Up until I was 12 or so, I was a crazed collector of baseball cards. There is no telling how much time and money I spent on them. I would buy them pack by pack, assembling a numerically ordered full set. I divided them up by player, giving Nolan Ryan and Rickey Henderson they own pages and binders. I spent hours poring over the stats on their backs; an opportunity to combine my childhood passions: baseball and math. One of the best days of my childhood was when I found an old box in my grandmother's attic, and opened it to find cards of Mickey Mantle, Roger Maris, Ernie Banks, and Ted Williams.
A couple of recent Slate pieces have rekindled thoughts of those times, and make it clear that those days have passed for good. The baseball card industry has shrunk and no longer cares about kids. And it turns out the companies are not such a great place to work anyway. It makes me wonder if much has changed, or if it was all just a childhood illusion. There have been many times I have returned to places of my childhood, both real and imaginative, to find that they are not what I remembered. That's probably partly it. But there was a real time when baseball parks had history and character and weren't named for agribusiness and tech companies. When shortstops looked like normal guys and not amateur body-builders. It was never perfect and pure, but it wasn't always the sham it is now.
Thursday, September 28, 2006
"Bush presses Senate on anti-terror bill"
The headline from Yahoo! News.
The Orwellianism continues.
Why are we adopting the tactics of people we spent most of the 20th century battling? Was that merely an expediency to global power?
Call torture by its right name.
The Orwellianism continues.
Why are we adopting the tactics of people we spent most of the 20th century battling? Was that merely an expediency to global power?
Call torture by its right name.
More Dumb Doctors
Following our ignorance of sanitation, witness the fall in medical settings of the second great health advantage of modern societies.
Simplicity just isn't sexy.
Simplicity just isn't sexy.
Wednesday, September 27, 2006
Medicate by Number
Here's a great, practical piece from Slate -- something many in health care would do well to read and understand better.
The public's general discomfort with numbers affects us more than we care to admit. People who understand numbers can take a data set and present it in ways that will be interpreted very differently and will prompt different decisions, a phenomenon known as "framing."
The point in this article is the difference between relative risk reduction and absolute risk reduction. A relative risk reduction of 25% is great if the number of people affected by an adverse event goes from 80/100 to 60/100 (an absolute risk reduction of 20 percentage points). A relative risk reduction of 50% is not so great if the number of people affected changes from 2/100 to 1/100 (absolute risk reduction of 1 percentage point).
The public's general discomfort with numbers affects us more than we care to admit. People who understand numbers can take a data set and present it in ways that will be interpreted very differently and will prompt different decisions, a phenomenon known as "framing."
The point in this article is the difference between relative risk reduction and absolute risk reduction. A relative risk reduction of 25% is great if the number of people affected by an adverse event goes from 80/100 to 60/100 (an absolute risk reduction of 20 percentage points). A relative risk reduction of 50% is not so great if the number of people affected changes from 2/100 to 1/100 (absolute risk reduction of 1 percentage point).
Dumb Doctors
It's amazing how we hold the medical profession in such high esteem, when it has trouble with something as simple as hand washing.
One of the things that has driven me most nuts over the last few years, and in my first few months of med school, is how easily we are distracted by technology and fancy gadgets. I admit it's tempting to be drawn in (and that we have much to gain from tech) because its fascinating and exciting. But I think it's probably a good idea to sort out the cheaper and simpler stuff first. All the helical CT scans in the world are of little comfort when doctors refuse to learn the lessons of centuries-old germ theory.
One of the things that has driven me most nuts over the last few years, and in my first few months of med school, is how easily we are distracted by technology and fancy gadgets. I admit it's tempting to be drawn in (and that we have much to gain from tech) because its fascinating and exciting. But I think it's probably a good idea to sort out the cheaper and simpler stuff first. All the helical CT scans in the world are of little comfort when doctors refuse to learn the lessons of centuries-old germ theory.
Pun of the Day
"Is there a human right to free and fair erections?"
- William Saletan, on the first ever penis transplant
It's even funnier because he's talking about a Chinese guy.
Several days old, but still a classic worth pointing out.
- William Saletan, on the first ever penis transplant
It's even funnier because he's talking about a Chinese guy.
Several days old, but still a classic worth pointing out.
Sans Trans Fats
After restaurants failed to satisfactorily comply with a voluntary ban on trans fats in New York City's restaurants, the city is planning legal enforcement of such a ban.
While I am a public health nut, I am not sure that this is a prudent move. Some are comparing it to the ban on indoor smoking in NYC, but this doesn't quite work. While the ban may have curbed overall smoking, its primary motivation was that smoking affects other people who don't smoke. This is not immediately the case with trans fat consumption.
NYC isn't banning trans fats altogether, e.g. from grocery story shelves. The ban in only restaurants seems arbitrary. NYC didn't ban cigarettes altogether, because we generally recognize that a rational person, knowing the risks, has the right to damage his own body. Why can we not say the same for eating trans fats?
The city's argument might be along the lines that when eating at a restaurant, consumers have no way of knowing what ingredients and nutrients are in the food they are eating. This could be easily solved. List nutrition info for each dish; this info is easy obtainable by establishments from nutrition info of ingredients and would be for the most part a one-time inconvenience. I would even go so far as to list a warning next to dishes containing trans fats, explaining the health risk their consumption entails. Using cigarettes as an example, foods containing trans fats could also be taxed. It is pretty well accepted that trans fats (and saturated, for that matter) contribute to cardiovascular disease. Don't remove the freedom to eat such foods, but make the consumer pay for the health care costs he is creating, costs which bear on private insurance rates and especially on Medicare budgets (the vast majority of health consequences of poor diet manifest as chronic disease later in life).
Every person has the right to harm himself. He just doesn't have the right to make the rest of us pay for it.
While I am a public health nut, I am not sure that this is a prudent move. Some are comparing it to the ban on indoor smoking in NYC, but this doesn't quite work. While the ban may have curbed overall smoking, its primary motivation was that smoking affects other people who don't smoke. This is not immediately the case with trans fat consumption.
NYC isn't banning trans fats altogether, e.g. from grocery story shelves. The ban in only restaurants seems arbitrary. NYC didn't ban cigarettes altogether, because we generally recognize that a rational person, knowing the risks, has the right to damage his own body. Why can we not say the same for eating trans fats?
The city's argument might be along the lines that when eating at a restaurant, consumers have no way of knowing what ingredients and nutrients are in the food they are eating. This could be easily solved. List nutrition info for each dish; this info is easy obtainable by establishments from nutrition info of ingredients and would be for the most part a one-time inconvenience. I would even go so far as to list a warning next to dishes containing trans fats, explaining the health risk their consumption entails. Using cigarettes as an example, foods containing trans fats could also be taxed. It is pretty well accepted that trans fats (and saturated, for that matter) contribute to cardiovascular disease. Don't remove the freedom to eat such foods, but make the consumer pay for the health care costs he is creating, costs which bear on private insurance rates and especially on Medicare budgets (the vast majority of health consequences of poor diet manifest as chronic disease later in life).
Every person has the right to harm himself. He just doesn't have the right to make the rest of us pay for it.
The Death of Rule of Law
The Bush administration is trying to gain the power to detain American civilian citizens indefinitely and without charges.
A major feature of the Bush administration's reign which has been largely missed by the news corps and the pundits is the erosion of rule of law. Bush prefers to enforce laws of his choosing (passive noncompliance), and when he doesn't like them, he often just ignores them (active violation). This is rule by man, and it represents a fundamental and dangerous shift in American governance.
It reminds me of a classic paradigm in old Communist China. China was (and still is, but to a lesser degree) run by renzhi (rule by individuals), as opposed to fazhi (rule by law). Renzhi is a hallmark of authoritarian regimes and is by definition antithetical to democracy. This change in American government is just one more example (along with torture, for example) of our succumbing to the corrosive practices of regimes we have long claimed to hate and whose existence long served as a cautionary counter-example to our greatest ideals.
Have the American people personally felt consequences from this yet? For the most part, no. But if history is any guide, societies usually realize these fundamental mistakes too late. Like the alcoholic who stops four drinks after he should, we are drunk on our own power and are consumed by notions that we are somehow different and "it won't happen to us."
Who will stop this bold power grab? Probably not Congress. I see it as likely that Republicans will retain both the House and the Senate. Americans are more concerned with tax cuts (in a deficit environment, mind you) and Christianism than with maintaining a free society with transparent governance. It is unlikely the that Supreme Court would stop this either, seeing as it's now loaded with justices deferential to boundless executive power.
A major feature of the Bush administration's reign which has been largely missed by the news corps and the pundits is the erosion of rule of law. Bush prefers to enforce laws of his choosing (passive noncompliance), and when he doesn't like them, he often just ignores them (active violation). This is rule by man, and it represents a fundamental and dangerous shift in American governance.
It reminds me of a classic paradigm in old Communist China. China was (and still is, but to a lesser degree) run by renzhi (rule by individuals), as opposed to fazhi (rule by law). Renzhi is a hallmark of authoritarian regimes and is by definition antithetical to democracy. This change in American government is just one more example (along with torture, for example) of our succumbing to the corrosive practices of regimes we have long claimed to hate and whose existence long served as a cautionary counter-example to our greatest ideals.
Have the American people personally felt consequences from this yet? For the most part, no. But if history is any guide, societies usually realize these fundamental mistakes too late. Like the alcoholic who stops four drinks after he should, we are drunk on our own power and are consumed by notions that we are somehow different and "it won't happen to us."
Who will stop this bold power grab? Probably not Congress. I see it as likely that Republicans will retain both the House and the Senate. Americans are more concerned with tax cuts (in a deficit environment, mind you) and Christianism than with maintaining a free society with transparent governance. It is unlikely the that Supreme Court would stop this either, seeing as it's now loaded with justices deferential to boundless executive power.
Saturday, September 23, 2006
Sustaining Our Waste
Some disturbing reporting and commentary about a recent chemical dump in Abidjan, Ivory Coast. While I'm not surprised, I had no idea transnational dumping was such a problem. I guess it's in part due to the lack of reporting on the subject, as the article points out. It's NIMBY on a global scale.
I think the questions the article raises are symptomatic of a larger problem. There is almost nothing which is sustainable about the U.S. economic paradigm. Our agriculture, energy consumption, budget deficits, trade imbalances, educational system (unless you're talking about sustaining an ignorant populace), none of it.
We are in many ways running a colonial system. Of course we no longer own other lands or people, but we do use them as a resource in the stead of internal development. This is not always a bad thing, for it's no doubt helped some countries to develop and gain wealth. But I can't help but feel that the only thing it sustains is a bloated sense of economic power. If our economy is perched on a pile of debt and a domestic workforce that is ever declining in relative skills and knowledge, how long can that last before it collapses from within?
I say this as someone who feels globalization is on the whole a good thing and possesses the potential to lift billions out of abject poverty. I am not a protectionist. I just feel that the economic challenge America faces is distinctly different from those of the past. The Soviet Union was hollow. Japan was brilliant, but small (and itself a bit protectionist). Europe has long kept pace with us on its own terms.
Asia presents something altogether new. If it can navigate dicey political problems (and that's a big "if"), it will become an economic and cultural force on an unprecedented scale. There's a priori that this change can't be of overall benefit, and I'm not saying it's necessarily a bad thing. But people of my generation shouldn't be surprised if 50 years from now our country is far less relevant than it was in our youths.
I think the questions the article raises are symptomatic of a larger problem. There is almost nothing which is sustainable about the U.S. economic paradigm. Our agriculture, energy consumption, budget deficits, trade imbalances, educational system (unless you're talking about sustaining an ignorant populace), none of it.
We are in many ways running a colonial system. Of course we no longer own other lands or people, but we do use them as a resource in the stead of internal development. This is not always a bad thing, for it's no doubt helped some countries to develop and gain wealth. But I can't help but feel that the only thing it sustains is a bloated sense of economic power. If our economy is perched on a pile of debt and a domestic workforce that is ever declining in relative skills and knowledge, how long can that last before it collapses from within?
I say this as someone who feels globalization is on the whole a good thing and possesses the potential to lift billions out of abject poverty. I am not a protectionist. I just feel that the economic challenge America faces is distinctly different from those of the past. The Soviet Union was hollow. Japan was brilliant, but small (and itself a bit protectionist). Europe has long kept pace with us on its own terms.
Asia presents something altogether new. If it can navigate dicey political problems (and that's a big "if"), it will become an economic and cultural force on an unprecedented scale. There's a priori that this change can't be of overall benefit, and I'm not saying it's necessarily a bad thing. But people of my generation shouldn't be surprised if 50 years from now our country is far less relevant than it was in our youths.
Friday, September 22, 2006
Calling Torture by Its Right Name
Andrew Sullivan weighs in on the torture bill with his usual intellectual and moral sobriety. I disagree with him on many topics of governance, but he has been a steady opponent of the tyranny of this administration. He calls the administration what it is. He is right to call this a "torture bill." I can't count how many times in the last few weeks I have seen Orwellian euphemisms in the mainstream media:
"Terror Bill"
"Interrogation Bill"
"Detainee Treatment Bill"
Blah, blah, blah. Journalistic fairmindedness does not require suspension of reason and honest interpretation. When someone is threatened with drowning, it is torture. Call it by its right name. When he is kept awake for weeks on end, it is torture. Call it by its right name. When a man is beaten until his legs turn to pulp, it is torture. Call it by its right name.
This administration is fighting for the right to torture people in its custody. Why can't we state that plainly in our headlines?
"Terror Bill"
"Interrogation Bill"
"Detainee Treatment Bill"
Blah, blah, blah. Journalistic fairmindedness does not require suspension of reason and honest interpretation. When someone is threatened with drowning, it is torture. Call it by its right name. When he is kept awake for weeks on end, it is torture. Call it by its right name. When a man is beaten until his legs turn to pulp, it is torture. Call it by its right name.
This administration is fighting for the right to torture people in its custody. Why can't we state that plainly in our headlines?
"They will raise your taxes!"
That's Bush's (worn-out) refrain. Some shit never changes.
Might raising taxes make sense? Seeing as we're running record budget deficits -- in addition to the fact that we have $43 trillion in unfunded fiscal liabilities (more than half on Bush's and the GOP Congress's watch) -- I think it would.
Nah, that would be too adult and responsible. Besides, taxes are evil and don't play well during election season. And why pay down our debts now when we can pass it on to our children with interest accrual?
The day will come when the world no longer needs our consumer and energy demands so much, and when it does, our debts will be due. Lets just hope we're able to pay it in cash and not heads.
Might raising taxes make sense? Seeing as we're running record budget deficits -- in addition to the fact that we have $43 trillion in unfunded fiscal liabilities (more than half on Bush's and the GOP Congress's watch) -- I think it would.
Nah, that would be too adult and responsible. Besides, taxes are evil and don't play well during election season. And why pay down our debts now when we can pass it on to our children with interest accrual?
The day will come when the world no longer needs our consumer and energy demands so much, and when it does, our debts will be due. Lets just hope we're able to pay it in cash and not heads.
The Election: Tracking and Toss-ups
Slate offers a wonderful feature to help you follow House, Senate, and state gubernatorial races.
Their mathematician gives a sobering insight into the statistical probability that the Dems will actually take over the House. I'm not sure what's that's worth, since the Dems' immense gift for recent losing isn't exactly quantifiable. Likewise for the shameless fearmongering of many in the GOP.
Their mathematician gives a sobering insight into the statistical probability that the Dems will actually take over the House. I'm not sure what's that's worth, since the Dems' immense gift for recent losing isn't exactly quantifiable. Likewise for the shameless fearmongering of many in the GOP.
Sharing a Bed
I love this recent NY times story about learning to share a bed. I know it's been a rough transition for me, especially since this year we're working with a full bed, for space and monetary reasons. As my sleep is increasingly at a premium, I've spent several nights on the futon not because I was in trouble, but because I needed a good night's sleep to catch up on rest!
The Frontier of Medicine
Now that I am about two and a half months into my first year of school, I've formed a few initial impressions.
The most astounding thing thus far has been my learning about just how limited our current collective medical knowledge is. Frequently in class -- across our wide-ranging discussions of human biology -- we are served mere sketches of the mechanisms of normal physiology and disease. A professor will describe and explain a system or process, only to stop short and say "...and that's all we know at this point." The knowledge we do have is impressive and inspires confidence, but it is nowhere near what I'd expected. And I say that as someone fairly acquainted with science. I think the general population thinks we know far more than we do.
A related point is that the idea of "disease" is far murkier than most people think. While it's usually clear-cut when a bacterium or virus can be detected, it's far less so for chronic disease and cancer. Normal and disease states can produce indicator values whose normal ranges often have substantial overlap. Scientists are left to draw a line at an optimal value, but that inevitably results in missing some disease and mislabeling some normal people. Some people who could benefit from treatment miss out, and others who don't need it are harmed by unnecessary intervention. Add to this that health and disease are not a binary states. Disease is not an on/off switch. Development of disease is often a gradual, incremental process. All heart disease is not created equal and neither are all cancers. I raise this point not to be critical of medicine, but merely to illuminate. It's a tough thing to navigate, especially when explaining it to a patient or his family members. Most people tend to want black and white answers, and it's just not that easy.
Finally, despite our current limitations, our knowledge and power in medical and related biology are advancing at paces that I think none but a very small, insular group truly appreciates. This advance is soon going to create dilemmas with which we as a society and world will be ill-educated and ill-equipped to cope. I'll write about that at much greater length in the future.
The most astounding thing thus far has been my learning about just how limited our current collective medical knowledge is. Frequently in class -- across our wide-ranging discussions of human biology -- we are served mere sketches of the mechanisms of normal physiology and disease. A professor will describe and explain a system or process, only to stop short and say "...and that's all we know at this point." The knowledge we do have is impressive and inspires confidence, but it is nowhere near what I'd expected. And I say that as someone fairly acquainted with science. I think the general population thinks we know far more than we do.
A related point is that the idea of "disease" is far murkier than most people think. While it's usually clear-cut when a bacterium or virus can be detected, it's far less so for chronic disease and cancer. Normal and disease states can produce indicator values whose normal ranges often have substantial overlap. Scientists are left to draw a line at an optimal value, but that inevitably results in missing some disease and mislabeling some normal people. Some people who could benefit from treatment miss out, and others who don't need it are harmed by unnecessary intervention. Add to this that health and disease are not a binary states. Disease is not an on/off switch. Development of disease is often a gradual, incremental process. All heart disease is not created equal and neither are all cancers. I raise this point not to be critical of medicine, but merely to illuminate. It's a tough thing to navigate, especially when explaining it to a patient or his family members. Most people tend to want black and white answers, and it's just not that easy.
Finally, despite our current limitations, our knowledge and power in medical and related biology are advancing at paces that I think none but a very small, insular group truly appreciates. This advance is soon going to create dilemmas with which we as a society and world will be ill-educated and ill-equipped to cope. I'll write about that at much greater length in the future.
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