Monthly Archives: October 2009

In Brief: Ze Frank, humorist, making Video Essays on Time.com

Ze Frank is doing videos on Time.com. I’m a fan of Mr. Frank from years ago when he was doing The Show. In the same spirit, he’s doing 3 minute videos at Time.com.

The one that is most salient for The Big Upshot is his little introduction to the Healthcare Debate, which I think sums up a lot of the absurdity. Have a look, you’ll get a chuckle, I think.

Ze Frank on the Healthcare “Debate”

Cheers,
Peter

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Healthcare Debate – Future Doctors Beware: this is part of your job.

At some risk of politicizing the Big Upshot, I’d like to draw the readers’ attention to two little articles:

The first is in the New England Journal of Medicine. It was written by Senator Max Baucus from Montanna, and I think the following quote sums it up:

“As patients’ greatest advocates, providers play a vital role in helping to achieve reform. The stakes are high, and now is the time to fight against the misinformation that threatens the promise of reform. Together, we can take the first steps toward lowering costs, improving quality, and expanding access to high-quality, affordable coverage. At the end of the day, Americans are counting on us to end the status quo and bring our health care system in line with the principles and character of this great nation.” [emphasis mine]

This was a plea to doctors to advocate change. Doctors, of course, are firmly in the upper-middle class and thus people who had a lot to lose in a socialized medicine scenario. On the other hand, nobody knows the problems with the system as it stands as well as physicians. So, it behooves someone who is in the healthcare (and biotechnology) fields to know something about the issue. All I can do to help you out, I’m afraid, is to tell you It’s complicated. And in some ways, that’s enough. If someone tries to explain it and makes it sound simple, they are leaving something out.

This from Reason.com did a nice job of summing up the only simple truth in the whole mess:

The problem is that the critics seem to imagine that once we crack down on insurance companies or go to a single-payer government health insurance plan, future patients like Nataline will get anything their doctors recommend.

They won’t. No matter how we “reform” health insurance, there will still be close calls, where it’s not clear that a costly procedure will actually do any good. There will have to be someone, either in government or in the private sector, to decide which operations and treatments should be covered and which should not. And there will be patients who will die after being refused … as long as someone else has to pay for those decisions, someone other than doctors and patients is going to make decisions about what treatments are worth the cost.

Good luck on your search for education on this issue. The Times has been doing pretty well in my estimation. Stay away from cable news. Did you know you can get the Times (and many other newspapers) on your Kindle every morning? It’s really cool.

-Peter

The Long awaited paper on observing evolution in E. Coli

Some sixteen months ago, we here at The Big Upshot took note of an amazing 21 year study in which bacteria were grown in a high citrate environment to which they were poorly adapted. After some 40,000 generations, the bacteria actually invented a new phenotype, true evolution in action.

This was not mere adaptation, but real bona-fide generation of novel “designed” attributes. This is like an animal with a beak turning into an animal with teeth given sufficient time and incentive. It turns out that what might seem “irreducibly complex” is not actually all that irreducible. Richard Lenski’s lab carefully saved samples of the little creatures all along the way, like an artificial fossil record. So not only is the proof eating citrate in a petri dish, something its ancestors couldn’t do, but the precise genetic changes that got it there are all “on file,” so to speak.

I’ve been waiting with bated breath for the follow up study where they go through the lineage of the Strain that Evolved. And lo, it has arrived. I’m going to level with you all, this is really, really cool. Kudos to all of the authors. If anybody ever tries to sell some intelligent design (deity-sign?) to you, slap this on the table like it’s your enormous stick of science.

-Peter

Happy birthday to the iron lung – forgotten legacy of polio

Credit Wikimedia Commons Wired magazine has a piece this morning on the iron lung, the amazing machine that let polio stricken children breathe (instead of suffocating when their nerve-damage became severe enough to cause respiratory failure). What is hard for us to understand in this modern age is that this hellish contraption was an amazing success – being trapped in a metal cylinder was better than dying for lots of little kids. This is the real picture of polio: life in a tube. That’s why it irritates me when people go disparaging vaccines in general.

-Peter

Addendum: There’s a nice article over at the Huffington Post that covers some more details on the “debate” over vaccines that’s going on in the news. My favorite part:

There is a lot of fear-mongering about the dangers or effectiveness of vaccines, particularly swine flu vaccine. But if you look at the sources of this information, they come from less than credible sources.

That “less than credible source” is David Icke. Less than credible, indeed.

Vaccines post – ‘moral statistics’ case-in-point

 

Let’s say that you’re a doctor some day. Or a professor, for that matter. And someone (e.g. your patient, a party guest, or friend on facebook) starts talking about the Dangers of Immunization. You could respond with “The anti-vaccination people are misled, crazy or amoral…” but that will be highly counterproductive. I think I’ve got a better one. I must preface, however: this argument applies to life-threatening childhood endemic diseases like polio, not so much to optional flu shots and such, whose risks and efficacy are less well known.

Why a person might not want a vaccine: All medical treatments carry a certain measure of risk. Like crossing the street or taking a bus, everything is a risk at some level. The problem is causation. If you get hit by a bus, it’s not your fault. If you choose to get vaccinated and there are some side effects, then you feel like you’ve screwed yourself. And that is a terrible feeling.
But, look, we need to evaluate risk in a sane and rational way. Let’s say that the choice is between:
1. Doing nothing and taking a 1 in 100 risk of contracting a life-threatening disease

or

2. Take a concrete action which carries a complication risk of 1:1000.

Clearly, your odds are better with option 2. But a 1:100 chance of being screwed by external random events may feel preferable to a 1:1000 chance of screwing yourself. So why not just say “screw statistics, I’m going with my gut”? Because there’s more at work than a choice between possible regret and ‘leaving the matter to fate’. There’s a moral imperative at work.

Why we are morally obligated to get vaccinated: Now, if everyone but one selfish guy gets vaccinated, then he will still be safe (because there’s nobody from whom he can catch the disease) and he has no risk of side-effects. So he gets all the reward without any of the sacrifice. That makes him a freeloader. It’s profiting from others’ misfortune. It’s cheating.

How good people avoid seeing this moral issue: If we can avoid the statistics and just say “vaccines are poison” then the vaccine looks worse than the disease it was meant to prevent. The moral/statistics problem is solved. Some people have heard that there is mercury in vaccines. That happens to be partially true for some vaccines. Mercury is not healthy. Thus the logic progresses.

But is mercury really so toxic? There is potassium in lethal injections and there is chlorine in bleach. Is potassium bad? Chlorine? No. Very different chemistry, scenario, concentration, etc. can give rise to wholly different levels of toxicity. Some mercury compounds are pretty nasty. Others are pretty benign. But gram for gram, there was more mercury in one salmon than was in the whole first-year vaccine course for an infant. And that was prior to it being removed completely in the last few years from infant vaccines.

In some other vaccines, there is a small amount of a mercury compound called thiomersal (not metallic mercury or methyl-mercury which are relatively nasty kinds). No mercury compound is good for you, but a little mercury-based preservative turns out to be statistically better than the risk of a bad batch of vaccine. Vaccines are made of protein – they are like broth. They will rot. Rotten vaccine is useless. Useless vaccine leaves you vulnerable to the disease that is supposed to be prevented.

A slight risk of low level toxicity is better than risking polio. The odds are still in your favor if you get vaccinated. But since there is a known risk (mercury!) versus an unknown risk (nobody gets polio any more, right?) people will be misled into false beliefs about relative risks.

The point is: this all comes down to statistics. We have to weigh the relative risks of a terrible disease becoming endemic again versus the risks of mass-scale injections. We have to weigh the risks of a trace quantity of mercury versus the risks of inactive or contaminated medicine. There’s math involved. And to someone who sees the world in terms of “us” and “them” – who sees Nefarious Motivations in the hearts of his fellow men – this can all look like obfuscation. I wish it were as simple as “it either works or it doesn’t” but in actual real life, things work with some probability, and weighing those probabilities is never an easy job.

Strangely enough, sound moral reasoning requires statistical analysis. And that puts us all at a disadvantage when trying to Do the Right Thing. Try telling someone that on Facebook. Or, for that matter, good luck getting your patient’s HMO to cover your time explaining all of that to your patient.

-Peter