Thu May 18 20:08:46 EDT 2017

Health Care Matters

Some interesting links related to health care in the U.S.

  • Mayo Clinic researchers demonstrate value of second opinions

    Many patients come to Mayo Clinic for a second opinion or diagnosis confirmation before treatment for a complex condition. In a new study, Mayo Clinic reports that as many as 88 percent of those patients go home with a new or refined diagnosis -- changing their care plan and potentially their lives. Conversely, only 12 percent receive confirmation that the original diagnosis was complete and correct.

  • The two major sources of our healthcare problem

    The first original sin appeared in the 1940s, when the government agreed to allow companies to deduct the cost of health insurance, but neglected to allow individuals to do the same. (I've discussed this in a number of posts over the years.) This made health insurance provided by employers much cheaper than health insurance purchased by individuals. Not only that, but it created a strong incentive for employers to offer health insurance which covered a whole lot of things; and why not, if the costs were uniquely deductible by companies?
    The second original sin, Cochrane argues, is that "Instead of straightforwardly raising taxes in a non-distortionary way (a VAT, say), and providing charity care or subsidies -- on budget, please, where we can see it -- our political system prefers to fund things by forcing cross subsidies. Medicare and medicaid don't pay what the service costs, because we don't want to admit just how expensive that service is. So, large hospitals make up the difference by overcharging you and me instead."

  • US healthcare: most people don't know what they're talking about

    In fact in the US case it's not even obesity, or indeed their greater pre-existing disease burden, that is doing most of the work in dragging their life expectancy down; it's accidental and violent deaths. It is tragic that the US is so dangerous, but it's not the fault of the healthcare system; indeed, it's an extra burden that US healthcare spending must bear. Just simply normalising for violent and accidental death puts the USA right to the top of the life expectancy rankings.
    Now this is not to say the US system works well. The fact that the US spends vastly more than everyone else, and only does a bit better, if that, makes the system pretty unimpressive. But it's important to understand why. The UK really does have "death panels" that refuse treatments because they're extremely costly relative to their tiny impact. The USA has a system where most people can buy--are even subsidised through the tax system to buy--insurance that is as extensive as they like, paying for ever more expensive and marginally beneficial therapies. Eventually you're spending a fifth of your GDP on it.

  • The secret monopoly behind America's outrageous drug prices

    The details of the PBM (pharmacy benefit managers) architecture are extraordinarily complicated, as Dayen's piece explains. But the basic idea is reasonably straightforward. PBMs date back to the 1960s, when they served as streamlined claims processors to intermediate between pharmacies and drug companies. As the industry grew, PBMs presented themselves as a way to keep drug prices low because they could "form large patient networks, and negotiate discounts from both drug companies and pharmacies, which would have no choice but to contract with them to access the network."

    Sounds reasonable enough. But over time, two big things changed: The health-care billing system got more and more hideously complex, and virtually all the PBMs were rolled up into three big companies -- ExpressScripts, CVS Caremark, and OptumRx, which now control a combined 75 to 80 percent of the market. As a result, the promised savings have not materialized. On the contrary, spending on prescription drugs exploded by 1,100 percent between 1987 and 2014, and all three companies -- which are each among the top 22 of the Fortune 500 -- rake in huge profits. Dayen reports that ExpressScripts' adjusted profit per prescription has increased by 500 percent since 2003.

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Sun Apr 30 20:43:06 EDT 2017

Items of Interest

Various web links I found to be of interest recently.

  • The Myth of a Superhuman AI

    by Kevin Kelly

    Yet buried in this scenario of a takeover of superhuman artificial intelligence are five assumptions which, when examined closely, are not based on any evidence. These claims might be true in the future, but there is no evidence to date to support them. The assumptions behind a superhuman intelligence arising soon are:

    1. Artificial intelligence is already getting smarter than us, at an exponential rate.
    2. We’ll make AIs into a general purpose intelligence, like our own.
    3. We can make human intelligence in silicon.
    4. Intelligence can be expanded without limit.
    5. Once we have exploding superintelligence it can solve most of our problems.

    In contradistinction to this orthodoxy, I find the following five heresies to have more evidence to support them.

    1. Intelligence is not a single dimension, so "smarter than humans" is a meaningless concept.
    2. Humans do not have general purpose minds, and neither will AIs.
    3. Emulation of human thinking in other media will be constrained by cost.
    4. Dimensions of intelligence are not infinite.
    5. Intelligences are only one factor in progress.

    If the expectation of a superhuman AI takeover is built on five key assumptions that have no basis in evidence, then this idea is more akin to a religious belief -- a myth.

  • How fascist is Donald Trump? There's actually a formula for that.

    Grading the billionaire on the 11 attributes of fascism.

    Add all this up, and you get 26 out of a possible 44 Benitos. In the fascist derby, Trump is a loser. Even Spain's Francisco Franco and Portugal's António de Oliveira Salazar might score higher. While there is a strong family resemblance, and with some features an uncanny likeness, Trump doesn't fit the profile so well on those points where the use of violence is required. Projecting an air of menace at rallies, uttering ambiguous calls for assassinations, tacitly endorsing the roughing-up of protesters, urging the killing of terrorists' families and whatever else Trump does -- while shocking by the standards of American politics -- fall far short of the genuinely murderous violence endorsed and unleashed by authentic fascists.

    Also see, Donald Trump isn't a fascist.

    A leading expert on 1930s-era politics explains that Trump is a right-wing populist, not a fascist -- and the distinction matters.

  • Scientists, Stop Thinking Explaining Science Will Fix Things

    Respondents who knew more about science generally, regardless of political leaning, were better able to identify the scientific consensus--in other words, the polarization disappeared. Yet, when the same people were asked for their own opinions about climate change, the polarization returned. It showed that even when people understand the scientific consensus, they may not accept it.

    The takeaway is clear: Increasing science literacy alone won't change minds. In fact, well-meaning attempts by scientists to inform the public might even backfire. Presenting facts that conflict with an individual's worldview, it turns out, can cause people to dig in further. Psychologists, aptly, dubbed this the "backfire effect."

  • David Chalmers Thinks the Hard Problem Is Really Hard

    Consciousness will still mystify us even if we scientifically solve it, philosopher predicts.

    John Horgan interviews philosopher David Chalmers

    I've always found him an admirably clear thinker, who doesn't oversell his ideas (unlike Daniel Dennett when he insists that consciousness is an "illusion").

  • Contra Tyler, on "Is rationality a religion?"

    Tyler Cowen called the rationality community a "religion" on Ezra Klein's podcast the other day.

    Julia Galef's quick reaction:

    Basically all humans are overconfident and have blind spots. And that includes self-described rationalists.

    But I see rationalists actively trying to compensate for those biases at least sometimes, and I see people in general do so almost never. For example, it's pretty common for rationalists to solicit criticism of their own ideas, or to acknowledge uncertainty in their claims.

    And another response to Tyler Cowen's comments to Ezra Klein from Bryan Caplan What's Wrong With the Rationality Community.

  • Disabled, or just desperate?

    Rural Americans turn to disability as jobs dry up

    Between 1996 and 2015, the number of working-age adults receiving disability climbed from 7.7 million to 13 million. The federal government this year will spend an estimated $192 billion on disability payments, more than the combined total for food stamps, welfare, housing subsidies and unemployment assistance.
    Across large swaths of the country, disability has become a force that has reshaped scores of mostly white, almost exclusively rural communities, where as many as one-third of working-age adults live on monthly disability checks, according to a Washington Post analysis of Social Security Administration statistics.

  • How America made Scandinavian social democracy possible

    The researchers suggest the migration flows, which were small relative to the native population of America but equivalent to about 25 per cent of the total population of Scandinavia, changed the character of Norwegian and Swedish society by removing the most ambitious and independently-minded people.

    In other words, Scandinavian social democracy might not be possible without America's historic willingness to absorb those who refused to follow the "Law of Jante".
    Had it not been for America's willingness to embrace enterprising nonconformist Scandinavians, "individualism" in Norway and Sweden would have been much greater and their particularly successful form of social democracy might never have been able to take root.

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Thu Apr 20 12:25:31 EDT 2017

Inequality Matters

Some web links on the topic of inequality.

  • It's Not Just Unfair: Inequality Is a Threat to Our Governance

    Why Economic Inequality Threatens Our Republic,

    In his fine book, both history and call to arms, Ganesh Sitaraman argues that the contemporary explosion of inequality will destroy the American Constitution, which is and was premised on the existence of a large and thriving middle class. He has done us all a great service, taking an issue of overwhelming public importance, delving into its history, helping understand how our forebears handled it and building a platform to think about it today.
    As recognized since ancient times, the coexistence of very rich and very poor leads to two possibilities, neither a happy one. The rich can rule alone, disenfranchising or even enslaving the poor, or the poor can rise up and confiscate the wealth of the rich. The rich tend to see themselves as better than the poor, a proclivity that is enhanced and even socially sanctioned in modern meritocracies. The poor, with little prospect of economic improvement and no access to political power, "might turn to a demagogue who would overthrow the government -- only to become a tyrant. Oligarchy or tyranny, economic inequality meant the end of the republic."

  • What Inequality Doesn't Mean

    Is inequality a death sentence for the American republic? Two recent books vigorously argue both sides of the case--with the naysayer pulling out ahead.

    Before accepting the conclusion(s), see the previous March 31 item What Do Economists Actually Know?

  • Stanford historian uncovers a grim correlation between violence and inequality over the millennia

    Professor Walter Scheidel examines the history of peace and economic inequality over the past 10,000 years.

    "It is almost universally true that violence has been necessary to ensure the redistribution of wealth at any point in time," said Scheidel, summarizing the thesis of The Great Leveler: Violence and the History of Inequality from the Stone Age to the Twenty-First Century, his newly published book.

    Surveying long stretches of human history, Scheidel said that "the big equalizing moments in history may not have always had the same cause, but they shared one common root: massive and violent disruptions of the established order."

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Fri Mar 31 23:46:26 EDT 2017

Items of Interest

Various web links I found to be of interest recently.

  • What Do Economists Actually Know?

    Turns out, not as much as you -- and they -- would like to think.   by Russ Roberts

    But there is no way of knowing reliably if the consensus reflects the truth. It may rely instead on the underlying biases of the prosecutors and defendants in the intellectual trial of ideas. Or where they received their PhD degrees. Or the fashionability of certain positions over time as society changes. Unlike product markets where poorly made products are punished by low prices or fewer and fewer consumers, there are no clear feedback loops in the world of academic economics. You can say something that is wrong and the price you pay may be zero. In fact you may be rewarded.

    And that is because of what does not happen. There is never a clean empirical test that ultimately settles these issues. There is no reliable scientific experiment where each side is forced to make a prediction and the results settle the matter.
    Most economics claims are really not verifiable or replicable. (And if you are interested in the related crisis of statistical reliability and replicability in psychology and elsewhere, follow Brian Nosek on Twitter and listen to him here). Most economic claims rely on statistical techniques that try to simulate a laboratory experiment that holds all relevant factors constant. That is the hope. My claim is that in general, holding all relevant factors cannot be done in a way that is reliable or verifiable. And that is why so many empirical issues such as the minimum wage, immigration, fiscal policy, monetary policy and so on, have smart people on both sides of the issue each with their own sophisticated analysis to bolster their claim.
    I am arguing that the math and science of economic predictions and assessments are nothing like the math and science of space travel. Economics provides the illusion of science, the veneer of mathematical certainty.

  • The economics of beard popularity in the US

    In the early 20th century, beards once again began to be associated with anti-capitalist movements, and for nearly a century they were nowhere to be seen in corporate board rooms and many parts of society, being relegated to "fringe" sets.

    Then along came the tech boom, which made many scruffy outsiders in Silicon Valley rich and powerful members of the capitalist landscape. People like Steve Jobs, Elon Musk, and Jack Dorsey redefined how we view powerful business heads and have helped usher in a new period of beard acceptance and popularity.

  • Mitt Romney's former policy director makes the case for the GOP's health bill

    Lanhee Chen explains why Republicans landed on this health care bill, and this process.

  • Breaking Faith -- Peter Beinart

    The culture war over religious morality has faded; in its place is something much worse.

    Secularism is indeed correlated with greater tolerance of gay marriage and pot legalization. But it's also making America's partisan clashes more brutal. And it has contributed to the rise of both Donald Trump and the so-called alt-right movement, whose members see themselves as proponents of white nationalism. As Americans have left organized religion, they haven't stopped viewing politics as a struggle between "us" and "them." Many have come to define us and them in even more primal and irreconcilable ways.
    For decades, liberals have called the Christian right intolerant. When conservatives disengage from organized religion, however, they don't become more tolerant. They become intolerant in different ways. Research shows that evangelicals who don't regularly attend church are less hostile to gay people than those who do. But they're more hostile to African Americans, Latinos, and Muslims.

  • The Unpersuadables

    Book Review: The Unpersuadables: Adventures with the Enemies of Science by Will Storr.

    We would like to believe people are rational. We would like to believe that if they have formed a false belief based on inaccurate information and poor reasoning, they will change that belief when they are provided with accurate information and better reasoning. We are frequently disappointed.
    We can't even trust our memories. They are reconstructed every time we access them, and they can become distorted or contaminated with other memories. Psychological studies suggest that about 30% of our memories are false, including some of the ones we are most confident about.
    Cognitive dissonance is painful; confirmation bias is comforting. Experience is re-interpreted in such a way that it doesn't force us to rebuild our internal models of reality. We are all prejudiced, but we need prejudices to function efficiently. They serve as a practical starting point for our guesses about the world.

    We are subject to confirmation bias; we get a feel-good "neurochemical kiss" as a reward for confirming a brain model. Confirmation bias serves a purpose. If we had to fairly evaluate every new argument and every bit of new evidence from scratch and constantly rebuild our models, we would become hopelessly overwhelmed and unable to function.

  • Heterodox Academy

    We are a politically diverse group of social scientists, natural scientists, humanists, and other scholars who want to improve our academic disciplines and universities.

    We share a concern about a growing problem: the loss or lack of "viewpoint diversity." When nearly everyone in a field shares the same political orientation, certain ideas become orthodoxy, dissent is discouraged, and errors can go unchallenged.

    To reverse this process, we have come together to advocate for a more intellectually diverse and heterodox academy.

  • Ping-Pong as the Fountain of Youth

    Ping-Pong, or table tennis as it is officially known, is one of the fastest racket sports, requiring muscular and cardiorespiratory endurance. Players need nimble footwork and upper body flexibility to return balls that can fly over 60 miles per hour, demanding faster response times than tennis or badminton.

  • What was the real paleo diet? Prehistoric plaque reveals what Neanderthals ate.

    If you are what you eat, Neanderthals might have been a diverse, flexible bunch ... just like their diets.

    Examining the contents of the calcified plaque of five Neanderthal specimens that range from 42,000 to 50,000 years old, researchers who study ancient DNA were able to determine their diet. And, it turns out, not all Neanderthals ate alike.

    Some dined on a lot of meat, eating the flesh of animals like woolly rhinoceros and wild sheep. But others may have been complete vegetarians, according to a paper published Wednesday in the journal Nature. In the plaque of these Neanderthal vegetarians, researchers found no evidence of any meat. Instead, they say these individuals dined on mushrooms, pine nuts, and moss.

  • Hit Makers by Derek Thompson

    The Science of Popularity in an Age of Distraction

    Nothing "goes viral." If you think a popular movie, song, or app came out of nowhere to become a word-of-mouth success in today's crowded media environment, you're missing the real story. Each blockbuster has a secret history--of power, influence, dark broadcasters, and passionate cults that turn some new products into cultural phenomena. Even the most brilliant ideas wither in obscurity if they fail to connect with the right network, and the consumers that matter most aren't the early adopters, but rather their friends, followers, and imitators -- the audience of your audience.

  • Messy: The Power of Disorder to Transform Our Lives

    by Tim Harford

    Messy: How To be Creative and Resilient in a Tidy-Minded World celebrates the benefits that messiness has in our lives: why it's important, why we resist it, and why we should embrace it instead.

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Thu Mar 16 12:00:00 EDT 2017

Philosophy cynicism

Links reflecting my cynicism about philosophy.

  • Five part series about What Is Philosophy's Point? by John Horgan in Scientific American:
    1. Part 1 (Hint: It's Not Discovering Truth)

      Philosophy can still serve many purposes, even if it can't compete with science as a method of accumulating knowledge

    2. Part 2--Maybe It's a Martial Art

      Philosophers sometimes seem more concerned with winning than wisdom

    3. Part 3--Maybe It Should Stick to Ethics

      Philosophers keep giving us moral advice in spite of their doubts about all ethical systems

    4. Part 4--Maybe It's Poetry with No Rhyme and Lots of Reason

      The line between philosophy and the arts can get awfully blurry

    5. Part 5--A Call for "Negative Philosophy"

      Philosophy's chief value is countering our terrible tendency toward certitude

    Followed by: Philosophers Push Back

    Philosophers react to a science journalist's critique of their calling

  • Philosophers' biased judgments persist despite training, expertise and reflection.

    We examined the effects of framing and order of presentation on professional philosophers' judgments about a moral puzzle case (the "trolley problem") and a version of the Tversky & Kahneman "Asian disease" scenario. Professional philosophers exhibited substantial framing effects and order effects, and were no less subject to such effects than was a comparison group of non-philosopher academic participants. Framing and order effects were not reduced by a forced delay during which participants were encouraged to consider "different variants of the scenario or different ways of describing the case". Nor were framing and order effects lower among participants reporting familiarity with the trolley problem or with loss-aversion framing effects, nor among those reporting having had a stable opinion on the issues before participating the experiment, nor among those reporting expertise on the very issues in question. Thus, for these scenario types, neither framing effects nor order effects appear to be reduced even by high levels of academic expertise.

    Full paper (pdf).

  • Cheeseburger Ethics

    Are professional ethicists good people? According to our research, not especially. So what is the point of learning ethics?

    Ethicists do not appear to behave better. Never once have we found ethicists as a whole behaving better than our comparison groups of other professors, by any of our main planned measures. But neither, overall, do they seem to behave worse. (There are some mixed results for secondary measures.) For the most part, ethicists behave no differently from professors of any other sort -- logicians, chemists, historians, foreign-language instructors.

    Nonetheless, ethicists do embrace more stringent moral norms on some issues, especially vegetarianism and charitable donation. Our results on vegetarianism were particularly striking. In a survey of professors from five US states, we found that 60 per cent of ethicist respondents rated 'regularly eating the meat of mammals, such as beef or pork' somewhere on the 'morally bad' side of a nine-point scale ranging from 'very morally bad' to 'very morally good'. By contrast, only 19 per cent of non-philosophy professors rated it as bad. That's a pretty big difference of opinion! Non-ethicist philosophers were intermediate, at 45 per cent. But when asked later in the survey whether they had eaten the meat of a mammal at their last evening meal, we found no statistically significant difference in the groups' responses -- about 38 per cent of professors from all groups reported having done so (including 37 per cent of ethicists).

    ... We aspire to be about as morally good as our peers. If others cheat and get away with it, we want to do the same. We don't want to suffer for goodness while others laughingly gather the benefits of vice. If the morally good life is uncomfortable and unpleasant, if it involves repeated painful sacrifices that are not compensated in some way, sacrifices that others are not also making, then we don't want it.

    Can one blame physicist Neil deGrasse Tyson for Dismissing Philosophy As 'Useless'.

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Tue Feb 28 13:03:51 EST 2017

Items of Interest

Various web links I found to be of interest recently.

  • Why Facts Don't Change Our Minds

    The vaunted human capacity for reason may have more to do with winning arguments than with thinking straight.

    Stripped of a lot of what might be called cognitive-science-ese, Mercier and Sperber's argument runs, more or less, as follows: Humans' biggest advantage over other species is our ability to cooperate. Cooperation is difficult to establish and almost as difficult to sustain. For any individual, freeloading is always the best course of action. Reason developed not to enable us to solve abstract, logical problems or even to help us draw conclusions from unfamiliar data; rather, it developed to resolve the problems posed by living in collaborative groups.

  • The Elephant in the Brain: Hidden Motives in Everyday Life

    Human beings are primates, and primates are political animals. Our brains were designed not just to gather and hunt, but also to get ahead socially, often by devious means. The problem is that we like to pretend otherwise; we're afraid to acknowledge the extent of our own selfishness. And this makes it hard for us to think clearly about ourselves and our behavior.

    The Elephant in the Brain aims to fix this introspective blind spot by blasting floodlights into the dark corners of our minds. Only when everything is out in the open can we really begin to understand ourselves: Why do humans laugh? Why are artists sexy? Why do people brag about travel? Why do we so often prefer to speak rather than listen?

    Like all psychology books, The Elephant in the Brain examines many quirks of human cognition. But this book also ventures where others fear to tread: into social critique. The authors show how hidden selfish motives lie at the very heart of venerated institutions like Art, Education, Charity, Medicine, Politics, and Religion.

    Acknowledging these hidden motives has the potential to upend the usual political debates and cast fatal doubt on many polite fictions. You won't see yourself -- or the world -- the same after confronting the elephant in the brain.

  • Most scientists 'can't replicate studies by their peers'

    Science is facing a "reproducibility crisis" where more than two-thirds of researchers have tried and failed to reproduce another scientist's experiments, research suggests.

    The reproducibility difficulties are not about fraud, according to Dame Ottoline Leyser, director of the Sainsbury Laboratory at the University of Cambridge.

    That would be relatively easy to stamp out. Instead, she says: "It's about a culture that promotes impact over substance, flashy findings over the dull, confirmatory work that most of science is about."

    She says it's about the funding bodies that want to secure the biggest bang for their bucks, the peer review journals that vie to publish the most exciting breakthroughs, the institutes and universities that measure success in grants won and papers published and the ambition of the researchers themselves.

  • The Only Thing, Historically, That's Curbed Inequality: Catastrophe

    Plagues, revolutions, massive wars, collapsed states--these are what reliably reduce economic disparities.

    The pressures of total war became a uniquely powerful catalyst of equalizing reform, spurring unionization, extensions of voting rights, and the creation of the welfare state. During and after wartime, aggressive government intervention in the private sector and disruptions to capital holdings wiped out upper-class wealth and funneled resources to workers; even in countries that escaped physical devastation and crippling inflation, marginal tax rates surged upward. Concentrated for the most part between 1914 and 1945, this "Great Compression" (as economists call it) of inequality took several more decades to fully run its course across the developed world until the 1970s and 1980s, when it stalled and began to go into reverse.

  • Donald Trump Isn't Mentally Ill. He's Just Unpleasant, Psychiatrist Says

    "Most amateur diagnosticians have mislabeled President Trump with the diagnosis of narcissistic personality disorder. I wrote the criteria that define this disorder, and Mr. Trump doesn't meet them," Frances wrote in a letter to the New York Times.

    Frances chaired the team that defined psychiatric disorders for the mental health profession -- the Diagnostic and Statistical Manual of Mental Disorders IV (called DSM 4). The DSM V or 5 is the most recent edition.

    "He may be a world-class narcissist, but this doesn't make him mentally ill, because he does not suffer from the distress and impairment required to diagnose mental disorder," Frances wrote.

    A personality disorder must lead to "clinically significant distress or impairment in social, occupational, or other important areas of functioning," the DSM IV says.

    "Mr. Trump causes severe distress rather than experiencing it and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy," Frances wrote.

  • Things Every Hacker Once Knew

    Eric S. Raymond reminisces

    There are lots of references to Unix in here because I am mainly attempting to educate younger open-source hackers working on Unix-derived systems such as Linux and the BSDs. If those terms mean nothing to you, the rest of this document probably won't either.

  • Evaluating partisan gains from Congressional gerrymandering

    Using computer simulations to estimate the effect of gerrymandering in the U.S. House

    The analysis reveals that while Republican and Democratic gerrymandering affects the partisan outcomes of Congressional elections in some states, the net effect across the states is modest, creating no more than one new Republican seat in Congress. Therefore, the partisan composition of Congress can mostly be explained by non-partisan districting, suggesting that much of the electoral bias in Congressional elections is caused by factors other than partisan intent in the districting process.

  • The Motion Microscope

    'Motion microscope' reveals movements too small for the human eye

    By using an algorithm that magnifies minute changes in color and movement, researchers are able to extract basic vital signs like heart rate and breathing from any old video.
    You can even use these algorithms to listen in on someone's conversation by keeping an eye on the objects around them. MIT researchers recently published a study in which they extracted intelligible audio by analyzing the movements of a nearby bag of chips. By magnifying its movements, they were able to reconstruct the soundwaves that were causing it to flutter imperceptibly.

    Michael Rubinstein TED Talk
  • Psychiatrists Must Face Possibility That Medications Hurt More Than They Help

    Mental health has declined as prescriptions for antidepressants and other drugs keep surging

    It is time for mental-health practitioners in the U.S. and elsewhere to come to grips with the possibility that medications are doing more harm than good.

  • India's Secret to Low-Cost Health Care

    Harvard Business Review

    At a time when health care costs in the United States threaten to bankrupt the federal government, U.S. hospitals would do well to take a leaf or two from the book of Indian doctors and hospitals that are treating problems of the eye, heart, and kidney all the way to maternity care, orthopedics, and cancer for less than 5% to 10% of U.S. costs by using practices commonly associated with mass production and lean production.
    The nine Indian hospitals we studied are not cheap because their care is shoddy; in fact, most of them are accredited by the U.S.-based Joint Commission International or its Indian equivalent, the National Accreditation Board for Hospitals. Where available, data show that their medical outcomes are as good as or better than the average U.S. hospital.

  • Fasting diet 'regenerates diabetic pancreas'

    The pancreas can be triggered to regenerate itself through a type of fasting diet, say US researchers.

    Dr Valter Longo, from the University of Southern California, said: "Our conclusion is that by pushing the mice into an extreme state and then bringing them back - by starving them and then feeding them again - the cells in the pancreas are triggered to use some kind of developmental reprogramming that rebuilds the part of the organ that's no longer functioning."

    Rhonda Patrick related interview:
    Valter Longo, Ph.D. on Fasting-Mimicking Diet & Fasting for Longevity, Cancer & Multiple Sclerosis

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Tue Jan 31 12:46:03 EST 2017

Items of Interest

Various web links I found to be of interest recently.

  • A new study shows American democracy is getting weaker. And not because of Trump.

    Every year, the Economist Intelligence Unit (EIU), the research arm of the company that publishes the Economist magazine, issues a report assessing the state of democracy in countries around the world. This year's report, released on Wednesday morning, has a striking finding: The United States has, for the first time, been rated as a "flawed" rather than "full" democracy.

    You'd think, given the timing, that the election of Donald Trump is the reason why. But that's not it. The report is based on a quantitative metric, linked to survey data and policy, that doesn't incorporate the election results.

    "The decline in the US democracy score reflects an erosion of confidence in government and public institutions over many years," the report states. '[Trump's] candidacy was not the cause of the deterioration in trust but rather a consequence of it."

  • Why Trump's Staff Is Lying

    By requiring subordinates to speak untruths, a leader can undercut their independent standing, including their standing with the public, with the media and with other members of the administration. That makes those individuals grow more dependent on the leader and less likely to mount independent rebellions against the structure of command. Promoting such chains of lies is a classic tactic when a leader distrusts his subordinates and expects to continue to distrust them in the future.

    Another reason for promoting lying is what economists sometimes call loyalty filters. If you want to ascertain if someone is truly loyal to you, ask them to do something outrageous or stupid. If they balk, then you know right away they aren't fully with you. That too is a sign of incipient mistrust within the ruling clique, and it is part of the same worldview that leads Trump to rely so heavily on family members.

  • The Heroism of Incremental Care

    We devote vast resources to intensive, one-off procedures, while starving the kind of steady, intimate care that often helps people more.

    Observing the care, I began to grasp how the commitment to seeing people over time leads primary-care clinicians to take an approach to problem-solving that is very different from that of doctors, like me, who provide mainly episodic care.
    Rose told me, "I think the hardest transition from residency, where we are essentially trained in inpatient medicine, to my practice as a primary-care physician was feeling comfortable with waiting. As an outpatient doctor, you don't have constant data or the security of in-house surveillance. But most of the time people will get better on their own, without intervention or extensive workup. And, if they don't get better, then usually more clues to the diagnosis will emerge, and the steps will be clearer. For me, as a relatively new primary-care physician, the biggest struggle is trusting that patients will call if they are getting worse." And they do, she said, because they know her and they know the clinic. "Being able to tolerate the anxiety that accompanies taking care of people who are sick but not dangerously ill is not a skill I was expecting to need when I decided to become a doctor, but it is one of the ones I have worked hardest to develop."

  • Fewer people are dying of cancer than ever before

    The number of deaths peaked in 1991.

    The number of Americans dying of cancer has dropped to a 25-year low, equaling an estimated 2,143,200 fewer deaths in that period, says the new annual report from the American Cancer Society. In that time, the racial and gender disparities that exist in cancer rates have also narrowed somewhat, but they remain wide in many places.
    The decline in deaths from cancer is attributed largely to the fact that fewer people smoke -- from about 42 percent in 1965 to 17 percent in 2013 -- as well as earlier detection for certain types of cancer.

  • Economic Crises and the Crisis of Economics

    Despite its aspiration to the certainty of the natural sciences, economics is, and will remain, a social science. Economists systematically study objects that are embedded in wider social and political structures. Their method is based on observations, from which they discern patterns and infer other patterns and behaviors; but they can never attain the predictive success of, say, chemistry or physics.

    Human beings respond to new information in different ways, and adjust their behavior accordingly. Thus, economics cannot provide -- nor should it claim to provide -- definite insights into future trends and patterns. Economists can glimpse the future only by looking backwards, so their predictive power is limited to deducing probabilities on the basis of past events, not timeless laws.

  • Derek Parfit Obituary

    Endearingly eccentric moral philosopher who was spoken of in the same breath as John Stuart Mill

    I don't know about his philosophy but a while ago I read this article about him Reason and romance: The world's most cerebral marriage and I could relate to the last three sentences:

    Here was obviously an extremely close and affectionate relationship between two people who were intellectually, morally and aesthetically compatible. Yet, at some level, Derek seemed strangely unaware that Janet was 60 miles away. "It matters to him that I exist," she says, "but it matters much less that I'm around."

    I also found the following excerpts to be pertinent:

    • Janet says she was initially "utterly baffled" by Derek. He lacks certain common traits and doesn't pick up on many normal social messages. In 2011, the night before they were due to get married in a register office, Derek and Janet were walking down Little Clarendon Street in Oxford on the way to a low-key celebration at an Indian restaurant. They had been together for 29 years, and had taken the decision to marry largely on pragmatic grounds. They felt they were getting old, and formalising their relationship made it easier to settle issues such as inheritance and next-of-kin. There were to be only four witnesses at the ceremony: Janet's sister and brother-in-law, her niece and her niece's partner.
    • "I may be somewhat unusual," he told the New Yorker, "in the fact that I never get tired or sated with what I love most, so that I don't need or want variety."
    • One of the reasons he dresses in the same outfit every day--black trousers, white shirt--is so he doesn't waste time selecting clothes.
    • Several of Derek's friends mention "Asperger's" when I ask them about him. What does he himself think? Might it explain the quality of some of his social interactions and his unusual lifestyle? "There may be something in this suggestion," he says, though he also attributes it to a boarding school education. The same friends also comment that his remarkable nature has required a huge amount of adjustment on Janet's part. She agrees. "But the adjustment was relatively straightforward once I had figured him out and stopped looking for what was not there. His way of life gives me enormous independence."

Posted by mjm | Permanent link | Comments

Thu Jan 19 14:01:18 EST 2017

Health Matters

  • The U.S. spends more on health care than any other country

    Here's what we're buying.

    A new study published in the Journal of the American Medical Association reveals what patients and their insurers are spending that money on, breaking it down by 155 diseases, patient age and category -- such as pharmaceuticals or hospitalizations. Among its findings:

    • Chronic -- and often preventable -- diseases are a huge driver of personal health spending. The three most expensive diseases in 2013: diabetes ($101 billion), the most common form of heart disease ($88 billion) and back and neck pain ($88 billion).
    • Yearly spending increases aren't uniform: Over a nearly two-decade period, diabetes and low back and neck pain grew at more than 6 percent per year -- much faster than overall spending. Meanwhile, heart disease spending grew at 0.2 percent.
    • Medical spending increases with age -- with the exception of newborns. About 38 percent of personal health spending in 2013 was for people over age 65. Annual spending for girls between 1 and 4 years old averaged $2,000 per person; older women 70 to 74 years old averaged $16,000.

  • What's Pushing Down U.S. Life Expectancy?

    Drug overdoses and flu may have been key drivers behind the latest death toll numbers

    For the first time in a decade our death rate increased from the year before; 2015 saw roughly 86,000 more deaths than 2014, according to the new report. The National Center for Health Statistics (NCHS), which released the numbers this week, found that in 2015 the death rate jumped 1.2 percent from 724.6 deaths per 100,000 people in 2014 to 733.1. The agency calculated that this spike pushed life expectancy down, too. Standard life expectancy at birth dropped to 78.8 years from 78.9 just a year earlier. Preliminary analysis suggests the increase in deaths may have been driven by drug overdoses and an unusually severe flu season in early 2015, which may have exacerbated potentially fatal conditions such as heart disease.
    Cancer mortality continued to decline, which is good.

  • Study Tied to Food Industry Tries to Discredit Sugar Guidelines

    The review was paid for by the International Life Sciences Institute, a scientific group that is based in Washington, D.C., and is funded by multinational food and agrochemical companies including Coca-Cola, General Mills, Hershey's, Kellogg's, Kraft Foods and Monsanto. One of the authors is a member of the scientific advisory board of Tate & Lyle, one of the world's largest suppliers of high-fructose corn syrup.
    Dr. Johnston said he recognized that his paper would be criticized because of its ties to industry funding. But he said he hoped people would not "throw the baby out with the bathwater" by dismissing the conclusion that sugar guidelines should be developed with greater rigor. He also emphasized that he was not suggesting that people eat more sugar. The review article, he said, questions specific recommendations about sugar but "should not be used to justify higher intake of sugary foods and beverages."
    But Barry Popkin, a professor of nutrition at the University of North Carolina at Chapel Hill, said he was stunned that the paper was even published at all because its authors "ignored the hundreds of randomized controlled trials" that have documented the harms of sugar.

  • Gestational vitamin D deficiency and autism-related traits: the Generation R Study

    There is a growing body of evidence linking gestational vitamin D deficiency with neurodevelopmental disorders such as schizophrenia and ASD (Autism-spectrum disorder). Birth cohort studies have provided evidence that gestational vitamin D deficiency (based on prenatal maternal sera) is associated with impairment on a range of cognitive outcomes related to language, motor development and general intelligence.

  • Chickenizing Farms and Food

    C-Span Video Interview After Words with Ellen Silbergeld

    Professor Ellen Silbergeld talked about her book Chickenizing Farms and Food: How Industrial Meat Production Endangers Workers, Animals, and Consumers, in which she looks at new farming methods and technology and their impact on consumers, the environment, and workers.

    Seems to me to be a fairly balanced overview of the good and bad of current farming methods.

Posted by mjm | Permanent link | Comments

Fri Dec 30 17:46:58 EST 2016


Various web links I found to be of interest recently.

  • Trump's Economic Team of Rivals

    The incoming president's advisers are all over the ideological map.

    It will be hard, and indeed structurally impossible, to reconcile the views on this team. The equivalent in foreign policy would be appointing a group comprised of isolationists, interventionists, realists and moralists. Something's got to give. How to square deregulation with abiding by environmental standards, as Cohn favors? How to square tariffs on imports designed to boost domestic production (Navarro and Ross) with the free flow of capital (Kudlow)? How to balance deconstructing Obamacare without price gouging and chaos in the health-care system that will surely hurt the working class that supported Trump? How to balance punitive tariffs with affordable goods? How to start mini-trade wars without the costs falling on, say, Walmart shoppers? How to juxtapose tax cuts that will benefit the 1% with the need to boost wages and employment for millions of disgruntled workers and unemployed who see Trump as a best last chance to turn things around?

    The answer is that you can't. If Trump's goal is to create tension and conflict and see who emerges bloodied but victorious from the fighting, he's setting up one hell of a battle.

  • Why Did Planned Parenthood Supporters Vote Trump?

    It's far from certain that these people, or others like them, will turn on Trump when and if he goes after reproductive rights. If the reality of his plans didn't penetrate during the campaign, there's no reason to think the reality of his policies will penetrate afterward, at least for those who aren't directly and immediately impacted. If support for Planned Parenthood was a serious priority for these voters, they wouldn't have voted for Trump in the first place. Nevertheless, there is a lesson here. If Democrats ever want to regain power, they don't need to wedge Trump away from the Republican Party. They need to yoke him to it. These voters might be OK with Trump talking about grabbing women by the pussies. What they didn't know is that they were voting for the federal government to do it.

  • Jonathan Haidt: The moral roots of liberals and conservatives

    TED Talk -- video and transcript.
    Psychologist Jonathan Haidt studies the five moral values that form the basis of our political choices, whether we're left, right or center. In this eye-opening talk, he pinpoints the moral values that liberals and conservatives tend to honor most."

    But also read Chris Hedges critical review The Righteous Road to Ruin of Haidt's book The Righteous Mind: Why Good People Are Divided by Politics and Religion

  • Yes, people really are turning away from democracy

    Public attitudes toward democracy, we show, have soured over time. Citizens, especially millennials, have less faith in the democratic system. They are more likely to express hostile views of democracy. And they vote for anti-establishment parties and candidates that disregard long-standing democratic norms in ever greater numbers.

    1. It's not just that one graph
    2. Young citizens are more critical of democracy than they used to be
    3. Citizens have grown more disenchanted with democracy over time
  • The long history of the U.S. interfering with elections elsewhere

    While the days of its worst behavior are long behind it, the United States does have a well-documented history of interfering and sometimes interrupting the workings of democracies elsewhere. It has occupied and intervened militarily in a whole swath of countries in the Caribbean and Latin America and fomented coups against democratically elected populists.

    I wonder what's the evidence that the United States has stopped. Although not an instance of interfering with an election, given the recent stuxnet computer worm I kind of doubt it.

  • Scott Adams: The Non-Expert Problem and Climate Change Science

    Victor Venema, scientist studying variability, responds to Scott Adams.

    • Scott Adams assertion: 1 It seems to me that a majority of experts could be wrong whenever you have a pattern that looks like:
      1. A theory has been "adjusted" in the past to maintain the conclusion even though the data has changed. For example, "Global warming" evolved to "climate change" because the models didn't show universal warming.

      The terms Global Warming and Climate Change are both used for decades

    • Scott Adams assertion: 2. Prediction models are complicated. When things are complicated you have more room for error. Climate science models are complicated.

      Climate models are not essential for basic understanding

    • Scott Adams assertion: 3. The models require human judgment to decide how variables should be treated. This allows humans to "tune" the output to a desired end. This is the case with climate science models.

      Model tuning not important for basic understanding

    • Scott Adams assertion: 4. There is a severe social or economic penalty for having the "wrong" opinion in the field. As I already said, I agree with the consensus of climate scientists because saying otherwise in public would be social and career suicide for me even as a cartoonist. Imagine how much worse the pressure would be if science was my career.

      The consensus is a result of the evidence

    • Scott Adams assertion: 5. There are so many variables that can be measured -- and so many that can be ignored -- that you can produce any result you want by choosing what to measure and what to ignore. Our measurement sensors do not cover all locations on earth, from the upper atmosphere to the bottom of the ocean, so we have the option to use the measurements that fit our predictions while discounting the rest.

      Scientists consider and weigh all the evidence

    • Scott Adams assertion: 6. The argument from the other side looks disturbingly credible.

      Arguments from the other side only look credible

Posted by mjm | Permanent link | Comments

Wed Nov 30 22:11:14 EST 2016

Items of Interest

Various web links I found to be of interest recently.

  • Two not so horrible assessments of Donald Trump's victory from the left:
    • Barney Frank Looks for the Bright Side of Trump's Win

      But the election of Donald Trump has not shattered his confidence about the nation's political future. "This was not a wipeout. People will tend to overinterpret it. Remember, we got more votes than they did," he said, in an interview this week. "And there is one silver living for us. They have succeeded in blaming us for everything that goes wrong in the world. From now on, anything bad that happens is on them.

    • UpFront special: Noam Chomsky on the new Trump era

      I wouldn't compare it with Wedemark Germany. Hitler was a sincere dedicated ideologue. Trump isn't. He has no known ideology other than ME.

      ... But on the other he's also talked about reducing tensions with Russia which is probably the most dangerous flashpoint in the world on the Russian border. So it's hard to predict. In fact the most predictable aspect of Trump is unpredictability. I think it's dangerous.

      ... There's been real gains in the protection of freedom of speech and I think they're pretty deeply embedded and my suspicion is that though there will be attacks on freedom of speech, my own feeling is they are not likely to get very far.

  • Reelection Rates Over the Years

    If US citizens are really unhappy with their government, why are reelection rates for U.S. House of Representatives and Senators reliably above 90% and 80% respectively?
    See the bar charts at the above link.

  • How Steve Bannon and Breitbart News Can Be Pro-Israel -- and Anti-Semitic at the Same Time

    Some on the alt-right, the emerging group of racist activists who support Trump, oppose the close U.S.-Israel relationship as part of a broader critique of U.S. interventionism abroad. Yet they admire Israel as a "model for white nationalism and/or Christianism," according to the right-wing online encyclopedia Conservapedia. Some also see Jewish immigration to Israel as helping their cause of a Jew-free white America.

  • Why Steve Bannon Hates Paul Ryan

    Perhaps, the most critical disparity between the two men's worldviews is the way they conceptualize the relationship between working people and America's economic elites. While Paul Ryan champions our nation's corporate titans as "job creators" -- whose prosperity is inextricably linked with that of the middle class -- Bannon paints them as rootless, godless elites whose wealth is harvested from the exploitation of ordinary people.

  • Recent pause in the growth rate of atmospheric CO2 due to enhanced terrestrial carbon uptake

    Here using global carbon budget estimates, ground, atmospheric and satellite observations, and multiple global vegetation models, we report a recent pause in the growth rate of atmospheric CO2, and a decline in the fraction of anthropogenic emissions that remain in the atmosphere, despite increasing anthropogenic emissions. We attribute the observed decline to increases in the terrestrial sink during the past decade, associated with the effects of rising atmospheric CO2 on vegetation and the slowdown in the rate of warming on global respiration.

  • Why America Is Rich, at Least for Now

    The U.S., along with a handful of European nations, has had solid, fairly consistent economic growth for more than two centuries (with, of course, some notable dark times), and for most of that period economic growth has benefitted poor and rich alike. That growth is best understood by pulling the focus far back from the narrow lens of one election. What matters most are those things that endure for decades and centuries: democracy, rule of law, a civilian-led military, political stability, and freedom of speech and movement. America is a rich country not because of what the Democrats or the Republicans did separately. It is successful because of those things that the parties share, national values and institutions.

  • US dementia rates drop 24%

    A new study finds that the prevalence of dementia has fallen sharply in recent years, most likely as a result of Americans' rising educational levels and better heart health, which are both closely related to brain health.

    Dementia rates in people over age 65 fell from 11.6 percent in 2000 to 8.8 percent in 2012, a decline of 24 percent, according to a study of more than 21,000 people across the country published Monday in JAMA Internal Medicine.

  • The MMR vaccine and autism: Sensation, refutation, retraction, and fraud

    The next episode in the saga was a short retraction of the interpretation of the original data by 10 of the 12 co-authors of the paper. According to the retraction, "no causal link was established between MMR vaccine and autism as the data were insufficient". This was accompanied by an admission by the Lancet that Wakefield et al. had failed to disclose financial interests (e.g., Wakefield had been funded by lawyers who had been engaged by parents in lawsuits against vaccine-producing companies). However, the Lancet exonerated Wakefield and his colleagues from charges of ethical violations and scientific misconduct.
    The final episode in the saga is the revelation that Wakefield et al. were guilty of deliberate fraud (they picked and chose data that suited their case; they falsified facts). The British Medical Journal has published a series of articles on the exposure of the fraud, which appears to have taken place for financial gain. It is a matter of concern that the exposé was a result of journalistic investigation, rather than academic vigilance followed by the institution of corrective measures. Readers may be interested to learn that the journalist on the Wakefield case, Brian Deer, had earlier reported on the false implication of thiomersal (in vaccines) in the etiology of autism. However, Deer had not played an investigative role in that report.

  • New Measles Study Shows Why Anti-Vaccination Thinking Is Deadly

    Since the measles, mumps and rubella (MMR) vaccine isn't recommended for children under 12 months, the only effective way of preventing it and fatal post-measles disorders like SSPE is through "herd immunity" --vaccinating enough people to prevent the spread of the disease even among those too young to receive the vaccine.

Posted by mjm | Permanent link | Comments