Thursday, 18 February 2016

Discredited?

Note: Delays continued, apparently. This post was drafted in March of 2015, it’s now mid-February of 2016 before something else came along to inspire me to get back to work.

Last September I called my doctor’s office to ask about getting a flu shot. I was told that they no longer gave them, that I should just go to the pharmacy instead, but that I should wait because a reformulated vaccine would be available in October. But that was a time during which radiation had sent my brain somewhere else, and I thought no more about it until this past Sunday when a scratchy throat and sore eyes suggested that perhaps I should have been paying more attention last fall.

I think I have a good excuse. The national news tells me, however, that there are a great many people who skip vaccinations for their children without having any such excuse. I can think of numerous words to describe these people, moronic and selfish come to mind.

It seems that in 1998 one Andrew Wakefield wrote a story in the Lancet, a British medical Journal, in which he discussed several cases of children in whom autism first became apparent immediately after receiving the mumps, measles, and rubella vaccine. Many of the recent news stories have mentioned this article, calling it either “discredited” or “debunked” – which I consider appalling.

In science, and we certainly hope that medicine is a subset thereof, an investigator or experimenter observes physical events, conjures up a hypothesis to explain those events, and then devises an experiment or plan of research that will prove or disprove his hypothesis. It has long been noted that it is easy for the experimenter to see the results he seeks even when no clear indication actually exists in the data. This was demonstrated last March by the Background Imaging of Cosmic Extragalactic Polarization 2 (BICEP2) project, a group of astronomers seeking signs of the gravity waves left echoing through the universe from the first microseconds following the big bang. They may have, in fact, seen some such result, but it’s also quite possible that what they saw was the result of cosmic dust and this has been modeled by others and additional work is planned. That’s what “discredited” means. The case of the Wakefield article is nothing like this at all.

Wakefield had a history of attacking vaccination programs, he had a business plan laid out to take it advantage of public fears about the MMR vaccine,and his work was funded by private tort lawyers who would have been able to generate significant fees as a result of any public concern generated. The article suggested that the 12 cases he found were the random result of vaccination, when in fact they had been very carefully chosen. In short, the article was not discredited, it was fraudulent from the start. Wakefield lied. Most of Wakefield’s co-authors asked that their names be removed from the article almost immediately, and after a distressingly long interval, the Lancet formally retracted the entire article. On top of that, the British medical establishment withdrew Wakefield’s credentials as a physician.

Wakefield has subsequently moved to the US where he can stir the pot as the head of his own foundation, and seems to have found favor with some idiots who are willing to help spread his bogus word. I’m sure he continues to present himself as a doctor, but he has never had the privilege of practicing medicine in the US. His history of prevarication probably means that he never will, but the nonsense he has spewed about vaccinations continues to damage the public.

If I were King, journalists who insisted on referring to his articles as discredited rather than fraudulent would be called to the throne room for a good talking to, and “Dr” Wakefield would be banished.

Sunday, 27 July 2014

Richard Feynman, a “curious character”

Surely You’re Joking, Mr. Feynman!: Adventures of a Curious Charactercover
Richard P. Feynman (Author), Ralph Leighton (Editor)
W. W. Norton, 1985, 1997 paperback, 346pp plus backmatter

What Do You Care What Other People Think?: Further Adventures of a Curious Character
Richard P. Feynman (Author), Ralph Leighton (Editor)
W. W. Norton, 1988, January 2001 paperback, ~250 pp

Richard Phillips Feynman (1918 to 1988) was truly a curious character as the subtitles of these two volumes assert. Feynman was an imp, rarely accepting any limits on his curiosity. He shared the 1965 Nobel prize in physics for his contributions to quantum electrodynamics, one of the most puzzling and challenging areas of physics. But he also played the bongo drums and picked locks.

While working on his doctorate at Princeton he joined the Manhattan Project to develop the atomic bomb. As if the difficulties in this work weren’t sufficient to occupy his genius, he learned to open all of the filing cabinets and safes in which highly-classified work of the entire organization was stored. This may have actually been a significant contribution, based on the frequency with which more-senior scientists were unavailable for meetings and their notes were needed.

One of the noted physicists involved in the project was Hans Bethe, who took advantage of a quirk in Feynman’s character that others might not have welcomed. As Feynman describes it in the first volume, when talking physics he completely forgot any sense of rank or propriety. This meant that when a senior and respected scientist like Bethe or Fermi presented a new idea, the young Feynman was the only one ready to shoot holes in it. He spent a great many hours doing exactly that.book cover

Shortly before joining the Manhattan project Feynman married his first wife, Arline, who was suffering from tuberculosis. There was no on-site housing for families, and Feynman tells of borrowing cars and hitchhiking to visit her in the hospital. The title of the second volume comes from a recurring comment of Arline’s, who died in 1945.

Fascinated by rhythm, Feynman arranged a temporary teaching job at Rio de Janeiro, in hopes of learning Latin styles of drumming while he was there. He was greatly frustrated by his students rote memory-based approach to the textbook material when their total lack of deeper understanding was revealed. On the other hand, he was welcomed into a small marching band and was cheered on the streets of Ipanema during Carnevale parades.

Feynman was often noted for solving problems in an almost visual manner, laying out a problem on the blackboard, staring at it for significant length of time, and then writing down the solution without remembering any of the steps his brain had to go through to get there. Teaching required him, on occasion, to spend significant time trying to figure out what those steps were so he could present them to students.

When teaching at Caltech he frequently used a local topless bar as his office, sketching formulae on placemats and napkins. When the county attempted to close the bar, Feynman was the only patron who would testify to the public benefits of the disreputable place. At another point in his career he actually sought training in picking up women, his account of that experience is particularly notable.

Ralph Leighton, the son of one of Feynman’s colleagues at Caltech and a fellow drummer, goaded Feynman into telling a great many stories about his life, which he recorded and transcribed. These transcriptions, lightly edited, are the source of both of these volumes. Most of the tales are whimsical, displaying the range of Feynman’s activities outside of science, but the second of these two volumes includes much material related to Feynman’s involvement in the investigation into the Challenger disaster. Although engineers at Morton Thiokol, manufacturer of the solid-state booster rockets which failed in this case, were aware that low temperature led to leaks that bypassed the O-rings that sealed the joints between the rocket sections, it was Feynman challenging the authority of the investigating committee’s chairman and demanding information from NASA that led to identifying the cause of the tragedy.

As it happened, I read the two books out of sequence and do not have the second title available at the moment, for the most part I can’t tell you which story is in which volume. I greatly enjoyed both, and if the antics and capers of this brilliant scientist are of interest to you, it won’t matter to you either because you’ll want to read them both. Feynman was among the greatest of physicists and apparently a pretty good drummer, his writing isn’t really at the same level. But it’s his story and his voice and if you have any interest in the subject (and I can’t imagine how you might not), curl up with these and enjoy.

Thursday, 28 March 2013

Multiple sclerosis breakthrough!

Or not. Over the period when Congress was debating “health care reform” I had a lot I wanted to say about it but always got too wound up to actually say it. Suffice it to say that, in my judgment, there has not actually been one whit of discussion in Congress about health care reform and altogether too much regarding who to stick with the bill. Perchance I will address some of these issues soon. But a story in today’s New York Times, 3rd Oral Drug to Treat MS Is Approved by the F.D.A. by Andrew Pollack, was too much for me.

It seems that a Massachusetts company called Biogen Idec has just won approval for Tecfidera as an oral treatment for multiple sclerosis, the chemical name is dimethyl fumarate. It seems that analysts are predicting that the price of this will be $51,000 per year. Pollack doesn’t mention an actual dosage but says it will be twice daily, the illustration shows a jar of 240mg capsules. So let’s assume that this capsule size is the adult dose.

Now, based on the cost of aspirin, of which I can buy 500 tablets for about $7.50 or a penny and a half each, let’s assume that if I walk into a modern compounding pharmacy with a drug in hand I can have it made into pills and put in bottles for two cents a pill. So what does this new wonderdrug cost?

Assuming I buy it the most uneconomical way possible, which means buying it in small quantities as a reagent from a chemical company that supplies laboratories, I can buy dimethyl fumarate from Sigma-Aldrich for $56.20 for 100 grams. At 365.25 days per year, 2 pills per day, and 240mg of compound per pill, that’s 175.32 grams per year or $98.53 for the drug and $14.61 for making into pills. Total cost per patient comes to $114.14. Even if they hire exotic dancers to personally deliver each month’s pills to the patient, there’s way too much profit in this at $51,000 per year.

But somehow I don’t think they’re going to be buying the compound in small quantities from Sigma-Aldrich, I think they’re going to buy it in China, from whence so many of our drugs originate. So I went to Alibaba, the great Chinese business-to-business portal where I found lots of sources capable of providing 15 to 2,000 metric tons per month. Most don’t quote prices online, but one source expected it would cost about $5 per kilogram delivered to a west coast port. That’s 87.5 cents for the medication, make it into pills and we’re looking at $15.49.

And what is this marvelous drug, this dimethyl fumarate? It’s a failed biocide. It was originally used in furniture and shoes to prevent the growth of mold when stored in tropical climates. It was packaged in little sachets, like silica gel, until it was noticed that it caused skin rashes. The European Union banned it in consumer products in 1998.

I’ve long felt that many drug patents allowed big pharma to exploit patients, but in this case Biogen Idec doesn’t even hold a patent on the material, merely a patent for a “novel use” of a material which has been mentioned in patents since at least 1978. The very idea of a patent for a novel use is as offensive as a patent for a business process, but then the patent office seems to exist to benefit the rent seekers these days.

The discovery that dimethyl fumarate appears to be efficacious in treatment of MS is a great and wonderful thing. Somebody should make a stunning amount of money by marketing it, a very suitable reward for the effort and expense of identifying the use and testing. In fact, they should charge a buck a pill, $730 per year. If I Were King, I might let them charge even twice that. But not $51,000 for pills that cost $15 to make.

Wednesday, 22 August 2012

Todd Akin, Redux

What Rep Akin said on Monday regarding his plan to not allow an exception for pregnancies resulting from rape in legislation he would like to see was this, “If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.” For obvious reasons, this has caused a dramatic kerfuffle, most of his own party wanted him to withdraw from the race. Significantly, he could have done just that by close of business on Tuesday and allowed the party to replace him with very little expense or inconvenience.

Apparently his political judgment is as acute as his comprehension of human physiology and he not only failed to withdraw he brazenly committed himself to continuing the race. He apologized for his remarks: “Rape is an evil act. I used the wrong words in the wrong way, and for that I apologize.” No, Congressman, you didn’t use the wrong words in the wrong way, you used very effective words in a brilliant way to demonstrate that you are absolutely clueless.

To my great surprise, much of the published discussion about the case somehow actually revolves around the extreme, if common among social conservatives in the Republican Party, position that there should be no exception for rape in any future ban on abortion. But that seems to dramatically miss the point. Akin is in a position of significant power and believes that he has the moral, theological, and philosophical authority to control the medical decisions of women when he doesn’t understand as much of the process as the average 13-year-old girl. At least where I grew up, girls seemed to have an extremely clear understanding of human reproduction, even if some of us boys were a little slower.

If I Were King I would be grateful that I was not king of Missouri.

Tuesday, 21 August 2012

Medical expertise and Todd Akin

In my youth, most Americans tended to defer to their doctors on questions of diagnosis and treatment. It was father-knows-best, most doctors were men and most patients treated them as demigods. I think it’s a clear improvement that we generally take responsibility for our own health care decisions now.

If my doctor tells me “We’re going to do blah-blah-blah” I am likely to reply “What if we try this <other> first?”. Or if a prescription is mentioned, I’m likely to ask if that’s the most effective solution or if a less-expensive drug might not avail. Or even, on rare occasions, “You’re not listening to me!” before overruling the doc’s initial plan.

On the other hand, my doctor has more training and more experience. I don’t think I’ve ever challenged a choice of antibiotic, I just don’t know all the variations on that theme and primary-care doctors do. Plus, she has the prescription pad, so as with almost every case, we have to agree on a plan before we can pursue it.

There are obvious exceptions. Young children would never choose to have their vaccinations, so parents have to make that decision. Some pathetic souls have been ruled incapable of managing their own affairs and a guardian steps in to the breech. And some simply lack the intellectual horsepower or discipline to make these decisions.

For example, Todd Akin, a Republican representative from Missouri’s second dictrict and now running for the Senate, recently avered that women who had been victims of a “legitimate rape” had physiological responses that prevented conception, so we shouldn’t need to exempt rape victims from a ban on abortions. That’s a two-fer: there should be no ban on abortion that would interfere with a woman’s ability to choose a course of medical treatment in consultation with her doctor, and Todd Akin is clearly among those without the knowledge and intelligence to manage anyone’s health.

If I Were King I would certainly work with my parliament, but I’m certain that a parliament elected by my subjects wouldn’t put an ill-informed cretin like Todd Akin on a committee on science, space, and technology.

Sunday, 30 January 2011

GM Alfalfa, Yummy!

The Department of Agriculture has announced its approval for unrestricted commercial cultivation of genetically modified alfalfa, according to “U.S. Approves Genetically Modified Alfalfa” by  Andrew Pollack in The New York Times. Unlike some, I’m not convinced that GM crops are a bad thing. There had been a proposal to restrict the areas in which this crop could be grown to protect traditional strains from contamination from wind-carried pollen. Again, I’m not overwhelmed by the problem. Organic farmers don’t use Roundup (glyphosphate) on their crops and thus don’t need Monsanto’s Roundup-Ready seed, nor would they benefit from it.

What I am convinced of is that there exists a huge problem in Monsanto’s approach to their Roundup-Ready GM seed, specifically the way they have defended their intellectual property. Anyone who uses any of their GM seeds is bound by contract to not save any of the crop to use as seed for the following year. This seems fundamentally unsound, farmers have traditionally processed a portion of each year’s crop to plant the following year. In every farming community, at least one supplier has operated a seed cleaning operation to process those seeds, presumably treating them with any necessary fungicide and ensuring they were properly dried. It’s a fundamental part of historical farming, the essence of sustainability.

Monsanto is entitled to make a complete replacement of their seed a condition of their sales contracts, and farmers are entitled to sign those contracts. However, Monsanto goes well beyond this. When their crops are grown, pollen blows off those fields into the fields of farmers that have not chosen to grow GM crops, and the resulting seed inevitably contains some that contains the glyphosphate-tolerant gene. Monsanto sends agents out, takes samples, and sues farmers who attempt to plant the seeds they have grown themselves if the gene is found. They have forced hundreds of suppliers to discontinue seed cleaning operations.

Some provision should have been made so that organic-certified farmers would be protected from the encroachment, as selling their crops as “organic” becomes impossible once genes from the GM crop has contaminated it. This is regrettable, one hopes that the farmers themselves will decide to not plant the expensive Monsanto product in enough areas that untainted seed continues to be available. Monsanto should be responsible for the additional expenses needed by farmers who choose to continue with the traditional product.

The very idea of patenting a gene still causes me some difficulty, but it’s currently the law and I don’t resist it. However, the law is running exactly the wrong direction on enforcing this. If I Were King, farmers who innocently ended up with the Monsanto gene in their seed would absolutely have the right to plant it the following spring. I would be tempted to consider Monsanto’s suits against such farmers to be frivolous and malicious and order that the farmers be granted at least three times their legal expenses and lost time spent in defending themselves.

Saturday, 29 January 2011

The Tevatron

The Department of Energy has announced that the Tevatron at Fermilab will shut down late this year. The idea is that the Large Hadron Collider is coming on line and promises more power and greater range of research opportunities. This is, intellectually, on the same plane as eschewing adult supervision of deep-water oil drilling.

Yes, the LHC will run at seven times the power of the Tevatron. Some day. Possibly in 2012, but maybe not. 2012 is the year they’re going to shut the LHC down to address the problems that have kept it from reaching its full potential. This does not necessarily mean that 2012 is the year they’ll turn it back on.

In addition, although there are certainly research projects that really need the higher levels of power, some 1,200 physicists are currently doing experiments on the Tevatron. The LHC is only one collider. Being much larger, it’s very likely that it will actually take longer to switch over from one experiment to another, which means if we only have one collider, while we can do higher-energy research on the LHC we may be stuck with less total research. And of the many projects that don’t require that level of power, it would make far more sense to run the Tevatron flat out while the LHC is running at a higher power level, rather than using the LHC at fractional power levels.

Do I need to mention that with the Tevatron retired and the LHC down for repairs, there will be a period next year in which none of the physicists will be able to do their research?

What about the fact that the LHC consumes so much electrical power that it will not be able to operate year-round? There’s only so much snow in the Alps.

I don’t know what it cost to build the Tevatron, but I doubt that reaching .98 terevolts came cheap. As long as we’ve made the investment, continuing to operate the accelerator as long as maintenance costs are reasonable is the right course. If we have research to do, shutting down what has been the most productive lab in that subject area for the last two decades is simply wrong.

If I Were King, there would be no question of trying to balance the nations huge budget with the nickels and dimes in Fermilab’s piggy bank.

Wednesday, 26 January 2011

As smart as cows?

A story in The New York Times, F.D.A and Dairy Industry Spar Over Testing of Milk by William Neuman, discusses a bit of a controversy going on between the FDA and the dairy industry over testing.

Disclosure: My dad grew up at Carnation, Washington, a company town for one of the major dairy companies, so I tend to be on the side of the dairy farmers. I have no use for milk, but there aren’t many cheeses I don’t enjoy, I do like cream in soups, and like Julia Child, butter is my favorite ingredient. On the flip side, I detest agriculture subsidies, which the dairy industry gets a lot of. I’m also solidly opposed to the prescription drug system in which doctors and pharmacists have the monopoly on deciding what drugs can be taken, but note that if there is one class of drugs where I see a public interest in controlling drug use, that one class would be antibiotics. And I’m always in favor of more information.

So here’s the kerfuffle: The FDA currently tests loads of milk for four to six common antibiotics. If the tests shows that the drugs have entered the milk, the entire load has to be destroyed. The FDA, based on results of testing on dairy cattle sent to slaughter, wants to test for two dozen other antibiotics, as well as flunixin, a common pain killer and anti-inflammatory used in the industry. However, the tests aren’t instant like the current simpler ones are, they can take a week.

The industry is frightened by the prospect of holding that milk until the test results are known (they obviously can’t actually do this, no dairy has the facilities to segregate and safely store that much milk), or that after processing the test results will lead to recalls of the product. At least one cooperative dairy has announced that it will not accept milk that has been sampled for the additional tests, and it’s likely that other processors will take the same stance.

Are these people as smart as the cows? They would clearly prefer to process milk with no idea what the level of drug contamination is than to consider the possibility that there might be a problem to address. I doubt that the FDA is guiltless here, it wouldn’t surprise me to learn that the rules require destroying the product if those traces are present. Zero-tolerance rules are much beloved by the mindless, a group that is often involved in government.

The question of antibiotics entering the food stream is important, and it would be a most excellent thing to understand the situation, monitor any trends, set standards, develop best practices in the industry, and finally establish go/no-go rules. But none of those things can be done without the result of the tests.

If I Were King I would have no power to increase the intelligence of stubborn farmers and bureaucrats. I could, however, insist that the tests be performed and the information recorded, charted, and analyzed. I could, and obviously would have to, declare that the results of these additional tests would not result in the destruction of any milk until everybody, on both sides of this issue, knew what the hell they were doing.

Thursday, 14 January 2010

The Devil Made Me Do It

It’s not always easy to be a devout Christian in an increasingly-secular world, but the worst of it doesn’t come from agnostics, or even the believers who just don’t feel moved to participate regularly in worship. I say grace before eating at McDonald’s and openly cross myself afterward, without attracting hostility. The hard part of it is that those who see me as Christian can’t help trying to reconcile that image with the image of some of the Lord’s spectacular fools. Yesterday, the day after a devastating earthquake in Haiti, the most spectacular fool was one Pat Robertson, who has a show called The 700 Club that appears on CNN.

On his broadcast yesterday, Robertson delivered this absurdity:

And you know Christy, something happened a long time ago in Haiti and people might not want to talk about it. They were under the heel of the French, uh, you know Napoleon the third and whatever. And they got together and swore a pact to the devil. They said we will serve you if you’ll get us free from the French. True story, and so the Devil said OK it’s a deal. And they kicked the French out. You know, the Haitians revolted and got themselves free. But ever since they’ve been cursed by one thing after the other.”

His broadcasting operation, CBN, doesn’t seem to be bothered by this. They admit it in this release, and they have the video online. (My system wouldn’t play it, but that’s okay, it’s all over the place, including right here.

Now it happens that a voodoo priest named Dutty Boukman performed a ceremony in August of 1791 which precipitated the start of the revolution, which lasted until 1804. I’ve not seen any accounts that include the number of people involved, but as it wasn’t broadcast we can assume that there were a half million Haitian slaves that had nothing to do with this, other than sharing the desire to end their slavery. I’ve not seen any account that suggests that Satan attended, nor that he clearly committed himself to a deal. We do know that Napoleon III was captured in battle, and the monarchy he led was dissolved on 4 September 1870. He was the last Napoleon to have anything to do with the government of France, and he died on 9 January 1873. Robertson’s pact with the devil didn’t take place until over twenty years after the last Napoleon left power.

I suppose it’s a waste of time to point out that earthquakes are the result of tectonic motion in the rigid structure immediately below the surface of this liquid-centered globe we live on. That’s not covered in the only book Robertson really accepts, my telling him the details of how the planet God created works would be lost on him.

It’s hard to admit to being a Christian when there are “Christian” embarrassments of this magnitude spewing their nonsense on national television. I want to make one thing clear: Pat Robertson doesn’t speak for me. I seriously doubt that he speaks for Jesus Christ. If he does, he has managed to find a Jesus that isn’t present in the Gospel I’ve read. Never mind that he has the historical scholarship of a third grader and the intellectual capacity of cauliflower.

Thursday, 25 June 2009

Motivation

In A Pound of Cure, published in the July/August MIT Technology Review, Andy Kessler challenges the possibility of addressing the cost of health care without addressing the motivations of the health-care industry. He references the recent Dartmouth College study that suggests, based on analysis of 4,000 hospitals, that eliminating 30% of the resources committed to Medicare patients would be possible, those resources having contributed nothing at all to the outcomes of the patients. He doubts that the $19 billion for health-care IT projects included in the $787 billion Obama stimulus package can accomplish anything.

Elsewhere I have stated my opinion that fully 50% of all health care spending could be eliminated with a combination of electronic records and diagnostic software. Electronic records would make it easy to use data-mining software to evaluate the success of different treatment regimes for various ailments. (If a patient knew there was an 80% probability of success with a $1,000 treatment and an 80% probability of success with a $1,000,000 treatment, which one would they choose?) Diagnostic software would help focus diagnosis, eliminating billions in wasted tests.

But as Kessler points out, the health-care industry makes more money when it consumes more resources. The bias of practitioners with an economic stake will always be to spend more. There are few, if any, practitioners with no economic stake.

This is, and will remain, a stubborn problem. If I Were King it would be no different. Better health insurance will not help, that just means that each patient has more resources available. The only thing that has a chance is a combination of patient understanding of the costs and benefits of different options, and an economic stake in choosing among them.

Should we spend a million bucks to keep Mom on life support for another six months? What if that means that nobody in the family will see a dentist for the next ten years? Clearly there are times when heroic (read: expensive) efforts are worthwhile, and times when they provide no more benefit than burning the same amount of currency.

We need better understanding of the costs and benefits, which open electronic records will enable, and then we need to empower patients and families, consulting with health-care professionals, to make judgments about the resources to be used. The industry’s motivation will always be towards growth in spending, I see no reason why we can’t cut that spending in half in the next ten years.