Month: December 2020

Chris Rock on Covid-19, Blackface, and Cancel Culture

(p. 7) [Rock:] Part of the reason we’re in the predicament we’re in is, the president’s a landlord. No one has less compassion for humans than a landlord. [Laughs.] And we’re shocked he’s not engaged.

Did you ever see that movie “The Last Emperor,” where like a 5-year-old is the emperor of China? There’s a kid and he’s the king. So I’m like, it’s all the Democrats’ fault. Because you knew that the emperor was 5 years old. And when the emperor’s 5 years old, they only lead in theory. There’s usually an adult who’s like, “OK, this is what we’re really going to do.” And it was totally up to Pelosi and the Democrats. Their thing was, “We’re going to get him impeached,” which was never going to happen. You let the pandemic come in. Yes, we can blame Trump, but he’s really the 5-year-old.

Put it this way: Republicans tell outright lies. Democrats leave out key pieces of the truth that would lead to a more nuanced argument. In a sense, it’s all fake news.

. . .

[Itzkoff:] Jimmy Fallon drew significant criticism this past spring for a 20-year-old clip of himself playing you in blackface on “Saturday Night Live.” How did you feel about that segment?

[Rock:] Hey, man, I’m friends with Jimmy. Jimmy’s a great guy. And he didn’t mean anything. A lot of people want to say intention doesn’t matter, but it does. And I don’t think Jimmy Fallon intended to hurt me. And he didn’t.

. . .

[Itzkoff:] There’s been a wider push to expunge blackface from any movies or TV shows where it previously appeared. Have people taken it too far?

[Rock:] If I say they are, then I’m the worst guy in the world. There’s literally one answer that ends my whole career. Blackface ain’t cool, OK? That’s my quote. Blackface is bad.

For the full interview, see:

Dave Itzkoff, interviewer. “Chris Rock’s New Universe.” The New York Times, Arts&Leisure Section (Sunday, September 20, 2020): 6-7.

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

(Note: the online version of the interview was updated Sept. 24, 2020, and has the title “Chris Rock Tried to Warn Us.”)

2016 Law Requires FDA to Move to Mining Real-World Data and Away from Costly and Slow Clinical Trials

(p. A1) Drugmakers are trying to win drug approvals by parsing vast data sets of electronic medical records, shifting away from lengthy, and costly, clinical trials in patients.

. . .

For the companies, the use of real-world data can cut costs and shorten drug-development times. Instead of finding trial subjects, companies simply mine hospital and doctor files for cases where patients already took a drug in routine medical care, looking for changes in blood pressure, tumor size and other readings to see if the medicine is helping or causing a side effect.

. . .

(p. A2) . . . for rare diseases especially, it can take a while to even enroll enough patients in studies. And their cost can limit the number of trials that companies can fund, drugmakers say.

A 2016 law required the FDA to explore greater use of real-world data, and the agency is developing standards to assess the reliability of different data sources and which kinds of decisions the data support.

“Real-world evidence should not be a means toward dropping standards, but rather a mechanism to have more efficiency in evidence generation while maintaining standards,” said FDA Principal Deputy Commissioner Amy Abernethy, a former executive at health-data firm Flatiron Health.

A market has emerged in recent years for digital drug-use information. Iqvia Inc., which tracks prescription and health data, has about a dozen projects under way, said Nancy Dreyer, the company’s chief scientific officer of real-world evidence.

For the full story, see:

Peter Loftus. “Drugmakers Mine Data to Avoid Clinical Trials.” The Wall Street Journal (Tuesday, Dec. 24, 2019): A1-A2.

(Note: ellipses added.)

(Note: the online version of the story was updated Dec. 23, 2019, and has the title “Drugmakers Turn to Data Mining to Avoid Expensive, Lengthy Drug Trials.”)

“Normal” Human Temperature May Be Lower When Baseline Inflammation Is Lower

When I was a child my mother would hand me an oral thermometer to take my temperature and often the temperature would come out below 98.6 degrees. She would be annoyed and hand it back to me, saying that I should put it in right this time. I would painfully jab the thermometer back under my tongue, discouraged that I would never figure out what I was doing wrong. So several decades later, I smiled when I read the commentary quoted below. (Hey mom, maybe I was doing it OK all along.)

(p. A2) Nearly 150 years ago, a German physician analyzed a million temperatures from 25,000 patients and concluded that normal human-body temperature is 98.6 degrees Fahrenheit.

That standard has been published in numerous medical texts and helped generations of parents judge the gravity of a child’s illness.

But at least two dozen modern studies have concluded the number is too high.

The findings have prompted speculation that the pioneering analysis published in 1869 by Carl Reinhold August Wunderlich was flawed.

Or was it?

In a new study, researchers from Stanford University argue that Wunderlich’s number was correct at the time but is no longer accurate because the human body has changed.

Today, they say, the average normal human-body temperature is closer to 97.5 degrees Fahrenheit.

. . .

“Wunderlich did a brilliant job,” Dr. Parsonnet said, “but people who walked into his office had tuberculosis, they had dysentery, they had bone infections that had festered their entire lives, they were exposed to infectious diseases we’ve never seen.”

For his study, he did try to measure the temperatures of healthy people, she said, but even so, life expectancy at the time was 38 years, and chronic infections such as gum disease and syphilis afflicted large portions of the population. Dr. Parsonnet suspects inflammation caused by those and other persistent maladies explains the temperature documented by Wunderlich and that a population-level change in inflammation is the most plausible explanation for a decrease in temperature.

For the full commentary, see:

Jo Craven McGinty. “THE NUMBERS; 98.6 Degrees Is No Longer the Body’s Norm.” The Wall Street Journal (Saturday, January 18, 2020): A2.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date January 17, 2020, and has the title “THE NUMBERS; 98.6 Degrees Fahrenheit Isn’t the Average Anymore.”)

Mathematical Disciplines Need the “Re-injection” of “Empirical Ideas”

(p. C4) Mathematicians have faced a similar choice between pure and applied work for millennia. In his 1940 book “A Mathematician’s Apology,” G.H. Hardy made a hard-core case for purity: “But is not the position of an ordinary applied mathematician in some ways a little pathetic?…‘Imaginary’ universes are so much more beautiful than this stupidly constructed ‘real’ one.”

On the other hand, John von Neumann rebuked purity in his 1947 essay “The Mathematician”: “As a mathematical discipline travels far from its empirical source…it is beset with very grave dangers. It becomes more and more purely aestheticizing,…whenever this stage is reached, the only remedy seems to me to be the rejuvenating return to the source: the re-injection of more or less directly empirical ideas.”

I think von Neumann has the better of this argument. In his own career, he used his mathematical talents to pioneer fields like game theory and computer science, leaving a titanic legacy, practical as well as intellectual.

For the full commentary, see:

Frank Wilczek. “WILCZEK’S UNIVERSE; Beautiful, Impractical Physics.” The Wall Street Journal (Saturday, Oct. 31, 2020): C4.

(Note: ellipses in original.)

(Note: the online version of the commentary has the date October 29, 2020, and has the same title as the online version.)

The John von Neumann essay mentioned above is:

Neumann, John von. “The Mathematician.” In Works of the Mind, edited by Robert B. Heywood. Chicago: University of Chicago Press, 1947, pp. 180-96.

Ranchers Will Protect and Invest in Brazilian Forest Land That They Own

(p. A1) POMBAL, Brazil—For the past 15 years, Carlos Pacheco has raised cattle in what was once virgin forest. When pastures went bad, he would simply cut deeper into the Amazon, one of millions of farmers who have helped strip away about a fifth of the world’s greatest rainforest.

Because he expanded into land he doesn’t own, he can’t use it as collateral for a loan to buy equipment and fertilizer, nor can he tap the expertise of a government agronomist. The upshot is that he uses more land to raise each cow than do legal farmers in the breadbasket of southern Brazil.

It may sound counterintuitive, but Brazilian authorities think giving Mr. Pacheco a deed to the land he farms might curtail deforestation. The idea is it could help him become a more efficient farmer, able to produce more on less land, and also make him hesitate to just walk away from depleted pastures and carve new ones. In short, it might discourage him and squatters like him from cutting ever deeper into the jungle.

“If this doesn’t happen, we will continue to deforest,” said the 49-year-old rancher, the leader of a tightknit group of several hundred settlers on the forest frontier.

The administration of Brazilian President Jair Bolsonaro wants to see if he is right. In February [2020], it plans to start handing out deeds to some 300,000 Amazon squatters, with a plan that might help but has raised a howl of disapproval for re-(p. A12)warding bad behavior.

. . .

Over the decades, 73-year-old cattleman João Bueno cut into the forest in Pará state to build a network of ranches totaling 45,000 acres, with 28,000 head of cattle.

He has a special document that allows him to produce and sell cattle to a slaughterhouse, but it isn’t a title, so it doesn’t allow him to use the land as loan collateral. Mr. Bueno said tapping credit would permit him to modernize his operation with fertilizer and techniques common elsewhere, raising three times as many head of cattle on the same acreage.

“Land without documentation is nobody’s land, so people take advantage of it to clear forest for pastures,” Mr. Bueno said.

For the full story, see:

Paulo Trevisani and Juan Forero. “Brazil’s Unusual Bid to Curb Deforestation.” The Wall Street Journal (Saturday, February 1, 2020): A1 & A12.

(Note: ellipsis, and bracketed year, added.)

(Note: the online version of the story has the date January 31, 2020, and has the title “Squatters Cut Down the Rainforest. Brazil Wants to Give Them the Land.”)

How “Single-Payer” Socialized Medicine Works for American Indians

(p. A1) EAGLE BUTTE, S.D.—Kate Miner walked into the Indian Health Service hospital, seeking help for a cough that wouldn’t quit.

An X-ray taken of Ms. Miner’s lungs that day, Oct. 19, 2016, found signs of cancer.

What exactly the IHS doctor said to Ms. Miner about her exam remains in dispute. Notations in her medical file indicate the doctor told her to come back for a lung scan the next day. Her family says they never were given such instructions and weren’t told of the two masses the X-ray revealed.

What is clear is that no further tests were done. And no IHS provider followed up when Ms. Miner returned twice more to the hospital, the only one on the Cheyenne River Reservation, over the next six months, medical records show.

Finally, on May 7, 2017, as the 67-year-old Ms. Miner lay crumpled on a hospital cot, the right side of her body shaking, a physician assistant ordered a CT scan, after her family insisted, according to the records and family members.

“You have two very large masses in your right lung. It’s probably a malignancy,” Ms. Miner’s daughter Kali Tree Top recalled the physician assistant saying.

Ms. Miner reached for her daughter’s hand and started to cry.

Ms. Miner’s encounters with the IHS, and her family’s repeated efforts to get her help there, illustrate how the federal agency can fail the patients who need it most.

For the full story, see:

Dan Frosch. “A Tragic Journey Through the Indian Health Service.” The Wall Street Journal (Tuesday, December 24, 2019): A1 & A8.

(Note: the online version of the story was updated December 23, 2019, and has the title “Kate Miner’s Tragic Journey Through the U.S. Indian Health Service.”)

Opposed by China and WHO, Trump Administration Declared Covid-19 Public Health Emergency on January 31, 2020

(p. A1) The U.S. imposed entry restrictions on foreign nationals and quarantines on Americans returning from the Chinese province at the center of the coronavirus outbreak, as markets tumbled over fears about the impact on global growth.

Health and Human Services Secretary Alex Azar declared a public health emergency Friday [Jan. 31, 2020]. He said foreign citizens who have traveled anywhere in China within the past 14 days would be denied U.S. entry, while Americans who visited Hubei province would be quarantined for up to two weeks.

. . .

(p. A8) “Many countries have offered China support in various means. In sharp contrast, certain U.S. officials’ words and actions are neither factual nor appropriate,” Chinese Foreign Ministry spokeswoman Hua Chunying said. “Just as the WHO recommended against travel restrictions, the U.S. rushed to go in the opposite way.”

For the full story, see:

Alex Leary and Brianna Abbott. “U.S. Curbs Entry to Combat Virus.” The Wall Street Journal (Saturday, February 1, 2020): A1 & A8.

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

(Note: the online version of the story has the date January 31, 2020, and has the title “U.S. Imposes Entry Restrictions Over Coronavirus.”)

Apple Will Make Its Own Mac Processor Chips

In similar stories told in books by Grove and by Christensen and Raynor, technology firms work better when large, if components require careful design to work well together. When components become standardized and interchangeable, technology firms work better when smaller, buying components from specialized component suppliers. Deciding what is best at any moment requires uncertain judgement, and can change over time. In the passages quoted below, it appears that Apple thinks better performance can be achieved by integrating a key component back within the firm.

(p. B4) Apple Inc. built its gadget empire by outsourcing production to a vast ecosystem of chip makers and other component specialists. Under Chief Executive Tim Cook, it is taking a lot of that business back.

The company, which released its first iPhone processor in 2010, said Monday [June 22, 2020] it plans to ship Macs later this year with custom chips, a move that ends a 15-year technology partnership with Intel Corp. Apple said the custom-designed chips are more efficient and offer higher-performance graphics.

. . .

The strategy springs from Apple’s philosophy—fostered by its late co-founder Steve Jobs—that owning core technologies provides a competitive edge. Customized chips and sensors can help its iPhone, iPads and Macs leapfrog rivals in battery performance and features. It also can protect Apple from Chinese rivals that buy universally available parts.

. . .

The initiative—called insourcing by some suppliers and analysts—can give Apple a two-year jump on competitors in device performance because Apple can plan how multiple chips work together to limit power consumption and free up space inside iPhones and iPads for other components, analysts said.

It also reduces potential leaks of its product plans.

For the full story, see:

Tripp Mickle. “By Making Its Chips, Apple Gains Control.” The Wall Street Journal (Wednesday, June 24, 2020): B4.

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

(Note: the online version of the story was updated June 24, 2020, and has the title “Apple Is the Newest Chip Giant in Town.”)

The Grove book mentioned above is:

Grove, Andrew S. Only the Paranoid Survive: How to Exploit the Crisis Points That Challenge Every Company. New York: Bantam Books, 1999.

The Christensen and Raynor book mentioned above is:

Christensen, Clayton M., and Michael E. Raynor. The Innovator’s Solution: Creating and Sustaining Successful Growth. Boston, MA: Harvard Business School Press, 2003.

“Run With the Herd or Be Crushed by It”

The author of the passages quoted below writes poetry and novels in Havana.

(p. 7) Throughout my life, I’ve seen how powerless parents are in matters regarding their own children. Parents have no say over how their children should be raised, whether they will be conscripted or sent away to school in rural areas, and what dangers could befall them being so far from home and such a young age. They have no say over their children’s manners, religious teachings and political ideologies. There are only two choices: Run with the herd or be crushed by it.

As a teenager in the 1980s, I was taught in a “scientific communism” class that family was the heart of society. But from what I could see, that was no longer the case; organizations with mass followings like the Young Communist League had taken its place.

. . .

I was born and raised in a system that exerts control under the guise of paternalism — a system that caresses you as it beats you, that teaches you but also inhibits you, enlightens you and censures you. We are hostages to a government that behaves like an abusive, old-fashioned and sexist father, from whom we must seek consent and forgiveness.

For the full commentary, see:

Wendy Guerra. “Cuban Women Need a Revolution.” The New York Times, SundayReview Section (Sunday, October 13, 2019): 7.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date Oct. 12, 2019, and has the title “‘Cuban Women Await Their #MeToo Moment.” The first paragraph quoted above is from the online version and differs in several respects from the equivalent paragraph in the print version.)

Resilient Eaten Beetle Persists to the End

(p. D2) It’s a familiar story: Predator hunts prey. Predator catches prey. Predator gulps down prey.

Usually, that’s it. But the water scavenger beetle Regimbartia attenuata says, “Not today.” After getting swallowed by a frog, this plucky little insect can scuttle down the amphibian’s gut and force it to poop — emerging slightly soiled, but very much alive.

For the full story, see:

Katherine J. Wu. “A Beetle Swallowed By a Frog Decides To Do an End Run.” The New York Times (Tuesday, August 11, 2020): D2.

(Note: the online version of the story has the date August 3, 2020, and has the title “There Are Two Ways Out of a Frog. This Beetle Chose the Back Door.”)

The scavenger beetle’s escape is documented in:

Sugiura, Shinji. “Active Escape of Prey from Predator Vent Via the Digestive Tract.” Current Biology 30, no. 15 (2020): 867-68.

Wasteful Administrative Health Care Costs

The study quoted from below suggests that the main cure for wasteful administrative costs is a “single payer” system, which is a politically correct euphemism for socialized medicine. I suggest that a better cure would be to eliminate the government middle-man, and make the patient be the payer. The patient as payer would seek and buy low-cost cures or therapies, which would shift efforts at healthcare innovation toward lower cost innovations. As has been suggested for education, vouchers could provide poor patients with the means to pay for basic care.

(p. B4) Even a divided America can agree on this goal: a health system that is cheaper but doesn’t sacrifice quality. In other words, just get rid of the waste.
A new study, published Monday [October 7, 2020] in JAMA, finds that roughly 20 percent to 25 percent of American health care spending is wasteful. It’s a startling number but not a new finding. What is surprising is how little we know about how to prevent it.

. . .

Teresa Rogstad of Humana and Natasha Parekh, a physician with the University of Pittsburgh, were co-authors of the study, which combed through 54 studies and reports published since 2012 that estimated the waste or savings from changes in practice and policy.

. . .

The estimated waste is at least $760 billion per year. That’s comparable to government spending on Medicare and exceeds national military spending, as well as total primary and secondary education spending.

. . .

The largest source of waste, according to the study, is administrative costs, totaling $266 billion a year. This includes time and resources devoted to billing and reporting to insurers and public programs. Despite this high cost, the authors found no studies that evaluate approaches to reducing it.

For the full commentary, see:

Austin Frakt. “THE NEW HEALTH CARE; Up to 25% of Health Costs Called Wasteful.” The New York Times (Tuesday, October 8, 2019): B4.

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

(Note: the online version of the commentary has the date Oct. 7, 2019, and has the title “THE NEW HEALTH CARE; The Huge Waste in the U.S. Health System.”)

The print version of the academic article in JAMA mentioned above is:

Shrank, William H., Teresa L. Rogstad, and Natasha Parekh. “Waste in the Us Health Care System: Estimated Costs and Potential for Savings.” JAMA 322, no. 15 (Oct. 15, 2019): 1501-09.