Category Archives: Social issues ( be civil ! )

Carly ‘s Cancer

Today Senator Cruz said that Carly Fiorina would be his running mate, should he get the republican nomination. It’s worth reposting (with a few modifications) what I wrote last September about her cancer when it looked like she had a chance of getting the nomination. See the end for why the health problems of our leaders are problems for us all.

Carly Florina had breast cancer surgery (bilateral mastectomy) 2 March 2009 at Stanford University Hospital followed by chemotherapy and radiation. She was given an excellent prognosis for full recovery — https://en.wikipedia.org/wiki/Carly_Fiorina.

So far so good and it’s just over 7 years. But it is reasonable to ask just what her prognosis really is, particularly as she may be our next vice-president. I asked an old friend and colleague who has been involved in research on breast cancer and in many of the clinical trials of therapy over the past 35 years.

So I wrote the following — I’m writing you for some idea what the chances of someone with breast cancer being free for 6+ years (Carly’s surgery was 2/09) will be free for the next 5+? I know that there are all sorts of statistics on survival in breast cancer (because the cohort is so large). If anyone would know them, it would be you.

and got this back

Impossible to answer your question. Too many variables and NO DATA or info. Many people, docs and patients alike call ductal carcinoma in situ,” cancer” but cure rate is 99%. If she was one of those then, of course, she’s likely to be cured . Stage 1 ,luminal A tumors (even though real cancers) have excellent prognoses—probably > 90% cured. For other real cancers Lots depend on stage, hormone receptors ad infinitum. On thin ice lumping anyone into a broad statement without lots more info

just what you’d expect from an circumspect intelligent expert

So I dug a bit more and sent him this

I tried to find out just what type of breast cancer Carly had. No luck, but various newspaper articles show that she did receive postop chemo causing her hair to fall out as well as radiation. Would ductal carcinoma in situ (Dcis) be treated this way? Would stage 1 luminal A tumors be treated this way?

He replied

Dcis definitely no. luminal a probably shouldn’t be. Sounds like a significant cancer. Next issue is did she get antihormonal therapy. Estrogen receptor tumors are the ones that tend to relapse after 5 years. ER neg. tumors while more aggressive overall seldom recur >5 yrs after dx. The radiation part doesn’t mean much unless she had a mastectomy since all lumpectomy patients get radiation. – If she had mastectomy and chemo and radiation it was probably a poorer risk tumor. Even chemo might not be so bad—–we give chemo to node neg tumors which could end up with very good long term prognosis.AMONG RELAPSES in ER pos pts. 15% recur before year 5 and 17% recur after year 5. However overall likelihood of relapse depends on whether or not she had positive or negative nodes and was ER + or Neg. Sorry to be so wordy but prognosis has been improving steadily. I would guestimate that we’re curing about 70% of women with newly diagnosed breast cancer—excluding dcis who are virtually all cured.

I realized that I’d neglected to tell him that she’d had a bilateral mastectomy as well and got the following back after I did.

If she indeed had radiation after a mastectomy as well as chemo it speaks for a more aggressive presentation. Rule of thumb—-post mastectomy xrt reserved for patients with > 4 positive nodes or tumors >5 cm in size. Today, many are giving post mastectomy xrt to 1-3 positive nodes although that was very controversial for years . newer data impies benefit. So, just guessing, but she probably had positive nodes—a poorer prognostic sign for long term—but only if she was estrogen receptor pos. as noted in prior email.

So there you have it — she’s fortunately well presently, but the tumor and prognosis doesn’t sound that good. Still unknown are histologic type of the tumor, presence or absence of spread to lymph nodes (and if so how many), estrogen receptor positivity, which would certainly give us a better idea of her ultimate prognosis (and the country’s should she become president).

I take no pleasure in any of these posts. https://luysii.wordpress.com/2016/04/24/why-hillary-clinton-had-a-stroke-in-2012/ Both Carly and Hillary are brilliant women it would be an honor to know and I wish them both the best. FYI Hillary was valedictorian of her class at Wellesley.

So why write about their potential health problems? Look at the sad saga of Hugo Chavez who claimed he was cured in July elected in the fall with death before he could take office in March of the following year — see https://luysii.wordpress.com/2013/03/05/q-e-d/. Also consider the last months in office of Woodrow Wilson and Franklin Roosevelt and the results of the League of Nations and the Yalta conference when they were both impaired.

Why Hillary Clinton had a stroke in 2012

Hillary Clinton decimated Bernie Sanders in the New York primary and is the likely nominee. This makes the nature of her illness in December 2012 even more important. This retired board certified Neurologist and Neurology Board examiner thinks she had a stroke back then. Here’s why.

First: a timeline.

At some point in the week of 9 December 2012 Mrs. Clinton is said to have fainted suffering a concussion. The New York Times reported on this 13 December.

She remained at home until 30 December at which point she was admitted to New York-Presbyterian Hospital when a blood clot was found in a vein draining her brain.

Subsequently she had double vision due to her eye muscles not working together for a month or so and had to wear special glasses (Fresnel lenses) to correct this.

Second: The following explanation for these events was given by Lisa Bardach M. D, a board certified internist in a letter released by the Clinton campaign 31 July 2015.

You may read the entire letter at http://online.wsj.com/public/resources/documents/clintonhealth2015.pdf but the relevant paragraph is directly quoted below.

“In December of 2012, Mrs. Clinton suffered a stomach virus after traveling, became dehydrated, fainted and sustained a concussion. During follow up evaluations, Mrs. Clinton was found to have a transverse sinus venous thrombosis and began anticoagulation therapy to dissolve the clot. As a result of the concussion, Mrs. Clinton also experienced double vision for a period of time and benefited from wearing glasses with a Fresnel Prism. Her concussion including the double vision, resolved within two months and she discontinued the use of the prism. She had followup testing in 2013, which revealed complete resolution of the effects of the concussion as well as total dissolution of the thrombosis. Mrs. Clinton also tested negative for all clotting disorders. As a precaution, however, it was decided to continue her on daily anticoagulation.”

In my opinion this letter essentially proves that Mrs. Clinton had a stroke.

Third: Why should you believe what yours truly, a neurologist and not a neurosurgeon says about the minimal likelihood of this clot being due to the head trauma she sustained when she fainted? Neurologists rarely deal with acute head trauma although when the smoke clears we see plenty of its long term side effects (post-traumatic epilepsy, cognitive and coordination problems etc. etc.). I saw plenty of it in soldiers when I was in the service ’68 – ’70, but this was after they’d been stabilized and shipped stateside. However, I had an intense 42 month experience managing acute head injuries.

To get my kids through college, I took a job working for two busy neurosurgeons. When I got there, I was informed that I’d be on call every other night and weekend, taking first call with one of the neurosurgeons backing me up. Fortunately, my neurosurgical backup was excellent, and I learned and now know far more about acute head trauma than any neurologist should. We admitted some of the head trauma cases to our service, but most cases had trauma to other parts of the body, so a general surgeon would run the show with our group as consultants. I was the initial consultant in half the cases. When I saw them initially, I followed the patients until discharge. On weekends I covered all our patients and all our consults, usually well over 20 people.

We are told that Hillary had a clot in one of the large draining veins in the back of her head (the transverse dural venous sinus). I’d guess that I saw over 300 cases of head trauma,but I never saw a clot develop in a dural sinus due to the trauma. I’ve spoken to two neuroradiologists still in practice, and they can’t recall seeing such a clot without a skull fracture over the sinus. Such a fracture has never been mentioned at any time about Hillary.

Fourth: Why does the letter essentially prove Hillary had a stroke back then ?

I find it impossible to believe that the double vision occurred when she fainted. No MD in their right mind would not immediately hospitalize for observation in a case of head trauma with a neurologic deficit such as double vision. This is just as true for the most indigent patient as for the Secretary of State. I suppose it’s possible that the double vision came up right away, and Dr. Bardach was talked into following her at home. Docs can be bent to the whims of the rich and powerful. Witness Michael Jackson talking his doc to giving him Diprivan at home, something that should never be given outside the OR or the ICU due to the need for minute to minute monitoring.

My guess was that the double vision came up later — probably after Christmas. Who gets admitted to the hospital the day before New Year’s Eve? Only those with symptoms requiring immediate attention.

Dr. Bardack’s letter states, “As a precaution,however, it was decided to continue her on daily anticoagulation.” I couldn’t agree more. However, this is essentially an admission that she is at significant risk to have more blood clots. While anticoagulation is not without its own risks, it’s a lot safer now than it used to be. Chronic anticoagulation is no walk in the park for the patient (or for the doctor). The most difficult cases of head trauma we had to treat were those on anticoagulants. They always bled more.

Dr. Bardack’s letter is quite clever. She never comes out and actually says that the head trauma caused the clot, but by the juxtaposition of the first two sentences, the reader is led to that conclusion. Suppose, Dr. Bardack was convinced that the trauma did cause the clot. Then there would be no reason for her to subject Mrs. Clinton to the risks of anticoagulation, given that the causative agent was no longer present. In all the cases of head trauma we saw, we never prescribed anticoagulants on discharge (unless we had to for non-neurosurgical reasons).

This is not a criticism of Dr. Bardach’s use of anticoagulation, spontaneous clots tend to recur and anticoagulation is standard treatment. I highly doubt that the trauma had anything at all to do with the blood clot in the transverse sinus. It is even possible that the clot was there all the time and caused the faint in early December.

Fifth: Isn’t this really speculation? Yes it is and this is typical of medical practice where docs do the best they can with the information they have while always wishing for more. The Clinton campaign has chosen to release precious little.

So what information would be useful? First Dr. Bardach’s office notes. I’m sure Mrs. Clinton was seen the day she fainted, and subsequently. They would tell us when the double vision came up. Second the admission history and physical and discharge summary from NY Pres. Her radiologic studies (not just the reports) — plain skull film, CT (if done), MRI (if done) should be available.

Sixth: why is this important.Fortunately, Mrs. Clinton has recovered. However, statistically a person who has had one stroke is far more likely to have another than a person who has never had one. This is particularly true when we don’t know what caused the first (as in this case).

We’ve had two presidents neurologically impaired by stroke in the past century (Woodrow Wilson after World War I and Franklin Delano Roosevelt at Yalta). The decision they made in that state were not happy for the USA or the world.

Too funny to pass up

This is 95%+ a scientific blog, but the following is simply too funny to pass up. None of the people receiving it had heard of it, and liberals and conservatives alike think it’s a riot. I don’t know who wrote it, but it isn’t me. Would the real author step forward? I googled the title but came up with nothing similar.

Subject: Canadians on illegal immigrants

The flood of Trump-fearing American liberals sneaking across the border into Canada has intensified in the past week, sparking calls for increased patrols to stop the illegal immigration. The Republican Presidential primary campaign is prompting an exodus among left leaning citizens who fear they’ll soon be required to hunt, pray, and live according to conservative ideas about the Constitution.

Canadian border farmers say it’s not uncommon to see dozens of sociology professors, global warming activists, and “green” energy proponents crossing their fields at night. “I went out to milk the cows the other day, and there was a Hollywood producer huddled in the barn,” said Southern Manitoba farmer Red Greenfield, whose acreage borders North Dakota. “The producer was cold, exhausted and hungry. He asked me if I could spare a latte and some free-range chicken. When I said I didn’t have any, he left before I even got a chance to show him my screenplay, eh?” In an effort to stop the illegal aliens, Greenfield erected higher fences, but the liberals scaled them. He then installed loudspeakers that blared Rush Limbaugh across the fields, but they just keep coming.

Officials are particularly concerned about smugglers who meet liberals near the Canadian border, pack them into electric cars and drive them across the border where they are simply left to fend for themselves after the battery dies.

“A lot of these people are not prepared for our rugged conditions,” an Ontario border patrolman said. “I found one carload without a single bottle of Perrier drinking water. They did have a nice little Napa Valley cabernet, though, and some kale chips.”

When liberals are caught, they’re sent back across the border, often wailing loudly that they fear assassination from Trump high hairers. Rumors have been circulating about plans being made to build re-education camps where liberals will be forced to drink domestic beer and study the Constitution.

In recent days, liberals have turned to ingenious ways of crossing the border. Some have been disguised as senior citizens taking a bus trip to buy cheap Canadian prescription drugs. After catching a half- dozen young vegans in blue-hair wig disguises, Canadian immigration authorities began stopping buses and quizzing the supposed senior citizens about Perry Como and Rosemary Clooney to prove that they were alive in the ’50s. “If they can’t identify the accordion player on The Lawrence Welk Show, we become very suspicious about their age,” an official said.

Canadian citizens have complained that the illegal immigrants are creating an organic-broccoli shortage, buying up all the Barbara Streisand c.d.’s, and renting all the Michael Moore movies. “I really feel sorry for American liberals, but the Canadian economy just can’t support them,” an Ottawa resident said. “How many art-history majors does one country need?”

=

The narrative rolls on

Let’s play spot the narrative and then, being scientific types, look at the numbers and see what they are telling us. The following is a direct quote of the headline and first few paragraphs of the following ‘news’ article appearing today followed a link to it.

Poll: Majority of American voters blame Donald Trump for violence at rallies

More than two-thirds of American voters hold Donald Trump responsible, in part, for the recent violence that has surrounded his Republican presidential campaign rallies, a new poll has found.

According to the Quinnipiac University national poll released this week, 37 percent of voters surveyed said they believe the GOP front-runner is “very responsible” for violent incidents involving supporters and protesters at his campaign rallies, while 27 percent said he’s “somewhat responsible.”

Less than a quarter said they believe he’s “not responsible.”

More than three-quarters of respondents, meanwhile, also blamed protesters at Trump rallies for being “very responsible” or “somewhat responsible” for such violence, while 70 percent said supporters of the businessman are very or somewhat responsible, the poll found.

Quinnipiac University Poll Assistant Director Tim Malloy contended that the results come somewhat in contrast to claims Trump has made about the origin of such incidents at his campaign events.

http://www.masslive.com/politics/index.ssf/2016/03/poll_majority_of_americans_bla.html#incart_most-comments

A Slanted headline at its best.

It should read

Poll: American voters think protesters at Trump rallies are more responsible for violence at his rallies than Trump.

This fits the facts as stated, if not the narrative. It’s right there in the numbers: 27 + 37 = 64% say it’s Trump’s fault while over 75% (why don’t they say just how far over) say it’s the fault of the protestors.

An omen

An Omen. Since omens are inherently nonscientific, the cognoscenti can stop reading right here. Last night I bought some beer at the package store I always go to. It’s run by a seriously large Polish guy, an immigrant like my late grandmother. I’m always interested in his take on things. He said he thought Trump would be the next president. The store is in a heavily latino neighborhood (mostly Puerto Rican). Given what Trump has said about Mexicans, I pressed him on it, but he wouldn’t budge, and said the people in the neighborhood liked Trump.

Flashback to my late grandmother, running a drygoods store in a little New Jersey town in the 40s and 50s. Family lore has it that she was certain that Truman would win in 1948, despite every poll to the contrary. She said “they’re talking Dewey but they’ll vote Truman”.

People in retail (particularly those running the show) talk to anyone walking in the door. They see a far wider mass of humanity and interact with many more people in the course of a day than you and I.  Think about Pauline Kael’s remark that she didn’t know anyone who’d voted for Nixon.  Probably in upper Manhattan she didn’t.

 

An omen? Perhaps.

Trump

Too late to start an enormous post on huntingtin, the protein mutated in Huntington’s chorea. Coming soon. Sorry. But consider this: If Trump wins the presidency it will be a remarkable demonstration of the the lack of power of the press. When have the following agreed on an issue — New York Times, Wall Street Journal, National Review, The Nation, Weekly Standard, etc. etc. They all hate Trump editorially and by their selection of articles and phraseology. I’ve never seen anything like it.

Remarkable times. There is tremendous dissatisfaction with the way things are going. Bernie taps into it as well.

A prospective experiment for you all to do at home

Here is a prospective journalistic experiment for you all to do in the privacy of your own home. Then it’s time for me to get back to the science.

The previous post (https://luysii.wordpress.com/2016/02/03/helping-hillary-along/) showed how the New York Times is working very hard to brand Rubio as a member of the Republican establishment and as their preferred candidate. Well, he might be just that, but if there ever was a candidate of the Democratic establishment it is Hillary Clinton.

So here’s the experiment for you to do. Pick a media outlet you follow (NPR, New York Times, Washington Post, any TV channel of your choice etc. etc.). Then count the number of times the term establishment is used in stories about Rubio and about Hillary. Since I read the NYT daily, I’ll choose them. I get the WSJ but never plow through the whole thing — just the first section.

There’s no point in being a scientific type if you don’t make predictions. Mine is that the word establishment will be used at least twice as often (if not more) in stories about Rubio than in stories about Hillary (this includes op-eds).

So pick your outlet and start tomorrow. Send your results here by writing a comment on this post.

Helping Hillary along

A friend of my son once said that all you needed was the first one or two measures of anything Bach wrote to know how the rest of the piece would go. So it is with the New York Times. The lead about the primary campaign 3 Feb ’16 contains the terms “Army, Attack, Dispatches” and the sublead contains the term “Establishment”.

Do you think this article is about Hillary?

Of course not. This is branding at its finest. Of whom? Of a viable Republican candidate (Rubio), so you’ll know just what to think about him without even reading the article.

Another article on the front page has a nice picture of Hillary. They mention that she won Iowa by the narrowest of margins, but nothing about how surprising this was given that she has the entire mainstream press and Democratic party establishment (term not used) on her side.

It’s why the mainstream press must be read the way the Russians (and the CIA) read Pravda during the cold war.

Addendum 4 Feb ’16 — When Barack Obama won the Iowa caucus in 2008, the press went bananas and noted that this was the first time a Black candidate won the Iowa caucus.

Have you read anything about the first Latino to win the Iowa caucus (Cruz) or that another came in third (Rubio) and that a Black candidate came in fourth (Carson), the three receiving an aggregate 60% of the vote in lily white Iowa?  I thought not.   That’s because the narrative that Republicans are racist must be upheld at all costs.

Second addendum 4 Feb ’16 — I should have looked at the editorial page of the Times before writing the above.  There is still nothing in the mainstream ‘news’ feeds about the Latino victory even now.  The Op-ed page contains “The Latino Political First We’re Ignoring”.  The victories of Rubio and Cruz are noted. The op-ed notes that “it is not being celebrated”.  So who is “we” and who is not celebrating?  “No less an arbiter than Jorge Ramos the Univision anchor” and La Opinion, the nation’s largest Spanish language newspaper.  One must ask who elected the arbiter and the editorial board of the La Opinion?  No one.  More media types holding forth in their echo chamber  Another example of self selected spokesmen being blindsided by events.

On the same opinion page we are told “The Republican establishment is thrilled”  about Rubio by Gail Collins.  This continues the meme on the front page yesterday of Rubio being the establishment.

I have no problem with Collins or the op-ed about Cruz and Rubio’s victory.  They are opinions and on the opinion page where they belong.  The problem was yesterday’s front page opinion piece masquerading as news.

 

 

Trumpenprolitariat

The irony is simply too delicious. Now that what Marx called the lumpenproletariat (https://en.wikipedia.org/wiki/Lumpenproletariat) has arisen and given voice to its discontents the left hates them. I speak of the Trump supporters, now described by the left as racist, homophobic, jingoistic, biased, violent — you name it. Read Slate, the Nation. They attack Trump of course, but what really disturbs them are his supporters (the Trumpenproletariat or the Proletrumpians). The times they are a’changin’.

Back in the 70s there was a fun movie called “Suppose They Gave a War and Nobody Came”

Now we have “Suppose They Gave A Proletarian Revolution and No One from the Left Came.

The left has morphed in other ways as well — see — https://luysii.wordpress.com/2015/11/22/from-banned-in-boston-to-banned-in-berkeley-in-55-years/

This just in — New York Times 30 Jan ’16 page 1 “Union Leaders Wary of Trump”  — The elites leading the unions (even the ‘more progressive’ ones such as SEIU)  are worried that “Mr Trump if not effectively encountered, may draw an unusually large numbers of union voters.”  If this isn’t the proletariat who is?

A variety of vignettes is given of various union members in unions all over the country supporting him, with estimates from 1/4 to 1/3.

This is another example of the disconnect between the political leadership (this time the unions) and the populace it claims to be speaking for.  Trump, Bernie, Cruz take your pick.  The discontent is out there.

Saepe falsus, sed numquam dubitans

Saepe falsus, sed numquam dubitans — “Sometimes wrong but never in doubt” should be on the Heraldic crest of Paul Krugman. He certainty came to mind at around noon today 20 Jan ’16 with oil breaking $27/barrel and the Dow down 550.

Here are two direct quotes from him as he held forth on the Opinion pages of the New York Times back in 2010.

“Conventional oil production has been flat for four years; in that sense, at least, peak oil has arrived.”

“So what are the implications of the recent rise in commodity prices? It is, as I said, a sign that we’re living in a finite world, one in which resource constraints are becoming increasingly binding.”

Name a commodity price that’s been rising.

He is, after all, a Nobel laureate in economics, a tenured Princeton professor, blah, blah, blah. You should take everything he writes with much salt even though, despite all this, he’s as certain as ever. It seems with such a disastrous track record that the Times could find someone better.

Here is a link to the entire column — see for yourself. http://www.nytimes.com/2010/12/27/opinion/27krugman.html?_r=0

A thank you to my niece Ruth Loop for providing the translation

Addendum 20 Jan ’16 — An unenviable economic prediction from the laureate in economics

https://en.wikiquote.org/wiki/Paul_Krugman

    • “Ricardo’s Difficult Idea,” in G. Cook (ed.), Freedom and Trade: The Economics and Politics of International Trade, Volume 2 (1998)
  • By 2005 or so, it will become clear that the Internet‘s impact on the economy has been no greater than the fax machine’s

Thanks Joe

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