though the government doles out the grants like tiny flecks of gold leaf, being given to a young apprentice at an artisan's guild.  "That's all you get, now run along and make something worthwhile out of it!"

Imagine, if you can, the depth and breadth of my astonishment, when I read the following in those venerable pages:
Despite its youth, the Medicare drug benefit is already chronically ill. But with extensive rehabilitation, it could go on for years, albeit with impaired functional capacity. Debate continues over whether its early spasticity was caused by inept management of its birth or a genetic disorder present at its creation. Proponents of the first explanation suggest that Medicare and its private insurers were not ready for the millions of applicants and hundreds of millions of prescriptions that poured in early in January, in a flood that they were ill prepared to handle. The layer of insurance companies inserted into the process in the name of efficiency exacerbated the confusion. An administration and Congress guided by Ronald Reagan's principle that "government is not the solution to our problem; government is the problem" put his vision into practice in a chillingly convincing way.
Oh my.  "Chillingly convincing."  That is from a Perspective article about the new Medicare Part D prescription drug benefit.  Read the whole thing.  It is available to the public here.

Tom DeLay Won't Seek Re-Election

I'm sure most of you have seen this already, but is planning to resign from Congress, and won't seek re-election.  I am so thrilled I just had to write about it.  The news is here, here, and here.  There is speculation that he would not be doing this unless he knew he is in serious trouble with Travis County District Attorney Ronnie Earle.  We all can hope that this puts a serious dent in the culture of corruption.

Monday, April 03, 2006

Expectation Of Laughter Boosts Endorphins

Tipped off by a post at Crumb Trail, I saw this report on the effects of the anticipation of "mirthful laughter" on stress:
Just the expectation of a mirthful laughter experience boosts endorphins 27 percent, HGH 87 percent
Public release date: 3-Apr-2006
American Physiological Society

SAN FRANCISCO – There's no doubt that laughter feels good, but is there real neurophysiology behind it and what can you do about it?

In a paper being presented in an American Physiological Society session at Experimental Biology 2006, Lee S. Berk of Loma Linda University, reports that not only is there real science and psychophysiology, but just the anticipation of the "mirthful laughter" involved in watching your favorite funny movie has some very surprising and significant neuroendocrine/hormone effects.

According to Berk: "The blood drawn from experimental subjects just before they watched the video had 27% more beta- and 87% more human growth hormone, compared to blood from the control group, which didn't anticipate the watching of a humorous video. Between blood pulls, the control group stayed in a waiting room and could choose from a wide variety of magazines," he explained.  [...]
The article goes on to explain that they also found beneficial effects on the immune response, suggesting that there could be benefit for those with autoimmune diseases.  It's just an armchair-musing kind of speculation, but since the effect is seen with mere anticipation of something positive, I wonder if it is related to the placebo effect?

RR4 (32-bit) XGL Version

RR4 Linux 3.0b0 XGL edition is unofficially out, available on bittorrent at Linux Tracker.  For those of you longing for the sweet smell of mouthwatering eye candy, it is only a 2.52GB download away.

This is still in beta, so I would not recommend it for general use yet. Should be fun to play with, though. RR4 and RR64 are turning out to be quite popular, climbing up to the 23rd spot on the Distrowatch most-clicks-per-day chart.

Post-Hoc Vindication?

Yesterday's Wall Street Journal contains an article about some recently-released documents pertaining to terrorist links with Saddam Hussein's government.  The documents were discovered during and after the invasion on Iraq.  Some of the documents are described as evidence that there were, in fact, links between the Iraqi government and terrorist organizations.  The author, on the WSJ article, Ms. Mylroie, concludes:
Many more documents are to be released in the coming months. Quite possibly, they will vindicate the decision to undertake the Iraq war; help maintain public support for fighting it; and radically change our understanding of Saddam's role in international terrorism.
I can't help but comment on this.  First of all, you can't justify starting a war based upon documents found after the war started.  The decision to go to war has to be judged based according to the information that was available at the time the decision was made.  Second, the webstie containing the documents states plainly that:
The US Government has made no determination regarding the authenticity of the documents, validity or factual accuracy of the information contained therein, or the quality of any translations, when available.
Vindication of the war may be desirable, but it is a serious matter.  Making such a judgment based upon unverified documents would be rash, at best.  A much more thorough analysis would be called for.

Universal Health Care

A local non-medical blogger comments on universal health care.  With any luck, the issue will gain greater visibility, and become more important in the upcoming election cycle.  Note that health care was considered an important issue in the last election, ranking in the top five in the polls.  The problem was, the top issue (national security) seemed to trump everything else.  That was, frankly, a reflection of the narrow-mindedness of the electorate.  Health care policy is going to affect more lives than the war on terrorism ever will, so it really is a part of the security issue.  I mean, the whole point of national security is to prevent premature death.  That happens to be the whole point of the health care system, too.

Sunday, April 02, 2006

Fundamental Principles of Design

There is an article in Seed about the influence of science on modern :
No shift in architectural practice in recent times has been more fruitful or astonishing than the profession's current embrace of scientific models and ideas. While the Modern movement of the last century famously incorporated the latest advances in technology and industry, there were remarkably few attempts to come to terms with the more radical scientific developments of the era, such as relativity or quantum mechanics.

Today's architect, however, is increasingly schooled in cutting-edge developments in science and mathematics, from neuroscience and computation, to complexity theory and embryology. Indeed, there has been a surprising turn in architectural thinking during the last 15 years that has brought it far from its ancient roots in mechanics—say from the post-and-lintel methods that remained nearly unchallenged for 3,000 years—to what one might call a biological habit of mind. Today's architect is more likely to study problems of form in the natural world than those within the history of his or her own discipline. [...]
The article got me to thinking that I should share with the world all that I know about design.  I learned this from my brother-in-law, an architect and web designer, who used to make furniture.  I learned that the application of scientific principles in design can not only lead to improvements in form and function, but can have significant practical implications as well.  Understanding of these principles can be intellectually enriching.

Before he married my sister, my brother-in-law used to make furniture out of concrete.  Yes, concrete.  The heavy stuff.  When my sister graduated from MSU, she had concrete furniture in her apartment.  There was a lot to be learned from that furniture:
  • Use of unconventional materials adds visual and tactile interest
  • Interesting design stimulates interesting thought processes
  • Concrete furniture is cool to the touch, which is beneficial in warm climates
  • Concrete furniture has high thermal mass, which promotes energy conservation
  • Bold, geometrical designs can be integrated successfully with traditional design elements
 Elaborating on the theme of geometry, the Seed article discusses the importance of geometry in the evolution of architectural principles:
While building science remained essentially the artful deployment of columns andSalisbury Cathedral detail beams, the Greeks could not help but add exquisite refinements such as the famous entases--the artificial bulges near the middles of columns that counteract the concaving effects of vision. This beguiling idea was derived from complex calculation systems based in geometry. Later, the Age of the () Cathedrals would bring an unprecedented virtuosity and expressiveness to bear on the production of architecture, as well as new techniques of templating stones in order to master the very subtle mathematics required for progressively-changing angles and massing of material.
The thing is, when my sister graduated, it was time to move that furniture.   Her husband-to-be conveniently had to be somewhere else.  So, it was I who had to move that concrete furniture.  This leads to the final principle of design:
  • If you make furniture that weighs hundreds of pounds, get someone else to move it for you

Illegals: Just Get Rid Of Them

No, not undocumented Mexican immigrants.  They are welcome to stay, as far as I am concerned.  What we need to get rid of are the illegal factories:

Report: Most U.S. factories violate Clean Water Act

The Ithaca Journal reports in this weekend's paper on the latest study of Clean Water Act compliance by the US Public Interest Research Group.

Among the alarming details:• Nationally, more than 3,700 major facilities (62%) exceeded their Clean Water Act permit limits at least once between July 1, 2003 and December 31, 2004. [...]
One of the arguments used to advocate for the deportation of illegal immigrants is that they are "illegal."  They are breaking the law.  Perhaps the knowledge, that law-breaking is actually normal in corporate America, will put this argument in a new light.

HT: Daniel Rhoades, A Concerned Scientist.

In other news:
Gross domestic income: profit growth swamps labor income

Today's data release from the Bureau of Economic Analysis (BEA) shows that the share of corporate profits in gross domestic income (GDI) reached the highest level since the 4th quarter of 1968. In the corporate sector, the current recovery has seen the largest swing from labor incomes to corporate profits of any recovery since World War II. Read EPI's new Snapshot for a full analysis.

Amusing Link For Today

An exercise in the archeology of popular culture:
Notes on a Strange World
The Walrus Was Paul!

Massimo Polidoro
Skeptical Inquirer
2006, Volume 30 1, Jan/Feb

Did you know that Paul McCartney, the ex-Beatle, never actually left the band because . . . he died in 1966 and was then replaced by a lookalike? It sounds bizarre, and it is. The “Paul is dead” myth is one of the most popular myths set in the world of rock music and perhaps the most fun to follow up. [...]
I find it amusing to think back at how seriously some people took this at the time.

Brain imaging can predict effectiveness of CBT

In the 1980's there was some attention interest in being able to figure out if a given case of depression was "psychological" or "biological" in origin.  The idea was, that if you could show that a person was depressed for psychological reasons, then you also would know that the patient should receive treatment with psychotherapy.  Likewise, a case of depression with a biological cause should be treated with medication.

Nothing ever came of that.  In fact, what happened was that practitioners came to think that there is no meaningful difference.   Even if we find some replicable way to distinguish between depression with a biological cause and depression with a psychological cause, there is no particular reason to think that  knowing the cause would enable us to predict which treatment would be more likely to be effective.

Still, there are some interesting ideas there to explore, even if the exploration cannot necessarily be expected to lead to improved treatment matching.  

Now we see a study that offers just such an exploration.  Some folks over at the University of Pittsburgh School of Medicine have done fMRI studies of depressed people, compared to control subjects, then looked to see if there were any findings that correlated with later response to cognitive-behavioral therapy.  They report that there were two findings that did tend to correlate with responsiveness to CBT.  The treatment responders were more likely to have decreased activity in the subgenual cingulate cortex.  They also were found to have "increased activity after reading negative words in a brain region called the amygdala."

This would be more exciting if they had a larger sample size.  There were only 14 depressed patients in the study, and 21 controls.  So at this point, it is fun to think about what the study means, but we certainly can't go around changing our clinical practice -- or our belief systems -- based upon the results.

Stories that could be pranks - but aren't

6. A Belgian police training manual which aims to help recruits understand body language has caused a row by likening George Bush's facial expressions to a chimpanzee's.
That's from a list of news items that are said to sound like April fool items, but are not.

Saturday, April 01, 2006

Got Fish?