August 25, 2016

"Doctors Often Do Not 'Know' What They Are Doing"



(p. A11) Into the "swift currents and roiling waters of modern medicine" plunges Dr. Steven Hatch, whose informative "Snowball in a Blizzard" adds an important perspective. Dr. Hatch believes that our health-care system can "champion patient autonomy" and facilitate "more humane treatment, less anxiety, and better care" by revealing to patients the "great unspoken secret of medicine." What's the secret? Simply stated, "doctors often do not 'know' what they are doing." In Dr. Hatch's view, despite spectacular advances in biomedical science, modern "doctors simply cannot provide the kind of confident predictions that are often expected of them."


. . .


He begins where Donald Rumsfeld ended: There will always be "known knowns, known unknowns, and unknown unknowns" in medicine. Dr. Hatch illustrates this spectrum of uncertainty with engaging exposés of popular screening tests like mammograms (attempting to detect breast cancer is like "finding a snowball in a blizzard"); common drug treatments, like those used to lower serum cholesterol or blood-pressure levels (about which expert national guidelines seem to change almost yearly); and health-care coverage in the lay media (whose "breaking news" too often ignores the uncertainty of the news being broken). Throughout his book, Dr. Hatch's message is "caveat emptor," warning his readers to beware not only the pseudoscientists, flim-flammers, anti-vacciners and celebrity doctors but also the all-too-certain pronouncements of the medical establishment.



For the full review, see:

BRENDAN REILLY. "BOOKSHELF; Give It To Me Straight, Doc; Doctors can't really be certain if any treatment will help a particular person. But patients are looking for prescriptions, not probabilities." The Wall Street Journal (Tues., March 15, 2016): A11.

(Note: the ellipsis between paragraphs, and the first two in the final quoted paragraph, are added; the third ellipsis in the final paragraph is in the original.)

(Note: ellipsis added.)

(Note: the online version of the review has the date March 14, 2016.)


The book under review, is:

Hatch, Steven. Snowball in a Blizzard: A Physician's Notes on Uncertainty in Medicine. New York: Basic Books, 2016.






August 24, 2016

Monopolist Ede & Ravenscroft Had 98% of Legal Wigs Market



(p. A1) British barristers and judges have worn wigs since Charles II Imported the idea from France in the 1670s. A London company, Ede & Ravenscroft Ltd., today claims 98% of the market for legal wigs in the United Kingdom. The wigs distinguish barristers from solicitors, lawyers who ordinarily don't appear In court.

Ede & Ravenscroft, 300 years old, pursues its monopoly from a narrow London shop whose carved mahogany paneling, brass rails and chest-high counters hark back to the Victorian era.


. . .


(p. A7) In a stuffy loft two floors above, six women fabricate about 1,000 wigs a year on pockmarked wooden blocks resembling shrunken skulls. The wigmakers attach rows
of tightly rolled curls and a pair of ponytails with painful hand stitching, using 12-yard lengths of bleached curls made from horses' tails and manes.

They strictly follow a pattern conceived by Humphrey Ravenscroft in 1822 when he invented the "modern" horsehair wig with fixed curls. It replaced ones made of goat hair, which had to be powdered and dressed with scented ointment every day to conceal the filth.



For the full story, see:

Lublin, Joann S. "Who Has Means and Motive to Steal in Halls of Justice?; British Barristers, It Seems, Can't Resist Purloining Each Other's Ratty Wigs." The Wall Street Journal (Weds., Oct. 4, 1989): A1 & A7.

(Note: ellipsis added.)






August 23, 2016

The Most Popular Kremlin Line



(p. A4) In an interview, Mr. Gorbachev shrugged off the fact that 25 years after the collapse of the Soviet Union, he remains among the most reviled men in Russia. "It is freedom of expression," he said.


. . .


Some adore him for introducing perestroika, or restructuring, combined with glasnost, or openness, which together helped to jettison the worst repressions of the Communist system. Mr. Gorbachev led the way, albeit haltingly, toward free speech, free enterprise and open borders.

"Some love him for bringing freedom, and others loathe him for bringing freedom," said Dmitri Muratov, the editor of Novaya Gazeta, one of the few remaining independent newspapers and one in which Mr. Gorbachev holds a 10 percent stake.


. . .


Mr. Muratov said they often recounted the same joke, based on Mr. Gorbachev's infamous campaign to lower alcohol consumption:

Two men are standing in a long, long vodka line prompted by the limited supply. One asks the other to keep his place in line, because he wants to go over the Kremlin to punch Gorbachev in the face for his anti-alcohol policy. He comes back many hours later and his friend asks him if he had indeed punched Gorbachev. "No," the man answered despondently. "The line at the Kremlin was even longer."



For the full story, see:

NEIL MacFARQUHAR. "Reviled, Revered, and Still Challenging Russia to Evolve." The New York Times (Thurs., JUNE 2, 2016): A4.

(Note: ellipses added.)

(Note: the online version of the story has the date JUNE 1, 2016, and has the title "Reviled by Many Russians, Mikhail Gorbachev Still Has Lots to Say.")






August 22, 2016

Economist Removed from Plane for Scribbling Math




The seatmate was wrong to think the scribbling was Arabic, but was right to be alarmed.


(p. A13) In May [2016], an Italian economist from the University of Pennsylvania was removed from an American Airlines flight in Philadelphia after his seatmate became alarmed, thinking that the math he was scribbling on a piece of paper was Arabic, The Washington Post reported.


For the full story, see:

CHRISTINE HAUSER. "American Airlines Orders 2 Muslim American Women Off a Long-Delayed Flight." The New York Times (Sat., AUG. 5, 2016): A13.

(Note: bracketed year added.)

(Note: the online version of the story has the date AUG. 5, 2016, and has the title "2 Muslim American Women Ordered Off American Airlines Flight.")






August 21, 2016

Brazilians See Government as a Father Who Should Hand Out Subsidies to His Favorites



(p. 9) . . . "Brazillionaires" offers more than a flat collection of billionaire tales. Cuadros shrewdly presents his collage of immense wealth against an underlying background of corruption. There are kickbacks for government contracts. There are gigantic taxpayer subsidies: In 2009 alone, the state-run development bank, BNDES, lent out $76 billion, "more than the World Bank lent out in the entire world." And of course there are lavish campaign contributions, attached to the inevitable quid pro quos. JBS, which leveraged government loans to become the largest meatpacking company in the world, spent $180 million on the 2014 elections alone. "If every politician who had received JBS money formed a party," Cuadros writes, "it would be the largest in Congress."

In his telling, Brazilians seem to embrace the cozy relationship between business and government as a source of pride rather than a risk for conflicts of interest. In one passage, Cuadros underscores the contrast between Adam Smith and the 19th-century Brazilian thinker José da Silva Lisboa, viscount of Cairu. Lisboa's "Principios de Economía Politica" was meant to be an adaptation of Smith's "Wealth of Nations." But rather than present a paean to the invisible hand of the market, the viscount offered a rather paternalistic view of economic progress.

"The sovereign of each nation must be considered the chief or head of a vast family," he wrote, "and thus care for all those therein like his children, cooperating for the greater good." Swap "government" for "sovereign" and the passage still serves as an accurate guide to the Brazilian development strategy. It's just that some children -- the Marinhos, the Camargos -- are cared for better than ­others.


. . .


It would be wrong, . . . , to understand Brazil's plutocracy as the product of some unique outcrop of corruption. The hold on political power by the rich is hardly an exclusive feature of Brazil. ­Latin America has suffered for generations from the collusion between government and business. Where I grew up, in Mexico, it is the norm.



For the full review, see:

EDUARDO PORTER. "Real Rich." The New York Times Book Review (Sun., JULY 24, 2016): 9.

(Note: ellipses added.)

(Note: the online version of the review has the date JULY 22, 2016, and has the title "Watching Brazil's Rich: A Full-Time Job.")


The book under review, is:

Cuadros, Alex. Brazillionaires: Wealth, Power, Decadence, and Hope in an American Country. New York: Spiegel & Grau, 2016.






August 20, 2016

Iowa State Students Go Bananas to Save (or Harm?) African Children



(p. A11) Student activists at Iowa State University are up in arms after researchers offered to pay them almost a thousand bucks to eat some genetically modified banana. The bananas, created by an Australian scientist, contain high levels of beta carotene, which converts to vitamin A when eaten.


. . .


"Those students are acting out of ignorance," Jerome Kubiriba, the head of the National Banana Research Program in Uganda, tells me. "It's one thing to read about malnutrition; it's another to have a child who is constantly falling sick yet, due to limited resources, the child cannot get immediate and constant medical care. If they knew the truth about the need for vitamin A and other nutrients for children in Uganda and Africa, they'd get a change of heart."



For the full commentary, see:

JULIE KELLY. "Anti-GMO Students Bruise a Superbanana." The Wall Street Journal (Tues., March 15, 2016): A11.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date March 14, 2016.)






August 19, 2016

"Draconian" Regulations Reduce Consumer Choice



(p. B1) The Consumer Financial Protection Bureau, the watchdog agency set up after the last financial crisis, is poised to adopt strict new national rules that will curtail payday lending.


. . .


(p. B6) A sweeping study of bans on payday lending, scheduled to be published soon in The Journal of Law and Economics, found similar patterns in other states. When short-term loans disappear, the need that drives demand for them does not; many customers simply shift to other expensive forms of credit like pawn shops, or pay late fees on overdue bills, the study's authors concluded.

Mr. Munn, who works as a site geologist on oil wells, first borrowed from Advance America eight months ago when his car broke down. He had some money saved, but he needed a few hundred more to pay the $1,200 repair bill. Then his employer, reacting to falling oil prices, cut wages 30 percent. Mr. Munn became a regular at the loan shop.

He likes the store's neighborhood vibe and friendly staff, and he views payday loans as a way to avoid debt traps he considers more insidious.

"I don't like credit cards," said Mr. Munn, who is wary of the high balances that they make it too easy to run up. "I could borrow from my I.R.A., but the penalties are huge."

At Advance America, he said, "I come in here, pay back what I've taken, and get a little bit more for rent and bills. I keep the funds to an extent that I can pay back with the next check. I don't want to get into more trouble or debt."


. . .


The rules would radically reshape, and in some places eliminate, payday borrowing in the 36 states where lenders still operate, according to Richard P. Hackett, a former assistant director at the Consumer Financial Protection Bureau.


. . .


"It's a draconian scenario," said Jamie Fulmer, an Advance America spokesman.



For the full story, see:

STACY COWLEY. "To Curb Abuse, Loan Rules May Cut a Lifeline." The New York Times (Sat., JULY 23, 2016): B1 & B6.

(Note: ellipses added.)

(Note: the online version of the story has the date JULY 22, 2016, and has the title "Payday Loan Limits May Cut Abuse but Leave Some Borrowers Looking.")






August 18, 2016

Androgen Lengthens Telomeres



(p. A3) Androgens, a kind of sex hormone, have been used to treat certain genetic blood disorders for decades. But doctors haven't been able to pinpoint exactly why they seem to help some patients. A small study puts forth a theory behind androgens' disease-fighting mechanism: They help stabilize and even rebuild telomeres, which increasingly diminish in certain conditions and aging.


. . .


The authors of the study, published Wednesday [May 18, 2016] in the New England Journal of Medicine, treated telomere-disease patients who had a variety of conditions with a high dose of a synthetic androgen called danazol. The goal was to test whether the treatment would help keep telomeres intact longer. Instead, they saw them lengthen.


. . .


Experts, including the study's authors, . . . warned against concluding danazol is a fountain of youth for the healthy, based on research that suggests that shrinking telomeres may be involved in aging.

"That," said Dr. Agarwal, "would be purely in the realm of speculation."



For the full story, see:

DANIELA HERNANDEZ. "How Sex Hormones Might Treat Some Diseases." The Wall Street Journal (Thurs., May 19, 2016): A3.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the story has the date May 18, 2016, and has the title "How Sex Hormones Might Treat Certain Diseases." The print version starts with a one-sentence summary paragraph that is absent in the online version. The second paragraph in the print version differs slightly from the first paragraph in the online version. The version quoted as the first paragraph above, is the first paragraph of the online version.)


The academic article mentioned above (though the date given by the NYT above appears to be a day too early), is:

Townsley, Danielle M., Bogdan Dumitriu, Delong Liu, Angélique Biancotto, Barbara Weinstein, Christina Chen, Nathan Hardy, Andrew D. Mihalek, Shilpa Lingala, Yun Ju Kim, Jianhua Yao, Elizabeth Jones, Bernadette R. Gochuico, Theo Heller, Colin O. Wu, Rodrigo T. Calado, Phillip Scheinberg, and Neal S. Young. "Danazol Treatment for Telomere Diseases." New England Journal of Medicine 374, no. 20 (May 19, 2016): 1922-31.






August 17, 2016

Creativity Is Correlated with "Openness to Experience"



(p. D3) "Insightful problem solving can't be boiled down to any single way of thinking," the authors say. Creative people have messy processes, and often messy minds, full of contradictions.

Contrary to the well-worn notion that creativity resides in the right side of the brain, research shows that creativity is a product of the whole brain, relying especially on what the authors call the "imagination network" -- circuits devoted to tasks like making personal meaning, creating mental simulations and taking perspective.

While creative people run the gamut of personalities, Dr. Kaufman's research has shown that openness to experience is more highly correlated to creative output than I.Q., divergent thinking or any other personality trait. This openness often yields a drive for exploration, which "may be the single most important personal factor predicting creative achievement," the authors write.

These are people energized and motivated by the possibility of discovering new information: "It's the thrill of the knowledge chase that most excites them."

Once the idea is found, alas, the creative process begins to resemble something more like grinding execution. It's still creative, but it requires more focus and less daydreaming -- one reason highly creative people tend to exhibit mindfulness and mental wandering.

"Creativity is a process that reflects our fundamentally chaotic and multifaceted nature," the authors write. "It is both deliberate and uncontrollable, mindful and mindless, work and play."



For the full review, see:

CHRISTIE ASCHWANDEN. "Books; The Blessed Mess of Creativity." The New York Times (Tues., FEB. 9, 2016): D3.

(Note: the online version of the review has the date FEB. 8, 2016, and has the title "Books; Review: 'Wired to Create' Shows the Science of a Messy Process.")


The book under review, is:

Kaufman, Scott Barry, and Carolyn Gregoire. Wired to Create: Unraveling the Mysteries of the Creative Mind. New York: TarcherPerigee, 2015.






August 16, 2016

Certificate-of-Need Regulations Protect Incumbents and Hurt Consumers



(p. A11) An important but overlooked debate is unfolding in several states: When governments restrict market forces in health care, who benefits? Legislative majorities in 36 states believe that consumers benefit, because restrictions help control health-care costs. But new research confirms what should be common sense: Preventing qualified health-care providers from freely plying their trade results in less access to care.

Most states enforce market restrictions through certificate-of-need programs, which mandate a lengthy, expensive application process before a health-care provider can open or expand a facility. The story goes: If hospitals or physicians could choose what services to provide, competition for patients would force providers to overinvest in equipment such as MRI machines--and the cost could be passed on to patients through higher medical bills.


. . .


These restrictions have largely failed to reduce costs, but they certainly reduce services. A 2011 study in the Journal of Health Care Finance found that certificate-of-need laws resulted in 48% fewer hospitals and 12% fewer hospital beds.



For the full commentary, see:

THOMAS STRATMANN and MATTHEW BAKER. "Certifiably Needless Health-Care Meddling." The Wall Street Journal (Tues., Jan. 12, 2016): A11.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date Jan. 11, 2016.)


The "new research" mentioned by Stratman in the passage quoted above, is:

Stratmann, Thomas, and Matthew C. Baker. "Are Certificate-of-Need Laws Barriers to Entry?: How They Affect Access to MRI, CT, and Pet Scans." Mercatus Working Paper, Jan. 2016.









Eight Most Recent Comments:



Ed Rector said:

There are more than 2000 colleges in the USA offering tens of thousands of degrees/majors. Oh yes, there are also a few thousand JC's, trade schools and apprentice programs that train welders. Who should decide what any individual student wants to study?? Senator Rubio, the Mercatus Center or the individual student?? And you call yourselves 'freedom-loving Libertarians' !!



Aaron said:

You need a "like" button. Here's to enjoying bacon and eggs on an unusually warm fall day and doing so guilt free.



Aaron said:

I'd also suggest that work is just part of who some people are and a reason they got rich. A friend's dad comes to mind; he's a millionaire and in his 60s and a couple years ago I saw him cleaning one of his rental houses and wondered why he didn't pay someone to do it, but he's just one of those guys who'd rather work than golf or relax.



Jim Rose said:

It is often forgotten that the Minister for International trade and industry in the late 1960s up until 1971 was Tanaka – the most corrupt man in postwar Japanese politics. He had previously been Minister for Public Works, but to generate the necessary bribe income to pay an entire generation of Japanese politicians to step aside to allow him to become Prime Minister in the early 1970s at a young age, he thought the Ministry of International trade and industry was a better position to garner influence and donations. My professors in Japan worked in the Ministry of International trade and industry and the Ministry of Finance in the 1970s and 1960s. None of them seemed to carry over their picking winners skills into their private portfolios when they retired. see http://utopiayouarestandinginit.com/2014/03/14/if-you-are-so-smart-why-arent-you-rich/



Aaron said:

Interested to see how not only did Hamilton gain a vote, but also how Jefferson lost one.



Dave Megan said:

Merging of companies is always better when they have a better goal. It will give better service for the public.



Ed Rector said:

The 'quickened pace of production' of the early Reagan years was directly attributable to RR's massive deficit spending. The national debt almost tripled under the watch of St. Ronnie. BO will have to work overtime to even approach this record of accomplishment.



Aaron said:

The last two paragraphs comport perfectly with what Paul Tough describes in a book you posted on a few months ago, "How Children Succeed." Tough advocates that a stable, loving relationship between kids and their parents, especially in the first few years of life, produces self-assured and less anxious adults due to brain formation or chemical reactions that take place in a baby's brain (simplified summary). As always, appreciate the posts, especially the Paul Tough book.





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