Category Archives: Social issues ( be civil ! )

Yes it’s hot, but

A few years ago, before things calmed down, hurricanes were predicted to become more frequent and more severe. So although global warming fans predicted higher temperatures, they also predicted this. Here’s an example

http://www.climatecentral.org/news/study-projects-more-frequent-and-stronger-hurricanes-worldwide-1620
and another — http://time.com/3706888/hurricane-warning-study/

So far this year (and the major part of the hurricane season is about to begin) the Atlantic hurricane season is the quietest it’s ever been. There have only been 4 tropical storms this year and no hurricanes at all not even one. One of the 4 storms occurred in January, which is rather bizarre.

Scientific theories when faced with a falsified prediction are usually modified or abandoned.  Not so with global warming.  It’s just been rebranded as climate change.

There is a rather imperfect measure of the amount of power produced by the storms of the season, called Accumulated Cyclonic Energy (ACE). The average per year is an ACE of 110. This year (so far) it’s only 6.

ACE is calculated as the square of the wind speed every 6 hours, and is then scaled by a factor of 10,000 for usability. The ACE of a season is the sum of the ACE for each storm and takes into account the number, strength, and duration of all the tropical storms in the season. The caveat to using ACE as a measure of the activity of a season is that it does not take the physical size of the hurricane or tropical storm into account which is why it’s imperfect.

If you know any physics, ACE is velocity squared * time — which is not the dimension of energy (it’s acceleration). I wonder if satellite radar is good enough to give us ground windspeed over small areas, which could be summed over the hurricane area if the division was fine enough. This would allow us to tell big storms from smaller ones. Unfortunately, there would be no way to compare this new measure to ones in the past such as ACE.

Where did this quote appear?

The following quote appeared in a major newspaper the day before the Brexit vote. Guess which one.

“David Cameron, the British prime minister has no one to blame but himself… made a promise … if re-elected, he would hold an in or out referendum on continued British membership” (in the EU).

The article goes on in this vein about what a mistake this was. Allowing people to actually vote, or as the article says “what many consider to be a wholly unnecessary roll of the dice”.

Various British mandarins are quoted as to the wisdom of Cameron’s decision, and a variety of arguments against Brexit are trotted out “sharp tones of xenophobia, racism, nativism and Islamophobia” — this by the authors of the article. No arguments for Brexit are given (as if any reasonable person could be in favor).

So where was it published? Pravda? Granma? People’s Daily?

No, the front page of the New York Times.

It’s the typical New York Times ploy of masquerading an opinion piece as a news article.

This is something I despise (see — https://luysii.wordpress.com/2016/02/03/helping-hillary-along/).

Not this time though. It is a perfect example of the elitist (and leftist) impulse of the Times in full cry. We know what’s best. The people are not to be trusted, but ruled by decree by their betters (vide Obama’s 13 million amnesty, and the BLM’s attempt to control fracking despite a law passed by congress).

It’s very good to see elite opinion lose. Americans should be aware that Brexit was opposed by the heads of all political parties, business elites, academic elites, Nature and the scientific elites, the church — essentially every class of elite imaginable. Perhaps this was its high tide.

Overweight is Good, Obesity is not.

“The attached article from the latest edition of Science News reports on a new study showing that the BMI associated with lowest mortality is 27 — FAT!” If a Berkeley PhD can be led astray by such an article, it’s time to set the record straight. The problem comes from conflating a term of art (overweight — BMI { Body Mass Index } between 25 and 30) with another (obese — BMI over 30). A BMI of 27 isn’t FAT but a BMI of 30 is. But normal people (even a Berkeley PhD) use the words fat and overweight interchangeably. To an obesity researcher they are not (in fact they don’t use the term fat at all).

To get started, calculate your own BMI– http://bmicalculator.cc/?gclid=CM66rIG2tc0CFYQ2gQodOdINEg. Don’t worry that BMI is usually given in kiloGrams and Meters, the site lets you put in your weight in pounds and your height in feet and inches. A 6 footer would have to weigh 222 pounds to be obese.

I’ve been posting that something is wrong with our model of obesity and mortality for years. The Nation continues to get fatter and fatter, and yet lifespan continues to increase. After *** you’ll find a post of 2013 about a paper showing that as we get older, the lowest mortality is with a BMI over 25, increasing each decade.

The new paper cited is interesting, as several different cohorts of the (rather homogeneous) Danish population were studied over time. The BMI of least mortality changed depending on when the cohort was recruited (1976 to 1978) vs. 2003 to 2013. The minimum mortality was 23.7 for the first cohort and 27 for the second.

Should you gain or lose weight to get to a BMI of 27? Not at all, although every continuous curve must have one low point, the mortality rate is pretty much the same between BMIs of 25 and 30. It would be like not going to Yellowstone to increase your chance of survival. Granted road travel has a risk and there are probably no bears where you live, but the increment in survival is not worth tying yourself in knots about.

What you should absolutely not conclude, is that if a BMI of 27 is OK, a BMI 30 and over is as well.  It most certainly is not, and mortality rapidly increases with BMIs over 30.  The higher you go the worse it gets.

Here’s the older post with a lot more discussion of these matters.

****

Something is wrong with the model — take 2

Nearly 4 years ago I wrote a post about the disconnect between the increasing longevity of the US population and its increasing obesity. You can read the whole thing after the ****. The post was titled “Something is Wrong with the Model”. Indeed something is. It doesn’t fit with a lot of data. Those proposing the model don’t like this at all. You can read all about the brouhaha in the 23 May issue of Nature (pp. 428 – 430).

In general I tend to skip medical articles involving meta-analysis under the garbage in garbage out theory. The most egregious example was Women’s Health Initiative when 3 separate meta-analyses of a bunch of uncontrolled studies concluded that estrogen replacement therapy decreased the risk of coronary heart disease by 35 – 50%. The gigantic (161,100 women followed for 12 years, with 1,000,000 clinic visits) Women’s Health Initiative trial of hormone therapy to prevent coronary disease was halted earlier than planned when it was found estrogen based therapies increasedthe risk of coronary heart disease, stroke and breast cancer.

The excitement was over a paper [ J. Am. Med. Assoc. vol. 309 pp. 71 – 82 ’13 ] which performed a meta-analysis on 97 studies of body weight and mortality which in aggregate involved nearly 3 million people.

A popular measure of weight is the body mass index (BMI) which is weight in kiloGrams divided by your height in Meters squared. Not something which is obvious. If you want to figure yours know that a kiloGram is 2.2 pounds, and a meter is 39.37 inches.

At any rate a BMI over 25 is considered overweight, and one over 30 is considered obese. At 6 feet 1+ (which I used to be) a weight of 190 puts me at 24.69. To be obese (BMI over 30) I’d need to weight 228 (which I almost did 50 years ago).

When you plot BMI vs. probability of death you get a U shaped cure, with the very thin and the very fat showing increased risk of dying (mortality). The Nature paper is interesting as it shows 6 curves for people at ages 20, 30, 40, 50, 60, 70. As one might expect the curves for each age lie below the next oldest. All of them rise with BMIs under 20 and over 30, so there’s no argument about whether obesity is bad for longevity.

Well, if the curve is U shaped, it has a minimum. The excitement comes in because the healthiest weight (the minimum) is a BMI of just over 25 for those in their 60s and around 26 for those in their 70s. Also in ALL 6 age groups the curve is pretty flat between 25 and 30, rising on either side of the range.

Naturally people who’ve invested their research careers in telling everyone to diet and that weight is bad, don’t like this, and a symposium involving 200 unhappy people convened 20 February at the Harvard School of Public Health is described, along with a lot of the back and forth between the authoress of the study (Flegel) and Willett of Harvard who didn’t like it one bit. The best comment IMHO is from Robert Eckel “We’re scientists. We pay attention to data, we don’t try to un-explain them.” Read the article, it’s well written and there’s a lot more.

One final point, which might explain why the minima of the curves shift to higher BMIs at older age — which the article didn’t contain. People lose height as they age, yet the BMI is quite sensitive to it (remember the denominator has height squared). The great thing about BMI is that it’s easily measured, and doesn’t rely on what people remember about their weight or their height. Well as a high school basketball player my height was 6′ 1”+, now (at age 75) its 6’0″. So even with constant weight my BMI goes up.

Well it’s time to do the calculation to see what a fairly common shrinkage from 73.5 inches to 72 would to to the BMI (at a constant weight). Surprisingly it is not trivial — (72/73.5) * (72/73.5) = .9596. So the divisor is 4% less meaning the BMI is 4% more, which is almost exactly what the low point on the curve does with each passing decade after 50 ! ! ! This might even be an original observation, and it would explain a lot.

****
Something is wrong with the model

Back in grad school when a theory came up with a wrong prediction, we all clapped hands because it showed us exactly where a new theory was needed, and just how it failed. No casting about for something to work on. A program that crashes intermittently is very hard to fix. Once you’ve found input that consistently makes it crash the job becomes much easier.

The Center for Disease Control released new data for 2007 (based on 90% of all USA death certificiates) showing that mortality rates dropped again (by over 2%) to 760/100,000 population. It’s been dropping for the past 8 years, and viewed longer term is half of what it was 60 years ago. Interestingly death rates from heart disease dropped a staggering 5% and even cancer dropped 2%.

But the populace is fat and getting fatter. This has been going on for 30 years. You can Google NHANES for the gory details, but the following should be enough. [ Science vol. 299 pp. 853 – 855, 856 – 858 ’03 ] The data from a recent NHANES (’99 – ’00) shows that the percentage of obese (as opposed just overweight) increased from 23% in the surveys from ’88 to ’94 to 31%. This is based on the body mass index (BMI). Someone 6′ 1″ would have to weigh 225 pounds to be obese.

We are told to be prepared for an epidemic of diabetes, high blood pressure, elevated blood lipids because of this. Every doc has seen blood sugar drop, blood pressure lowered, lipids come down in people with any/all of the above when they are able to lose a significant amount of weight. These diseases are significant only if they kill people, which they certainly seem to do in my experience. The next time you’re visiting a friend in the hospital, look at what’s lying in the beds. Very likely, many more than 31% of them are obese.

So why are death rates dropping and people living longer? Something must be wrong with the model — it’s pretty hard to quarrel with the data as being inadequate. Certainly the increased incidence of obesity should have produced something by this time (it started 30 years ago).

Well, the self serving answer for the drug developers is that their drugs are better. MDs would like to think it’s due to better care. Possibly. Here’s some detail.

#1: More people are exercising than they used to. How many joggers and walkers did you see on the streets 20, 30 years ago?

#2: Fewer people are smoking. Forget lung cancer (if you can). The big risk for smokers is premature vascular disease. Normally we all have carbon monoxide in our blood (it comes from the breakdown of hemoglobin). [ Brit. Med. J. vol. 296 pp. 78 – 79 ’88 ] Natural carbon monoxide production would lead to a carboxyhemoglobin level of .4 – .7%, but normal levels in nonsmokers in urban areas are 1 – 2%. Cigarette smoke contains 4% carbon monoxide, so smokers have levels of 5 – 6%. This can’t be good for their blood vessels.

#3: Doctors know more than they did. My brother is a very competent internist. He took over the practice of a similarly competent internist after his very untimely many death years ago. Naturally he got all the medical records on the patients. He found letters (now over 25 years old) from the late MD to his patients informing them of their lab results, and assuring them that their cholesterol was just fine at 250 mg%.

#4: The drugs are better. In addition they may be working in ways that we have yet to fathom. Consider the statins — their effect on vascular disease is far greater than their effect on blood lipids (cholesterol, triglycerides) — particularly when compared to other agents that lower blood lipids to the same extent.

The impeccable timing of the New York Times

After putting ex-Weatherman Bill Ayers on page 1 saying he wished he’d ‘bombed more’ the day of the attack on the World Trade Center in 2001, the New York Times kept its unenviable timing record intact by posting “Dreams of my Muslim Son” about Islamophobia on the editorial page the day of the Orlando massacre. Usually they run their invariable innocent Muslims fearing hate crimes by American rednecks story a day or so after the latest atrocity.

Unfortunately Orlando can’t be camouflaged as workplace violence or the response to some video or other a la Benghazi. The perp was far too explicit. Nor can it be blamed on the failure of ‘the MidEast Peace Process’ or Israel, although undoubtedly some will try.

If I were the Muslim leadership in this country, I’d try to put together a Million Muslim March on Washington to protest the Orlando, San Bernadino, Boston etc. etc. massacres, as blots on the name of Islam. ISIS would probably try to kill a few, but it’s time for them to stand up, assuming there are large numbers of US Muslims that actually think this way.

Reproducibility and its discontents

“Since the launch of the clinicaltrials.gov registry in 2000, which forced researchers to preregister their methods and outcome measures, the percentage of large heart-disease clinical trials reporting significant positive results plummeted from 57% to a mere 8%”. I leave it to you to speculate why this happened, but my guess is that probably the data were sliced and diced until something of significance was found. I’d love to know what the comparable data is on anti-depressant trials. The above direct quote is from Proc. Natl. Acad. Sci. vol. 113 pp. 6454 – 6459 ’16. The article looked at the 100 papers published in ‘top’ psychology journals, about which much has been written — here’s the reference to the actual paper — Open Science Collaboration (2015) Psychology. Estimating the reproducibility of psychological science. Science 349(6251):aac4716.

The sad news is that only 39% of these studies were reproducible. So why beat a dead horse? The authors came up with something quite useful — they looked at how sensitive to context each of the 100 studies actually was. By context they mean the time of the study (e.g., pre- vs. post-Recession), culture (e.g., individualistic vs. collectivistic culture), the location (e.g., rural vs. urban setting), or the population (e.g., a racially diverse population vs. a predominantly White or Black or Latino population). Their conclusions were that the contextual sensitivity of the research topic was associated with replication success (e.g. the more context sensitive, the less likely it was that the study could be reproduced). This was even after statistically adjusting for several methodological characteristics (e.g., statistical power, effect size, etc. etc). The association between contextual sensitivity and replication success did not differ across psychological subdisciplines.

Addendum 15 June ’16 — Sadly, the best way to say this is — The more likely a study is to be true (replicable) the more likely it is to be not generally applicable (e.g. useful).

So this is good. Up to now the results of psychology studies have been reported in the press as of general applicability (particularly those which enforce the writer’s preferred narrative). Caveat emptor is two millenia old. Carl Sagan said it best — “Extraordinary claims require extraordinary evidence.”

For an example data slicing and dicing, please see — https://luysii.wordpress.com/2009/10/05/low-socioeconomic-status-in-the-first-5-years-of-life-doubles-your-chance-of-coronary-artery-disease-at-50-even-if-you-became-a-doc-or-why-i-hated-reading-the-medical-literature-when-i-had-to/

Back from the 50th Med School Reunion

Mostly some social notes from my 50th Med School reunion (Penn), but first some serious science.

I did two years of graduate work in chemistry between college and med school, and one of the guys I taught organic to is an academic research neurologist. He told me that they had some encouraging results using antisense oligonucleotides to remove the excessive repeat CTGs from myotonin, the gene defective in myotonic dystrophy. They were able to get it into cells, and even showed some clinical benefit in animal models. So he’s still using chemistry.

Myotonic dystrophy is one of the few triplet expansion diseases that makes sense to me, because unlike most of them, it affects a wide variety of tissues, not just the nervous system.

Just about everyone had a great time at the reunion. On entering med school I was told, that I’d know my classmates better than my spouse. Well, I certainly spent more time with them in the clinical years.

It was a happy time and yet sad as well, as we all knew that this was probably the last time we’d all see each other.

The previous post https://luysii.wordpress.com/2016/05/11/off-to-the-50th/ had a lot about (the lack of) minority representation back then.

Things have improved, as there is now an office of diversity (so Penn is now doing more than paying hypocritical lip service to it — vide Elizabeth Warren).

Our Nigerian classmate came back. He’d spent 17 years back home in Africa but left because he was unable to fight the corruption there, even as a native son. He hassled a black medical student from Africa, finding that she was of the Yoruba tribe, telling her to go back and serve her country (at least for a while).
So things have improved, but not enough. An an affair Friday night, all 5 or so of the blacks present were sitting at the same table. I barged in saying I was bringing some diversity to their table, and initially got some strange looks. But then I told them a few of the events of the previous post and they warmed up. At least the country is  now getting the benefit of their brains.

We’ll know things have really improved, when black physicians feel comfortable enough to mingle with the crowd.

About 65 of the 125 of us were back. Only 18 people were listed as having died, which seems like a very small number for a group of 125 26 year olds 50 years later. I do know of one unreported death of a classmate from AIDS.

This is actually nothing new — and here are my notes on a study done nearly 30 years ago. My speculation is that, docs get a lot of reinforcement, seeing the effects of negative health choices. I doubt that all of it is due to social or economic class, although some must be.

****

[ J. Am. Med. Assoc. vol. 259 p. 3158 ’88 ] This is an overview of the Physicians’ Health study in which 22,000 American physicians took either aspirin or placebo in a double blind study. They were only taking 5 grains of aspirin every other day. Cardiovascular mortality was cut, but overall mortality was not. However the group experienced just 88 deaths when 733 would have been expected. . This may be due to a beneficial life style, or social class. Thus the EIGHTFOLD lower mortality throughout makes the study harder to interpret. Amazingly, the authors of the study don’t really focus on why the study group (even those on placebo) did so well, but whether the aspirin added anything extra. What we need is to reduce mortality in our patients eightfold and then worry about giving aspirin.

****

Here is a tale of the bad old days for the feminists among you. There were under 10 women in our class of 125. One very bright woman wanted to be a surgeon. She asked Dr. Everett Koop about it. This was when Koop was basically inventing the specialty of pediatric surgery at Children’s Hospital of Philadelphia (CHOP), and long before he became Surgeon General.

He gave her some very hard and very honest advice (this was Koop after all). He told her that the first rate surgery residencies simply were not accepting women. To rise to the true level of her ability, she’d need to choose something else. She didn’t like this one bit, but did follow his advice, went into another field and became department chair at another Ivy League med school.

Lastly two stories about the All American basketball player in our Class (Jerry Gardner Kansas ’62). He’s about 6′ 2″ now, and using a cane as he’d had hip surgery a few months ago. He did note that back then Freshman weren’t allowed to play, so he still has a year of eligibility left. Jerry went to NIH after graduation and established a lab studying GI hormones.

Further proving that time does not heal all wounds, Jerry reminisced about the two foul shots he missed at the tail end of a game in the NCAA final (or semifinal) which might have won them the game. For further examples of the phenomenon see — https://luysii.wordpress.com/2010/10/25/time-does-not-heal-all-wounds/

Off to the 50th

No posts for a while as I’ll be going to my 50th Med School Reunion (Penn ’66) tomorrow. If there is a creator, he has a fairly sardonic sense of humor

Here’s why.

I arrived in the fall of ’62 having spent 2 years as a grad student in the Harvard Chemistry department (Woodward the last year or so), quite full of myself. The biochemistry (and chemistry) being taught at Penn was quite primitive compared to what I’d been exposed to, and I was a fairly obnoxious prick about it.

How could I have known that classmate (Mike Brown) would win a Nobel for his work on the LDL receptor which led to the statins. The work involved some fairly brilliant chemistry (particularly on regulated intramembrane proteolysis). I hope he doesn’t remember me when we meet, but he probably will.

In defense, although none of us knew it at the time, the Harvard Chemistry department back then was probably one of the greatest in world history. Here’s why. There were 7 future Nobel laureates in the department when I was there from ’60 to ’62 — Woodward, Corey, Lipscomb, Bloch, Herschbach, Gilbert and Karplus. Even better, these guys weren’t sitting on their laurels having already won, but were engaged in doing the work which won them the  Nobels.

But there are far more issues to address at Penn than just this. Here’s a copy of an old post —

Two American (social) tragedies

When the team members entered the clinic, they were appalled, describing it to the Grand Jury as ‘filthy,’ ‘deplorable,’ ‘disgusting,’ ‘very unsanitary, very outdated, horrendous,’ and ‘by far, the worst’ that these experienced investigators had ever encountered. There was blood on the floor. A stench of urine filled the air. A flea-infested cat was wandering through the facility, and there were cat feces on the stairs. Semi-conscious women scheduled for abortions were moaning in the waiting room or the recovery room, where they sat on dirty recliners covered with blood-stained blankets. All the women had been sedated by unlicensed staff – long before Gosnell arrived at the clinic – and staff members could not accurately state what medications or dosages they had administered to the waiting patients. Many of the medications in inventory were past their expiration dates… surgical procedure rooms were filthy and unsanitary… resembling ‘a bad gas station restroom.’ Instruments were not sterile. Equipment was rusty and outdated. Oxygen equipment was covered with dust, and had not been inspected. The same corroded suction tubing used for abortions was the only tubing available for oral airways if assistance for breathing was needed…”[29]
[F]etal remains [were] haphazardly stored throughout the clinic– in bags, milk jugs, orange juice cartons, and even in cat-food containers… Gosnell admitted to Detective Wood that at least 10 to 20 percent… were probably older than 24 weeks [the legal limit]… In some instances, surgical incisions had been made at the base of the fetal skulls. The investigators found a row of jars containing just the severed feet of fetuses. In the basement, they discovered medical waste piled high. The intact 19-week fetus delivered by Mrs. Mongar three months earlier was in a freezer. In all, the remains of 45 fetuses were recovered … at least two of them, and probably three, had been viable.”

A classic back alley abortion mill, except that it was all quite legal.

This wasn’t supposed to happen after Roe vs. Wade. It is so uncanny that the doc (Kermit Gosnell) convicted yesterday of these 3 infanticides graduated from a med school in Philly (Jefferson) the same year (1966) that I graduated from another (Penn). At the time Philly had 3 more (Hahnemahn, Women’s and Temple).

What is so socially tragic about Gosnell, is that he was one of very few blacks in medical school back then. Our class of 125 at Penn had one, but he was a Nigerian Prince. Whether Gosnell liked it or not he was a standard bearer for what we hoped (at the time) was the wave of the future (it was). For just how very few Blacks were being educated at elite institutions back then please see

https://luysii.wordpress.com/2012/05/22/warren-harvard-and-penn-sanctimony-hypocrisy-and-fraud/ — copy to be found below

The second tragedy is a black woman M. D twenty or so years younger (Harvard undergrad, Penn Med followed by an MBA from Wharton) who lost her license to practice in NY State after she went off the deep end and became a holistic practioner (or whatever). She treated a new onset juvenile diabetic with diet and juice after which he came to the ER in diabetic ketoacidosis with a sugar over 300.

My father was an attorney as was my uncle, later a judge. They took it very personally when an attorney was disbarred for some malfeasance or another. I feel the same way when this happens to an M. D. Imagine how the black docs must feel about Gosnell, or the idiot, Conrad Murray, who basically killed Michael Jackson with Diprivan.

If you didn’t follow the link, I’ll close with a more uplifting ending from it.

My wife has a cardiac problem, and the cardiologists want her to be on coumadin forever, to prevent stroke. As a neurologist, having seen the disasters that coumadin and heparin could cause when given for the flimsiest of indications (TIAs etc. etc.), I was extremely resistant to the idea, and started reading the literature references her cardiologist gave me, along with where the references led. The definitive study on her condition had been done by a black cardiologist from Kentucky. We had a long and very helpful talk about what to do.

Diversity is not an end in itself, although some would like it to be. I’ve certainly benefitted from knowing people from all over. That’s not the point. Like it or not, intelligence is hereditary to some extent (people argue about just how much, but few think that intelligence is entirely environmental). The parents and grandparents of today’s black MDs, Attorneys, teachers etc. etc. were likely just as intelligent as their offspring of today. This country certainly pissed away an awful lot of brains of their generations.

*****

Warren, Harvard and Penn — Sanctimony, Hypocrisy and Fraud

I find the behavior of Elizabeth Warren, Harvard and Penn incredibly disturbing and sad. It’s the perfect storm of sanctimony, hypocrisy and fraud. I imagine that I’m a lot older than the readership, so let’s revisit the bad old days of the 50’s and 60s to see how things were back then and why the behavior of all three besmirches heroic attempts to set things right.

Fall 1956: Enter Princeton along with 725+ others. The cast of characters included about 5 Asians, 1 Indian Asian, no hispanics and/or latinos as I recall, and all of 2 blacks. I was the first to attend from a small (212 kids in 4 grades) NJ High School. I’d never been west of Philly, and immediately appreciated what passed for diversity back then — a roommate from Florida, and 2 guys next door from Wisconsin and Tennessee, the four of us packed like sardines into two miniscule rooms (each of which is now a single).

Although my High School was above the Mason Dixon line, there was only 1 black student in all 4 classes when I was there. A 2nd cousin who graduated 6 years before I entered, noted that there were NO blacks when she was there and asked why, and was told “we don’t encourage them to attend”. To be fair, there were very few black families in the area.

So, because we were musicians, and in the marching band, I got to know one of the blacks. At away games there were postgame parties (what’s the point of having games after all?). Girls would come up to Harvey and tell him that he must meet Virginia, she’s wonderful. etc. etc. Virginia being the black girl at their school, as Harvey was the black boy at ours. There was no condescension involved, and I never saw anyone at Princeton give Harvey a hard time, and we had plenty of southerners. It was the way things were, and we had no idea that things could be different.

Spring 1958: Back at the H. S. The one black girl in the class 2 years behind me was very smart. She graduated as the Salutatorian. However, she should have been the Valedictorian, the powers that be having decided that it wouldn’t do to have a black in that position. That didn’t stop her of course. The high school was so small that it was folded into a regional H. S. the next year. So our little school has reunions every 5 years or so for anyone who ever went there, and I saw her 40 – 50 years later. She’d become a very high powered R. N. with a very responsible position.

Fall 1960: Harvard Chemistry department. Not a black, not a latino, not an Asian to be found in the grad school (there was one Sikh). I don’t recall seeing any as undergraduates. There were a fair number of Japanese, and Asian Indian postdocs however. Fast forward to the present for what it looks like now — https://luysii.wordpress.com/2012/04/19/the-harvard-chemistry-department-reunion-part-i/.

Fall 1962: Entering Penn Med school — 125 students, one black (a Nigerian) no latinos/hispanics, no asians of any sort, under 10 women. They really can’t be blamed for this, the pipeline was empty.

Summer 1963: Visiting my wife to be at her home in Alexandria Virginia. A drive perhaps 10 – 20 miles south toward Richmond finds restaurants with Colored entrances.

2008: My wife has a cardiac problem, and the cardiologists want her to be on coumadin forever, to prevent stroke. As a neurologist having seen the disasters that coumadin and heparin could cause when given for the flimsiest of indications (TIAs etc. etc.), I was extremely resistant to the idea, and started reading the literature references the cardiologist gave me, along with where the references led. The definitive study on her condition had been done by a black cardiologist from Kentucky. We had a long and very helpful talk about what to do.

Diversity is not an end in itself, although some would like it to be. I’ve certainly benefitted from knowing people from all over. That’s not the point. Like it or not, intelligence is hereditary to some extent (people argue about just how much, but few think that intelligence is entirely environmental). The parents (grandparents) of today’s blacks , are likely just intelligent as their MD, Attorney, teacher etc. etc. offspring today. This country certainly pissed away an awful lot of brains of these generations. So clearly, I’m all for letting the best into our elite institutions whatever they look like.

This is why Warren, and the behavior of Harvard and Penn is such a perversity.

First the sanctimony. Many at Harvard think they are head, neck and groin above you in every sense, intellectual and moral. Do not think for a minute that their previous rejection of a military presence on campus had anything to do with the military’s treatment of gays. It was a cover for their antiwar and antimilitary agenda (present when I was there ’60 -’62 long before Vietnam). They were what my father called “Bible-backed Bastards”, using scripture as cover for what they wanted to do.

Second and Third. That Warren would claim to be Indian and that Penn and Harvard would tout her as evidence of their commitment to diversity, is hypocritical in the extreme and fraudulent as well.

Well, it’s just another scam.like all the rest. Isn’t it? We’ve got State Troopers sitting on their ass in their cars with lights flashing on the Mass. Pike at construction sites. We’ve got politically connected drones handing out tickets on the Pike standing next to machines which do the job when they’re not around. No one seems to mind. It may be one of the reasons unenlightened Florida and Texas grew faster in the last 10 years and acquired one of our representatives (along with 5 more from NY, NJ, Illinois and Pennsylvania).

But it isn’t like the rest. It perverts something the country desperately needed to do and gives arms to those opposing it. Ironic that it wasn’t done by rednecks, but by the very institutions that led the charge.

I hope the powers that be at Penn don’t cluck about diversity at the reunion,  but if they do I plan to find my inner obnoxious prick again.

A Touching Mother’s Day Story

Yes, a touching mother’s day story for you all. It was 49 years ago, and I was an intern at a big city hospital on rotation in their emergency room. The ER entrance was half a block from an intersection with a bar on each corner. On a Saturday night, we knew better than to try to get some sleep before 2AM or until we’d put in 2 chest tubes (to drain blood from the lungs, which had been shot or stabbed). The bartenders were an intelligent lot — they had to be quick thinking to defuse situations, and we came to know them by name. So it was 3AM 49 years ago and Tyrone was trudging past on his way home, and I was just outside the ER getting some cool night air, things having quieted down.

“Happy Mother’s day, Tyrone” sayeth I

“Thanks Doc, but every day is Mother’s day with me”

“Why, Tyrone?”

“Because every day I get called a mother— “

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.

Follow

Get every new post delivered to your Inbox.

Join 93 other followers