Thursday, March 17, 2016

The Obama doctrine -- I will so miss our Vulcan President

From the Obama Doctrine, quoting the President:

… Right now, across the globe, you’re seeing places that are undergoing severe stress because of globalization, because of the collision of cultures brought about by the Internet and social media, because of scarcities—some of which will be attributable to climate change over the next several decades—because of population growth…

… As I survey the next 20 years, climate change worries me profoundly because of the effects that it has on all the other problems that we face. If you start seeing more severe drought; more significant famine; more displacement from the Indian subcontinent and coastal regions in Africa and Asia; the continuing problems of scarcity, refugees, poverty, disease—this makes every other problem we’ve got worse. That’s above and beyond just the existential issues of a planet that starts getting into a bad feedback loop.

By “collision of cultures” I think he means “existential threats to patriarchy” — because he’s obviously reading my mind. Must come with his Vulcan heritage.

We are never ever going to get another President this good (even though he’s wrong about encryption). HRC isn’t bad, but she’s no Obama.

Using Gmail and the link to correspond with patients -- HIPAA 2013 clarification

HIPAA is designed to protect patient confidentiality. It’s widely misunderstood, not least because of the scary fines for violations. I think on balance it’s a good law, but it needs regular adjustment.

Happily in 2013 a major adjustment was made. Rule makers allowed use of conventional email applications, perhaps without robust encryption, for patient communications if informed consent is given and recorded. I recently put together a set of references on this:
Covers the 2013 final rule changes.
Pretty good discussion of implications
Example of a patient consent to receive unencrypted email‐2013‐01‐25/pdf/2013‐01073.pdf
HIPAA language is on page 5634 (I didn’t confirm this, just copied from the Austin Med Clinic consent form.

I’d still worry about risks associated with using Gmail (though communication is now actually well encrypted for most users) — the message will be both sender and receiver’s server forever unless it’s deleted. Tricky business!

Still, it’s encouraging to see this clarification. I hope the HIPAA rules continue to be adjusted. Having robust encryption built into laptops helps — at least until the FBI forces backdoors which will, of course, be widely exploited by hackers.

Tuesday, March 15, 2016

Phenazopyridine (pyridium, AZO) - yet another example of missing research

Phenazopyridine is an old drug, discovered in the 1930s. Chemically it’s classified as an “azo dye”, these chemicals are usually used to color clothing. Phenazopyridine will stain clothing orange. Another Azo dye was once used a seizure med

Two-thirds of a dose is excreted unchanged in the urine (and sweat and tears), the rest is metabolized to unknown substances. It has some sort of anesthetic action on the urinary tract, we don’t know how that works. “Trace amounts” may enter the cerebrospinal fluid. With prolonged use there is injury to both liver and kidney.

Historically phenazopyridine was prescribed for use in the very early stages of a bladder infection, before antibiotics did their job (since it’s older than antibiotics I suspect it was used heavily in the past). It’s over the counter now, to be used for one to two days.

Except some patients use phenazopyridine for longer than a few days. Interstitial cystitis is particularly nasty syndrome. Like many poorly understood disorders (osteoarthritis, autism, etc) it’s probably several different disorders that share common features. One pattern of interstitial cystitis causes severe sleep disruption; patients wake up to void every 10 to 60 minutes with very small volume urination. On bladder biopsy the protective lining of the bladder has been disrupted. 

Sleep deprivation is a well understood and effective form of torture, so it’s not surprising that IC patients get a bit desperate (you would too). Phenazopyridine may allow sleep when all else fails. So it’s used more than it should be, especially since it’s available without a prescription.

Since phenazopyridine has an anesthetic effect, we presume it interacts with the peripheral nervous system.  So what happens to the brain with large lifetime doses of phenazopyridine? I can’t see that this has ever been investigated, even in animal models.  Tartrazine, another azo dye used in food coloring, was associated with oxidative brain damage in one rat study.

Medicine is full of things like phenazopyridine. Medications that were adopted long ago, and have received minimal research review since. We could employ an army of scientists studying these drugs. But then we’d have to figure out how to pay for them…

Saturday, March 05, 2016

The Man's Book (1978)

I remember the early 1970s as quite odd - particularly based on the books of the time. I like to pick them up if I can find them, but I think others share my interest. I rarely see them in used book stores.

I remembered on recently. Actually, it’s late 70s, so not nearly as odd, but still quite a long time ago. The topic is what makes it interesting…

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The Man’s Book was published in 1978 (ISBN-13: 978-0380018994). There were no later editions, though suspiciously similar books with the same name have been published more recently. I wonder if they just pilfered the original.

It’s a real cultural artifact, required reading for a historian of the era …

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Some of the contents are very 1970s…

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Most of it, however, still works today. That surprised me a bit, but really a lot changed between 1968 and 1978 and the book is written from a liberal perspective. It would have been a very different book if it were written in 1973.

The advice to a man on how to support a working wife is the most dated …

… If you say, “No wife of mine is going to work,” you’ll be considered antiquated …when you both work, something or someone is always getting neglected … The household is often on the brink of chaos …

… To make a two-career marriage work, you both need sensitivity, cooperation, flexibility, and a boundless sense of humor…

… In spite of women’s lib [ed note: at the time that would not have been meant sarcastically] when you run out of catsup … there’s no question, in your mind or hers, whose fault it is … you’ll make it easier on both of you if you pitch in and share responsibility for the household …

… it’s necessary to be willing to share power…

Dated, but perhaps not as dated as we might wish it to be. The rest of the book still kind of works. I’m going to hand it off to my #2 son…

Thursday, March 03, 2016

Everyone needs an AI in their pocket

Two articles from my share feed today …

Transit systems are growing too complex for the human mind

… “What makes it messy is the presence of different possibilities," Barthelemy says. "When you arrive at a specific point, you have many choices."

The Paris system has 78 such choice points. The New York subway, the most complex in the world, has 161. New York's system is so sprawling and interconnected, Barthelemy and colleagues Riccardo Gallotti and Mason Porter concluded in a recent analysis, that it approaches the maximum complexity our human minds can handle, the equivalent of about 8 bits of information.

“But then if you add the bus,” Barthelemy warns, “the 8-bit limit is exploded."...


Google Research: An Update on fast Transit Routing with Transfer Patterns

What is the best way to get from A to B by public transit? Google Maps is answering such queries for over 20,000 cities and towns in over 70 countries around the world, including large metro areas like New York, São Paulo or Moscow…

… Scalable Transfer Patterns algorithm [2] does just that, but in a smart way. For starters, it uses what is known as graph clustering to cut the network into pieces, called clusters, that have a lot of connections inside but relatively few to the outside…

… Frequency-Based Search for Public Transit [3] is carefully designed to find and take advantage of repetitive schedules while representing all one-off cases exactly. Comparing to the set-up from the original Transfer Patterns paper [1], the authors estimate a whopping 60x acceleration of finding transfer patterns from this part alone….

Humans can’t manage modern transit complexity — but the AIs can. Including the AI in your pocket.

Everyone needs a portable AI, including people with no income and people with cognitive disabilities. That’s one reason I’m writing my smartphone for all book.

See also:

Wednesday, March 02, 2016

Minnesota explained: Rubio, Sanders and the President Gordon agenda.

My home state of Minnesota, most annoyingly, uses caucuses. I attend the Dem variety in the bluest of neighborhoods. They are crowded, disorganized and well meaning. When I ride my bike to caucus cars slam to a stop as though I were a family of 5 on foot. Which is wrong and dangerous, but I appreciate the sentiment.

The Dem caucus is not representative of the Dem voter. You have to be very persistent to fight through traffic and crowds to hit the narrow window for voting. Only the most committed can get there. The caucus system is a bad, bad idea. I think the same is true of the GOP caucuses here.

So the caucus results last night were not too surprising.

The GOP, as usual, went for the extreme right candidates. This year there were three of ‘em - Trump, Rubio and Cruz. Since we have one of the strongest economies in the US, with unemployment under 5% for years, Trump didn’t have his usual vote-of-despair left-behind advantage. So the three extremes ended up with fairly similar numbers, but the anti-Trump movement focused on Rubio and he won.

My team went, as usual, for the more left candidate. Sanders won by 20%, so he might even have won a primary. I voted for HRC, but the MN DFL is effectively to the left of me — which is saying a lot.

I’m backing HRC but, in truth, we need to go down some variation of the Sanders road over the next two decades. We’re going to have to bias the post-AI globalized economy to generate jobs for the non-college — even at the cost of economic efficiency. We have to build more social supports for people who aren’t working, with some kind of rethinking of what we do for disabled workers. We may end up with a non-binary definition of disability, or even some kind of guaranteed income.

We will end up taxing wealth in one form or another and we’ll do a  lot more government redistribution. We should also, and this is not so much Sanders, execute on the old Gore “reinventing government” mission, refactoring regulatory systems. We need to break the accounting, tax and regulatory frameworks the mega-corporations (“neo-Chaebol is a term I like) have built; the foundations of a great stagnation ecosystem wherein new companies are built only for acquisition.

We need to build supports that enable entrepreneurial types to pick business designs off a shelf and implement them. We need to strip benefits from employment completely, and both fix and finish the mission the ACA started — while breaking the corporatization of that great compromise.

Phew. It’s a big mission, but it is doable. We have to do it, or we get President Trump. Or worse. Sooner or later. 

So I don’t feel that bad that Sanders won Minnesota. It’s a good sign for the future. I don’t want him to go up against the GOP though. By the time their attack machine is done with him he’ll be hiding in a stone shelter in the wilderness. HRC’s great strength is she’s lived that machine for decades. Nobody short of Obama can equal that. (And, of course, I would love him to keep his job. Alas, even if our constitution allowed that I think he’s ready for a change.)

See also:

Tuesday, March 01, 2016

Pediatric TMJ disorder and Developmental Dysplasia of the Hip: Separated at birth?

Early onset disruption of the Temperomandibular Joint (TMJ) reminds me of what we once called Congenital Dislocation of the Hip (CDH). That syndrome has since been better named as Developmental Dysplasia of the Hip. Untreated DDH is thought to result in severe early arthritis of the hip.

I wonder if early-onset (pediatric) TMJ syndrome should be renamed Developmental Dysplasia of the Temperomandibular Joint (DDTMJ).

I don’t see any hint of this in my PubMed searches though.