Map of life expectancy at birth from Global Education Project.

Sunday, May 30, 2010

Simple answers to complex problems







Thursday, May 27, 2010


As I've been saying now and again (and again and again) a major reason why so many people believe in so much stuff that just isn't true is innumeracy. Orac discusses an editorial in Vaccine by Gregory Poland and Ray Spier. I link to the good doctor because the editorial itself is behind a subscription wall and at least he gives you an idea of what's in it. I'm just going to quote a bit -- this is all about why people believed in the fraudulent link between the MMR vaccine and autism, as promoted by psychopathic charlatan Andrew Wakefield.

An innumerate (the inability to use and understand numbers and mathematical concepts) press and public resonated with each other. An innumerate person or organization uses such phrases as "I don't care what the data show . . . I believe . . . ". The answer to innumeracy is a slow and long-term one -- better scientific and public education.

Well okay, but how can we accomplish that? This web site is trying, but after rooting around in it for a while I don't think it really works -- partly because it depends on the user to find her or his own way around, instead of beginning at the beginning and muddling through to some definite end; partly because it just doesn't have enough material that will really get through to people. There is some on-site content and a lot of links out, but the links out are all a pig in a poke.

At least it helps me realize more about the task. I probably jumped in too hard here getting straight to the binomial distribution and all that mathy hoo hah, when in fact a lot of people just have the wrong idea about how the world works qualitatively.

The gambler's fallacy, that a number is "due" to hit, has emptied many a wallet.

Then there is the ubiquity of coincidence. An immense, effectively infinite number of events come to our awareness every day. There are bound to be apparent patterns and associations among them, and our brains are wired to see them. But there is no way to know if they are real unless we see them repeated many times and never violated. Alas, due to a psychological proclivity called confirmation bias, we are relatively unlikely to notice or remember violations of our original hypotheses. That's how superstitions develop.

For these and other reasons, we need to investigate problems systematically, and use disciplined means to overcome the sloppiness of our intuitions. This requires structured ways of stating and evaluating questions, which is really what mathematics is all about. Math doesn't necessarily have to be mainly about numbers, although numbers are very helpful in structured thinking and sometimes necessary.

But what people really need to be able to do is not so much learn about mathematical theorems and memorize formulas. People need to learn how to think. Reality reveals itself to those who know how to interrogate it. Because so many people do not know how, we end up with all these critical debates over matters which simply are not in doubt. There aren't two sides to every question, and not every controversy should be taught. Yet people on both sides of every false controversy "know" they are correct.

The issue is that they "know" in different ways. My way keeps winning out in the end -- as Copernicus and Hubble, Crick and Watson, and yes, Darwin can attest. But people still don't get it.

Wednesday, May 26, 2010

Back to civilization

from the wasteland of Miami Beach. I couldn't post yesterday because a) I actually wanted to participate in the conference instead of writing blog posts about it and b) various women kept plying me with alcohol in the evenings so I was a little bit out of it. Unfortunately, they were only trying to get me to talk.

Anyway, as I reported last time, the HIV pandemic is running away from us, particularly in Africa but probably in some parts of Asia and perhaps Eastern Europe as well. In the U.S., new infections continue at a steady state of around 65,000/year. Up until now, we have been treating most people who engage in care, although that may be about to change -- right now 10 states have waiting lists for their HIV Drug Assistance Programs that purchase drugs for people who have no other way of affording them. About 1,000 people are on waiting lists and that number will likely grow sharply in coming months as states struggle with budget deficits and curtail or eliminate their contribution to the program, which is required to obtain the federal match. For example, Florida is about to start a waiting list, and North Carolina's program is closed to new enrollment with the list expected to grow sharply.

However, even many people who are in treatment fail to achieve suppressed viral loads because they don't take the pills consistently. I haven't been able to find any reliable national estimates (let me know if I've missed something) but from the various studies I've read of clinical populations, somewhere around 30% tend to have detectable viral loads. Since some people are not in treatment, the proportion of people with HIV who have unsuppressed viral loads is obviously a bit higher than that.

Everybody knows that HIV is a life threatening disease, unless they've been listening to psychopaths, but guess what? So is hypertension. The consequences can be just as unpleasant -- renal failure, stroke, heart disease. It turns out that only about 50% of Americans with hypertension have it under control. That actually represents major progress since 1990 and that's how this number is being spun, but really, there's no excuse for it. 72.5% of people with hypertension are no in treatment for it, which I suspect is not that different from the percentage of people with HIV who are in treatment; and about 70% of people in treatment have controlled blood pressure, also not that different.

A few people have really intractable hypertension, mostly because they are very obese; but for most people, two pills a day, maybe three, will do the trick. Full disclosure: I take two, lisonpril and nifedipine, and that totally works. I am absolutely committed to taking them every day; it's just part of getting up in the morning and taking a shower and getting dressed. But lots of people get the scrips and never fill them, or stop taking them. Side effects of these meds are minimal. A few people have side effects from lisonopril and similar drugs, called angiotensin converting enzyme (ACE) inhibitors, but if they just tell their doctors, they can get an alternative prescription. But lots of people don't do it, they just stop.

It's wise to question the conventional wisdom and educate yourself about your own health, but let me tell you something -- if you have hypertension, most of the time, very inexpensive and very safe pills will fix it, if you take them every day. Just do it.

Monday, May 24, 2010

Penny stupid and pound moronic

A couple of years ago, when I blogged from the International AIDS Conference in Mexico City, I reported hearing a lot of optimism, or at least hope (which I didn't really share), or at least insistence on the necessity, of meeting the the goal of universal access to HIV treatment by 2010. This goal was accepted by the world community (if there is such a thing), and at one time seemed feasible because the drug companies had accepted -- or had forced upon them, more accurately -- licensing agreements which made standard antiretroviral packages available in resource poor countries at low cost, and in middle-resource countries such as Mexico at affordable prices. The U.S. and other wealthy countries had pledged to provide enough money to make it happen -- which is in the tens of billions of dollars annually, a trivial sum compared to the cost of war and corporate welfare. Infrastructure in the poor countries was building and the personnel were trained.

But we have failed. The donor countries did not come up with enough cash and the rate of new infections is now running ahead of the rate at which people are offered treatment. We're losing the AIDS war.

Last night Julio Montaner, president of the International AIDS Society, told us why this isn't just a moral failure. It is a profound failure of wisdom. It turns out -- although we weren't 100% sure of this before -- that when people are successfully treated and have undetectable viral loads, they are far less infectious -- perhaps not infectious at all. That doesn't mean you should go out and practice risky behaviors. You don't know, at any time, if you really do have undetectable viral load. Not everybody is completely adherent to drug regimens, and resistance can develop.

But on a population level, Dr. Montaner has shown that expanding treatment can greatly reduce HIV incidence. (As you will recall from a couple of weeks ago, that's the rate of new infections.) The result is that if you invest enough, you can catch up to the epidemic and cap it like a top-killed oil gusher. In the end, obviously, you will save a lot of money as well as human lives and you'll have a lot fewer orphans. If you don't do enough, the epidemic will start running away from you, as it is doing now, and you will never be able to catch up.

So which choice is the world making?

Sunday, May 23, 2010

Where I'm at

I'm in Miami Beach at the Eden Roc resort and spa, for the 5th International Conference on Antiretroviral HIV Treatment Adherence. I'll do some blogging about the conference and what it all means, but hey, today is Sunday so it's a day of rest. I haven't been to Miami Beach for more than 20 years -- also for a conference, at the Fountainbleu -- but it hasn't changed that I can tell. A solid wall of hotels and condos faces the ocean, and it's pretty much a wasteland if you're interested in real life. People do live in those condos, but I'm darned if I can figure out where they shop or get their hair done. There must be a real world section of Miami Beach but it's not within walking distance of the hotels.

I can see the ocean right from my window - the hotel is right behind the boardwalk and it's no more than 1/4 mile to the water. So far, it's a transcendentally beautiful aquamarine that looks purer than the milk of the Blessed Virgin. Let's hope it stays that way.

The weirdness is that the Eden Roc has a big pool complex between the boardwalk and hotel, from which one cannot even see the ocean. The pool is surrounded by people lying in lounge chairs while others cavort in the chlorine. For extra dough, you can have the Exclusive Eden Roc Cabana Experience, which consists of a tent by the swimming pool. In the Ocean Garden, as they call it, it is completely impossible to discern whether you are 300 yards from the ocean in Miami Beach, or in Indiana. Nevertheless most of the people here seem to prefer it to the real ocean.

Explain it to me.

Thursday, May 20, 2010

Biological oceanography

I generally try to stay within my expertise here, but believe it or not I'm not going to far out of bounds by talking a bit about the ocean and the effects of the oil volcano at the bottom of the Gulf of Mexico. I have a master's degree in environmental policy, and I actually took some marine biology on the way to getting it.

It may surprise most people to learn that most of the ocean is what is called a biological desert -- it has very little biological productivity, and little life. The reason is that unless it is very close to freezing, warm water is less dense than cold water, which means that warmer surface water sits on top of colder water and the layers don't mix. Any possible nutrients that might support photosynthetic organisms and create a base for a food chain therefore sink below the depth where sunlight can reach. In the ocean depths, there are organisms that subsist on stuff that rains down, or on reactive chemicals that spew from hot vents along the mid-Atlantic ridge; but none of these are any fun to eat.

The only productive regions of the ocean, therefore, are cold arctic and antarctic waters -- yep, the cold parts of the ocean are more biologically productive than most of the warm parts, while more temperate waters can have seasonal productivity before the thermocline appears in late spring; upwelling zones, where deep currents hit a rise in the sea floor and shoot water upward (e.g. the Peruvian anchovy fishery); shallow coastal waters; and river estuaries and salt marshes. The latter are particularly important because they are highly productive, relatively sheltered places. Many species spawn there, and their larvae spend some time getting started before heading out to the open ocean.

That is why, bad as the effects of the disaster have already been, this is indeed worse news. Oil washing ashore from Port Fourchon to Grand Isle. "Councilman Tom Capella said this morning that oil from the BP rig explosion has washed up on Elmer's Island just west of Grand Isle. And Councilman Chris Roberts said oil was hitting the beaches in a wide area from Port Fourchon in Lafourche Parish to Grand Isle, which is the southern tip of Jefferson Parish. Even heavier oil can be seen just offshore, Roberts said."

Once those marshes and salt ponds are oiled, they will not come back to life for who knows how long. And the primary productivity they represent is irreplaceable.

Wednesday, May 19, 2010

What cannot be denied







Tuesday, May 18, 2010


Today is the anniversary of the eruption of Mount St. Helens. In Henry IV, part 1, one of the most notable of my Cymric ancestors gets a pie in the face.

* Glendower. I cannot blame him: at my nativity
The front of heaven was full of fiery shapes,
Of burning cressets; and at my birth
The frame and huge foundation of the earth
Shaked like a coward.

* Hotspur. Why, so it would have done at the same season, if
your mother's cat had but kittened, though yourself
had never been born.

* Glendower. I say the earth did shake when I was born.

* Hotspur. And I say the earth was not of my mind,
If you suppose as fearing you it shook.

* Glendower. The heavens were all on fire, the earth did tremble.

* Hotspur. O, then the earth shook to see the heavens on fire,
And not in fear of your nativity.
Diseased nature oftentimes breaks forth
In strange eruptions; oft the teeming earth
Is with a kind of colic pinch'd and vex'd
By the imprisoning of unruly wind
Within her womb; which, for enlargement striving,
Shakes the old beldam earth and topples down
Steeples and moss-grown towers. At your birth
Our grandam earth, having this distemperature,
In passion shook.

Monday, May 17, 2010

More on the peculiarities of priorities

You've probably already heard about the new study in Pediatrics that finds a link between urinary levels of metabolites of organophosphate pesticides and diagnosis of ADHD in children. I've been saying forever that there is plenty of evidence that chronic exposure to low levels of organophosphates causes neurological harm with behavioral symptoms in humans. We've known this for more than 20 years, but malathion and its cousins are still sprayed all over our crops. (In case you didn't know, these are just somewhat weaker versions of the "nerve gas" invented by Nazi scientists in WWII.)

However, on the very same day, another study came out, in the very same journal, that has been completely ignored. Mothers' Spanking of 3-Year-Old Children is associated with aggressive behavior at age 5. Aggressive behavior means whether "the child argues a lot; is cruel, bullies and shows meanness to others; destroys . . . things; . . . gets in many fights; physically attacks people . . ." You know, the kind of stuff Christians endorse since non-Catholic Christian mothers, as you might expect, are more likely to hit their children. By the way, we aren't necessarily talking a lot of spanking -- 2 or more times a month is enough to do it.

And the association is about the same strength as the association between organophosphate exposure and ADHD.

I wonder why this study wasn't in the news? Oh yeah - the Family Research Council would freak out and accuse the reporters of being commies if they wrote about it.

Do not hit your kids.

Emergent matters

Even as the Boston Globe yesterday published the worst article about global warming ever (and congratulations, Globe editors, for nearly completing the utter destruction of a once-great newspaper), the truth, as I always say, has it's day.

NASA -- you know, that far left conspiracy against technological progress -- reports that:

Overall, the combined global land and ocean surface temperature anomaly for April 2010 was the warmest April on record since records began in 1880. The previous record was set in 1998. The combined global land and ocean temperature anomaly was 0.76°C (1.37°F) above the 20th century average. . . .

The combined global land and ocean surface temperature for January–April period was the warmest January-April period on record. This value is 0.69°C (1.24°F) above the 20th century average.

Meanwhile, Quest for oil leaves trail of damage across the globe:




But it's absolutely futile.

There is convincing evidence that conventional oil production has already peaked, since we have been stuck at around 74 mbpd for over half a decade (despite the incentive of record high prices). There also seems to be growing consensus that global liquids production (currently around 86 mbpd) is likely to peak within the next decade and almost certainly at less than 95 mbpd.

The world we all grew up in, the one we've come to take for granted, is indeed coming to an end, although events will bear no resemblance to the Revelation of John. Jesus isn't coming back to save us. We're on our own, and this can either be very, very ugly or basically okay after all. But three decades of denial, capped by 8 years of rule by the oil companies, has left us with no time to waste at all. Our folly is catching up with us, now. Right now. Nothing else matters very much.

Sunday, May 16, 2010

Let's get reasonable







Friday, May 14, 2010

A persecuted minority?

These are tough times, it seems, to be a scientist. One of the two major political parties in the United States requires its candidates to publicly proclaim that the theory of evolution is false, that "this world and everything in it is a masterpiece created by the hands of God," and that "every single word" of the Bible is true." The Attorney General of Virginia is suing a former professor at the state university for fraud because he believes that humans are causing global climate change. The Republicans also claim we can achieve energy independence and reduce the price of fuel by offshore drilling. Er, no we can't.

Sadly, while conservatives in general are particularly hostile to reason, they aren't the only ones. Robert Kennedy Jr., who pretends to be a liberal and was actually seriously considered by Barack Obama to be administrator of the EPA, is a crank who believes that all the world's physicians, biomedical researchers and public health authorities are part of a massive conspiracy to poison children. The whole "vaccines are a conspiracy by greedy scientists" thing is not particularly a hallucination of left or right, but it's mostly touted by celebrities with a liberal sheen.

I could go on and on but you know all this. Charlie Pierce has put it very well:


It seems impossible to crack the granite walls of smug, self-regarding ignorance with facts and reason. To my mind, the basic problem is what Robert T. Carroll calls communal reinforcement. For most people, belief is not a matter of evidence and logic; it's a matter of tribal loyalty. If you try to reason with them, and show them why their beliefs are mistaken, it's taken as an assault and an insult to their friends and their virtue.

Like many people on the side of reason these days I'm starting to wonder why I bother. Truth is all I've got. If that's worthless, I'm helpless. Oh well, gotta keep on doing it.

Update: BTW, I probably should have mentioned that one reason I got all het up to write this post was this. Do check it out.

Oh yeah, it turns out Orac is having some of the same angst today.

Thursday, May 13, 2010

The most dangerous place in town








Just one more way we may get our comeuppance.

Wednesday, May 12, 2010

In a nutshell







Tuesday, May 11, 2010

Science and medicine

Harriet Hall, at Science Based Medicine, discusses Druin Burch's Taking the Medicine: A Short History of Medicine’s Beautiful Idea, and Our Difficulty Swallowing It. Discussion and debate ensues about what percentage of accepted medical interventions today have an adequate base in scientific evidence. Here's my take:

I would say that the greater challenge right now is not so much to increase the evidence base for medicine and find new and better treatments, although that should certainly continue; but rather to implement what is already known. This is particularly a problem in the United States where we have no equivalent of the UK’s NICE and it is, in fact, politically toxic even to suggest such a thing.

I’m looking right now at Bridget Kuhn’s article from the April 28 JAMA about inappropriate prescribing of antipsychotic drugs. In spite of a black box warning, doctors keep giving these to elderly people with dementia. She notes that in an analysis of VA data, 60% of people who got a scrip for an AP in 2007 had no record of a diagnostic indication. These drugs have potentially terrible side effects and shorten people’s lives. She quotes Douglas Leslie of Penn State College of Medicine as saying that docs are prescribing these drugs off label because they have heard “anecdotal stories of benefit.” They are also widely prescribed to children, by the way, who ostensibly have "bipolar disorder," although there is no evidence whatsoever to support that and they cause diabetes and dyslipidemia and all sorts of horrible stuff that you do not want to happen to children.

Of course it’s because of illegal marketing by the drug companies, and they’re getting away with it.

More science is great, but let's use the science we already have.

Monday, May 10, 2010

It's actually more complicated . . .










Friday, May 07, 2010

A notable and exemplary career

I just got back from a farewell luncheon for Stephen Shestakofsky, who is the retiring director of state legislation (i.e. lobbyist) for the Massachusetts Medical Society. Steve symbolizes in his person the very interesting historical fact that for the past 15 years or so the MMS, unlike physicians' organizations elsewhere, has been on the light side of the force. Steve had a lot to do with that, it isn't just because this is the People's Republic of Massachusetts.

Steve was involved in many campaigns for justice and health equity, but one of the most important, because the trickle we started here in Massachusetts turned into a nationwide flood, was tobacco control. It started with the successful referendum campaign to impose a tax on tobacco products, to be used for programs to combat tobacco use. The industry poured in millions of dollars and conscripted convenience store owners and, yes, pharmacies to their fight, but they lost, and the voters passed it. Then the MMS joined with its coalition partners for the workplace smoking bans, strong and enforceable bans on tobacco sales to minors, and other measures that made our state a leader and have now been adopted all over the country.

However, Australia, believe it or not, is ahead of us. This is what all cigarette packages are going to look like in Australia in 2012:

The packages will all be standard, with the strong and graphic health warnings you see here. The merchants of death won't be able to use any of the imagery, colors or lying words they put on packages to seduce children into a deadly addiction. The kangaroo jockeys are also going to raise the sales tax on tobacco by 25% and spend more on anti-tobacco advertising. Naturally, British American Tobacco Australia says they are "surprised and disappointed." Awwww. I'll tell you what guys -- why don't you go to hell.

Thursday, May 06, 2010

People are Stupid

Isaac Asimov spoke at my college back in the day, and those were his opening words, still as true as ever. I was thinking about why our political culture seems incapable of confronting the real problems we face when I happened to come across an essay by David Hemenway in the new NEJM that seems quite relevant, titled "Why We Don't Spend Enough on Public Health." He breaks down four reasons: medicine often has immediately perceivable benefits, whereas the benefits of public health programs are somewhere off in the gauzy distance; we know specifically who benefits from medical intervention but the beneficiaries of public health programs are individually unidentifiable -- you will never know that you are the person who didn't get sick; physicians are often famous heroes but who ever heard of the guy who invented sewers?; and powerful vested interests often oppose public health programs, such as (and he names the names) "the alcohol, tobacco, firearm automobile, coal and oil industries."

When I started to think about this post I was pondering the comparable, if not greater attention given to Faisal Shahzad and the petroleum gusher in the Gulf of Mexico. Shahzad apparently attended a terrorist training school in Pakistan and majored in bomb making. If that is true, the first thing his lawyer should do is try to get his money back. But we pay so much attention to the relatively inconsequential threat of "terrorism" because when these attempts occur, they are specific, immediate, and visible. There is an individually identifiable malefactor and had he succeeded, there would be individually identifiable victims.

We are suddenly re-evaluating deep water oil exploration but of course the risk of a blowout was always there, and the most important reason not to do it -- that we have to stop using so much petroleum in the first place rather than spending tens of billions of dollars to find more -- is a) based on abstract, long-term concerns and b) furiously opposed by the world's largest, most powerful vested interest.

Until we can rewire our brains we are just going to march on to our doom like cattle in a chute.

(I missed two consecutive weekdays for probably the first time ever, due to proposal hell. Friday is a big NIH deadline. Maybe in the future if that happens I'll throw up some classics. Anyway, I am now coming up for air.)

Monday, May 03, 2010

Hijacking our lizard brains






Sunday, May 02, 2010

An evil, evil day

I picked this up from a commenter at Grist:

A reader who is an engineer of considerable experience says watch this
one evolve carefully because it is destined to continue to grow and he shares this long (but worthy) explanation why:



That's an enormous catastrophe. (I removed some of the quote because I think it was a bit over the top, on reflection -- but I do believe it is very unclear when they will be able to cap this well and it might indeed be many weeks. So yes, it's really, really bad.) This is a product of a hubristic ideology that claimed that allowing people to do whatever the hell they want to make as much money as they possibly can will create the best of all possible worlds; and that anyone who tries to interfere on behalf of some imagined greater interest or common cause is an enemy of humanity. Is this what it will take for people to finally confront the enormity of our folly?