Tuesday, January 23, 2018

Cutting Edge Medicine

An interest of mine, partly from reading political philosophy.

Swift suggests in the third voyage of Gulliver's Travels that if science and technology work, they will make "real" scientists indifferent to their fellow humans, and miserable insofar as they fail to see themselves as human beings in need of certain satisfactions. "Engineers" will be excited at the prospect of dramatic progress in the material world, for human beings, and they will be willing to sacrifice the human beings in front of their eyes for this progress.

To something specific: can Watson the IBM computer diagnose the bulk of common cases, making family docs largely unnecessary?

Unlikely.

To diagnose and prescribe for a specific patient, it may be necessary to have social/personal info, including genetics. Few health-care centres gather or keep that info, or report it to anyone in a useful way. Partly this is docs having personal relationships with patients, and keeping info to themselves. Patients always say they want confidentiality, and docs like having a little monopoly where possible. Ontario makes a big deal about changing family docs.

Cancer is a genetic disease, always caused by damage to DNA. Sometimes the genetic damage is inherited; more often it is acquired in a person's lifetime. Prolonged exposure to cigarette smoke or direct sunlight will increase the incidence of cancer by causing specific kinds of genetic damage. Cancer becomes more common with advancing age because people have had more exposure to things that might cause genetic damage. Yet it is still unusual to be able to trace a specific case of cancer, in a specific patient, to a specific type of genetic damage. Many different genes may be found to be irregular or damaged, and the cancer as it grows will cause, rather than result from, some of the genetic damage that is found. My understanding is that there is more and more evidence that each person's cancer is to some degree unique. Watson may help with the inherited ones.

There are genes that are co-related with cancer and other diseases that might result from smoking. One study: the benefits of quitting smoking are the same regardless of the genetic makeup of patients--genetically high risk or low risk. Implies that getting cancer is only indirectly related to genes; the crucial middle step is human behaviour. It is possible that the gene predisposes to chemical dependency and/or addictive behaviour, and these are the things that make cancer more likely. That would help explain the fact that when the behaviour "improves," so does the person's health.

Years ago I was told that each patient with seizures has unique seizures. Just by the way, I think the treatment of seizures is still very hit or miss; a few drugs to try; phenobarbitol, which our daughter got, allows you to establish a consistent blood level and prevent breakthrough seizures, but it doesn't work for everyone; other drugs may work for other patients, but probably allow for breakthrough seizures. I think there's a lot that's not known about seizures.

The beautiful Teri Garr of Young Frankenstein is not only old, she has MS. I just saw part of a video. I don't think the treatments available are anything to write home about. Something similar seems true for dementia, ALS, Parkinson's, other neurological disorders.

Maybe human docs are not great at dealing with patients as individual cases; will Watson be better?

Sooner or later, the great hope of prevention comes up. Wouldn't it be great to save people from having the falls that cause them to break their hips? The single initiative that has done the most to reduce the incidence of cancer has been the largely successful campaign to get people to quit smoking. The hopeful view is: maybe we can get people to make other behaviour changes (diet? lifestyle?) or change their environment, in a way that will prevent injury and disease. The more immediate thought is: nothing doctors or hospitals do has ever reduced the incidence of cancer by very much--not early detection, annual physicals, not the combination of x-ray, CATscan, MRI. Maybe surgery if detected early, radiation if not so early, chemo if it's time to get your affairs in order, have all prolonged lives a bit, but my God the fortune that is spent on all this. Perhaps the best prevention is getting richer, working a safer job, and living in a better neighbourhood. I guess with leukemia affecting children and teens the death rate came down from about 90% to about 50%--this was the end of a whole genre of TV movie.

Rutherford says of the aftermath of the Human Genome Project:
"We know that the genomes of cancers change and evolve as the tumors grow, making medicine’s quarry even harder to tackle, but potentially offering up new and highly personalized treatments. However, the number of diseases that have been eradicated as a result of our knowing the genome? Zero. The number of diseases that have been cured as a result of gene therapy? Zero. … What we started uncovering in the wake of the HGP was that complex chracteristics and complex diseases are affected by many genes, and, within those genes, variations that look innocuous enough, but cumulatively might correspond with a syndrome or behavior. … [In the case of Cystic Fibrosis, which has been identified as a genetic disorder for many years] “In autumn 2015 … a set of five genetic modifiers were identified that were not part of the CFTR gene but changed the severity of symptoms. How these genetic variations affect the patients isn’t known…." (Rutherford, Adam. A Brief History of Everyone Who Ever Lived: The Human Story Retold Through Our Genes. The Experiment, LLC, 2017; 290-92)

For decades we have heard promises of practical artificial organs; now the talk is of 3-D printed organs. In the later paragraphs of an article on the subject, we are likely to find that it is actual organs from actual human beings that are still highly coveted—and in fact there is a global competition between the rich and the poor to get some of those organs. This is not exactly Star Trek medicine.

I keep thinking there may be no more magic bullets in medicine. The great period was maybe 1900-1955 (the last polio epidemic coming in 1952-3). We have "allowed" some diseases to come back, or hold their own, through sloppiness, anti-Vax thinking, political correctness. Where is the next anti-biotic or vaccine? Are there any other organs that are nice and simple like the pancreas--and of course, there is still no cure for diabetes. More people live to 100 than ever before, setting aside Old Testament stories. Virtually no one lives past 100, just like always. As high-tech wizards get older, this really bothers them, so they fund experiments on living a whole lot longer. Do expanded hopes for medical care mainly make us more preoccupied with fear of death, more pathetically unable to think about anything else?



Monday, January 22, 2018

Lead and other threats; who protects us?

Fantastic article about the history of lead poisoning, and how hard it was for one researcher to get a hearing for the truth that lead in the atmosphere had gone way up with the use of leaded gasoline in cars, and this had serious health effects. Industry was left to do most of the research on lead, and they succeeded in co-opting government agencies who didn't realize that there was so much lead contamination everywhere, results were almost always flawed.

For children, lead may have lowered IQ by 5 points. The greatest harm probably came from eating and breathing lead from old paint. African-Americans were disproportionately affected in the U.S. IQ is not necessarily an important indicator of success in life.

What about life expectancy at birth in the U.S.? Did it go down noticeably during the lead-in-gasoline years, and then go up? Doesn't seem so.

You can actually notice the flu epidemic of 1919, which killed more people than the world war that had just ended. After that, men made much slower progress than women. One would think they were all breathing the same air. Men were more likely to pump gas, work on cars? I think smoking made more difference than anything else.

Men briefly hit 60 years in 1921, and there were three years there when men tied with women. Men didn't hit 60 or above again until 1932, and they weren't consistently in the 60s for some years after that. Women didn't go below 60 from 1930 on, having reached the 60s several times by then. Men didn't reach 70 until 1979, and didn't go below 70 after that. Women reached that milestone in 1949.

Progress has been steady in the post-lead years, but I would think no more so than in the many lead years. Surely there are many factors extending life expectancy. When the big magic bullets were arriving--antibiotics, vaccines--likelihood of reaching age 20 went up as children survived. Since then the likelihood of reaching 60, then 70, then 80 is up.

Of course homage is paid to Rachel Carson. Lead poisoning and mercury poisoning result from natural substances, but also from "industrial" processes in that we use materials in a way that greatly increases our exposure. Have any man-made chemicals actually caused cancer?

Benzidine, I guess.

Trump IV

Trump and the Liberal Arts

1. Anger at Trump, including a tendency to interpret a tweet to prove incapacity for high office, comes disproportionately from people with post-secondary education, especially the humanities/journalism. Show business people are in a class by themselves, but many of them focus on "the college crowd."

2. Problems with Trump from the point of view of those people: if he succeeds, who needs a degree in political science, or a degree in any kind of liberal arts? Who needs even to hire people with a degree in political science? Who needs journalists or pundits who are supposedly trained/experienced in a way that is relevant for judging political events? There is a bit of a threat to the craft guilds here.

3. Strauss said that of the groups that you are likely to find in any society, the one that is likely to consistently defend--or perhaps even the only one likely to tolerate--the liberal arts (assuming these studies are pursued with clarity and relentlessness, playing no favourites) is the landed gentry. Democrats won't, and oligarchs or successful business people won't.

4. We don't have any landed gentry.

5. Perhaps some of the Trump-haters legitimately speak for groups that are as close as we come to a landed gentry, like Ivy League professors. Perhaps such professors are the most likely group in our world to defend the liberal arts, and if they don't, no one will? Ivy League professors may be a kind of proxy for other groups: other professors, and other kinds of paid intellectual, may be more or less self-consciously lesser versions of Ivy League professors--less accomplished, less highly regarded, less likely to be in the media, less likely to present a reasoned account of what they are doing, etc.

6. Professors (and bureaucrats, who again carry less weight) have tenure, which probably has a similar psychological effect as inheriting property and title, like the landed gentry. If you expect to inherit, you develop a way of life and attitude that fits this expectation and waiting. Once you inherit, you can spread your wings, and even be controversial or unconventional. But: for many people, why bother making trouble? It becomes a self-fulfilling prophecy that only people lacking respectability and judgment will make waves: given developments like social ostracism, people with respectability and judgment mostly won't make waves. Persuasion may require that one not appear as too much of a crank.

6. If one criticism of Trump is that he gives no sign of putting his views into a reasoned context that you might learn in a liberal studies classroom--none of the vocabulary, none of the conventional lip-service to texts or speeches of the past--the implication is that people who have this vocabulary are more to be trusted, more likely to be public spirited, than Trump or others like him.

7. This might be true even if the actual views of today's Ivy League professors tend to be head-up-ass progressivism. The landed gentry probably tended to believe a lot of clap-trap even while they defended the liberal arts. Of course, if the clap-trap was conservative, the gentry might at least see some relationship in the focus on "nature" in any serious study in the liberal arts. If today's clap-trap is progressive, that in itself might threaten the liberal arts.

8. So: is it better to have a more conventional conservative, who is likely to lose politely to progressives, or an entrepreneur whose thinking is unpredictable, but who at least promises to grapple with one big problem: the acceptance of something close to open borders?

9. Was Romney a lot better than Trump? Even though year one seems to suggest that in many ways Trump will function as a conventional Republican, with neo-con tendencies in foreign policy?

Climate

1. Thanks to Judith Curry: the IPCC, the UN body that is supposed to teach us the truth about the climate of the world, without asking too many questions, changed its mind on whether changes in the world can be attributed to man-made CO2 or not. The change resulted not primarily from new science, but from clear indications that the flow of money, and the right to sit at the big persons' table, was dependent on supporting a narrative: yes, we have found evidence to support attribution.

2. Same source: climate scientists of approximately the same degree of expertise don't really disagree very much about the uncertainties in what is known, and in the official narrative; the difference is more that some choose to ignore or downplay uncertainty in their public communication in order to support the official narrative. This decision may be well-meaning (real science has to be dumbed down in order to be comprehensible, we're saving Bambi) but it's very problematic to have the weight of public opinion and governments thrown behind conclusions based on what turns out to be questionable evidence. This is supposed to be a golden age of enlightenment--decision-making based on truth. The boomers have a tendency to go in different directions--the guiding theme may be more a matter of what makes them feel good. There are plenty of anti-vaxxers, anti-GMO folks, and opponents of nuclear power, among the college crowd and even the highly educated. Does this count as anti-science? If there is a science of economics, and a science of politics, why are some manifestations of poverty still so prevalent even though starvation and even a total absence of cash are quite rare? Why is open borders, which is likely to make some problems worse, seen as the enlightened approach of educated people? There are always factors other than "science" which can exert a powerful draw.

My comment on Dr. Curry's post: This is all good stuff. It seems rude to say we are dealing with a combination of ignorance and dishonesty, but yes, that seems to be the case. Logical leaps, or wild guesses that happen to coincide with a certain political perspective, turned into a dogma, then presented as if guard-dog-like defence of the dogma is good science. Some defenders of the dogma will say that “teaching the uncertainty” will do more harm than good. They might use the example, which somehow I always find hilarious, of people doubting that anyone ever walked on the moon. For a while NASA tried to respond to concerns/questions, one by one, but the volume of complaints, in more than one sense of “volume,” kept increasing, so NASA finally stopped acknowledging them. My guess is the problem here is that the commitment to send humans to the moon, rather than a machine which could best make observations, was political (Cold War, etc.). Then there was no follow through. Where else might humans go? To some lame space station, much closer to the earth? Were those lumbering and accident-prone commuter buses, the shuttles, the state of the art? The somewhat comical aftermath made it seem unlikely to some that men actually walked on the moon. For the record: yes, I know this happened, but I find the whole thing funny.

On the one hand, if I am right, the post-Moon launch aftermath encouraged a kind of exaggerated deflation of hope: we didn’t even accomplish what we said we did. On the other hand, the exaggerated hopes may be part of what has inspired the warmists: we need to hit a home run, come up with reasons to transform the entire economy, exploit resources that are right there in front of us, do things that evil capitalists don’t want us to do. In fact, capitalists will apparently pay to sustain the (supposed) lie that the home run either is impossible, or has not been hit yet. The rich are born at third base, and congratulate themselves for hitting a triple. The warmists claim they have hit a home run, hoping we don’t notice that while they hit the ball hard (they certainly made an impressive noise), they were out at first.

Sunday, January 21, 2018

Trump III

I try to be aware of two somewhat separate sources of criticism of Trump: the progressives, and NeverTrump conservatives or Republicans.

For the progressives, nothing that Trump has said constitutes any kind of proof of racism. He speaks carelessly or crudely, without due consideration to the feelings of people who are used to being promised hope to make up for certain failures and obstacles in life. The hate of progressives for Trump must have to do with a belief that any resistance to open borders constitutes a threat to a commitment to diversity as something that is so good, such a proof of humanitarianism and virtue, that it is not to be questioned. I for one do question it.

For the NeverTrumpers: character does matter, and Trump's character certainly isn't perfect. Possibly even a bigger deal is that he has little or no truly statesmanlike rhetoric in him--many people have been known to forgive bad character if they get some of that. Lovable scamp and all that. Some would say Trump has revealed that he hates a lot of people, especially if they don't resemble him. I would say indifference can be worse than hate for the recipient (hate implies a kind of respect, you are a problem that must be solved). Trump may not care that much about many people, although I think he must have some genuine public-spiritedness to do what he is doing. His lack of inspirational or aspirational rhetoric reinforces his indifference if not hatred for many people and many things. Hard to believe his approach will persuade undecided voters, although one poll showed that only two groups are more pro-Trump now than they were on election day: African-American males, and Hispanic males. I'm guessing they try to avoid talking politics with their wives, which is also my approach.

I keep thinking of Trump as a throwback to the 50s, the rat pack and all that. Sinatra went to great lengths to get Sammy Davis Jr. on more stages--integrating some businesses in the process. He was ga ga over JFK. Twenty years later he was ga ga over Reagan. Lefties said: contradiction, crazy old man or whatever. I would say: Sinatra recognized he didn't belong in the "noble" business, and he was capable of hero-worship for someone who did belong there. Reagan didn't favour any kind of return to the segregation to which Sinatra objected in the case of his friend Davis and others.

Some people don't even want to give Trump credit as a successful entrepreneur. I'm trying to do just a little work on the Trump-P.T. Barnum comparison, and American public opinion. It seems true that there is generally a line between entrepreneurs and politicians. Politicians have either already made their money, and put it in a blind trust, or they don't need more than the salary. They're not supposed to be actively engaged in money-making while they hold high office, and even their past is supposed to be clean in a way, more on the side of idealism or political vision or the liberal arts. Of course, all of these can be used in successful practices of deception. Herbert Hoover was an entrepreneur who crossed over, but his money-making days were behind him, and he is generally seen as a failed president. More recently you come to entertainers: Reagan, Schwarzenegger, Ventura. Is Trump in this category, or the entrepreneur category? Either way it drives intellectuals and often Never Trump types crazy: this guy has never focussed enough on the finer things in life, or something like that. For conservatives of all kinds Reagan was a kind of pleasant shock--we might actually win a few battles; and it's not simply a joke to say he had played the part of a statesman for so long, it came naturally to him. Carly Fiorina and Meg Whitman are two high-tech entrepreneurs (although they were never considered to be intellectually on top in that sector) who spent fortunes on their campaigns, and crashed and burned. Did anyone ever want Steve Jobs or Bill Gates to run for President? Is making money in real estate somehow even grubbier than high tech or show business? What about retail? The guy who owns Carl's Jr. is some kind of friend of Trump's, and may be appointed to something. Sam Walton of WalMart? Ray Kroc of McDonald's? There's probably a CEO of a national used-car business?

I'm not sure Trump hates anyone at all; as he says, he hits back when he is hit. Pride? Narcissism? Something punctures his usual indifference? I'm still not sure whether he's going to require restrictions on immigration or not, he seems to go back and forth. If he doesn't have principles on that, does he have principles on anything? De-regulation and the tax bill are conventional Republican items, and they may be attracting investment. Democrats are against all this mainly because of ideological clap-trap. Trump promised conservative judges, and he is delivering. Is Trump's (let us say) indifference better than ideology? More persuasive to voters than what the NeverTrumpers have to say? Is it true the NeverTrumpers are saying basically nothing about immigration? There were those who were convinced that Trump was fooling Republicans, and to the extent he has convictions, they would resemble Obama's: pro-choice, big government etc. Surely some of this at least has become questionable? Then there are the endless wars ....

Trump II

Another comment from the Althouse blog: Scott Adams has a point in saying Trump has had a successful first year--the kind of first year many presidents would have killed for. The Woolf book is encouraging some people to say: everything good is due to long-suffering staff, everything bad is Trump personally. That's what some of the long-suffering staff say when they get a chance to spill their guts. Not gospel.

Year One has had different priorities than the Trump campaign. Are we shocked by this? Shocked, shocked? A politician not keeping promises, or deviating from what was said in his campaign? From about the first month of Year One, no one should be surprised that Trump has signed a very Republican tax bill, and he now wants to include Democrats in an immigration bill. To me he has been pretty clear that he thinks successful presidents sign legislation, as opposed to using "a pen and a phone" to issue executive orders that affect many aspects of the lives of Americans. Congress is important. He has come pretty close to telling people he meets with: you present a bill that can actually pass, and I'll sign it. He said this to Republicans on an Obamacare bill, and he failed mainly because of no support from Dems.

Trump said recently he has made changes that will put financial pressure on Obamacare, and this should put pressure on Dems to come to the table. Now immigration and infrastructure. Some purists may detect a lack of guiding principle from mid-2016 until now, but these are not the actions of an unintelligent person--nor of one who is somehow completely lacking in sanity or public-spiritedness.

Trump I

Putting together some things I've written recently. This one's a comment on the Althouse blog.

Very Stable Genius may be a bit of a (humorous) exaggeration, but Trump deserves credit that he often doesn't get. "Populists" can be slightly nuts--Bannon may be an example, Sarah Palin, Roy Moore. (Bernie Sanders, anyone?) Trump from the beginning has been somehow bigger than the Tea Party, bigger than everyday populism. I don't know if he's really going to found a successful movement, or even shift the tide of debate in Washington. He's acting like a Republican, and enjoying success, on taxes and regulations. I think we will see something similar with the judiciary. A bigger test will be immigration: many Republicans are all for open borders, and without Trump,there would not be much of a debate about it. The global corporations which are liking Trump so far, and investing (and creating jobs) will argue that open borders are the key to economic growth, even if some people are left behind. In the meantime, Trump is bright and funny, and even if he loses his temper when he's attacked, or his vanity is at stake,he must be pretty stable to achieve what he is achieving.

Trump is like the Fool in Shakespeare: much of what he says is designed to reveal the intellectual and moral poverty, and even stupidity, of people with credentials.