Category Archives: Social issues ( be civil ! )

One good thing about Trump’s election (maybe two)

Two comments on the election then back to some neuropharmacology and neuropsychiatry which will likely affect many of you (because of some state ballot initiatives).

First: Over the years I’ve thought the mainstream press has become increasingly biased toward the left (not on the editorial page which is fine) but in supposedly objective reporting. Here are just two post election examples

#1 Front page of the New York Times 9 Nov — the first sentence from something they characterize as ‘News Analysis’

““Donald John Trump was elected the 45th president of the United States on Tuesday in a stunning culmination of an explosive, populist and polarizing campaign that took relentless aim at the institutions and long-held ideals of American democracy.”

#2 Front page of the New York Times 10 Nov — more ‘News Analysis’ — Here’s the lead “Populist Fury may Backfire”. Don’t they wish.

I’ll never complain about this sort of thing again (well at least not for four years). Why? Because I’ve been reading the Wall Street Journal, The New York Times, The Nation and the National Review for probably 50 years, and Trump as the antiChrist is the first thing I’ve ever seen all four agree on. This biased coverage simply no longer matters. If it did, Trump would have lost and lost big. This just confirms the marked loss of credibility that the mainstream media has suffered.  People aren’t as dumb as the elites think they are.

Second: Political correctness and attempts to control speech so as not to offend lost big. That’s very good for us all right and left (although the impetus for speech control has switched to the left from the right over the past 56 years) — see https://luysii.wordpress.com/2015/11/22/from-banned-in-boston-to-banned-in-berkeley-in-55-years/

What do the state ballot initiatives have to do with neuropharmacology? Just this. Voters in California, Massachusetts and Nevada approved recreational marijuana initiatives Tuesday night, and several other states passed medical marijuana provisions.

I don’t think this is good. One of the arguments in its favor is that marihuana isn’t as bad as alcohol, which may be true, but if marihuana isn’t all good why add it to the mix? We don’t have a good handle on marihuana use, but it is likely to increase if it’s legal.

Why do I think this is bad (particularly for adolescents)? It is likely that inhibiting synaptic feedback isn’t a good thing for a brain which is pruning a lot of them (which happens in normal adolescence as the thickness of the cerebral cortex shrinks).

There have been many explanations for the decline in College Board Scores over the years. This has led to their normalization (so all our children are above average). If you’re a correlation equals causation fan, plot the decline vs. time of atmospheric lead. It is similar to the board scores decline. Or you can plot 1/adolescent marihuana use vs. time and get a similar curve. The problem, of course, is that we have no accurate figures for use.

Here’s the science — it’s an old post, but little has happened since it was written to change the science behind it

Why marihuana scares me

There’s an editorial in the current Science concerning how very little we know about the effects of marihuana on the developing adolescent brain [ Science vol. 344 p. 557 ’14 ]. We know all sorts of wonderful neuropharmacology and neurophysiology about delta-9 tetrahydrocannabinol (d9-THC) — http://en.wikipedia.org/wiki/Tetrahydrocannabinol The point of the authors (the current head of the Amnerican Psychiatric Association, and the first director of the National (US) Institute of Drug Abuse), is that there are no significant studies of what happens to adolescent humans (as opposed to rodents) taking the stuff.

Marihuana would the first mind-alteraing substance NOT to have serious side effects in a subpopulation of people using the drug — or just about any drug in medical use for that matter.

Any organic chemist looking at the structure of d9-THC (see the link) has to be impressed with what a lipid it is — 21 carbons, only 1 hydroxyl group, and an ether moiety. Everything else is hydrogen. Like most neuroactive drugs produced by plants, it is quite potent. A joint has only 9 milliGrams, and smoking undoubtedly destroys some of it. Consider alcohol, another lipid soluble drug. A 12 ounce beer with 3.2% alcohol content has 12 * 28.3 *.032 10.8 grams of alcohol — molecular mass 62 grams — so the dose is 11/62 moles. To get drunk you need more than one beer. Compare that to a dose of .009/300 moles of d9-THC.

As we’ve found out — d9-THC is so potent because it binds to receptors for it. Unlike ethanol which can be a product of intermediary metabolism, there aren’t enzymes specifically devoted to breaking down d9-THC. In contrast, fatty acid amide hydrolase (FAAH) is devoted to breaking down anandamide, one of the endogenous compounds d9-THC is mimicking.

What really concerns me about this class of drugs, is how long they must hang around. Teaching neuropharmacology in the 70s and 80s was great fun. Every year a new receptor for neurotransmitters seemed to be found. In some cases mind benders bound to them (e.g. LSD and a serotonin receptor). In other cases the endogenous transmitters being mimicked by a plant substance were found (the endogenous opiates and their receptors). Years passed, but the receptor for d9-thc wasn’t found. The reason it wasn’t is exactly why I’m scared of the drug.

How were the various receptors for mind benders found? You throw a radioactively labelled drug (say morphine) at a brain homogenate, and purify what it is binding to. That’s how the opiate receptors etc. etc. were found. Why did it take so long to find the cannabinoid receptors? Because they bind strongly to all the fats in the brain being so incredibly lipid soluble. So the vast majority of stuff bound wasn’t protein at all, but fat. The brain has the highest percentage of fat of any organ in the body — 60%, unless you considered dispersed fatty tissue an organ (which it actually is from an endocrine point of view).

This has to mean that the stuff hangs around for a long time, without any specific enzymes to clear it.

It’s obvious to all that cognitive capacity changes from childhood to adult life. All sorts of studies with large numbers of people have done serial MRIs children and adolescents as the develop and age. Here are a few references to get you started [ Neuron vol. 72 pp. 873 – 884, 11, Proc. Natl. Acad. Sci. vol. 107 pp. 16988 – 16993 ’10, vol. 111 pp. 6774 -= 6779 ’14 ]. If you don’t know the answer, think about the change thickness of the cerebral cortex from age 9 to 20. Surprisingly, it get thinner, not thicker. The effect happens later in the association areas thought to be important in higher cognitive function, than the primary motor or sensory areas. Paradoxical isn’t it? Based on animal work this is thought to be due pruning of synapses.

So throw a long-lasting retrograde neurotransmitter mimic like d9-THC at the dynamically changing adolescent brain and hope for the best. That’s what the cited editorialists are concerned about. We simply don’t know and we should.

Addendum 11 Nov ’16:  From an emerita nonscientific professor friend of my wife. “Much of the chemistry/pharmacology etc. is way beyond me, but I did get the drift of the conversation about marihuana and am glad to now have even a simplified concept of what it does to the brain. Having spent the last 20 years working with undergraduate and graduate students, I’ve seen first hand the decline in cognitive ability.” 

Scary ! ! ! !

Having been in Cambridge when Leary was just getting started in the early 60’s, I must say that the idea of tune in turn on and drop out never appealed to me. Most of the heavy marihuana users I’ve known (and treated for other things) were happy, but rather vague and frankly rather dull.

Unfortunately as a neurologist, I had to evaluate physician colleagues who got in trouble with drugs (mostly with alcohol). One very intelligent polydrug user MD, put it to me this way — “The problem is that you like reality, and I don’t”.

Tom Wolfe — an appreciation

Tom Wolfe’s writing style and the genre he created have been part of the intellectual wallpaper for so long, that it’s easy to forget how badly he was needed. The following is quite autobiographical, but it does put his emergence in context.

Intellectually isolated adolescents in the early 50s read books, lots of them (minimal TV of any intellectual content, no internet etc. etc.) I had plenty of time in high school, with two 16 mile rides on the school bus each day. So I managed to read a book a day my senior year in high school. I particularly loved Balzac and Dickens for the way they wrote about all levels of society.

So although I was fairly well read on entry into Princeton in the fall of 1956, I was a geographic naif, never really having travelled west of Philly. I was a social naif as well, with only 6/24 boys in my high school class going on to collage. The ones that didn’t went into the military, law enforcement or the trades. None of the 24 girls got further education, initially at least. This was not a high or wealthy social background. I was the first member of my family not to go to Rutgers (the state school of New Jersey).

The Princeton Triangle Club put on a rather sophomoric show each year which toured the east coast and midwest on Christmas break. Earlier famous members included Jimmy Stewart and Josh Logan. Later, after women were admitted, Brooke Shields. I was good enough to make pianist in the pit band for the show and did this for two years.  The incredibly creative guy writing the shows was Clark Gesner, who soon after wrote “You’re a Good Man Charlie Brown” and essentially retired in his late 20s.

The class of 1959 was the first at Princeton to have more High School graduates than preppies. To the alums that put us up in their homes after the show, it was assumed that we were to the manor born (as many of them were).

Seeing upper class society was quite an education. After each show the performers (and band) were invited to debutante parties. I’d never seen anything like it, and none of the American novels I’d read dealt with it. The musicians in the band would listen to the society orchestras playing (Lester Lanin, Peter Duchin, Meyer Davis) and dance with the debs. In Chicago, I even was the male presenting one debutante, rather than a local — probably because she was Jewish and none of the locals would do it. In Grosse Point Michigan the following exchange occurred with a deb who seemed intelligent. Where do you go to school? Oh someplace back East. How do you like the party? Enough for me to decide not to attempt to become part of that world (not that it was ever possible).

Then in grad school at Harvard, I met extremely intelligent guys from the West Coast (Caltech, Berkeley, Brigham Young) who were reading “Road and Track” in all seriousness (camp hadn’t been invented yet). Road and track was for the guys back home who went to work in garages, and dragraced with each other.

No one in the 50s and early 60s was writing about this stuff — here’s a link to the best-sellers of the 50s — https://en.wikipedia.org/wiki/Publishers_Weekly_list_of_bestselling_novels_in_the_United_States_in_the_1950s
if you don’t believe me. Some were good (To Kill a Mockingbird). A lot were by foreigners (Dr. Zhivago, Francois Sagan, Simone de Beauvoir).

We had this fascinating diverse society, and our literature wasn’t dealing with it — that is until Tom Wolfe came along. He wrote about car customizers, astronauts, high society, low society, enjoying it all. These weren’t thought to be the stuff of serious literature until then. Some of the best sellers back then bore the same relationship to reality (Marjorie Morningstar, Not as a Stranger) as the Doris Day Rock Hudson movies of the time.

So hats off to Tom Wolfe. He’s still writing — I recommend his latest – “The Kingdom of Speech” about which I wrote 3 posts. Although the book starts in Victorian England, it winds up in the USA with Chomsky and company and the social high jinks of the left, which Wolfe has been skewering for decades. Here’s a link to one of the posts — https://luysii.wordpress.com/2016/10/16/book-review-the-kingdom-of-speech-part-iii/

Book Review — The Kingdom of Speech — Part III

The last half of Wolfe’s book is concerned with Chomsky and Linguistics. Neurologists still think they have something to say about how the brain produces language, something roundly ignored by the professional linguistics field. Almost at the beginning of the specialty, various types of loss of speech (aphasias) were catalogued and correlated with where in the brain the problem was. Some people could understand but not speak (motor aphasia). Most turned out to have lesions in the left frontal lobe. Others could speak but not understand what was said to them (receptive aphasia). They usually had lesions in the left temporal lobe (e.g. just behind the ear amazingly enough).

Back in the day this approach was justifiably criticized as follows — yes you can turn off a lightbulb by flicking a switch, but the switch isn’t producing the light, but is just something necessary for its production. Nowadays not so much, because we see these areas lighting up with increased blood  flow (by functional MRI) when speech is produced or listened to.

I first met Chomsky’s ideas, not about linguistics, but when I was trying to understand how a compiler of a high level computer language worked. This was so long ago that Basic and Pascal were considered high level languages. Compilers worked with formal rules, and Chomsky categorized them into a hierarchy which you can read about here — https://en.wikipedia.org/wiki/Chomsky_hierarchy

The book describes the rise of Chomsky as the enfant terrible, the adult terrible, then the eminence grise of linguistics. Wolfe has great fun skewering him, particularly for his left wing posturing (something he did at length in “Radical Chic”). I think most of the description is accurate, but if you have the time and the interest, there’s a much better book — “The Linguistics Wars” by Randy Allen Harris — although it’s old (1993), Chomsky and linguistics had enough history even then that the book contains 356 pages (including index).

Chomsky actually did use the term language organ meaning a facility of the human brain responsible for our production of language of speech. Neuroscience never uses such a term, and Chomsky never tried to localize it in the brain, but work on the aphasias made this at least plausible. If you’ve never heard of ‘universal grammar, language acquisition device, deep structure of language, the book is a reasonably accurate (and very snarky) introduction.

As the years passed, for everything that Chomsky claimed was a universal of all languages, a language was found that didn’t have it. The last universal left standing was recursion (e.g. the ability the pack phrase within phrase — the example given “He assumed that now that her bulbs had burned out, he could shine and achieve the celebrity he had always longed for” — thought within thought within thought.

Then a missionary turned linguist (Daniel Everett) found a tribe in the Amazon (the Piraha) with a language which not only lacked recursion, but tenses as well. It makes fascinating reading, including the linguist W. Tecumseh Fitch (yes Tecumseh) who travelled up the Amazon to prove that they did have recursion (especially as he had collaborated with Chomsky and the (now disgraced) Marc Hauser on an article in 2002 saying that recursion was the true essence of human language — how’s this horrible sentence for recursion ?

The book ends with a discussion of the quote Wolfe began the book with — “Understanding the evolution of language requires evidence regarding origins and processes that led to change. In the last 40 years, there has been an explosion of research on this problem as well as a sense that considerable progress has been made. We argue instead that the richness of ideas is accompanied by a poverty of evidence, with essentially no explanation of how and why our linguistic computations and representations evolved. We show that, to date, (1) studies of nonhuman animals provide virtually no relevant parallels to human linguistic communication, and none to the underlying biological capacity; (2) the fossil and archaeological evidence does not inform our understanding of the computations and representations of our earliest ancestors, leaving details of origins and selective pressure unresolved; (3) our understanding of the genetics of language is so impoverished that there is little hope of connecting genes to linguistic processes any time soon; (4) all modeling attempts have made unfounded assumptions, and have provided no empirical tests, thus leaving any insights into language’s origins unverifiable. Based on the current state of evidence, we submit that the most fundamental questions about the origins and evolution of our linguistic capacity remain as mysterious as ever, with considerable uncertainty about the discovery of either relevant or conclusive evidence that can adjudicate among the many open hypotheses. We conclude by presenting some suggestions about possible paths forward.”

One of the authors is Chomsky himself.

You can read the whole article at http://journal.frontiersin.org/article/10.3389/fpsyg.2014.00401/full

I think, that Wolfe is right — language is just a tool (like the wheel or the axe) which humans developed to help them. That our brain size is at least 3 times the size of our nearest evolutionary cousin (the Chimpanzee) probably had something to do with it. If language is a tool, then, like the axe, it didn’t have to evolve from anything.

All in all a fascinating and enjoyable book. There’s much more in it than I’ve had time to cover.  The prose will pick you up and carry you along.

Book Review — The Kingdom of Speech — Part II

Although Darwin held off writing up his ideas for 20 years, fearing the reaction he knew would come from the church, the criticisms that really bothered him the most were those of fellow intellectuals about the evolution of language. They began immediately after the Origin of Species came out in 1859, by linguists and later by Wallace himself. Even worse, one critic mocked him. The idea that language evolved from animal sounds was called the bow wow theory, or language arose from sounds that things made (the ding dong theory).

This is all detailed in pp. 54 – 87 of The Kingdom of Speech, about which I knew very little. If any real experts on the early history of evolutionary theory are out there and reading this and disagree, please post a comment. I am assuming that the facts as given by Wolfe are correct (I’ve already disagreed with him about his interpretation of some of them — https://luysii.wordpress.com/2016/10/03/book-review-the-kingdom-of-language-part-i/).

The real attack on Darwin’s ideas is that man’s mental capacities were so far above those of animals, that there was no missing link (particularly since there were lots or primates still around). By this critique man was so special, that a special act of creation (not evolution) was called for.  It’s theology getting in the back door, but of course this is essentially the claim of all theologies — special creation by a superior being(s).

In his later book “The Origin of Species and the Descent of Man” – 1871 (which I’ve not read), according to Wolfe Darwin made up all stories (many involving his beloved dog) to show the antecedents of all sorts of things in animal behavior — Darwin actually said that language originated with the songs birds sang during mating. Female protolanguage persists today in mothers cooing to their babies. Darwin spent a lot of time discussing his dog — how it recognized other dogs as a sign of intelligence. Religion came from the love of a dog for his master (Wolfe claims that Darwin said this in the book– I haven’t read the Descent of Man).

Darwin’s second book didn’t get much response. Postive reviews avoided his reasoning, and negative reviews said it was thin. In 1872 the Philological Society of London gave up on trying to find out the origin of language, and wouldn’t accept patpers about it. The Linguistic Society of Paris did this even earlier (1866).

Evolutionists basically stopped talking about language from 1872 to 1949.

As soon as Mendel’s work on genetics was discovered, evolution went into scientific eclipse. Here was something that wasn’t just armchair speculation about things happening in the remote past, something on which experiments could be done.
Mendel’s experiments with green peas took 9 years and involved 28,000 plants.

In a fascinating aside, Wolfe notes that Mendel actually sent his work to Darwin. Tragically it was found unread with its pages uncut in Darwin’s papers after his death. In all fairness to Darwin, he and his peers had no idea how heredity worked and there are parts in The Origin of Species in which Darwin appears to accept the inheritance of acquired characteristics (the blacksmith’s large muscles passed on to his son etc. etc.). I don’t think you can read the Origin without being impressed by the tremendous power of Darwin’s mind, and how much work he put in and how far he got with how little he had to go on.

Wolfe says Darwin’s ideas about the origin or language were mocked by Gould  one hundred years later (1972) as “Just So Stories”, fantastic bizarre explanations for why animals are the way they are — see http://etc.usf.edu/lit2go/79/just-so-stories/. I’m not so sure, the citation for this gives an article  Sociobiology which Gould and Lewontin (see later) relentlessly attacked. Gould himself saw what he wanted to see in his book “The Mismeasure of Man” — for details see — https://luysii.wordpress.com/2011/06/26/hoisting-steven-j-gould-by-his-own-petard/

As you can see,The Kingdom of Speech is full of all sorts of interesting stuff, and I’m not even halfway through talking about it.

Next up, linguistics, to include Noam  Chomsky and his admission that he doesn’t understand language or where it came from.

The energy of the future

Almost 60 years ago to the day, a group of Princeton freshman (including yours truly) were dazzled by a talk by Professor Lyman Spitzer, as he described the “Stellarator”, a machine designed to mimic the thermonuclear reaction of the sun. He said it would produce all the energy one could want using nothing more complicated than water (once it was broken down into hydrogen and oxygen). He described it as the ‘energy of the future’.

60 years later it still is.

An article in today’s Nature (vol. 537 pp. 14 – 15 ’16) describes the malfunction of the National Spherical Torus Experiment Upgrade (NSTX-U) at the Princeton Plasma Physics Laboratory (PPPL) founded by Spitzer himself. Apparently some component failed, and the machine will be taken offline for repairs. The machine was being upgraded to produce higher magnetic fields using new coils, and one of them failed.

Since a machine at MIT is being permanently shut down, this leaves US fusion physicists with just one functional machine for experiments.

Book Review — The Kingdom of Speech — Part I

If you’re interested in evolution, its history, English social and intellectual history, language, Chomsky and the origins of the journal Nature then Tom Wolfe’s “The Kingdom of Language” is the book for you. Fellow blogistas will be awed by the clarity and elegance of his writing, and how he easily carries the reader easily along. It’s very funny and sardonic as well. The review will be split into several parts because there’s so much in the book.

One caveat: I’ve made no attempt to check any of the historical statements in the book. Hopefully they are all true. If you think any of it is incorrect, please post a comment.

Although the book has a lot to say about language, it doesn’t get into this until nearly 1/3 of the way through. It starts with Alfred Russell Wallace in 1858 lying in a sickbed with Malaria in the Malay peninsula coming up with the idea of natural selection, survival of the fittest (his term) and the origin of species. He writes an essay of 20+ pages and sends it off to Darwin, in the hopes that Darwin will pass it to Sir Charles Lyell (who Wallace didn’t know) who might find it worthy enough to publish.

Darwin gets it in June and is floored. The ideas that he’s been working on since 1838 (in silence for fear of what the religious establishment will say) are all laid out by what was called a ‘flycatcher’, someone making their living by going off to the colonies and sending back exotica for British Gentleman back home.

Tom Wolfe has always been fascinated by social class and distinctions between them (about this much more in part II).

British Gentlemen were landed gentry, who inherited land and wealth (if not noble titles). Darwin’s history went back to Erasmus Earle who was an attorney for Cromwell in the mid 1600’s. He made so much money, that no one in the succeeding EIGHT generations had to work. Robert Darwin, Charles’s father) nonetheless did — he was an M. D. but was more a businessman. He also attained even more money by marrying Wedgewood’s daughter.

Fortunately Robert had lots of money, as Charles was something of a slacker. He started by studying medicine at Edinburgh, but dropped out. He then went to Christ’s College Cambridge to become a clergyman — he dropped this as well, graduating eventually from Cambridge without an honor to his man. So Robert paid to have Charles to on a 5 year voyage of exploration on the Beagle. On return, Robert bought Charles a amLL pied a terre in the country (Down House) with 8 – 9 servants. (Did you know any of this).

The idea of species change was not new. Erasmus Darwin (Darwin’s grandfather) in 1794 and Lamarck in 1800 thought present day species had evolved from earlier ones.

Lamarck’s rather blasphemous thinking was saved by his heroics in battle at age 17 (as a private). His unit was decimated, all officers killed, Lamarck took command somehow and held their position until reinforcements arrived.

There’s a lot in the book about how Darwin Lyell and Hooker screwed out of the priority of thinking of evolution and natural selection first. Here Wolfe gets things seriously wrong, while Wallace was first into print, his thinking lagged Darwin’s by 20 years. However, Darwin, not wishing to be attacked by the clergy kept things to himself, only telling Lyell about is in 1856.

Most of the readership is probably fully engaged with work, family career and doesn’t have time to actually read “The Origin of Species”. In retirement, I did,and the power of Darwin’s mind is simply staggering. He did so much with what little information he had. There was no clear idea of how heredity worked and at several points he’s a Lamarckian — inheritance of acquired characteristics. If you do have the time I suggest that you read the 1859 book chapter by chapter along with a very interesting book — Darwin’s Ghost by Steve Jones (published in 1999) which update’s Darwin’s book to contemporary thinking chapter by chapter.

Wolfe also gets evolution wrong, saying there is no evidence for it. E.g. no one has seen a species change, etc. etc.  Perhaps, but the biochemical evidence is incontrovertible for descent with modification, otherwise you couldn’t replace a vital yeast protein gene with the human homolog and have it work.

Do you know what the X club is? It was a group of 9 naturalists (including Thomas Huxley and Hooker) who met monthly to defend Darwin’s ideas. They also created the journal we know today as Nature.

This actually explains a lot of stuff there that I’ve read over the years — the correct interpretation of evolutionary doctrine receives a great deal of space — punctuated evolution, group selection, kin selection, what is the proper unit of selection etc. etc.

The attacks that bothered Darwin the most, were those about language. That’s the subject of the next part of the review.

Hillary’s health — you can see a lot by looking

Last night’s debates should put two suggestions about Hillary’s health to rest and gives some evidence for two others. First, she does not have Parkinson’s disease. Second, she does not have epilepsy. Third, her eye movements still show some residua from the stroke of December 2012. Fourth, she may have a mild proximal myopathy.

Now to elaborate.

Parkinson’s disease: Two great things happened in September 1970 — I finished my two years in the Air Force and L – DOPA was released for use in the USA. American neurologists had been reading about the great things it was doing for the disease in Europe for almost 10 years. So when I went back to complete the last two years of my residency, the chief put me in charge of the L – DOPA clinic he’d just set up. So until retirement in 2000, I treated lots of people with it.

As the chief said — Parkinson’s disease is a Yellow Cab disease. If you see a Yellow Cab on the street, you don’t write down the license number, go down to city hall and find that it was registered as a Yellow Cab. You look at it and say “that’s a Yellow Cab”.

Parkinsonians have a rather immobile face (masklike) — Hillary’s face is quite mobile. Their speech lacks the normal musicality of speech (prosody), Hillary’s speech has normal inflection. Parkinsonians have a slow, stiff gait with difficulty initiating it. Hillary has none of this. Finally there is no sign of any tremor.

Epilepsy: Videos of purported seizures are out and about on the internet, particularly one during an interview. I thought that the ones I saw looked rather edited, as though some individual frames had been deleted from the videos. Fortunately last night we had an opportunity to see for ourselves. Toward the end of the debate, she had another episode, during which she shook her head and her shoulders for a few seconds. This happened in real time, so we could run the video recording backwards and forwards. At no time did she appear to be out of contact, and she then continued on with what she was saying without pause. So it’s just something she voluntarily does. It isn’t epilepsy.

Eye movements: Recall that after the stroke in December 2012, Hillary had double vision and had to wear Fresnel lenses to correct it for a few weeks afterwards — pictures of her testifying in congress January 2013 show this. So last night there was a 90 minute opportunity to watch the way her eyes move. They aren’t quite normal – on looking to her left the right eye lags and doesn’t bury the white. Even though Trump was to her right, she turned her head rather than her eyes to look at him, so I only saw her look to her right on a few occasions, but when she did her eyes appeared to move together. No other residua of a brainstem stroke were present such as slurred speech (dysarthria), facial weakness, facial asymmetry.

Proximal muscle weakness: The internist referred to in a previous post noted the following:

“There were shots a month or so ago of her needing help to get up outdoor stairs and also needing a small step-stool to get up into a Secret Service Suburban. My wife and I hop in and out of a Yukon and do not need any step device (they are of comparable age). After a photo of her doing that was published, she started getting in and out of vehicles on the side away from cameras and was also switched to a taller van with a step mounted on the vehicle. In February, press was forbidden by her staff from filming her climbing the stairs to board her private jet.”

He wondered if she could have something like limb girdle dystrophy.

Well, such a dystrophy is certainly possible. Although Hillary  had no difficulty standing for 90 minutes, at the end, she appeared to waddle as she walked toward the moderator.. There wasn’t really enough time to definitely say that she waddled.  It’s worth carefully watching the way she walks in the future.

Why is waddling a sign of mild weakness of the muscles of the pelvic girdle? Believe it or not the buttocks are not a secondary sexual characteristic. The main buttock muscle (gluteus maximus) is so big because it has so much work to do.

Think about what you do when you take a step forward with your right foot. To remain stable, your entire upper body weight must  be strongly plastered to your left hip. You need a strong, large muscle to do this (the gluteus maximus). What happens if the muscle is weak? Your upper body would fall to the right. How would you prevent this? By throwing your upper body to the left, putting its center of gravity there, so it presses on the left hip with greater force. A similar thing happens when stepping forward with the left foot. The net effect is that you waddle, which is what Hillary appeared to do.

It’s worth watching her walk in the future.

Stamina: she was under 90 minutes of stress, and showed no sign of fatigue.

Now, hopefully, back to the science, with a very long (over 1,000 Angstroms) allosteric effect.

Trump’s health

Here is a link to an article containing the full text of the letter by Trump’s personal physician Harold Bornstein M. D. -=-https://www.washingtonpost.com/apps/g/page/politics/letter-from-donald-trumps-doctor-on-his-latest-physical-exam/2091/?tid=a_inl

Trump’s lipids could be better (total 232) and he is currently taking a lipid lowering agent (a statin). Aside from this, his labs are good (perfect in fact). He does take care of himself, and has annual physicals.

It isn’t clear why he had a transthoracic echocardiogram 2 years ago. Otherwise aside from that every test performed is pretty standard for a man his age.

Despite being overweight his blood pressure is excellent (particularly for man his size).

The indications for low dose aspirin aren’t stated, but yours truly has taken much more for decades based on a reading of the literature while in practice showing that doses of two adult aspirin a day reduced the recurrence rate of stroke by 33%.

So his main health problem is weight and mildly elevated lipids (even on medication).

His BMI (Body Mass Index) is stated to be 29.5. So it’s time for you to calculate your own — don’t worry that BMI is usually based on weight in kilograms and height in meters — the following site lets you put in your weight in pounds, and your height in inches — To get started, calculate your own BMI– http://bmicalculator.cc/?gclid=CM66rIG2tc0CFYQ2gQodOdINEg. A 6 footer would have to weigh 222 pounds to be obese (BMI over 30).

So is Trump’s BMI of 29.5 bad? Overweight is defined as a BMI over 25. So is a BMI over 25 bad? Not if you’re interested in mortality (death) as opposed to morbidity (things like heart attack and stroke). It turns out that the BMI with the lowest mortality at 70 is over 25 — e.g. 26. e.g. in the overweight range as currently defined. I don’t think there are good statistics on overall morbidity vs. BMI (there probably is for heart attack and stroke separately).

Now it gets interesting. That statistic cited above is based on the following data on 3 million people in 97 different studies [ J. Am. Med. Assoc. vol. 309 pp. 71 – 82 ’13 ].

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 weigh 228 (which I almost did 54 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 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 (BMI over 30) 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 unexplain 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 78) it’s 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.

Well, that’s the take of this neurologist on Trump’s health — e.g.it’s pretty good. I’m going to pass this post on to the very smart internist (whose comments about Hillary you can read in — https://luysii.wordpress.com/2016/09/13/hillarys-fainting-spell/) for his take, as there really isn’t anything in the history suggest a neurologic problem. Unlike Hillary, he hasn’t fainted twice in the past 4 years, and hasn’t had a neurologic deficit persisting for a month.

The impeccable timing of the New York Times — take II

Reality keeps intruding. I’d much rather be posting about a marvelous paper (see the end), but the Sunday New York Times of 18 September 2016 had 3 articles telling us all how deplorable, irrational and islamaphobic we are, the day after 3 separate attacks on the citizenry (the Chelsea and Seaside Park bombs and the knife attack in Minnesota).

Two were on the opinion page — one comparing the Jews of the 30s trying to escape the Nazi’s with the mideast refugees, another concerned “England’s Forgotten Muslin History”. Well, we all know what a bunch of terrorists the Jews of the 30s were.

On p. 13 “Level of Hate Crimes Against U. S> Muslims Highest Since After 9/11” “Some Tie Attacks to Trump’s Statements” It couldn’t possibly be anything they’ve done.

For your enjoyment, here’s the post of just 3 months ago (13 June)

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.

—-

You could not have a better example of how totally out of touch elite opinion is and the placement and timing of these articles is exactly an expression of elite opinion.

I had thought that the terrorists would be lying low until after the election, as terrorist acts work in Trump’s favor. But as a friend said about another Muslim group — they never miss an opportunity to miss an opportunity.

The paper I’d planned to write about is Nature vol. 537 pp. 107 ’16 (1 September 2016 Issue).

Now on to Trump’s health information.

Thank God for the internet, warts and all

Here’s the New York Times Monday reporting on Hillary’s fainting spell the previous day — “Clinton Treated for Dehydration and Pneumonia”, “Falling Ill at 9/11 Event”. Then it states that she ‘had to be helped into a van by Secret Service Agents”.

Still on the first page, “about 90 minutes after arriving there (Chelsea’s apartment) Mrs.Clinton wearing sunglasses emerged from the apartment” She is then quoted as “I’m feeling great” “It’s a beautiful day in New York” On the front page there’s a picture of her at the 9/11 service before anything happened. Inside there’s a picture of her leaving the apartment looking just wonderful and smiling.

The Times does mention the video, and noted that it captured ‘what appeared to be her legs buckling’.

Back in the day when the NYT controlled the news, you’d think nothing much happened. However, anyone looking at the video can see her passing out and nearly hitting the pavement, until she was caught by her handlers.

As I predicted in an EMail to some friends, the Times in its letters to the editor today had a letter praising Hillary as a typical plucky lady who carried on no matter what. For a paper that routinely headlines articles dumping on the church (the front page of 14 Sep has an article concerning how Putin is using the Russian Orthodox Church to extend Russian power abroad) they certainly love one of its institutions (the amen corner — aka letters to the editor).

The paper of record in Northampton described the event has Mrs. Clinton becoming “Unwell”, With Hillary in seclusion and unable to campaign, the lead story on Yahoo yesterday, concerned an attack ad of Hillary’s on Trump, not anything he said or did.

The internet and the blogosphere is often scatological, misleading, irritating and biased. But there’s such massive coverage on the internet that it has broken the monopoly of the mainstream press. Thank God for them warts and all.

Now, hopefully back to the science.