PSA 1

PSA is a protein measurable in the blood of all males with prostates that is loosely connected to prostatic cancer.
Medicare officials are considering a measure that would penalize doctors who order routine prostate-cancer screening tests for their patients, as part of a federal effort to define and reward quality in health-care services.
The proposal, which hasn’t been widely publicized, has prompted a flurry of last-minute comments to the Centers for Medicare and Medicaid Services, virtually all in opposition. The official comment period is now expired and the government is holding off on their decision.
Many of those commenting said the measure would discourage doctors from discussing the pros and cons of screening for prostate-specific antigen (PSA) with their patients and allowing them to decide, as several major medical groups recommend.
“PSA screening is a very controversial topic. The debate is ongoing and people feel very strongly about it, one way or another,” said David Penson, chair of public policy and practice support for the American Urological Association, which urged CMS to reject the proposal. “To make it a quality measure would say, ‘You’re a poor quality doctor if your patients get this test.’ ”
The proposed measure is part of continuing federal efforts to develop ways to identify and reward value in health care. The Obama administration has said it plans to tie 50% of Medicare payments to such quality measures by 2018.
Since 2012, the U.S. Preventive Services Task Force has recommended against routine screening for prostate cancer for men of any age on the grounds that the benefits don’t outweigh the harms.
This is an astonishing development. There are two points here: First, there is a wide spectrum of prostate cancer. That is "cancer," as it is generally understood, does not adequately describe the entity we see under the microscope when "prostate cancer" is diagnosed. It fits the microscopic criteria but does not behave physiologically like other cancers all the time. Second, PSA testing finds the "prostate cancer" at a high rate, regardless of its position on the spectrum.
It is the disease that is complicated, not the test. In true bureaucratic, anti-science fashion, the government would ban the test.

You Say ISIL, I Say ISIS, You Say Tomato...

In our time, political speech and writing are largely the defense of the indefensible… Thus political language has to consist largely of euphemism, question-begging and sheer cloudy vagueness… the great enemy of clear language is insincerity. Where there is a gap between one's real and one's declared aims, one turns as it were instinctively to long words and exhausted idioms-- Politics and the English Language, George Orwell

It is high time that everyone sees the Heroes of Beslan clearly.
Burnings. Beheadings. Torture. Mass gang rapes. This kind of man is not unknown among us. The drug cartels, Mengela, the murderers of the Clutter family all have spotted human history with unspeakable savagery and pain.
It is clear that governments the world over are paralyzed with some inexplicable conflict here. There seems to be uncertainty, some unique thinking that exceeds our grasp, that makes even the name ISIS--spoken pointedly as "ISIL" by administrators--abstract. With such ambivalence, action is hard to follow.
I have a modest proposal. I propose a popular uprising of words. No more use of words and phrases like "action," "violence," "terrorism" or "attack" by these people. Only "atrocity, " "fiendishness" and similar words and phrases should be used. And no more "fighter," or "Islamist," or "terrorist." Only truly judgmental words like "Unhinged," "Deranged," "Sadist" and "Maniac" should be used. No "killed," only "murdered." When a maniac is killed , he should be "put out of his misery." Everyone involved is an "accomplice" or "enabler" until proven otherwise.
And everyone should spread the word that "virgin" is a mistranslation of "raisin." Fewer guys are likely to die for 72 raisins. And nothing hurts self-absorbed mania like humor.

Orwell believed language meant something and could do things. Let's try to prove it.

Sunday 6/17/16

Today's gospel is Mary and Martha. Christ always tries to contrast the physical and the spiritual, the mundane, daily world from the world of God. Often these examples are startling--leaving one's home, selling all you own, leaving the plow. But those examples have a certain harsh context: Christ is contrasting the world of the New Testament with the older, contracted world of Israel, tribe and family. He wants to free the people's minds from the black hole of their land and history. With Mary and Martha, He places it in a softer light, a domestic setting with two devoted friends.

Martha and Mary are entertaining Christ but Mary is spending her time sitting and listening to Christ. When Martha, who has been busy with the entertaining work, complains to Christ, He says: "Martha, Martha, thou art careful, and art troubled by many things: But one thing is necessary. Mary hath chosen the best part.."

His comfort is a function of Martha's efforts. He knows and appreciates that. She is "careful and...troubled by many things." That is how we all are; that is our world. He knows that, too. He sympathizes with her.

But He will not allow her to be distracted by the world from the universal that is the world.


There has been a debate recently over productivity; productive people have come up as less high-minded, a bit rustic beside the more thoughtful elite.
The "Sons of Martha" by Kipling is a different, surprisingly American, take:

The Sons of Mary seldom bother, for they have inherited that good part;
But the Sons of Martha favour their Mother of the careful soul and troubled heart.
And because she lost her temper once, and because she was rude to the Lord her Guest,
Her Sons must wait upon Mary’s Sons, world without end, reprieve, or rest.

It is their care in all the ages to take the buffet and cushion the shock.
It is their care that the gear engages; it is their care that the switches lock.
It is their care that the wheels run truly; it is their care to embark and entrain,
Tally, transport, and deliver duly the Sons of Mary by land and main.

They say to mountains, ‘Be ye removed’. They say to the lesser floods, ‘Be dry’.
Under their rods are the rocks reproved – they are not afraid of that which is high.
Then do the hill-tops shake to the summit – then is the bed of the deep laid bare,
That the Sons of Mary may overcome it, pleasantly sleeping and unaware.

They finger death at their gloves’ end where they piece and repiece the living wires.
He rears against the gates they tend: they feed him hungry behind their fires.
Early at dawn, ere men see clear, they stumble into his terrible stall,
And hale him forth like a haltered steer, and goad and turn him till evenfall.

To these from birth is Belief forbidden; from these till death is Relief afar.
They are concerned with matter hidden, under the earthline their altars are;
The secret fountains to follow up, waters withdrawn to restore to the mouth,
And gather the floods as in a cup, and pour them again at a city drouth.

They do not preach that their God will rouse them a little before the nuts work loose.
They do not teach that His Pity allows them to leave their work when they damn-well choose.
As in the thronged and the lighted ways, so in the dark and the desert they stand.
Wary and watchful all their days that their brethren’s days may be long in the land.

Raise ye the stone or cleave the wood to make a path more fair or flat:
Lo, it is black already with blood some Son of Martha spilled for that:
Not as a ladder from earth to Heaven, not as a witness to any creed,
But simple service simply given to his own kind in their common need.

And the Sons of Mary smile and are blessed, they know the angels are on their side.
They know in them is the Grace confessed, and for them are the Mercies multiplied.
They sit at the Feet – they hear the Word – they see how truly the Promise Runs:
They have cast their burden upon the Lord, and – the Lord He lays it on Martha’s Sons.

Nice

We are products of history. We must be; Hegel, Marx and Fukuyama all agree.
Europe is awash with theoretical responses to the current terroristic Politics of Derangement. One was Hollande’s plan to strip French nationality from dual citizens convicted of terrorism. Quite a threat.

There is a review of Christiane Taubira’s Murmures à la jeunesse on the terrorism in France. The reviewer says the short book, translated as "Whispers to the Young," offers a "particularly compelling (and upbeat) contribution to the debate of managing this"... Politics of Derangement. Taubira, from Guyana, was France’s Justice Minister until her resignation in late January 2016 because of her opposition to Hollande’s plan. As she notes pointedly, none of the nine men who carried out the November 2015 attacks in Paris was binational; but twenty-seven of the victims were. Her tract caused a sensation when it was published a week after Taubira’s resignation.

Taubira’s silent interlocutor, never mentioned explicitly, is her nemesis the hardline Socialist Prime Minister Manuel Valls, who publicly declared that there was no point trying to understand the appeal of jihadism, as “to understand terrorism was already in some sense to justify it”.

The reviewer states "Taubira makes a powerful case against the securitization of Islam, and of Muslims in general: she points out that jihadism is attractive not for its religious message, but in its quest for a radical break with the established social and political order. She observes, in this context, that a high proportion of jihadist sympathizers are recent converts to Islam. Above all, she affirms that jihadism is not a purely home-grown phenomenon, but is inextricably intertwined with the calamitous failings of Western policy in the Middle East, from Palestine and Iraq to the more recent cases of Libya and Syria."

It is a reaction, a dialectic, of history.

But there is a lot less going on here in Nice and Orlando than that. These were peripheral philosophical acts, at most. These were acts of seriously deranged people who, in the heat of a homicidal frenzy, wrapped themselves in an available flag.

There is an obvious problem here: Every individual , however destructive, if sane, has a point. He has some combination of educational and personal factors that led to his position and action. Nazis, embittered over the first war and its treaty, had a point. But the homicidal derangement syndrome we are watching unfold (and, probably, develop to larger and more efficient weaponry) has a very special characteristic: The loss of human empathy, the inability to identify with fellow members of the species.
That is very rare among the sane although it is characteristic of shards within the culture like drug cartels. And, of course, cartels have their story too. But dealing with them as a logical outgrowth of history might be giving them a lot more depth than they deserve..

Facts vs. Knowledge‏

The Human Genome Project published the first draft of the complete human genome in Nature magazine on February 15, 2001. 2001! That is fifteen years ago. I think people, on reflection, would express surprise. Why? Because we have now had the complete genome for fifteen years now and the expected dramatic changes have not happened.
We--the modern Western world--have a subtle prejudice: We believe that facts are part of a whole understanding and that more facts imply more understanding. Facts are not isolated bits, they are clues. Like puzzle pieces, each fact brings us closer to an understanding of the whole. Like a parlor game or a Sherlock Holmes story, each bit of information leads us to the solution of the problems of life.
Except they do not. When Vanna White spins the wheel, the next letter may or may not solve the puzzle but the puzzle itself is quite limited, only one line of a crossword. It may hold the truth of life but so far it has not.
So our culture builds information bits, amassing information, store-housing "knowledge" with the confidence that we will eventually come to some conclusions about life. The computer and entertainment electronics are built to complement this thinking.
Or maybe created it. 

Medical Complaints‏

I received this note recently:

The state of medicine in the US is in shambles. The problem is an overshooting in the bastardization of concepts like evidence-based medicine and the patient-satisfaction, which are viewed as something like (fictitious and functional) opposites to "paternalistic medicine". Of course the terms are not even poles of any kind of conceptual spectrum. Some quick clarifications/definitions:

evidence-based: typically the results are based on a *population*. There was this group of people with some condition. We did X to them. Y happened as a result, and here is our statistical confidence on seeing Y when we do X. 

- nothing wrong with this result really, and it sure helps us understand what works *in general*.

guideline: An operational rule book on a particular condition, whose basis strives to be "evidence based" (i.e. the result of those studies), and from which any *care giver* can deviate ("....oh, of course these are no substitute for actual practice with individual patients") at their own legal and financial risk. 

paternalistic medicine: "I am your doctor. I know what is good for you and what is not good for you. Trust me, I will make medical decisions for you. 

patient-centered medicine: "I am the patient. I know what I value, not you, doc. I will make all the decisions on my care, doc. I am a "client", see. What I feel is right is actually best for me.

- implicit is the thought that: "of course the doctor's job is to clarify the entire situation in 7th-grade language so I can make that decision".

- of course years of learning and experience can easily be translated into 7th grade, culture-sensitive language on short notice, so that you (who has every prior experience, including that of end of life issues, your probability of survival, success etc) can make snap decisions on the spur of the moment in real time, leaving open every possible loophole for lawyer and your own hindsight to return to in all legal glory for an aftermath of financial (and maybe criminal) plundering of the care-giver and medical infrastructure (which is what they/it fear, making for some interesting preemptively evasive behaviors). 

doctor: a red-listed species, soon to be replaced by the invasive *care giver*. Originally represented by some Oslerian entity of remarkable learning and clinical skill, that could in most cases stand in for your, priest and lawyer (in terms of advocacy), MRI/CT/US machine and lab (low-efficiency, but passable diagnostic equivalent), pharmacist and dispenser of treatments, as well as mother when you need someone to hear the cry ("Mummy!"). 

care-giver: an invasive species that wears white coats, and is the result of a convergent evolutionary process to fit a common evolutionary niche. Many also carry stethoscopes that they hardly know how to use (in a traditional sense). Protean species that have evolved into this include nurses (now known as the "clinical nurse practitioner", or CNP), and an entirely new 2-yr enlightened group called PA or "physician's assistant", who are non physicians elevated to the lowest calorie doctor standard that "less-money" can buy. Optometrists and even medical technologists wear the white coat and patients mistakenly call everyone "doctor".

- but lo and behold, even doctors are evolving into care-givers these days. your average physician today is no better than a PA IMO.

medical-care: an evolving concept, even a misnomer. At present represented as a combination of interactions between care-givers and infrastructure (MRI/CT/US/lab/pharmacy/OR/ER) and the laws laid down in the unassailable 'guidelines', what the market will bear and legal risk.

- it optimizes patient-satisfaction, care-giver adherence to guidelines and legally supportive documentation.  

common-sense in medicine: an extinct skill, previously referring to medical judgement that considers the vagaries of an individual patient navigating a disease, now to be replaced by a mindless executions of the care-giver, based almost entirely on the guidelines, which are of course justified as they are evidence-based whenever we can have evidence for it, what legality dictates and the workload.

with that we come to the state of affairs: a Procrustean approach where you, the patient, will be fit to a few standardized racks (your feet will be cut off or you will be stretched to make it work), so that the population statistics look great (while each individual differs from the "mean" by about 0.8 std deviations - the standardized mean difference), and you will be bulldozed by interacting with caregivers and infrastructure, suffer at the hands of the insurance companies, and the system will sustain minimal (legal, financial) risk, while perpetuating itself. You will subscribe to dual incompatible illusions that you have both a doctor looking after you in a paternalistic manner (which you desire despite your protestations) while you believe you are the ultimate decision-making/consumer (the satisfied "patient-center" of it all). You will not know better. The numbers will speak well of the well oiled machine. You will be sold short, but will die obliviously happy.

 

This was my response:

 

Medicine and politics is a "target-rich environment," perhaps deserving of an Ambrose Bierce approach. But I think there is a lot more going on, and going wrong, than such definitions allow. The Procrustean pressures are on everything, not just the patient, and are the direct result of the divided loyalties of the medical system. And the problem is much larger than at the interface between patient and doctor.

Is medical care a right? A result of holding a job? A charity?

Is the physician a scientist? A humanist? A technician?

What are we to do with physician extenders?
Is the fact that the majority of ground-breaking studies in pharmacology over the last years are irreproducible important?

Do patients have no responsibility for their behavior or, should they, like bad drivers, suffer financially for their bad statistics? Would such an attitude prejudice their rights?
Is Lee Hood right? Will the physician be the mere moderator in the discussion between the patient, the geneticist and the statistician?

We can explain the disparity between our high health costs and our mediocre life expectancies but what can we do about it?

We have had months of political campaigning yet I have not heard any discussion about medical care. There are complaints about the Affordable Care Act but not a single alternative. Yet there is a defining alternative, one proposed by the self-appointed Hillary Clinton in the 1990s when she offered her health plan along the guidelines of Uwe Reinhardt. It limits health care spending to 10% of GDP. It was her idea then, is it her idea now? And, if so, what does the kind of contraction such a plan implies mean for health care?

In some ways, medicine is a metaphor for the nation, a complicated mix of good will, science and technology, populated by practitioners raised in an environment of outdated principles, receiving information corrupted by economics and politics, serving a naïve patient population with suicidal tendencies and run by grasping non-scientific leaders who refuse to confront significant and basic problems that soon will be exaggerated by the growing demand and a discouraged work force.

Fortunately we all have the audacity of hope to hold on to. 

Cab Thoughts 7/13/16

"I was told by the founding members of the Women's Studies Department at the State University of New York at Albany that I had been brainwashed by male scientists to believe that hormones even existed, much less had any role in the shaping of our identity and character."--Camille Paglia

The Greeks used to have a word for it. Now it's the Japanese.  Kodokushi or “lonely death” refers to the Japanese phenomenon of people dying alone and remaining undiscovered for a long period of time. First noticed in the 1980s, kodokushi has become an increasing problem in Japan, attributed to economic troubles and Japan's increasingly elderly population. It represents upwards of 5% of total deaths – about 30,000 people a year.

In the Middle Ages, the Church viewed translations of the Bible from ancient languages into English, French and other common languages as heresy, and a direct threat to the importance and power of the Church. William Tyndale, whose English translation of the Bible in 1526 was the first to take advantage of the printing press, was tried on a charge of heresy in 1536 and was condemned to be burned to death. Tyndale was a young cleric who had become disillusioned with the pomp and power of the Church; he was ascetic and scholarly by nature, and was instinctively attracted to the purer faith associated with the Lollards and the 'new men.' 

The individualism handed down from the Scottish Enlightenment was concerned with finding a social system that "does not depend for its functioning on our finding good men for running it, or on all men becoming better than they now are, but which makes use of men in all their given variety and complexity, sometimes good and sometimes bad, sometimes intelligent and more often stupid." This is from Hayek, explaining that individualism is not a reactive greedy isolationism but rather a social theory. Importantly, much of the orderliness of social life is often the result of human action, but not of human design. The distinguishing feature of this brand of individualism is that it takes the self-interest of the individual (which includes caring for one's friends and family) as a psychological fact of human action, not as endorsing the unattractive characteristic of selfishness or greed. For Hayek, the intellectual confusion that leads to the belief that individualism approves and encourages human selfishness (which it does not) is one of the main reasons why so many people dislike it. The next element of his thinking is the limitation of man's knowledge. Hayek elaborates further on what he calls the "pretence of knowledge" in his Nobel Speech.

 

Who is....Horace Greeley?

 

The university as we know it today evolved from guilds or unions. Men studying at universities who reached a middling level of competence were know as "bachelors", since, though they had some ability, it was not enough to support a family. A student with considerable experience, he would lec­ture and otherwise aid apprentice students and serve masters, somewhat in the fashion of teaching assistants in modern research universities. ... A bachelor would then have to pass through two stages on his way to becoming a master.

 

The Sohn Investment Conference (run by investment guru Ira Sohn) pulls together some of the greatest traders and hedge fund managers in the world every year. “The conference wants a specific recommendation from me. I guess ‘Get out of the stock market’ isn’t clear enough,” said Stanley Druckenmiller from the conference stage in New York. Gold “remains our largest currency allocation.”The billionaire investor expressed skepticism about the current investment environment due to Federal Reserve’s easy monetary policy and a slowing Chinese economy.
“The Fed has borrowed from future consumption more than ever before. It is the least data-dependent Fed in history. This is the longest deviation from historical norms in terms of Fed dovishness than I have ever seen in my career,” Druckenmiller said. “This kind of myopia causes reckless behavior.”
He believes U.S. corporations have not used debt in productive investments, but [have] instead relied on financial engineering with over $2 trillion in acquisitions and stock buybacks in the last year.

 

After the Civil War, Washington was a wreck. With the country growing and expanding, many wanted to move the capital in the direction of the nation's growth, west. St. Louis was a prominent candidate. Horace Greeley of the New York Tribune , who advised Civil War veterans to 'go West and grow up with the country,' wanted the capital to do the same, as did the editor of the Chicago Tribune. Reavis even held a 'national' con­vention in St. Louis to champion his city. 

 

Turkey and Iran are the heirs of the Ottoman and Persian empires. They have a history of expansion and militarism. Iran is Shi'a. Saudi Arabia is Sunni but only a recently minted state and with no military. Iraq is a shell and Syria is tearing itself apart. Israel is armed to the teeth but has no real interest in the breakdowns of the neighboring Arab states other than defensive.

But if Syria and Iraq hollow out a chaotic and powerless center, what will its neighbors, Turkey and Iran, do?

 

In September 2015, writer and statistician Nate Silver urged people to "calm down" about the possibility of Donald Trump winning the Republican presidential nomination. Two months later, he wrote that the media should "stop freaking out about Donald Trump's polls" and that Trump's odds were "higher than 0 but (considerably) less than 20 percent." Six months after that, after Ted Cruz had dropped out of the race but before John Kasich had done so, Silver wrote: "Donald Trump is going to win the Republican nomination." "Other than being early skeptics of Jeb Bush, we basically got the Republican race wrong," Silver wrote.

 

Truculent: adj: 1. fierce; cruel; savagely brutal. 2. brutally harsh; vitriolic; scathing: his truculent criticism of her work. 3. aggressively hostile; belligerent. ety: 1540s, from Latin truculentus "fierce, savage," from trux (genitive trucis) "fierce, wild."

Strangely enough, the word truculent in French, same word, is a very positive word applied to people larger than life, with a great ability for words and the language in general. A lot of Shakespeare characters can be seen as truculents in the French sense, a storyteller often is, Gérard Depardieu can be at times and in real life too. It describes someone who takes a lot of space, speaks with wit and laughs aloud, shows a lot of panache and tells impressive stories, some kind of big-hearted lion without the cruelty nor the claws.
[dictionary definitions for the French truculent: colorful, earthy]  

 

The average savings of a 50-year-old is only $42,000. The average net worth of somebody between 55 and 64 is $46,000. A couple at age 65 can expect to pay $218,000 just for medical treatment over the next 20 years. Eighty percent of people between 30 and 54 believe they will not have enough money to retire. One in three people have no money saved for retirement at age 65, and almost 40% are 100% dependent on Social Security.

 

Those that support what they believe to be isolationism frequently cite Thomas Jefferson’s warning against involvement in entangling alliances. Yet, the American Revolution was won only because the colonies used extensive diplomacy and alliance building. Benjamin Franklin was sent to Paris to recruit the French government to the side of the US. Franklin used the conflict between Britain and France to try to position the US as a French ally. The French, at first, provided some covert supplies to the US during the revolution. France would later make a large-scale commitment to the US because it wanted the British defeated in North America.

 

Former Fed Chairman Ben Bernanke was quite candid in saying that zero interest rates and quantitative easing were intended to create a “wealth effect.”  He wanted asset values to rise so the affluent would spend more, so the economy could boom. He achieved the first of these: asset values rose. But who owns assets?

 
Ticket splitting is becoming rare in polarized America: In 2012, only 5.7 percent of voters supported a presidential candidate and a congressional candidate of opposite parties. At least half a dozen Republican senators seeking reelection and Senate aspirants can hope to win if the person at the top of the Republican ticket loses their state by, say, only four points, but not if he loses by 10. A Democratic Senate probably would guarantee a Supreme Court with a liberal cast for a generation. Only three Democrats — Andrew Jackson (twice), Franklin Roosevelt (four times) and Lyndon Johnson — have won more than 53 percent. So if Trump gets blown out, what happens to the Rube-publican Party?

Rube-publican strategist Mary Matalin has left the Rube-publican Party.

An observation in an article by David Roberts : Almost irrespective of what you think of Clinton's politics or her policies, she is manifestly more prepared to run the federal government than Donald Trump. The number of people who recognize this elemental fact about the election, however, has probably already reached and passed its peak. It will decline from here on out. The moment of clarity is already ending.....The campaign press requires, for its ongoing health and advertising revenue, a real race. It needs controversies. "Donald Trump is not fit to be president" may be the accurate answer to pretty much every relevant question about the race, but it's not an interesting answer. It's too final, too settled. No one wants to click on it.What's more, the campaign media's self-image is built on not being partisan, which precludes adjudicating political disputes. How does that even work if one side is offering up a flawed centrist and the other is offering up a vulgar xenophobic demagogue? It would be profoundly out of character for reporters to spend the six months between now and the election writing, again and again, that one side's candidate is a liar and a racist and an egomaniac. It would be uncomfortable, personally and professionally." So, according to him, the press will make a race out of an obvious mismatch. Hide the women. Save yourselves.

 

Golden oldie:
http://steeleydock.blogspot.com/2010/11/wikileaks-and-stuxnet.html 

 

The earth is getting younger and older with more children and more older people. The problem is that we have not arranged ourselves on the planet in neat, homogeneous groups. In fact, most of the children are going to be in Africa and the arc around the Indian Ocean while most of the retirees will be in the developed world and China. The China demographics are surprising and a result of the "one child policy."

 

From Crestmont: Short-term interest rates (one year or less) are generally determined by the Federal Reserve; long-term interest rate yields are driven by the inflation rate or inflation expectations. The relationship between interest rates and inflation was not evident before the 1960’s. Current research now suggests implications for the future.
Though there are occasional, very limited periods that break the general rule, according to research from Crestmont's The 6/50 Rule states: “Interest rates will change by at least 50 basis points (0.5%) within the next 6 months.” There’s almost 50 years of history–virtually without exception–in our favor. Chances are that the change will be a good bit more than that.

AAAAAAAAaaaaaaaannnnnndddddd......a map of Israel and her neighbors: