Easy primary care research project: good for fellowship, residency etc

I don't do clinical research any more, but occasionally I come across questions that might produce a cheap, interesting and publishable study.

Here's one.

What percentage of parents run out of their child's liquid antibiotic medication prior 24 hours early? My guess is that the percentage is over 70% due to normal loss, spillage, and over accurate dispensing.

Simple study, publishable unit.

For extra credit, what are the financial incentives for "precise" dispensation of liquid antibiotics?

Giuliani - time to go away. Please.

Really. It's time to quit. Actually, it's time to have never started.

Rudy Giuliani's loopy foreign-policy statement. - By Fred Kaplan - Slate Magazine

Rudy Giuliani's essay in the latest issue of Foreign Affairs, laying out his ideas for a new U.S. foreign policy, is one of the shallowest articles of its kind I've ever read. Had it been written for a freshman course on international relations, it would deserve at best a C-minus (with a concerned note to come see the professor as soon as possible). That it was written by a man who wants to be president—and who recently said that he understands the terrorist threat "better than anyone else running"—is either the stuff of high satire or cause to consider moving to, or out of, the country...

...Two months ago, when Giuliani issued some of his first pronouncements on foreign policy, I wrote that he is "that most dangerous would-be world leader: a man who doesn't seem to know how much he doesn't know." Judging from his Foreign Affairs article, the breadth and depth of his cluelessness are vaster than even I had imagined.

Kaplan, in other words, is shrill. The GOP candidates are having that effect on a lot of people.

Gwynne Dyer - 9 essays - July through Aug 16 2007

Dyer has 9 new ones.

1. Bangladesh: When Democracy Goes Bad
2. The Turkish Election
3. Libya, Bulgarians and Lockerbie
4. Oil: $100 a Barrel -- or $200?
5. Zimbabwe Meltdown
6. Pakistan: Forecasts of Disaster
7. Arctic Scramble
8. Slow Forward
9. "Boys Go To Baghdad..."

I'm convinced now he'll never add a syndication feed or otherwise update the web site. I think his may be the last site in the world serving "pages" as .txt files. I assume that's not a clever technique to prevent blogging/quoting, but you never know -- he may be curmudgeonly, but he's a very good writer.

Anyway, I've added a Dyer tag to Gordon's Notes -- if Blogger adds tag-specific RSS it will become a de facto Dyer feed.

The Apple iMovie debacle: Pogue smacks 'em

Pogue is a longtime Apple user, author, and informed fan. So this smackdown might get noticed in Cupertino (emphases mine) ...

Apple Takes a Step Back With iMovie ’08 - Pogue’s Posts - Technology - New York Times Blog

... To rephrase (and sanitize) the wailing on the discussion boards: What the [bleep]! What was Apple thinking?

Apple says that it was thinking: “It’s 1.0. We’ll bring it up to par with free software updates, like we always do.” Internally, I’m guessing that it was also thinking, “iMovie had gotten pretty old, and it was haunted by some intractable bugs.” And also, perhaps, “iMovie was getting so powerful, it was taking sales away from Final Cut.”

But it must also have been thinking, “Then again, it is a little embarrassing to take so many steps backward.”

That’s why, with what I imagine is a certain degree of sheepishness, the company is offering a free download of the previous iMovie version to anyone who has iMovie ‘08. In that regard, all the wailing is a bit overblown; Apple is not actually taking away the older version. The only real raw part of the deal is that people who pay $80 for a new software rev expect an enhanced version—not another copy of the old one.

I can’t remember any software company pulling a stunt like this before: throwing away a fully developed, mature, popular program and substituting a bare-bones, differently focused program under the same name.

I’ve used the real iMovie to edit my Times videos for three years now. The results are perfectly convincing as professional video blog work. But the new version is totally unusable for that purpose. It’s unusable, in fact, for anyone doing professional work that requires any degree of precision...

Apple's historic danger is getting drunk with arrogance. That's why we Apple customers love them to feel the blistering heat of competition -- it keeps 'em sober. The iMovie story tells me they've fallen off the wagon again -- but the rapid release of the 'free version' (I've read anyone can get it) suggests they might be back in rehab. Maybe.

I don't buy the 'continual free upgrades' to iMovie_II 1.0 though -- Apple's been saying they can't do free function upgrades any more without charging for 'em (accounting rules).

My money is on the 'protect Final Cut' answer. I think that's the same reason Apple won't provide Library management (import/export Libraries) for iPhoto.

Thanks Pogue. Please kick Apple again for us. Harder.

Alas, what's really needed is more competition for iLife, and I'm afraid there's nobody likely to do that. Apple has pulled far enough ahead that they can do things like this and still have the best solutions for any platform.

Pigs teleport

Fallows finds a WSJ OpEd that's not stupid and David Brooks says something sane.

Ok, so maybe the hand of Sauron is behind the WSJ OpEd and maybe Brooks respectful comments on John Edwards are an attempt to sabotage the Dems. Even so, the pigs aren't just flying today...

The history of amphetamines in America

It's surprisingly hard to find the history of drugs in the medical literature -- Dexedrine, Benzedrine, Norodin and the like don't show up in today's reference books. So I appreciated this Salon book review summary, but I found it confusing -- on first reading I thought they were claiming that Benzedrine was methamphetamine! I've added some clarifications in square brackets.

The highs and lows of methamphetamines

... The synthetic methamphetamine has a horticultural analog in ephedra vulgaris, used for millennia by the Chinese as an herbal remedy for asthma and other breathing ailments. In 1887, a Japanese scientist identified ephedra's active ingredient, ephedrine, a chemical similar to adrenaline. The same year, the German L. Edeleano used ephedrine as the base to create phenylisopropylamine, now known as amphetamine.

But because the substance seemed to have no useful medical applications, the malign genie remained in the bottle until the 1920s, when ephedrine was first used to treat asthma in clinical trials in North America and Europe. Meanwhile, a Japanese scientist developed a more powerful synthetic version of the drug that came to be known as methamphetamine [d-desoxyephedrine]. In 1927, a British research chemist at UCLA named Gordon Alles resynthesized Edeleano's drug [amphetamine sulfate] for use as a bronchodilator, and subsequently sold the formula for use as an over-the-counter inhalant.

The new drug, christened Benzedrine [amphetamine sulfate], was initially marketed as a miracle cure, "used to treat obesity, epilepsy, schizophrenia, cerebral palsy, hypertension, 'irritable colon,' 'caffeine mania,' and even hiccups." By the 1950s, variations on its chemical theme included Dexedrine [dextroamphetamine sulfate], whose "gentle stimulation will provide the patient with a new cheerfulness, optimism, and feeling of well-being"; Norodin [?], "useful in reducing the desire for food"; Desoxyn [methamphetamine], for "When she's ushered by temptation"; and Syndrox [?], "For the patient who is all flesh and no will power."

All these testimonials originated in medical journals, and the drugs were targeted at women, mostly as "pick-me-ups" and diet aids. But even prior to the 1950s, amphetamine and methamphetamine had begun to leave their mark upon the American heartland. During World War II, factories at the San Diego naval base provided troops overseas with Benzedrine. Owen claims "GIs consumed an estimated 200 million pills," causing untold numbers of soldiers to return stateside with an amphetamine habit...

Methamphetamine was sold as Methedrine and Desoxyn in the US -- and administered to Japanese industrial workers to increase productivity, I can't figure out what Norodin and Syndrox were, but I'm willing to believe they were also methamphetamine.

While trying to figure this out I came across references like this one ...

THE BEHAVIOR OF CHILDREN RECEIVING BENZEDRINE

Charles Bradley M. D. Am J Psychiatry 94:577-585, November 1937

The psychological reactions of 30 behavior problem children who received benzedrine sulfate for one week were observed. There was a spectacular improvement in school performance in half of the children. A large proportion of the patients became emotionally subdued without, however, losing interest in their surroundings...

Well, there had to be something before Ritalin. [Update 8/17: I'm a bit behind on my sleep. Adderall, which is in use today, is amphetamine-dextroamphetamine. So this was probably one of the first studies of what is now sold as Adderall. When I came across this out of context, I was shocked by the study. In my case, the reaction is noteworthy.]

I'm sure methamphetamine was very effective as a weight loss pill. It would be interesting to know the stories of the women who used Desoxyn for weight loss in the 1950s. Many should be living today. How did their stories compare to the meth addicts of the modern era?

Levitt on terrorism

Steven Levitt now blogs for the NYT. In a burst of misplaced enthusiasm he channeled Schneier and blogged on how to give terrorist great new ideas. I'm not sure this is a great idea when Schneier does it, but Levitt ought to leave this kind of thing to the pros.

Why am I a bit uneasy? After all, I've probably done the same sort of thing at one time or another. My unease comes because I worry that there's a reasonable number of fairly dull would-be terrorists out there. The pros (Hamas, the former IRA, etc) don't need ideas, but the dimwits probably appreciate 'em. I'm only a "bit" uneasy though, even the dimmest terrorist has an infinite amount of material to work from.

So why don't they do more, and can we really do much about it? In a better column Schneier digs deeper ...

Terrorism, Part II - Freakonomics - Opinion - New York Times Blog

... Like the British and Israelis have done, if faced with this situation, Americans would figure out how to live with it. The actual cost of this low-grade terrorism in terms of human lives is relatively small, compared to other causes of death like motor-vehicle crashes, heart attacks, homicide, and suicide. It is the fear that imposes the real cost.

But just as people in countries with runaway inflation learn relatively quickly to live with it, the same happens with terrorism. The actual risk of dying from an attack while riding a bus in Israel is low – and so, as Gary Becker and Yona Rubinstein have shown, people who have a lot of experience riding Israeli buses don’t respond much to the threat of bombings. Similarly, there is little wage premium for being a bus driver in Israel....

....it strikes me that there are two possible interpretations of our current situation vis-à-vis terrorism.

One view is the following: the main reason we aren’t currently being decimated by terrorists is that the government’s anti-terror efforts have been successful.

The alternative interpretation is that the terror risk just isn’t that high and we are greatly overspending on fighting it, or at least appearing to fight it. For most government officials, there is much more pressure to look like you are trying to stop terrorism than there is to actually stop it. The head of the TSA can’t be blamed if a plane gets shot down by a shoulder-launched missile, but he is in serious trouble if a tube of explosive toothpaste takes down a plane. Consequently, we put much more effort into the toothpaste even though it is probably a much less important threat.

Likewise, an individual at the CIA isn’t in trouble if a terrorist attack happens; he or she is only in trouble if there is no written report that details the possibility of such an attack, which someone else should have followed up on, but never did because there are so many such reports written.

My guess is that the second scenario — the terrorism threat just isn’t that great — is the more likely one...

Preventive care - a marginal idea?

I've suspected this was true for about 18 years:

NYT Leonhardt - Free Lunch on Health Care ...

... Jay Bhattacharya, a doctor and economist at Stanford’s School of Medicine, estimates that to prevent one new case of diabetes, an antiobesity program must treat five people — “not cheaply,” he says. Along the same lines, Mr. Gruber found that when retirees in California began visiting their doctor less often and filling fewer prescriptions, overall medical spending fell. People did get sick more often, but treating their illnesses was still less costly than widespread basic care — in the form of doctors visits and drugs. Louise Russell, an economist at Rutgers, points out that programs that focus on at-risk patients cost the least, but even they are rarely free.

As Dr. Mark R. Chassin, a former New York state health commissioner, says, preventive care “reduces costs, yes, for the individual who didn’t get sick.”

“But that savings is overwhelmed by the cost of continuously treating everybody else.”

The actual savings are also not as large as might at first seem. Even if you don’t develop diabetes, your lifetime medical costs won’t drop to zero. You might live longer and better and yet still ultimately run up almost as big a lifetime medical bill, because you’ll eventually have other problems. That would be an undeniably better outcome, but it wouldn’t produce a financial windfall for society.

I don't know if it's an urban legend, but I read over a decade ago that Japan's finance ministry blocked anti-smoking programs because the led to high social security costs. The new addition is that preventive care is not economically efficient because it's not targeted. Presumably, if you could target preventive care more effectively (genomics, patient readiness to change) you'd get more value. Of course if a "pay for performance" program tracks preventive care metrics ...

It's often cheaper to cure than to prevent.

One caveat is that for the informed individual, preventive care makes LOTS of sense. It's only a marginal investment from a societal perspective. Another caveat is that this the research doesn't apply to immunization programs, it was looking at programs that advocate behavioral change.

How toy makers can save themselves

Toy makers are worried ....

Toy Makers Brace for a Chill in Sales - New York Times

...Meantime, toy makers are trying to prove to lawmakers that they can handle the matter themselves. Carter Keithley, the president of the Toy Industry Association, called tests at ports of entry “belt and suspenders checks,” arguing that such a measure would be overly cautious....

There's an easy way for toy makers to reassure the public. They can offer a $10 million prize to anyone who finds a problem that leads to a recall.

DeLong: China prior to WW I

DeLong has published a portion of what appears to be a textbook in process. He starts  by exploring the The Needham question, though he doesn't seem to know of Needham (I sent him a link). This paragraph is typical:

Grasping Reality with Both Hands: Brad DeLong's Semi-Daily Journal

...By the beginning of the twentieth century it looked like that Malthusian crisis had arrived. The more than 300 million people of late nineteenth-century China had no mechanized farm machinery and no industry-produced nitrogen fertilizers. They were crowded into the wet, arable eastern slice of what is "China" on today's maps, with the median family of 6 farming perhaps 4 acres at a time when the Radical Republicans were still hoping to somehow find 40 acres plus a mule for each family of American ex-slaves. Average adult height was, we think, significantly under five feet. There were enough landless and other desperate peasants that perhaps ten million joined the Taiping Rebellion of Hong Xiuquan--who declared himself the younger brother of Jesus Christ after repeatedly failing the shengyan exam--which burned through the Yangtze valley for nearly fifteen years. Perhaps ten million, 3% of China's population, died in that war alone....

It's a fascinating essay. I'm looking forward to the book.

Reality, perception, Hume, the red pill - and John Tierney

There's no way I have time to do this post justice, but I'll put something up anyway. Maybe I'll fill it in later.

What do these things have in common?

• Measurement in quantum mechanics and the "shut up and calculate" response to questions about reality and quantum mechanics
• Hume, Common Sense Philosophy and life in simulation (both of these are basically links to the end of a post, sorry, more below)
• How a digital picture taken of an analog photo can show more detail than is present in the analog original
• The output of the retina compared to the post-processed signals that become the fodder for perception
• The Red Pill and how to detect a VM

As a hint, here's a little bit more on the In Our Time programme on Common Sense Philosophy

• David Hume realized he couldn't "get out of his head". That is, he couldn't show that his "perceptions" were attached to an external truth, he had to simply assume there was an "out there". Thomas Reid responded with an 18th century version of "shut up and calculate", asserting that philosophy had to begin with the assumption of a physical reality and this could not be questioned. Reid was a deist, like Descartes he began with the assumption of a benign Principle Designer who wouldn't resort to trickery. Of course if one attributes more complex attributes to the PD then all bets are off ...
  

So, do we live in a simulation in a "real" world, or do we live in a simulation in a simulation?

Update 8/15/07: It must be something in the air. I just saw this: Tierney (NYT) interviews Nick Bostrum.

... The math and the logic are inexorable once you assume that lots of simulations are being run. But there are a couple of alternative hypotheses, as Dr. Bostrom points out. One is that civilization never attains the technology to run simulations (perhaps because it self-destructs before reaching that stage). The other hypothesis is that posthumans decide not to run the simulations...

Oh dear, it's getting harder to keep this blog on the fringes. I'll have to try harder. So, if we are (or I am) in a simulation run by ripples of space time in the infinite dying years of the endless universe, is this heaven, hell or are we (I) simply glitches in the software? Ok, now I'm back on the fringe ...

Or maybe not. Tierney, who was a miserable political columnist, is more imaginative than I could have imagined:

... My gut feeling is that the odds are better than 20 percent, maybe better than even. I think it’s highly likely that civilization could endure to produce those supercomputers. And if owners of the computers were anything like the millions of people immersed in virtual worlds like Second Life, SimCity and World of Warcraft, they’d be running simulations just to get a chance to control history — or maybe give themselves virtual roles as Cleopatra or Napoleon.

It’s unsettling to think of the world being run by a futuristic computer geek, although we might at last dispose of that of classic theological question: How could God allow so much evil in the world? For the same reason there are plagues and earthquakes and battles in games like World of Warcraft. Peace is boring, Dude...

Not bad really, though he's jumping to conclusions by assuming that whatever runs our purported simulation need have any similarity to us. This next bit I know Tierney got from a rather good science fiction story (I'll look it the story reference):

... There could be layer upon layer of simulations until you finally reached the architect of the first simulation — the Prime Designer, let’s call him or her (or it)...

and

...We’d start our simulation, expecting to observe a new virtual world, but instead our own world might end — not with a bang, not with a whimper, but with a message on the Prime Designer’s computer...

Darn, he took that one from me. I have to check if I ever seeded the meme that quantum computers would make us all dumber, since they'd suck the cycles that drive our simulations (hmm, is that testable? Probably not, the clock speed would simply drop.)

Next thing you know, Tierney will be onto the Fermi Paradox connection -- maybe after he recovers from the beating that he's about to receive from the general public.

I guess I can't stay on the fringe forever.

Update 8/15/07b: I remembered Reid's name and revised the post accordingly.

Update 1/18/08: See this later post on the same topic.

INTEL DUMP's insider comments on the Bush-era military

 Hoisted from INTEL DUMP - Tone Deaf comments:

... I, like many others have frustrations with GEN Casey. That said, he is about as good as we could have hoped for (other than making Petraeus CSA). He's got a hell of a challenge on his hand: 1) his VCSA is a cretin; 2) the Sergeant Major of the Army he inherited is useless; 3) he assumed control of an Army already bleeding out in the officer ranks and reserve components; 4) he oversees an ideologically culled general officer corps that saw 25-30 of its 2, 3 and 4 stars unceremoniously sacked by Schoomaker/Cody/Rumsfeld. Kern, Cavin, Byrnes, Taguba ... the list is Looong...

It's always interesting to get the insider perspective. Blogs let us do that.

See What Rove left us... is another comment about what you get when you select first and foremost for loyalty to one political party. You get the same thing every government that's ever done this gets -- and it's a long and unhappy list. You get incompetence.

Update on Peter Hausmann post - family fund

A few days ago I was moved by the story of Peter Hausman, a father of four who escaped the fall of the 35W bridge then drowned trying to help other victims. With a bit of trepidation, since not everyone knows that geek is a term of praise, I wrote:

... One might wish Peter, father of four, had been less heroic, but he was. MPR has a small article about him. I'd have titled this post "A geek dies heroically" but I can't know if Peter would have approved...

I never think my posts are widely read, so I was a bit surprised to hear from Peter's family. They told me Peter would have appreciated my sentiments. I've updated the post with information on a memorial fund to support his four young children.

Peter Hausmann Memorial Fund
c/o Anchor Bank
66 Thomas Ave E
West St. Paul, MN 55118

What Rove left us: a broken government

Rove went after the quiet professionals that used to keep America running. He eliminated many of them ...

The rise and fall of Turd Blossom (Sidney Blumenthal, The Guardian)

.... Rove's merger of politics and policy was an effort to forge a total one-party state. While he is acclaimed as a political strategist, his true innovation was in governing. He sought to subordinate the entire federal government to his goal of creating a permanent Republican majority. Every department and agency has been subject to an intense and thorough politicization. Indeed, Rove's ambitious plan was tantamount to a nascent Stalinism. Even science has been suppressed in the name of the party line, recalling the flawed biology propagated in the Soviet Union by Trofim Lysenko. Cheney and Rove acted as the pincers of the unitary executive. While Cheney sought to concentrate unaccountable power in the presidency, Rove brought down the anvil of politics on the professional career staff.

Rove's radicalization of government was early described by the first member of the administration to quit in disgust, John DiIulio, a University of Pennsylvania professor and the first director of the White House Office of Faith-Based and Community Initiatives. He discovered that "compassionate conservatism," Rove's slogan for Bush's 2000 campaign, was little more than a sham. "What you've got is everything - and I mean everything - being run by the political arm. It's the reign of the Mayberry Machiavellis," said DiIulio....

Rove would have been most content in a totalitarian state.

Update 8/15/07: Fallows points out that the occupation of Iraq was staffed with young republican Rove clones. Good point.

Google strikes a mighty blow against DRM

Actions always count more than mere words. No vendor's actions have been as "loud" as Google's.

Google recently abandoned a video retail scheme. This means their customers have lost access to the videos they "bought".

Does anyone really imagine that their Microsoft or Apple DRMd materials will still be playable in 2015?

No. Way.

DRM'd material is never purchased, it is always leased. The lease holder can terminate support at any time, sooner or later the material will become unavailable.

Eventually the market is going to get this.

Or will it? Macrovision is not digital. Still it's a partial counter-example to consider. Why did it last until the videotape died? It was extremely effective over its commercial lifespan.