Surgeons Often Excise Useful Appendix Even When Antibiotics Would Have Cured–“Surgeons Who Don’t Operate Miss Out on a Hefty Fee”

(p. D7) The appendix is a finger-shaped pouch attached to the large intestine (colon), usually on the lower right side of the abdomen. Long considered a vestigial organ with no known function, many people, young and old, have theirs removed in the course of another operation.

However, there are now indications that the appendix serves as a repository of healthy bacteria that can replenish the gut after an extreme attack of diarrhea. People who have had appendectomies, for example, are more likely to experience recurrent infections with the bacterium Clostridium difficile, a debilitating intestinal infection that causes severe, difficult-to-treat diarrhea.

. . .

Acute appendicitis is the nation’s most common surgical emergency.  . . .  Some 300,000 people in the United States undergo an appendectomy each year, but sometimes, the appendix turns out not to have been inflamed, meaning the operation was not necessary.

The results of several recent studies suggest that patients with uncomplicated appendicitis should not be rushed into surgery and instead should be offered the option of a trial of antibiotics.

In a controlled study among 540 adult patients, 72.7 percent of 257 patients randomly assigned to take antibiotics in lieu of an operation did not require subsequent surgery a year later, and those who did need surgery had no bad effects from the delay.

In another nonrandomized study of 3,236 patients who were not operated on initially, the nonsurgical treatment failed to cure the appendicitis in 5.9 percent of cases, and the inflammation recurred in 4.4 percent.

Some patients may choose an operation so they won’t have to worry about developing another attack of appendicitis, but if they aren’t told they have a choice, they can hardly make one.

Writing in JAMA [in February 2016] . . ., Dr. Dana A. Telem, a surgeon at Stony Brook University Medical Center, noted that “the notion of nonoperative treatment of appendicitis has not been well-received by the majority of the surgical community.” This is hardly surprising, because doctors, like many of us, are creatures of habit, and surgeons who don’t operate miss out on a hefty fee.

For the full story see:

JANE E. BRODY. “PERSONAL HEALTH; A Choice for Treating Appendicitis.” The New York Times (Tuesday, March 22, 2016 [sic]): D7.

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

(Note: the online version of the story has the date March 21, 2016 [sic], and has the title “PERSONAL HEALTH; A New View of Appendicitis.”)

The controlled randomized study mentioned above is:

Salminen, Paulina, Hannu Paajanen, Tero Rautio, Pia Nordström, Markku Aarnio, Tuomo Rantanen, Risto Tuominen, Saija Hurme, Johanna Virtanen, Jukka-Pekka Mecklin, Juhani Sand, Airi Jartti, Irina Rinta-Kiikka, and Juha M. Grönroos. “Antibiotic Therapy Vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The Appac Randomized Clinical Trial.” JAMA 313, no. 23 (2015): 2340-48.

The nonrandomized study mentioned above is:

McCutcheon, Brandom A., David C. Chang, Logan P. Marcus, Tazo Inui, Abraham Noorbakhsh, Craig Schallhorn, Ralitza Parina, Francesca R. Salazar, and Mark A. Talamini. “Long-Term Outcomes of Patients with Nonsurgically Managed Uncomplicated Appendicitis.” Journal of the American College of Surgeons 218, no. 5 (May 2014): 905-13.

“The Economic Mobility That Springs From Property Ownership”

(p. C9) Mr. Husock, a senior fellow at the American Enterprise Institute, traces the progress of a seemingly sensible but ultimately destructive idea: that “low-income neighborhoods built by ordinary builders were exploitative, overcrowded, and dangerous.”

. . .

What these reformers failed to understand, Mr. Husock contends, is that the poor neighborhoods of large cities provided what planned and subsidized neighborhoods never could: tightly knit communities, a sense of belonging and attendant political participation, ethnic character and the economic mobility that springs from property ownership.

. . .

The unreformers, Mr. Husock writes, “understood something fundamental: Community develops when keeping one’s property becomes part of a positive conspiracy of shared self-interest.”

For the full review, see:

Barton Swaim. “The Tragedy of the Progressive City.” The Wall Street Journal (Saturday, Oct. 30, 2021 [sic]): C9.

(Note: ellipses added.)

(Note: the online version of the review has the date October 29, 2021 [sic], and has the title “Politics: When the Lights Go Down in the City.”)

The book under review is:

Husock, Howard A. The Poor Side of Town: And Why We Need It. New York: Encounter Books, 2021.

As Temps Rise, Trees Adapt to Global Warming by Slowing Their Increasing Release of Carbon Dioxide

The late great physicist Freeman Dyson was courageously skeptical of global warming based on forces that move Earth back toward equilibrium when initially nudged away. The story quoted below provides evidence consistent with Dyson’s narrative.

(p. D2) The bend-don’t-break adaptability of trees extends to handling climate change, according to a new study that says forests may be able to deal with hotter temperatures and contribute less carbon dioxide to the atmosphere than scientists previously thought.

In addition to taking in carbon dioxide during photosynthesis, plants also release it through a process called respiration. Globally, plant respiration contributes six times as much carbon dioxide to the atmosphere as fossil fuel emissions, much of which is reabsorbed by plants, the oceans and other elements of nature. Until now, most scientists have thought that a warming planet would cause plants to release more carbon dioxide into the atmosphere, which in turn would cause more warming.

But in a study published Wednesday [March 16, 2016 [sic]] in Nature, scientists showed that plants were able to adapt their respiration to increases in temperature over long periods of time, releasing only 5 percent more carbon dioxide than they did under normal conditions.

Based on measurements of short-term temperature responses in this study and others, the scientists expected that the plants would increase their respiration by nearly five times that much.

At two forest-research sites in Minnesota, scientists tested how the respiration rates of 10 different species of trees — from boreal and temperate forests — were affected by increases in temperature over a period of three to five years, using heating cables to warm some of the trees.

The trees were monitored in two conditions: ambient, and about 6 degrees warmer than that.

To demonstrate how the plants adapted to long-term temperature increases, the scientists compared three things: how much carbon dioxide the trees released in ambient conditions; how much the trees released in the warmer conditions; and how much carbon dioxide the trees released when they were exposed to the warmer temperature for a short period of time (minutes or hours).

When the scientists compared the results, they found that the trees that were acclimated to the warmer temperatures increased their carbon dioxide release by a much smaller amount than the trees that were only exposed to a short-term temperature increase of the same magnitude.

Boreal and temperate forests account for a third of the world’s forest areas. If they are able to adapt respiration rates as this study suggests, the planet will breathe easier.

The source of the story is:

Tatiana Schlossberg. “Energy Appetite in U.S. Endangers Goals on Climate.” The New York Times (Tuesday, March 22, 2016 [sic]): D2.

(Note: bracketed date added.)

(Note: the online version of the story was updated March 16, 2016 [sic], and has the title “Trees Deal With Climate Change Better Than Expected.” The last two sentences quoted above differ in a non-trivial way in the print and the online versions. Above I choose to quote the less politically correct print version. The wimpish politically correct online version is: “Boreal and temperate forests account for a third of the world’s forest areas, and if they adapt their respiration rates in the way this study suggests, the forests, the planet’s lungs, can breathe easy.”)

The Nature article mentioned above is:

Reich, Peter B., Kerrie M. Sendall, Artur Stefanski, Xiaorong Wei, Roy L. Rich, and Rebecca A. Montgomery. “Boreal and Temperate Trees Show Strong Acclimation of Respiration to Warming.” Nature 531, no. 7596 (March 16, 2016): 633-36.

Researchers and Entrepreneurs Experiment with Once-Taboo Geoengineering Projects to Reverse Global Warming

(p. A3) Dumping chemicals in the ocean? Spraying saltwater into clouds? Injecting reflective particles into the sky? . . .

These geoengineering approaches were once considered taboo by scientists and regulators who feared that tinkering with the environment could have unintended consequences, but now researchers are receiving taxpayer funds and private investments to get out of the lab and test these methods outdoors.

. . .

In Israel, a startup called Stardust Solutions has begun testing a system to disperse a cloud of tiny reflective particles about 60,000 feet in altitude, reflecting sunlight away from Earth to cool the atmosphere in a concept known as solar radiation management, or SRM. Yanai Yedvab, Stardust chief executive and a former deputy chief scientist at the Israel Atomic Energy Commission, wouldn’t disclose the composition of the proprietary particles.

Yedvab said Stardust has raised $15 million from two investors and has conducted low-level aerial tests using white smoke to simulate the particles’ path in the atmosphere. After the company completes indoor safety testing, it intends to conduct a limited outdoor test of the dispersion technology, monitoring devices and particles in the next few months, Yedvab said.

. . .

Experiments aimed at cooling the atmosphere by reflecting sunlight away from Earth are an attempt to mimic what happens when a volcano erupts. In 1991, Mount Pinatubo, an active volcano in the Philippines, spewed sulfur and ash into the upper atmosphere, lowering the Earth’s temperature by .5 degrees Celsius (.9 degrees Fahrenheit) for an entire year.

For the full story, see:

Eric Niiler. “New Experiments Aim to Cool Planet.” The Wall Street Journal (Thursday, February 15, 2024): A3.

(Note: ellipses added.)

(Note: the online version of the story has the date February 14, 2024, and has the title “Scientists Resort to Once-Unthinkable Solutions to Cool the Planet.” The online version says that the title of the print version was also “Scientists Resort to Once-Unthinkable Solutions to Cool the Planet.” But my print version has the title “New Experiments Aim to Cool Planet.”)

Mandated Fukushima Evacuations Killed 1,600; Radiation Killed 0

Berkeley scientist Noah Whiteman’s Most Delicious Poison argues that often chemicals that are therapeutic at low doses are poisons at high doses. The commentary quoted below provides evidence that what Whiteman argues is true of many chemicals, is also true of radiation.

(p. D3) This spring [2015], four years after the nuclear accident at Fukushima, a small group of scientists met in Tokyo to evaluate the deadly aftermath.

No one has been killed or sickened by the radiation — a point confirmed last month by the International Atomic Energy Agency. Even among Fukushima workers, the number of additional cancer cases in coming years is expected to be so low as to be undetectable, a blip impossible to discern against the statistical background noise.

But about 1,600 people died from the stress of the evacuation — one that some scientists believe was not justified by the relatively moderate radiation levels at the Japanese nuclear plant.

. . .

“The government basically panicked,” said Dr. Mohan Doss, a medical physicist who spoke at the Tokyo meeting, when I called him at his office at Fox Chase Cancer Center in Philadelphia. “When you evacuate a hospital intensive care unit, you cannot take patients to a high school and expect them to survive.”

Among other victims were residents of nursing homes. And there were the suicides. “It was the fear of radiation that ended up killing people,” he said.

Most of the fallout was swept out to sea by easterly winds, and the rest was dispersed and diluted over the land. Had the evacuees stayed home, their cumulative exposure over four years, in the most intensely radioactive locations, would have been about 70 millisieverts — roughly comparable to receiving a high-resolution whole-body diagnostic scan each year. But those hot spots were anomalies.

By Dr. Doss’s calculations, most residents would have received much less, about 4 millisieverts a year. The average annual exposure from the natural background radiation of the earth is 2.4 millisieverts.

How the added effect of the fallout would have compared with that of the evacuation depends on the validity of the “linear no-threshold model,” which assumes that any amount of radiation, no matter how small, causes some harm.

Dr. Doss is among scientists who question that supposition, one built into the world’s radiation standards. Below a certain threshold, they argue, low doses are harmless and possibly even beneficial — a long-debated phenomenon called radiation hormesis.

. . .

Life evolved in a mildly radioactive environment, and some laboratory experiments and animal studies indicate that low exposures unleash protective antioxidants and stimulate the immune system, conceivably protecting against cancers of all kinds.

. . .

. . ., a study of radon by a Johns Hopkins scientist suggested that people living with higher concentrations of the radioactive gas had correspondingly lower rates of lung cancer. If so, then homeowners investing in radon mitigation to meet federal safety standards may be slightly increasing their cancer risk. These and similar findings have also been disputed.

. . .

There is more here at stake than agonizing over irreversible acts, like the evacuation of Fukushima. Fear of radiation, even when diluted to homeopathic portions, compels people to forgo lifesaving diagnostic tests and radiotherapies.

We’re bad at balancing risks, we humans, and we live in a world of continual uncertainty. Trying to avoid the horrors we imagine, we risk creating ones that are real.

For the full commentary, see:

George Johnson. “RAW DATA; When Radiation Isn’t the Risk.” The New York Times (Tuesday, Sept. 22, 2015 [sic]): D3.

(Note: ellipses added.)

(Note: the online version of the commentary has the date Sept. 21, 2015 [sic], and has the title “RAW DATA; When Radiation Isn’t the Real Risk.”)

The recent book by Whiteman mentioned above is:

Whiteman, Noah. Most Delicious Poison: The Story of Nature’s Toxins―from Spices to Vices. New York: Little, Brown Spark, 2023.

The study of radon mentioned above is:

Thompson, Richard E. “Epidemiological Evidence for Possible Radiation Hormesis from Radon Exposure: A Case-Control Study Conducted in Worcester, Ma.” Dose-Response 9, no. 1 (2011): 59-75.

Isaacson Reprises His Themes of “Science, Genius, Experiment, Code, Thinking Different” in Book on CRISPR

(p. 12) The landmark research that brought Doudna and Charpentier to the pinnacle of global acclaim has the potential to control future pandemics — either by outwitting the next viral plague through better screening and treatment or by engineering human beings with better disease resistance programmed into their cells. The technique of gene editing that they patented, which goes by the unwieldy acronym of CRISPR-Cas9, makes it possible to selectively snip and alter bits of DNA as though they were so many hems to take up or waistbands to let out. The method is based on defenses pioneered by bacteria in their ages-old battle against viruses.

. . .

The CRISPR history holds obvious appeal for Walter Isaacson, a biographer of Albert Einstein, Benjamin Franklin, Steve Jobs and Leonardo da Vinci. In “The Code Breaker” he reprises several of his previous themes — science, genius, experiment, code, thinking different — and devotes a full length book to a female subject for the first time.

. . .

Isaacson keeps a firm, experienced hand on the scientific explanations, which he mastered through extensive readings and interviews, all of which are footnoted.

For the full review, see:

Dava Sobel. “Deus Ex Machina.” The New York Times Book Review (Sunday, March 21, 2021 [sic]): 12.

(Note: ellipses added.)

(Note: the online version of the review has the date March 8, 2021 [sic], and has the title “A Biography of the Woman Who Will Re-Engineer Humans.”)

The book under review is:

Isaacson, Walter. The Code Breaker: Jennifer Doudna, Gene Editing, and the Future of the Human Race. New York: Simon & Schuster, 2021.

“A Richer World Is Much More Resilient Against Weather Extremes”

(p. A15) A new peer-reviewed study of all the scientific estimates of climate-change effects shows the most likely cost of global warming averaged across the century will be about 1% of global gross domestic product, reaching 2% by the end of the century. This is a very long way from global extinction.

Draconian net-zero climate policies, on the other hand, will be prohibitively costly. The latest peer-reviewed climate-economic research shows the total cost will average $27 trillion each year across the century, reaching $60 trillion a year in 2100. Net zero is more than seven times as costly as the climate problem it tries to address.

. . .  A richer world is much more resilient against weather extremes. In the short term, therefore, policymakers should focus on lifting the billions of people still in poverty out of it, both because it will make them more resilient against extreme weather and because it will do so much good in a myriad of other ways.  . . .

Careful science can inform us about the problem of climate change, but it can’t tell us how to solve it. Sensible public debate requires all the facts, including about the costs of our choices. Some of the most popular climate policies will have costs far greater than climate change itself. When politicians try to shut down discussion with claims that they’re “following the science,” don’t let them.

For the full commentary, see:

Bjorn Lomborg. “‘Follow the Science’ Leads to Ruin.” The Wall Street Journal (Thursday, March 14, 2024): A15.

(Note: ellipses added.)

(Note: the online version of the commentary has the date March 13, 2024, and has the same title as the print version.)

The “new peer-reviewed study” mentioned above is:

Tol, Richard S. J. “A Meta-Analysis of the Total Economic Impact of Climate Change.” Energy Policy 185 (Feb. 2024): 113922.

The “latest peer-reviewed climate-economic research” mentioned above is:

Tol, Richard S. J. “Costs and Benefits of the Paris Climate Targets.” Climate Change Economics 14, no. 04 (2023): 2340003.

Federal and State Regulatory Thicket Thwarts “Permitting, Siting, Construction and Operation” of New Energy Infrastructure and Technology

(p. C5) Environmentalists have long argued that tackling climate change will require regulations to discourage fossil-fuel use, such as a carbon tax or a cap-and-trade program. In reality, there is no plausible path to a low-carbon economy without a serious deregulatory program. Today’s thicket of environmental regulation at the federal and state levels thwarts permitting, siting, construction and operation of virtually every class of new infrastructure and technology. There are simply too many veto points and opportunities for obstruction, at too many procedural and jurisdictional levels, to conceivably embark on a rapid mission to remake the nation’s energy economy.

. . .

The U.S. can no longer continue to neglect its compounding infrastructure and clean-energy needs. We aren’t going to regulate our way to a thriving low-carbon economy and a more stable climate. America needs to get back to building again.

For the full commentary, see:

Ted Nordhaus. “For a Clean-Energy Future, We Need Deregulation.” The Wall Street Journal (Saturday, February 19, 2022 [sic]): C5.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date February 17, 2022 [sic], and has the same title as the print version.)

Banning the SAT as Racist Is an Insult “Against Black Intelligence”

The soundness of Prof. McWhorter’s argument is neither increased nor decreased by the fact that he is black. His courage in stating the argument is increased by the fact that he is black.

(p. 4) . . . lately, evidence has mounted, steadily, that the SAT is in fact useful in demonstrating students’ abilities regardless of their economic backgrounds or the quality of their high schools. Some studies show scores correlate with student performance in college more strongly than high-school grades, and that without the standardized test data it is harder to identify Black, Latino and lower-income white kids who would likely thrive in elite universities.

. . .

The SAT as racist, objectivity as white privilege, making academic training easier to attract Black majors and graduate students — there is a family relationship between them. Namely, an assumption that it is graceless or unfair to require Black people to grapple with detail, solve puzzles and make sense of the unfamiliar. At least, we are not to be expected to engage in such things nearly as much as, say, white people.

. . .

I’m sorry, but I find this a diminished, not to mention depressing, and downright boring racial self-image. It just doesn’t correspond with so very much that Black people do, and are, and seek and always have.

. . .

No coherent admissions assessment would use the SAT as the sole measure of an applicant’s potential. However, the elimination of such tests from the process is less a favor to than an insult leveled against Black intelligence.

For the full commentary, see:

John McWhorter. “No, the SAT Isn’t Racist.” The New York Times, SundayOpinion Section (Sunday, March 17, 2024): 4.

(Note: ellipses added.)

(Note: the online version of the commentary has the date March 14, 2024, and has the title “The Best Way to Find Out if We Can Cool the Planet.”)

9,000 Years Ago 10,000 Humans Lived in the City of Catalhoyuk

The Catalhoyuk section of Four Cities appears germane to the question: how long have humans more or less like us existed on earth? Apparently at least 9,000 years. But only in the last few hundred years have some humans flourished. The bigger question is: what novel economic system has allowed the the flourishers to leapfrog previous humans?

(p. 16) Nine thousand years ago, the people of Catalhoyuk, maybe 10,000 of them, lived in cuboid clay houses packed against one another above the Konya Plain of south-central Turkey. Their dwellings were uniform, suggesting a highly regulated society: one or two rooms, painted in white or with red ocher designs. You exited not via a front door but by climbing a ladder to the roof. Much of life was lived up there: cooking, socializing, ambling along sidewalks that ran across the top of the city.

Let me say that again in case you missed it: This was 9,000 years ago. In terms of human society, that is just an imponderable span of time. The oldest of the books of the Hebrew Bible date to roughly 3,000 years ago; the pyramids of Egypt go back about 5,000 years. These were not prehumans or near relatives. They were like us: complex, organized, alive to meaning and living at a time beyond reckoning.

. . .

At Catalhoyuk, Newitz hangs out with Ruth Tringham of the University of California, Berkeley, who has devoted years to humanizing the remnants of this city of the dim past by focusing on one skeleton, of a woman she has dubbed Dido. Dido replastered her walls regularly, kept her home swept clean, covered the floor in reed mats and decorated the place with art: clay figures of animals and stylized human females. In other words: much like us.

Catalhoyuk was founded by pioneers of urban living. “When the earliest construction began,” Newitz writes, “many people coming to live at Catalhoyuk were only a generation or two removed from nomadism.” It was brand-new, this fixed settlement thing, but it proved remarkably successful. By the time Dido was born, the city was about 600 years old. I’m tempted to repeat a number yet again. Think of the settled, structured history Dido could look back on. As evidence of her awareness of the past, Dido, like everyone else in town, buried her ancestors in her home, beneath her bed. Some were given a special honor: Their skulls sat in niches in the walls. Dido could enjoy the comfort of her forebears’ empty eye sockets following her as she went about her daily chores. In other words: not so much like us.

. . .

Perhaps looking back 9,000 years can yield practical guidance on how to move forward from where we are. For me, the effect of reading “Four Lost Cities” was more meditative. This is a long, long, long ride we are on. Much is beyond our control. Humanity trundles on.

For the full review, see:

Russell Shorto. “In Ruins.” The New York Times Book Review (Sunday, March 14, 2021 [sic]): 14.

(Note: ellipses added.)

(Note: the online version of the review has the date Feb. 25, 2021 [sic], and has the title “Searching for Our Urban Future in the Ruins of the Past.”)

The book under review is:

Newitz, Annalee. Four Lost Cities: A Secret History of the Urban Age. New York: W. W. Norton & Company, 2021.

“Momentum Around Solar Geoengineering Is Building Fast”

(p. A19) A few years ago, the idea of deliberately blocking the sun to combat climate change was taboo for scientists. But a lot can change in a short time.

As the disastrous effects of climate change mount, Congress has asked federal scientists for a research plan, private money is flowing and rogue start-ups are attempting experiments — all signs that momentum around solar geoengineering is building fast. The most discussed approach involves spraying tiny particles into the stratosphere to reflect sunlight and cool the planet. Other proposals include injecting sea salt into clouds to increase their reflectivity or using giant space parasols to block the sun.

It might all sound like dystopian science fiction, but some techno-futurists, like OpenAI’s chief executive, Sam Altman, are already normalizing it: “We’re going to have to do something dramatic with climate like geoengineering as a Band-Aid, as a stopgap,” he said in January [2024] at the World Economic Forum in Davos.

No one fully understands the risks of these technologies — which could include calamitous disruptions in weather — or how significant the benefits could be. I’m increasingly convinced that we should do more research on solar geoengineering.

. . .

. . . science is fallible precisely because it is a practice, a cooperative human activity. And as the moral philosopher Alasdair MacIntyre reminds us, engaging in a practice well requires exercising its virtues — which for science include transparency, honesty, humility, skepticism and collaboration.

For the full commentary, see:

Jeremy Freeman. “Let’s Find Out if This Can Cool the Planet.” The New York Times (Tuesday, March 19, 2024): A19.

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

(Note: the online version of the commentary has the date March 17, 2024, and has the title “The Best Way to Find Out if We Can Cool the Planet.”)