The PSA fiasco, where a task force announced guidelines for PSA testing that disagrees with just about every expert in the field, raises some specific questions but general ones too. How good are any of these studies we hear and read?
I read two Ian Rankin books recently. He is well regarded but I'll bet not in Scotland. Scotland is failing if he is correct.
The husband of "The Chinese Tiger" is Jed Rubenfeld. He has written two books, the first, "The Interpretation of Murder", is quite good. This family is so talented they have displaced my former Queen of Redistribution of Qualities, Gwenyth Paltrow.
I saw a picture of Obama's speech in Pittsburgh. Most of the seats were empty.
Romney's Mormon problem has another side. Why can't he blunt to "cult" charge and claim it's a truly American religion. After all, it was invented here. Appeal to American patriotism.
Sunday, October 16, 2011
Thursday, October 13, 2011
Big Guys in the NBA and the Little Guy
There is more going on than you might expect in the NBA struggle. The players want money, the owners want money but the owners want something else. They want a salary cap to ensure more competitiveness among the teams and the players do not. The impasse has resulted in the cancellation of several weeks of games and no resolution is in sight. The players and the owners are taking a financial hit but there is more. The working man. The average guy hurt by the trickle down effect of the work stoppage. Said George Cohen, Federal Mediator: "It is evident that the ongoing dispute will result in a serious impact, not only upon the parties directly involved, but also, of major concern, on interstate commerce — i.e., the employers and working men and women who provide services related to the basketball games, and, more generally, on the economy of every city in which those games are scheduled to be played." And many of these teams already have considerable community "investment."
This looks like a good spot for TARP. The federal government could guarantee a portion of salary above the cap, even an elevated playing field and create work for the little guy.
This looks like a good spot for TARP. The federal government could guarantee a portion of salary above the cap, even an elevated playing field and create work for the little guy.
Wednesday, October 12, 2011
Bomber's Remorse ("The Sorrowful Men")
A secret cable dated Sept. 3, 2009, was recently released for the first time by WikiLeaks. Sent to Secretary of State Clinton, it reported Japan's Vice Foreign Minister Mitoji Yabunaka telling U.S. Ambassador John Roos that "the idea of President Obama visiting Hiroshima to apologize for the atomic bombing during World War II is a 'nonstarter.'" The Japanese feared the apology would be exploited by anti-nuclear groups and those opposed to the defensive alliance between Japan and the U.S.
Samir Khan, the al-Qaida propagandist and recruiter, was killed along with the terrorist Anwar al-Awlaki with a drone strike in Yemen. The U.S. State Department contacted his family to "express its condolences."
Whatever your political viewpoint, this is a peculiar administration.
Samir Khan, the al-Qaida propagandist and recruiter, was killed along with the terrorist Anwar al-Awlaki with a drone strike in Yemen. The U.S. State Department contacted his family to "express its condolences."
Whatever your political viewpoint, this is a peculiar administration.
Tuesday, October 11, 2011
P.S.A., Prostate Cancer, and the NYT
The NYT and WashPo recently published the results of a review done by a task force on the value of P.S.A. testing. (P.S.A. is a protein --Prostatic Specific Antigen--made by the prostate that gets into the bloodstream depending on number of blood vessels, their permeability and age. It rises in many instances of prostate cancer, as well as other conditions that increase vasculature and vessel permeability.)The report is astonishing in a number of ways and offers remarkable insights into problems facing the United States and its fragile relationship with science.
The task force, The United States Preventive Services Task Force, is an independent panel of experts in prevention and primary care appointed by the Department of Health and Human Services. They offer opinions on medical practice in the United States. While these positions are unsolicited, they often determine the approach taken by Medicare with regard to standards in health care management and, significantly, payment for testing. (A few years ago the task force determined that mammograms should been done only every two years rather than the traditional one year. The limits of funding followed.) In this particular task force study, the complications of therapy for the prostate cancers discovered was seen as unjustified when compared to the improvement in survival rate, which was seen as slight. In essence, P.S.A. elevation was seen to result in complications from biopsies and eventually complication from therapy when the biopsy was positive and no advantage in life expectancy was seen over a ten year period.
Several of the studies were particularly interesting as they compared tested and untested groups rather than diseased and healthy groups--they used testing as a proxy for disease found. So the Scandinavian study compared groups tested for P.S.A. against those not tested for P.S.A. and compared their life expectancy over seven to ten years. Men declining biopsy as well as those with negative biopsies were included in the tested group. As elevated P.S.A. is associated with negative biopsy 70% of the time, the tested group give a muted idea of the disease. But most complications of biopsy--like blood in the semen at 50%--while harmless are reported as serious complications.
Another factor not considered is the target population of biopsy. Most agree that clinical prostate cancer, that is cancer that is symptomatic and/or can be appreciated on examination, does not limit the life expectancy in men over the age of 70 in most cases but does in those men under 70. However, P.S.A. elevation--when associated with prostate cancer--precedes clinical findings by 5 to 7 years. Thus the target group for physicians treating prostate cancer is men under the age of 65 or so. Another group is those with rapidly growing disease in the generally low risk populations as P.S.A. changes often reflect that. Targeting these groups is more than reasonable; in a civilized society that understands the implication of illness and feels a responsibility towards its victims, it is obligatory. Another important factor is the development of symptoms which can be decreased or eliminated by early detection; thus survival rate does not tell the whole story.
What is particularly galling about these haphazard investigations and reviews is that they are done by seemingly reasonable people, people who should know the limits of their studies and the difficulties inherent in making good scientific generalities. Perhaps the makeup of the task force is illuminating: There is no one on the task force collecting information on P.S.A. and prostate cancer who clinically evaluates or treats either.
In essence, for the sake of unbiased neutrality, expertise and knowledge on the task force were screened out.
The task force, The United States Preventive Services Task Force, is an independent panel of experts in prevention and primary care appointed by the Department of Health and Human Services. They offer opinions on medical practice in the United States. While these positions are unsolicited, they often determine the approach taken by Medicare with regard to standards in health care management and, significantly, payment for testing. (A few years ago the task force determined that mammograms should been done only every two years rather than the traditional one year. The limits of funding followed.) In this particular task force study, the complications of therapy for the prostate cancers discovered was seen as unjustified when compared to the improvement in survival rate, which was seen as slight. In essence, P.S.A. elevation was seen to result in complications from biopsies and eventually complication from therapy when the biopsy was positive and no advantage in life expectancy was seen over a ten year period.
Several of the studies were particularly interesting as they compared tested and untested groups rather than diseased and healthy groups--they used testing as a proxy for disease found. So the Scandinavian study compared groups tested for P.S.A. against those not tested for P.S.A. and compared their life expectancy over seven to ten years. Men declining biopsy as well as those with negative biopsies were included in the tested group. As elevated P.S.A. is associated with negative biopsy 70% of the time, the tested group give a muted idea of the disease. But most complications of biopsy--like blood in the semen at 50%--while harmless are reported as serious complications.
Another factor not considered is the target population of biopsy. Most agree that clinical prostate cancer, that is cancer that is symptomatic and/or can be appreciated on examination, does not limit the life expectancy in men over the age of 70 in most cases but does in those men under 70. However, P.S.A. elevation--when associated with prostate cancer--precedes clinical findings by 5 to 7 years. Thus the target group for physicians treating prostate cancer is men under the age of 65 or so. Another group is those with rapidly growing disease in the generally low risk populations as P.S.A. changes often reflect that. Targeting these groups is more than reasonable; in a civilized society that understands the implication of illness and feels a responsibility towards its victims, it is obligatory. Another important factor is the development of symptoms which can be decreased or eliminated by early detection; thus survival rate does not tell the whole story.
What is particularly galling about these haphazard investigations and reviews is that they are done by seemingly reasonable people, people who should know the limits of their studies and the difficulties inherent in making good scientific generalities. Perhaps the makeup of the task force is illuminating: There is no one on the task force collecting information on P.S.A. and prostate cancer who clinically evaluates or treats either.
In essence, for the sake of unbiased neutrality, expertise and knowledge on the task force were screened out.
Monday, October 10, 2011
"Ides of March" Movie Review
Directed by George Clooney (who headlines along with a powerhouse cast that includes Ryan Gosling, Philip Seymour Hoffman, Paul Giamatti, Evan Rachel Wood, Marisa Tomei and Jeffrey Wright)
"The Ides of March" is a new film co-written and directed by George Clooney, a film adapted from a play called "Farragut North," (the name of a Washington D.C. Metro stop). It is a gripping, well acted film. It opens with Ryan Gosling mishandling a political debate question in a darkened room. It is soon apparent that it is a practice setting for a future debate and Gosling is merely testing the mechanics of the debate. He is not even the candidate. Let the deception and the "Everything is not what it seems" begin.
The cast includes Gosling, Clooney, Philip Seymour Hoffman, Paul Giamatti, Marisa Tomei and someone new (to me) Evan Rachel Wood. The setting is the Ohio Democratic primary between two presidential candidates and the winner probably will become the national candidate, the endorsement by the North Carolina Senator will probably deliver the nomination regardless of who wins the primary. Clooney is the modern, thoughtful and apparently moral candidate and his second assistant is Gosling. His campaign staff chief is Hoffman and their opponent's is Giamatti. The battle lines center on the competition for the Ohio votes, the Senator's (Wright) endorsement, and the complex manipulation of people by both sides as well as the inevitable secrets of explosive potential. The story ostensibly is the story of Gosling's maturity in the hard world of politics.
Everyone in this story is terrific; Wood is a special surprise and Tomei's character is defining for the story. But there are a number of problems in the story--not the acting--that hamper it. There are a number of crucial coincidences, deadly ones that generate the story. In the modern world, no story should hinge on the ability to get a phone call.
One would like a struggle in the changing characters; the process from good guy to bad guy is not an evolution, it should be a crisis that is poorly resolved. People in this story accept their circumstances. There is no struggle except in the effort of characters to extricate themselves from trouble. Goslin's development is more of a change of clothes; he merely changes style.
The notion that politics is seamy is a given in modern society; no one is surprised by it and it will not carry a plot. Hypocrisy, insincerity and moral danger are powerful in the hands of good actors. But, in itself, it is not enough. And with a title like "The Ides of March" you have set a high bar, too high here.
"The Ides of March" is a new film co-written and directed by George Clooney, a film adapted from a play called "Farragut North," (the name of a Washington D.C. Metro stop). It is a gripping, well acted film. It opens with Ryan Gosling mishandling a political debate question in a darkened room. It is soon apparent that it is a practice setting for a future debate and Gosling is merely testing the mechanics of the debate. He is not even the candidate. Let the deception and the "Everything is not what it seems" begin.
The cast includes Gosling, Clooney, Philip Seymour Hoffman, Paul Giamatti, Marisa Tomei and someone new (to me) Evan Rachel Wood. The setting is the Ohio Democratic primary between two presidential candidates and the winner probably will become the national candidate, the endorsement by the North Carolina Senator will probably deliver the nomination regardless of who wins the primary. Clooney is the modern, thoughtful and apparently moral candidate and his second assistant is Gosling. His campaign staff chief is Hoffman and their opponent's is Giamatti. The battle lines center on the competition for the Ohio votes, the Senator's (Wright) endorsement, and the complex manipulation of people by both sides as well as the inevitable secrets of explosive potential. The story ostensibly is the story of Gosling's maturity in the hard world of politics.
Everyone in this story is terrific; Wood is a special surprise and Tomei's character is defining for the story. But there are a number of problems in the story--not the acting--that hamper it. There are a number of crucial coincidences, deadly ones that generate the story. In the modern world, no story should hinge on the ability to get a phone call.
One would like a struggle in the changing characters; the process from good guy to bad guy is not an evolution, it should be a crisis that is poorly resolved. People in this story accept their circumstances. There is no struggle except in the effort of characters to extricate themselves from trouble. Goslin's development is more of a change of clothes; he merely changes style.
The notion that politics is seamy is a given in modern society; no one is surprised by it and it will not carry a plot. Hypocrisy, insincerity and moral danger are powerful in the hands of good actors. But, in itself, it is not enough. And with a title like "The Ides of March" you have set a high bar, too high here.
Sunday, October 9, 2011
Sunday Sermon 10/9/11
Today's gospel contains the third of the three parables of the vineyards, all three delivered by Christ in his last weeks during his final, fatal visit to Jerusalem. The first parable is of the two brothers asked by their father to work in the family vineyard, one says he will go but doesn't and the other said he would not but eventually does. The second is of the king who sends men and eventually his son to collect profits from his vineyard and all of his emissaries are killed by the sharecroppers. The third is of the wedding guests who don't come to the wedding and are eventually replaced by people from the highways and byways. The first is pretty straightforward--as straightforward as genius is--the third is the most famous with the scary ejection of the guest who has not worn the correct wedding clothes. The second is really interesting; according to most biblical authorities this is the first major allusion Christ makes as being the Son of God and this parable is responsible for the rage of the Jewish infrastructure that leads to His crucifixion.
There is an interesting part of the parable where the sharecroppers finally explain their violence towards the king's men and, eventually, his son. They say they want to take the son's inheritance. What could all this mean?
First, the king is beyond patient; he is optimistic about the sharecroppers almost to the naive. They kill two groups of ambassadors and yet he sends his son to negotiate. Second, the sharecroppers have a motive, a strange motive but a motive. If they kill the heir they will get his inheritance. Thus it is a revolt, a revolution, but on the face of it there is no chance this will be successful; the logistics will not allow it. It is as if they are trying to create an alternative universe. How will killing the son get them anything other than destroyed? The sharecroppers are farmers trying to change a system that is written in stone. There is no chance they will succeed against the king. Their revolt is a symbolic and egocentric act doomed to fail. Their acts are monstrous specifically but tiny in the eyes of the king who can--and will--bring a terrible vengeful justice upon them. Not only is the behavior of the tenants reprehensible, it is stupid; it defies the way of the world. It defies how things are.
Like walking naked in a snowstorm, it mocks freedom. It is the rebellion of Adam and Eve. It is an attempt to replace the certainty of God with the uncertain ambitions of men.
There is an interesting part of the parable where the sharecroppers finally explain their violence towards the king's men and, eventually, his son. They say they want to take the son's inheritance. What could all this mean?
First, the king is beyond patient; he is optimistic about the sharecroppers almost to the naive. They kill two groups of ambassadors and yet he sends his son to negotiate. Second, the sharecroppers have a motive, a strange motive but a motive. If they kill the heir they will get his inheritance. Thus it is a revolt, a revolution, but on the face of it there is no chance this will be successful; the logistics will not allow it. It is as if they are trying to create an alternative universe. How will killing the son get them anything other than destroyed? The sharecroppers are farmers trying to change a system that is written in stone. There is no chance they will succeed against the king. Their revolt is a symbolic and egocentric act doomed to fail. Their acts are monstrous specifically but tiny in the eyes of the king who can--and will--bring a terrible vengeful justice upon them. Not only is the behavior of the tenants reprehensible, it is stupid; it defies the way of the world. It defies how things are.
Like walking naked in a snowstorm, it mocks freedom. It is the rebellion of Adam and Eve. It is an attempt to replace the certainty of God with the uncertain ambitions of men.
Saturday, October 8, 2011
Cab Thoughts 10/8/11
There was a lot of evidence against Ms. Knox. And she clearly lied--hugely and badly--to the investigators. But most of it seems to prove that she was there, not necessarily the killer. But being there is pretty bad.
Who would you rather have as president, Hillary Clinton or any of the Republican front runners?
Age of the average car in the United States? 10 years, 7 months. Car sales are up but may be a sign of attrition of current stock, not improvement in domestic economy.
Since 2000 the global growth rate for natural gas vehicles has been 26 per cent per year. About 1 per cent of all vehicles on planet earth now run on natural gas and most of them are light duty or cars. In the U.S. only 1 in 10,000 vehicles run on natural gas. It's clean and plentiful; why do the Americans not use it?
Bank protesters are in my neighborhood this week. I am at a loss to explain why unless they prefer areas with good coffee houses.
I oppose the collection of wealth but I also know it is rare. My idea of reasonable wealth is that earned by Franklin Raines. I want no more than that.
About 92 percent of the coal used in the United States is used for generating electricity. That makes cutting down coal use, or increasing electric vehicles without coal, difficult.
Pointless demonstrations are things only a parent can understand.
Who would you rather have as president, Hillary Clinton or any of the Republican front runners?
Age of the average car in the United States? 10 years, 7 months. Car sales are up but may be a sign of attrition of current stock, not improvement in domestic economy.
Since 2000 the global growth rate for natural gas vehicles has been 26 per cent per year. About 1 per cent of all vehicles on planet earth now run on natural gas and most of them are light duty or cars. In the U.S. only 1 in 10,000 vehicles run on natural gas. It's clean and plentiful; why do the Americans not use it?
Bank protesters are in my neighborhood this week. I am at a loss to explain why unless they prefer areas with good coffee houses.
I oppose the collection of wealth but I also know it is rare. My idea of reasonable wealth is that earned by Franklin Raines. I want no more than that.
About 92 percent of the coal used in the United States is used for generating electricity. That makes cutting down coal use, or increasing electric vehicles without coal, difficult.
Pointless demonstrations are things only a parent can understand.
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