Category Archives: Social issues ( be civil ! )

A Touching Mother’s Day Story

Yes, a touching mother’s day story for you all. It was 48 years ago, and I was an intern at a big city hospital on rotation in the 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 48 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— “

Disentangling Heredity and Environmental effects on IQ

No sensible person thinks intelligence is completely determined by heredity or by environment. Recent Swedish work [ Proc. Natl. Acad. Sci. vol. 112 pp.4612 – 4617 ’15 ] tries to control for heredity while measuring environmental effects on IQ, assuming that IQ measures intelligence, a position some find contentious. Every Swedish 18 year old man is conscripted into the military apparently. IQ tests are given to all. Amazingly the authors found 436 sibships where the brothers had been raised apart.

The intelligence of the biological and adoptive parents wasn’t measured. Rather the surrogate of educational level was used instead. It was divided into 5 classes.

What did they find? Adopted sibs had an IQ 4.41 points higher than the nonAdopted sib (recall that average IQ is stated to be 100 points although it’s been rising, and that IQ levels of the population fall on the Bell (Gaussian) curve, with a standard deviation of 15 points). These results are not surprising, as few willingly give children up for adoption, so the adopted environment was quite likely better. The educational level of the adoptive parents was an average of 2.6 points higher.

Next, the authors measured the effect of the surrogate marker for intelligence (educational level) on IQ. For each point in the 5 point scale that the adoptive parent was at a higher educational level than the biologic ones there was an increase in IQ of the adopted sib relative to the unadopted one. This is as unequivocal evidence as we have for the effect of environment and educational level on IQ.

We’ll never have perfect data, and many caveats about this work are possible, but it is an impressive effort. 436 sibs is a huge number compared to the twins who’ve been reared apart and studied this way.

Just how large an effect do you think it was? I’ve already told you everything you need to know.

Each additional unit of rearing parental education was associated with 2 IQ units. Are you surprised? I was, because I thought the effect would be much larger. So environment is important in determining intelligence, just not so much.

Hillary’s stroke

Hillary Clinton had a stroke toward the end of 2012. It was not due to the faint she had presumably because of the flu in mid December. The information given out at the time was extremely sketchy and confusing (see the copy of the post of 31 Dec ’12 at the end).

She fainted while giving a speech in Buffalo according to one account and at her home in Washington according to another and was not hospitalized. She is said to have suffered a concussion when she fell. Then on the 30th of December she was hospitalized because a blood clot was found (more later) and placed on blood thinners. She suffered double vision and had to wear corrective glasses (Fresnel lenses) for congressional testimony 23 January 2013.

So she had a blood clot in her head and a neurologic deficit persisting for a few weeks. That’s what a stroke is.

Could it have been due to the head trauma? This is extremely doubtful based on 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. 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. 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. The initial consultant in half the cases was me. If 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 (venous sinuses actually). In all the head trauma I saw (well over 300 I’d guess), I never saw a clot develop there. I’ve spoken to two neuroradiologists still in practice, and they can’t recall seeing such a clot without a skull fracture near the vein. Nothing like this was mentioned at any time about Hillary.

Hillary’s neurologic deficit involved a nerve going to the muscles of her left eye. These start in the brainstem, a part of the brain quite near the site where she is said to have the clot in her vein. The brainstem is crucial in maintaining consciousness, and it is far more likely that the faint in early December was a warning sign of the stroke she had subsequently.

I can’t believe that she would not have been hospitalized had she complained of double vision when she fainted in early December, so it must have come on later.

So the issue is why did she have the stroke, and how likely is it to recur. I seriously doubt that it had anything to do with the head injury she sustained when she fainted. We’ve have two presidents neurologically impaired by stroke in the past century (Woodrow Wilson after World War I and Franklin Delano Roosevelt at Yalta). The results were not happy for the USA or the World.

Certainly all this would be cleared up if her medical records were released. Only Hillary can do this, but at least she cannot destroy them, as although she ‘owns’ them, they are not in her sole possession.

The following is a post written 31 December ’12 when the news of Hillary’s illness first broke showing how fragmentary the information about it was back then (it isn’t a good deal better now).

Medical tribulations of politicians — degrees of transparency

Remarkably on the last day of the year, 3 political figures and their medical problems are in the news. Here they are in order of medical transparency (highest first).

l. George Bush Sr. — the most transparent. We are told what he has (pneumonia), when he was admitted to hospital when he was in the ICU, when he came out. Docs call pneumonia ‘the old man’s friend’ not out of cynicism, but because its a mode of death with (relatively) little suffering. The patient lapses into unconsciousness and usually dies quickly and quietly. It took my cellist’s father only a day or two to pass away this month. Clearly it isn’t invariably fatal, and Bush Sr. was now out of the ICU at last count (he’s 88).

2. Hillary Clinton — admitted to the hospital yesterday with a ‘blood clot’ somewhere, said to be a complication of the concussion she suffered a few weeks ago. Also said to be under treatment with anticoagulants. Most clots due to head trauma are inside the head and treating them with anticoagulants is a disaster. The most likely type of clot given the time from the concussion is a subdural hematoma. It is possible that she’s been so inactive since the concussion that she developed thrombophlebitis in her legs, in which case anticoagulation would be indicated.

More disturbingly, is that her passing out a few weeks ago is a sign of something more serious going on. Hopefully not.

The powers that be should have told us where the clot actually is.

Update 5:50 PM EST — Well the powers that be did open up and it is a most unusual complication of head injury (and one I’d never seen in nearly 4 decades of practice) — a venous thrombosis in the head. I’m not even sure it’s due to her head injury. It might have even caused her syncope, but presumably she had some sort of radiologic study of her head when she fainted, which should have picked it up. The venous sinuses draining the brain in the back of the head are notoriously asymmetric, so a narrowing attributable to a clot could just be a variant anatomy. One very bad complication of cerebral venous thrombosis back there (which I saw as a complication of chronic mastoid bone infection — not head trauma) is pseudotumor cerebri. I really wonder if these guys have the right diagnosis.

3. Hugo Chavez — Yesterday it was announced that he’s had a third complication since his surgery for cancer 3 weeks ago. Naturally, we’re not told just what this complication actually is. This is consistent with the information that has been released about his case. We know almost nothing about his actual tumor (except that he has one). He most assuredly is not free of cancer as he stated last fall. He is said to have have a bleeding problem and a lung infection as the first two complications.

My guess for this third complication is that it is a dehiscence of his abdominal incision, which must have been fairly large for a 6 hour operation. Dehiscence just means that the wound has spontaneously opened up exposing abdominal contents (which means that peritonitis is not far behind). Why should this happen? Two reasons — he’s had radiation to the area which inhibits wound healing, and he’s been on high dose steroids in the past (and perhaps presently) which also inhibits wound healing.

I don’t think he’s going to be able to take office 10 days hence, and doubt that he’ll come back to Venezuela alive. Transparency has been zilch. Hopefully the people of Venezuela are beginning to realize just how misleading the information they’ve been fed about his health has been.

This is the sort of thing physicians taking care of really sick people deal with daily, which may explain why your doc friends aren’t as jolly as you are at the New Year’s Eve parties you’re about to attend.

Nonetheless, Happy New Year to all ! ! ! !

The dietary guidelines have been changed — what are the faithful to believe now ?

While we were in China dietary guidelines shifted. Cholesterol is no longer bad. Shades of Woody Allen and “Sleeper”. It’s life imitating art.

Sleeper is one of the great Woody Allen movies from the 70s. Woody plays Miles Monroe, the owner of (what else?) a health food store who through some medical mishap is frozen in nitrogen and is awakened 200 years later. He finds that scientific research has shown that cigarettes and fats are good for you. A McDonald’s restaurant is shown with a sign “Over 795 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 Served”

Seriously then, should you believe any dietary guidelines? In my opinion you shouldn’t. In particular I’d forget the guidelines for salt intake (unless you actually have high blood pressure in which case you should definitely limit your salt). People have been fighting over salt guidelines for decades, studies have been done and the results have been claimed to support both sides.

So what’s a body to do? Well here are 4 things which are pretty solid (which few docs would disagree with, myself included)

l. Don’t smoke
2. Don’t drink too much (over 2 drinks a day), or too little (no drinks). Study after study has shown that mortality is lowest with 1 – 2 drinks/day
3. Don’t get fat — by this I mean fat (Body Mass Index over 30) not overweight (Body Mass Index over 25). The mortality curve for BMI in this range is pretty flat. So eat whatever you want, it’s the quantities you must control.
4. Get some exercise — walking a few miles a week is incredibly much better than no exercise at all — it’s probably half as good as intense workouts — compared to doing nothing.

Not very sexy, but you’re very unlikely to find anyone telling you the opposite 50years from now.

It’s off topic, but I’d use the same degree of skepticism about the dire predictions of the Global Warming (AKA Climate change) people, particularly since there has been no change in global mean temperature this century.

Big Brother is watching you and you’re telling him everything he needs to know (if you’re on Facebook)

Big Brother is watching you and you’re telling him everything he needs to know (if you’re on Facebook). Here’s why. A computer analysis of your ‘likes’ predicts the results of your completing a 100 item personality questionnaire, better than those whom you’ve friended on Facebook. [ Proc.Natl. Acad. Sci. vol. 112 pp. 1036 – 1040 ’15 ] Has the gory details.

We do know that people lie when completing such things and the MMPI (Minnesota Multiphase Personality Inventory) has a scale for lying. Apparently everyone steals from mommy’s purse at some point, and your lie score on the MMPI goes up if you say you never did.

The study used a mere 86,220 volunteers who completed the 100-item International Personality Item Pool (IPIP) Five-Factor Model of personality questionnaire, measuring traits of openness, conscientiousness, extroversion, agreeableness, and neuroticism. The sample used in this study was obtained from the myPersonality project. myPersonality was a popular Facebook application that offered to its users psychometric tests and feedback on their scores. The data was anonymized and is in the public domain. How normal such an individual can be I leave up to you.

Human personality judgments were obtained from the participants’ Facebook friends, who were asked to describe a given participant using 10 of the 100 items of the IPIP personality measure. E.g. the friends were filling out the 10 items as they thought the subject would (or as they saw the subject).

So it’s the same questionnaire. The paper pitted a computer algorithm based on your Likes to predict your IPIP responses against those of your so-called Facebook friends who presumably know much more about you than just your Facebook Likes. The algorithm won. It didn’t win by much. Computer-based judgments (r = 0.56) correlate more strongly with participants’ self-ratings than average human judgements did (r = 0.49). Surprisingly, neither did terribly well, but then we all know that our judgement of ourselves is usually rather different than others. It’s why city people often tell you what they’re ‘really like’, while Montanans don’t. They know that there are so few people around that they’ll see you again. Your long term behavior will tell them everything they need to know.

Update 31 Jan ’15 — I told the people I play piano trios with about the paper. The cellist (a retired Actuary) had an excellent explanation of why the algorithm was more accurate than the friends individually. See if you can think of the reason.

She notes that the 3 of us interact with each other individually, e.g. we act differently for each of our friends, exposing just the parts of our personalities we choose. They aren’t the same for everyone. Obvious, now that she’s thought of it (did you?)

As usual the Poets have said it better

And would some Power the small gift give us
To see ourselves as others see us!
It would from many a blunder free us,
And foolish notion:

Robert Burns (1786)

What a difference a change of administration makes

This is not a scientific post. Having a son who majored in journalism educated me to the various and sundry ways news is slanted. Here in Massachusetts, the administration changed from 8 years of Democratic governance to Republican. Liberals shouldn’t fret as the legislature remains 90% Democratic.

For the past 8 years the local press has been carrying water for increased spending and taxes. We have been regaled with headlines decrying “Draconian cuts” and budget gaps. Such was the case with the outgoing administration, where stories began appearing last December about budget gaps on the order of 700 million. I wrote the reporter asking what this represented in terms of the total budget and never got anything back, ditto for the response from one of the few Republican senators still standing. Throughout the decade I could never get a straight answer as to the actual amount of the budget and the year to year changes in same.

Now we have the following http://www.masslive.com/politics/index.ssf/2015/01/gov_charlie_baker_massachusetts_765_million_budget_gap.html#incart_m-rpt-1, and from the same reporter who never responded last month. Here’s what the reporter was forced to report.

“tax revenues are coming in on target, with an approximately 4.5 percent increase over last year. However, state spending is on target to increase by 7.3 percent“. It will be amusing to see if ‘Draconian cut” stories appear as they have in the past. Mr. Micawber always had a budget gap and so do we.

Along the same lines here’s a heartwarming headline, to disguise an appeal for higher taxes. http://finance.yahoo.com/news/obama-channels-inner-robin-hood-as-rich-get-richer-154533477.html.

Derek Lowe always regrets posting anything remotely political on his blog “In the Pipeline”. Hopefully I won’t. If you must respond, please be civil.

The New York Times and NOAA flunk Chem 101

As soon as budding freshman chemists get into their first lab they are taught about significant figures. Thus 3/7 = .4 (not .428571 which is true numerically but not experimentally) Data should never be numerically reported with more significant figures than given by the actual measurement.

This brings us to yesterday’s front page story (with the map colored in red) “2014 Breaks Heat Record, Challenging Global Warming Skeptics“. Well it did if you believe that a .02 degree centigrade difference in global mean temperature is significant. The inconvenient fact that the change was this small was not mentioned until the 10th paragraph. It was also noted there that .02 C is within experimental error. Do you have a thermometer that measures temperatures that exactly? Most don’t, and I doubt that NOAA does either. Amusingly, the eastern USA was the one area which didn’t show the rise. Do you think that measurements here are less accurate than in Africa, South America Eurasia? Could it be the other way around?

It is far more correct to say that Global warming has essentially stopped for the past 14 years, as mean global temperature has been basically the same during that time. This is not to say that we aren’t in a warm spell. Global warming skeptics (myself included) are not saying that CO2 isn’t a greenhouse gas, and they are not denying that it has been warm. However, I am extremely skeptical of models predicting a steady rise in temperature that have failed to predict the current decade and a half stasis in global mean temperature. Why should such models be trusted to predict the future when they haven’t successfully predicted the present.

It reminds me of the central dogma of molecular biology years ago “DNA makes RNA makes Protein”, and the statements that man and chimpanzee would be regarded as the same species given the similarity of their proteins. We were far from knowing all the players in the cell and the organism back then, and we may be equally far from knowing all the climate players and how they interact now.

The Battle for the Soul of Smith College

The following letter to the Smith college newspaper “The Sophian” appeared in the current issue. Disclaimer: our neice went there, I’ve played chamber music with one of the Physics profs there, I’m currently studying a math book with an emeritus Smith prof who wrote it, I’ve audited a course there, I may take piano lessons from a retired music prof there. It’s a great institution with plenty of intelligent articulate undergraduates. Wendy Kaminer is a Smith Alumna. It will be fascinating to see how this plays out.

Chris Pyle

Mount Holyoke Professor

Thanks to The Sophian for publishing a transcript of what Wendy Kaminer actually said in New York. Now it is perfectly clear she is not a racist, but used the “n-word,” unexpurgated, to make a point about those caring souls who, in their effort to protect the sensibilities of students, violate free speech. The hyperventilating that followed Kaminer’s uncensored prose proves her point conclusively.

Imagine that Mark Twain had been invited to read some of his writings on campus, but that Kaminer’s critics discovered that he had used the “n-word” liberally in “The Adventures of Huckleberry Finn.” What should the college do? Disinvite him? Ask him to tone down his remarks because they might traumatize someone? Post “trigger warnings” all over campus?

The Sophian would publish Twain’s speech, but post warnings, like those that preceded the Kaminer transcript, declaring that “This author is guilty of ‘racism/racial slurs, sexist/misogynist slurs,’ and writes about ‘race-based violence.’” Twain’s admirers might be offended by such prissiness, but that’s too bad. The Sophian has a moral duty to give its adult readers early warning of impending isms on it pages. Otherwise they might be shocked, like little children confronted by age-inappropriate messages.

Unnoticed in last month’s kerfuffle was Kaminer’s provocative suggestion: “colleges and universities should . . . fire almost all of the student life administrators.” Why? Because they are the primary source of the patronizing idea that college students, especially women, are psychologically delicate souls, easily wounded by unvarnished prose. It is the duty of student life deans to create “safe spaces” for all students, free from words and ideas that might traumatize them (or anyone else).

These deans are direct descendants of Harriet Bowdler, the Victorian lady who persuaded her brother John, a publisher, to sanitize the great books so that they would be suitable for the fragile sensibilities of women and servants. As a result, it wasn’t until the 1950s that professors could find an unexpurgated edition of Shakespeare’s plays to assign to their students.

Kaminer is not the only critic of these well-meaning deans. The American Association of University Professors rejects the “presumption that students need to be protected rather than challenged” is both “infantilizing and anti-intellectual.” The American Library Association, the Foundation for Individual Rights in Education and the American Civil Liberties Union oppose content warnings for much the same reason that Smith professors once opposed Joe McCarthy’s censors who, when they weren’t removing books from libraries, stamped them with warning labels.

“When labeling is an attempt to prejudice attitudes,” the AAUP warns, it is a censor’s tool…If ‘The House of Mirth’ or ‘Anna Karenina’ carried a warning about suicide, students might overlook the other questions about wealth, love, deception and existential anxiety that are what those books are actually about.” The AAUP additionally says, “Trigger warnings also signal an expected response to the content (e.g. dismay, distress, disapproval) and eliminate the element of surprise and spontaneity that can enrich the reading experience and provide critical insight.”

When President McCartney’s committee meets, it will struggle over nothing less than the soul of the college. Will Smith continue to be a liberal arts college for strong women, or will it become a therapeutic shelter for the easily offended?

Professor Chris Pyle

It

Newer isn’t better in web page display

Something bad has happened to the displays of the journals I read online (Nature, Science, Cell, Nature and PNAS). It’s also happened to this WordPress as it displays the blog. Suddenly it is no longer possible to expand what is shown horizontally. This is important (to me) as I’m slightly visually impaired, which requires enlarging text size for readability. Limiting horizontal expansion, while increasing text size means that there is less on each line. This makes reading more irritating than it needs to be.

For an example of where this still is not happening, see In the Pipeline by Derek Lowe.

Does anyone out there know of a workaround? I see the same problem in FireFox and Safari.

I’m going to write WordPress to see if they have any suggestions. Their help service is remarkable, friendly, fast and even more amazing — free

The peculiar blindness of the highly intelligent

This is not a scientific post. While at Graduate Alumni day last April at Harvard, I listened to the main speaker go on and on about how irrational (translation: stupid) people were when it came to risk, particularly that of flying after 9/11. In terms of miles traversed, flying is far safer than driving. The speaker was Louise Richardson
PhD ’89, government, presently Principal and Vice-Chancellor of the University of St Andrews. Her topic was “Terrorism: what have we learned?”

Here’s who she is and what she’s done. In the years after 9/11, in addition to her teaching and management roles, Professor Richardson gave over 300 talks and lectures on terrorism and counter-terrorism to educational and private groups as well as policy makers, the military, intelligence, and business communities. She has testified before the United States Senate and has appeared on CNN, NBC, the BBC, PBS, NPR, Fox and a host of other broadcast outlets. Her work has been featured in numerous international periodicals.

Clearly, she’s listened to. As I sat there I wondered how her advice for society could be any good, given her contempt for the way most of its members think. I’m sure in the several hundred of so listeners there were some adamantly opposed nuclear power. Two years previously we heard professor Daniel Schrag talk on a geologist’s perspective on global warming, saying there was no such thing as ‘clean coal’ and how slowly carbon dioxide is cleared from the atmosphere. Clearly, nuclear power is cleanest mode of energy production, with the lowest risk etc. etc. Why are some highly educated (and presumably intelligent) people against it?

Which brings us to the mind set of Professor Gruber. Amazingly, Howard Dean (a man of the left) had the following to say about Professor Gruber and Obamacare on MSNBC

First Gruber: “The problem is not that Gruber said it– the problem is that he thinks it”

Then ObamaCare “The core problem under the damn law is that it was put together by a bunch of elitists who don’t fundamentally understand the American people. That’s what the problem is”

How could free health care be so unpopular.

The common delusion of the highly intelligent is that since they think so well, everyone should think like them, and if they don’t their behavior and institutions should be directed by their intellectual betters. Nothing much has changed in Cambridge in 54 years. This mindset was just as common then as it is now. You can see how well it’s working.

Well, probably most readers of this blog are highly educated (technically at least), and years away from dealing with the mass of humanity. Most doctors in practice see the full spectrum of the populace, because everyone gets sick.

Here’s what’s out there. Part of the neurologic examination is the mental status examination. One assesses a variety of things — orientation, speech, affect, calculation, memory etc. etc. One part often used to assess higher cognitive function is the ability to abstract. People are asked things like, what’s similar about an apple and an orange, a table and a chair. What’s different about a river and a lake. They can be asked for the meaning of familial proverbs “a stitch in time saves nine, people who live in glass houses shouldn’t throw stones. The point of the mental status is to separate the normal from the abnormal.

I pretty much had to abandon similarities and differences because so many normally functioning people thought extremely concretely. For the apple/orange similarity I’d get back they’re both round, or (worse) one is red the other is orange (not a similarity), or the proverb would be repeated back verbatim. I’d guess that 1/3 of people think this concretely.That table and chair were both furniture or that apples and oranges were both fruit was only the response about 60% of the time. You can either call the 1/3 abnormal (which means you need to redefine normal) or decide that the test is useless for picking up pathology. I chose the latter.

This is why I’ll only interview high school students for my Ivy league alma mater (Princeton). Princeton needs them as much as they need Princeton. They bring a dose of reality to a very cloistered environment.

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