Minnesota naturopaths can order MRIs

Michael Paymar is our state representative. I want to know how he voted on this bill. Note, this was a DFL bill!

A bitter fight over who can be called 'doctor'

It took 99 years, but Minnesota has finally given official recognition to the practice of naturopathic medicine, which relies on the body's powers to heal itself.

Under a new state law, naturopaths -- who use everything from herbal remedies to biofeedback -- will be allowed to register with the state and call themselves doctors without fear of running afoul of the medical establishment.

... "I didn't realize how much of an issue it was going to be," said Rep. Neva Walker, DFL-Minneapolis, who championed the bill for years before it finally passed and was signed into law in May. "[I] didn't realize somebody who had supported all forms of alternative healing for years was going to be an enemy."

It allows those who qualify to use the title "naturopathic doctor" and expand their "scope of practice" to include such things as ordering blood tests and MRIs, and admitting patients to hospitals....

...The Minnesota Medical Association (MMA), representing conventional doctors, objected to allowing naturopaths to prescribe drugs and perform minor surgery. When those items were dropped, the MMA withdrew its opposition.

So, if a naturopath orders an MRI, do payors have to pay for it?

I'll ask Mike Paymar that question.

In the meantime the DFL dominated Minnesota legislature has decided that they want to continue to limit medical decision making to "professionals". What's new is that they've decided that medical science is no longer the basis for measuring professional expertise. Social judgment alone is the new criteria.

It's the same sort of reasoning that brings creationism into science classes. People who believe solar variation explains most climate change fall into this category. We're used to this, it's a familiar fight. I don't think there is any alternative to science for making judgments about the natural world, but I accept most of society doesn't agree with me.

So I object to the decision on the basis of using social fashion as the basis for measuring expertise, but that's not my primary objection.

My real problem with this bill is that it doesn't go far enough.

If you abandon science as the basis for expertise, then you shouldn't stop with naturopaths. Certainly nurses should be included, but also teachers, chiropractors, shamans, plumbers, lawyers, accountants, radiology technicians, cab drivers, flight attendants, mothers, fathers and, heck, children too.

Nor should the boundary be artificially set at test ordering. An MRI is not a small procedure, nor necessarily benign.

Let us open up all of medicine and surgery. If Naturopaths are ordering MRIs, then carpenters should be doing hip replacements. If you've every seen a 110 lb orthopedic surgeon rear back to slam the silver hammer down, you'd appreciate the role a good carpenter can play.

Seriously.

If you abandon science as a measure for expertise, then there are no more boundaries. I expect the courts will, in time, agree with me.

Payors and insurance companies will love this. Plumbers are not only much cheaper than neurosurgeons, the follow-up care will also be much shorter and less costly.

Caveat emptor.

Update 6/14/08: Representative Michael Paymar responded promptly by mail. He's guilty - he vote for this sucker. To his credit he doesn't mince words. He's a believer, Mike Paymar is not a rationalist. The Minnesota Medical Association approved the bill, so he felt he had cover to proceed.

Shame on them too.

Sigh.

Paymar is a very good representative, he wins this district by huge margins, and it's not like I'm going to vote for anyone else. On the other hand, it will be much harder now to send him our yearly campaign donations.

Joy of the global web -- what's 101 mean?

A reader of a 2006 post of mine on "Wiki 101" asked what the "101" means.

It's a wonderful question. I answered ...

Blogger: Gordon's Tech - Post a Comment

In North American universities there's a convention that introductory courses are assigned a course number of '101'.

I've never thought about why that's so, and why all schools in the US and Canada follow this rule.

So 'Wiki 101' means 'introductory course in Wiki'...

I'm guessing the question came from an international reader.

Google is investing a lot in integrated machine language translation software. Over time we'll get more more of these questions, and I'll be asking the same sort of questions when I read blogs from other languages.

I love this stuff.

Modern management literature and the Hammer of Thor

I'm obliged to consume a regular diet of management books.

There are some good ones*, often outside the best seller lists, but a heck of a lot of them remind me of 18th century medicine. They're case studies, or stories, about complex and emergent behaviors we can't yet understand. The most successful ones, unsurprisingly, spend quite a bit of time bolstering the surprisingly frail egos of corporate leadership. Once a CEO decides a book is worth reading, their enthusiasm will sell tens of thousands of corporate copies - mostly unread.

That's the formula, by the way. If you have the stomach for it, and some writing skills and a lot of luck, you can be wealthy.

Emily pointed out this morning that the meme is older than 18th century medicine. It's as old as myth. Living without science in the natural world, you live with lightning and earthquakes, storms and drought, plague and locusts and the mixed miracle of life itself. Humans are compelled to create internally coherent stories, and so myth is born. Thunder is the Hammering of Thor.

That's what most best seller management books are. Stories of The Hammering of Jack Welch, God of Thunder.

At least they're quick reading.

* I'd forgotten about this old page of mine -- I last updated over eight years ago! There's some good stuff there ... I'll recycle bits of it for the internal corporate blogging I do.

Another week, another bridge closing

The collapse of the 35W bridge was no fluke.

That's the lesson of the fourth or fifth major bridge closure in the metro area: MnDOT barricades Hwy. 43 bridge in Winona.

Minnesota's GOP legislature and GOP governors have been neglecting public infrastructure for a long time.

We finally got the GOP out of the senate, but still have a GOP governor. He's not what he used to be though, deaths from the 35W bridge put Pawlenty on the defensive. His presidential ambitions are at stake.

Maybe we need a law to hold legislators personally responsible for criminal neglect. Shame that legislators would have to write the law.

Why did Hillary Clinton lose?

Gail Collins opinion:

Op-Ed Columnist - Gail Collins - What Hillary Clinton Won - Op-Ed - NYTimes.com

... I get asked all the time whether I think Hillary lost because sexism is worse than racism in this country. The answer is no. She lost because Obama ran a smarter, better-organized campaign. It’s possible that she would have won if the Democratic Party had more rational primary rules. But Obama didn’t make up the rules, and Clinton had no problem with them until she began to lose...

Yes, Democratic primaries are pretty weird, not least in Minnesota. There's another factor though, which nobody has mentioned.

Nobody. You're reading it here first. So only five people understand this!

Collins has forgotten John Edwards. Nobody has noticed that when Edwards dropped out Clinton became more competitive.

I suspect Obama's victory was a side-effect of the who else was in the race and the sequence in which they left. Had Edwards stayed in I think Obama would have won sooner. Edwards split Clinton's base.

Why was that base splittable? Well, I like John Edwards, but I suspect a major factor was "Bush-Clinton-Bush-Clinton". At some level I think running the presidency forever between two families struck many people as Banana republic.

Gail Collins should have picked this one up, I think she got caught up in the feminist storyline. The current fad is to focus on millions of allegedly enraged feminist voters. My bet is that a week from now that meme will evaporate from lack of substance. These voters will realize that they don't want to emulate the Naderites who brought us GWB.

Boring explanation of course, so you'll never read it in the media.

A shift in diabetes control

It's bad news that we weren't able to improve outcomes with tight control, but I suspect many diabetics found that control very hard to attain ...

Tight Rein on Blood Sugar Has No Heart Benefits - NYTimes.com

...Dr. John Buse, president for medicine and science of the diabetes association, the blood sugar/cardiovascular disease hypothesis has failed for people with established Type 2 diabetes.

For these patients, “intensive management of A1C for cardiovascular risk probably isn’t worth it,” Dr. Buse said.

The focus now will turn back to preventing and/or curing diabetes mellitus.

Raising gas prices may help reduce obesity, and thus reduce disease incidence over time.

UK university lecture podcasts – tears to my eyes

This kind of stuff brings tears to my eyes.

No, really.

Aaronson’s MIT lectures on theoretical computer science, MIT OpenCourseWare, OpenAccess journals, Apple’s iTunes U, the BBC’s In Our Time – all beautiful contradictions to recent history.

Today that illustrious group is joined by several illustrious UK institutions …

BBC NEWS | UK | Education | UK university lectures on iTunes

University College London, the Open University and Trinity College Dublin are putting lectures onto iTunes.

Educational content is already available in the United States through the non-charging "iTunes U" section of the music downloading service.

But European universities are now joining, providing video and audio material for students to use on iPods or computers.

The service will include recordings of lectures from leading academics…

… The initial offerings from UCL will include material about neuroscience, the university's "lunch time lectures" and an audio news round-up.

The Open University is promising to make available 300 audio and video files with material from current courses.

Trinity College Dublin is promising lectures from journalist Seymour Hersh, scientist Robert Winston, author Anita Desai and politician Alex Salmond.

This will be available from iTunes U, launched by Apple computers last summer as a free education area within the iTunes online music and video store.

It is intended to make lectures available to students at the institutions and to a wider public audience.

This has been used by leading US universities to provide lectures and research news, including Harvard, Yale, Stanford, UC Berkeley and MIT.

Many universities in the UK have been making their own podcasts of lectures, but this will be the first time they have been distributed on the iconic iTunes service.

Open University vice-chancellor Brenda Gourley said it was an exciting new opportunity for anyone, anywhere in the world to gain easy access to its courses.

"Our aim is to partner our established distance learning expertise with the power of the internet to provide as mobile, flexible and personalised learning as possible, whatever your current educational level, personal circumstances or technological abilities."…

One hundred years ago we thought radio would bring expertise to anyone able to listen, and, thanks in large part to the BBC, it had some success. Fifty years ago people thought television would contribute, but the twin barriers of time, reach, and limited bandwidth were too high for real progress. Twenty-five years ago Bill Gates father (William Henry Gates - "CD-ROM: The New Papyrus") and I thought the CD-ROM would do this, and it might have but for the net.

Now it’s happening, and almost nobody notices.

Sniffle.

[1] See also: The quiet demise of the CD

Amazon is down?!

Other sites are online, but Google is slow and Amazon is …

http://www.amazon.com/

Http/1.1 Service Unavailable

It’s probably a local router issue, but weird.

Update 6/6/08: Yes, it was down. Not a DOS attack though, probably human error.

Gourmet magazine: world's most successful spammer?

There are three classes of true spam, by which I mean spam for which unsubscribe requests don't work.

There's fraudulent spam with fake email addresses. That's 95% and it's hard to stop.

There's political spam with valid, albeit fungible, email addresses. It's legal. Congress always exempts itself from its own laws.

And then there's Gourmet Magazine and Conde Nast. Valid email addresses, but unsubscribe doesn't work. They're breaking the law, but the spam keeps coming ...

Nast and Spam: what's the deal here?

... It's easy to eliminate -- I just block 'condenastpubs.com'. Still, it's weird. I suspect a good portion of the middle class doesn't mind getting spam from Gourmet ...

Update 10/14/07: Judging from a helpful comment, this appears to be a business decision by Conde Nast, not a technical error or a fluke. I think there's a strong case to be made for blacklisting the condenast.com domain.

Update 1/18/07: I got another Gourmet magazine spam -- but the domain was erol.com. Turns out this is not a Gourmet spam after all; it's a phishing email. I suspect even Conde Nast hasn't fallen that far. It's a measure of how low they have fallen, however, that phishers are now riding their spammy coattails."

Today they started using gourmetmagazine.com. I noticed because I had to add that to my 'delete on receipt filter'. (Note to Gourmet, if you want to comment email won't work, your domain filters to the trash.)

So how and why does a theoretically legit enterprise become a unique category of spammer?

It must be working for them. There's evidently something vulnerable about a significant number of people who subscribe to Gourmet magazine (cough, not you Emily). They must be somewhat lonely or bored, and they must be uniquely easy to sell to. Gourmet probably makes a good bit of change selling these email addresses to crooks.

If I were an IRS agent with time on my hands, I'd be auditing Conde Nast. A company that does this sort of thing probably has other shady practices. You may know them by their deeds ...

Update 7/31/08: Phishers are leveraging Conde Nast's penchant for spam and various email addresses, today a phisher used condemailings.com". If you hand out in the swamps, you tend to attract alligators ...

Google transit - slowly growing, now to add bike routes

The Twin Cities has many great things, but transit hasn't been among them since we lost our trams in the 30s.

The good news is we're extending our light rail system, and gas prices are being very helpful.

Still, it's no surprise Google Transit hasn't gotten to our area yet. On the other hand, they've done Montreal:

Beaconsfield, QC, Canada to Lucien-L'Allier, Canada - Google Maps

The integration is very elegant -- you see pt-to-pt route by multiple modalities. The mobile version has transit as well.

It would be nice if they were to add bicycle routes as well.

Ok, it would be extremely nice. Minneapolis has the best bicycle transit system of any snowy city in North America, and is probably #2 or #3 by any criteria. It would be wonderful to see that appear in our Google transit maps.

I think I heard gas break $4/gallon today ...

Update 6/5/08: Per comments, we'll be getting coverage in the TC's this summer! Yay! No bike routes yet, but that's gotta come soon. I suspect Google people like bikes ...

Britannica finally goes social

I've been a Britannica Online subscriber since they launched -- mostly out of sentiment. I really don't use them very often -- even though I set Google up so Britannica is searched with every Google query.

Years ago I hoped they might find common cause with the New York Times and build a joint community. Heck, I'd have been happy if they simply built their own community.

They never did, and eventually I figured they'd lost their way for good. I mostly forgot about the EB, even though I still subscribed. Recently, though, I began reading the Britannica blog. It's pretty good. A sign of life!

Today there were two blogs on Britannica's long delayed social reinvention. It sounds like they'll try to merge a Wikipedia like community with the core formal encyclopedia

• Britannica's New Site: More Participation, Collaboration from Experts and Readers
• Collaboration and the voice of experts

I hope it works, I'm just glad to see there's some energy left in the place.

Evolution in action - captured and dissected

A 20 year longitudinal study of bacterial evolution is further constraint on the argument facades creationists use to conceal their faith-based opinions. Emphasis mine, arguably this research evolved a new species of bacteria ...

The Loom : A New Step In Evolution (yes, Carl Zimmer again)

... After 33,127 generations Lenski and his students noticed something strange in one of the colonies. The flask started to turn cloudy. This happens sometimes when contaminating bacteria slip into a flask and start feeding on a compound in the broth known as citrate...

...Many species of bacteria can eat citrate, but in an oxygen-rich environment like Lenski's lab, E. coli can't. The problem is that the bacteria can't pull the molecule in through their membranes. In fact, their failure has long been one of the defining hallmarks of E. coli as a species.

...In nature, there have been a few reports of E. coli that can feed on citrate. But these oddballs all acquired a ring of DNA called a plasmid from some other species of bacteria. Lenski selected a strain of E. coli for his experiments that doesn't have any plasmids, there were no other bacteria in the experiment, and the evolved bacteria remain plasmid-free. So the only explanation was that this one line of E. coli had evolved the ability to eat citrate on its own.

Blount ...went back through the ancestral stocks to see if they included any citrate-eaters.... in generation 31,500, they made up 0.5% of the population. Their population rose to 19% in the next 1000 generations, but then they nearly vanished at generation 33,000. But in the next 120 generations or so, the citrate-eaters went berserk, coming to dominate the population.

This rise and fall and rise suggests that the evolution of citrate-eating was not a one-mutation affair. The first mutation (or mutations) allowed the bacteria to eat citrate, but they were outcompeted by some glucose-eating mutants that still had the upper hand. Only after they mutated further did their citrate-eating become a recipe for success.

... Lenski's research has shown that in many ways, evolution is repeatable. The 12 lines tend to evolve in the same direction... Often these parallel changes are the result of changes to the same genes. And yet when it comes to citrate-eating, evolution seems to have produced a fluke.

To gauge the flukiness of the citrate-eaters, Blount and Lenski replayed evolution. They grew new populations from 12 time points in the 33,000-generations of pre-citrate-eating bacteria. They let the bacteria evolve for thousands of generations, monitoring them for any signs of citrate-eating. They then transferred the bacteria to Petri dishes with nothing but citrate to eat. All told, they tested 40 trillion cells...

... Out of that staggering hoard of bacteria, only a handful of citrate-eating mutants arose. None of the original ancestors or early predecessors gave rise to citrate-eaters; only later stages in the line could--mostly from 27,000 generations or beyond. Still, even among these later E. coli, the odds of evolving into a citrate-eater was staggeringly low, on the order of one-in-a-trillion...

If E. coli is defined as a species that can't eat citrate, does that mean that Lenski's team has witnessed the origin of a new species? The question is actually murkier than it seems, because the traditional concept of species doesn't fit bacteria very comfortably. (For the details, check out my new article on Scientific American, "What is a Species?")...

There's a tangent here Zimmer didn't call out.

The researchers were able to replicate the speciation-vent, but it took trillions of tries from the relatively late stage precursors of the citrate eaters. It might take hundreds or thousands of trillions of "tries" to get the same outcome from wild E. Coli. Of course that's only a few hundred years of bacterial evolution.

If they repeated the same experiments fifty times, they'd probably get other one-in-a-hundred-trillion flukes over a 20 year trial, but they'd likely be different flukes.

Flip a coin a thousand times and there's a 100% probability you'll get a sequence made up of Heads and Tails. The chance that the next thousand flips will get the same sequence is very, very low.

Naive old-style creationists got hung up on the impossibly small probability that evolution, replayed from the start, would produce us.

Well, ummn, no, it wouldn't.

The more interesting question is, if you replayed evolution on earth 1000 times, how many times would you produce something that would do experiments about evolution on earth?

That's a Drake equation question. The "expert" wild guesses are in the 20% to 0.33% range, but we could do with a few data points ...

Aging is a very old strategy -- proteins in the cap

I almost missed this astounding Boston Globe article. Mercifully I track Zimmer's blog, so I'm only 48 hours behind.

Note the explanation of why evolution has not produced immortal species (it sucks resources from adaptive capacity), and the analogy between bacterial "caps" and human eggs (emphases mine) ...

Aging is older than you think - The Boston Globe Carl Zimmer

... why hasn't evolution favored perfect repair - in other words, immortality?

"Immortality is not cost-effective," says Stewart.

To never get old, organisms would have to invest a huge amount of energy in repair. They'd be left with little energy to reproduce. Natural selection would instead favor other organisms that put less energy into repair and produced more offspring.

A common solution to this trade-off is to set aside a special population of cells that will reproduce. Our bodies put a great deal of energy into keeping eggs and sperm from becoming damaged. They put much less care into repairing the rest of our cells.

"My children are born young and rejuvenated. So the damage of my aging is kept just to me," says Stewart.

Many scientists assumed that symmetrically dividing microbes could not take advantage of the aging strategy we use. "Every problem that would arise, the cell would have to fix," says Stewart...

... Stewart and his colleagues have revealed that even symmetrically dividing bacteria get old.

They put a single E. coli on a slide and allowed it to reproduce. They engineered it to produce a glow, which made it and its descendants easier to film. Using sophisticated image-processing software, they were able to track 35,000 cells, observing how long each one took to divide.

In 2005, Stewart and his colleagues reported that some bacteria began to reproduce more slowly than their cousins, and over the generations their descendants slowed down even more.

There was one crucial difference between the old and young microbes: the caps at each end of their rod-shaped bodies. Each time E. coli divides, the two new microbes each inherit one of its caps, and the microbe must manufacture a new cap for each one. When these two microbes divide again, they each make two new caps. Over the generations, there will be some bacteria that inherit the original caps from the common ancestor of the entire colony, while others have younger caps. After a cap ages for 100 generations, the scientists estimate, the cell can no longer reproduce.

The scientists then took a closer look at what was happening inside the bacteria. Earlier this year, they reported that clumps of tangled proteins grow in E. coli. As the bacteria divide, these clumps end up in the old caps. Somehow, the defective proteins help slow down the growth of old bacteria.

Stewart sees these results as evidence that single-celled bacteria use the same strategy multicellular animals do to cope with cell damage.

"It's probably cheaper to throw away your garbage in one cell while the rest of your population grows."

Daniel Promislow, an expert on the genetics of aging at the University of Georgia, finds the research exciting. For one thing, it suggests that the common ancestor of bacteria and animals was already aging 3 billion years ago.

"Aging would be a really old phenomenon," he says.

Studying aging in quick-breeding E. coli could allow scientists to get answers about the process faster than with other lab animals, like flies or mice, Promislow says. "There's a lot you can do in a short amount of time."

It might even be possible to translate some of those lessons to medical applications. Alzheimer's disease, for example, is associated with clumps of proteins called plaques that form in neurons.

"It may be possible to find a way to alleviate protein damage in E. coli that would have a use in higher organisms," says Stewart. "I'm not saying it's going to be easy to find, though.

To the non-expert this certainly has the smell of "breakthrough". Changing the evolutionary address of aging is a big deal, and developing a new "instrument" to study aging is an equally big advance.

It feels astounding to me, but I'm easily excitable.

PS. While Death sacrifices the individual to power adaptation, Sex sacrifices offspring to power adapatation. Sex is an even more radical gambit than Death, so it's not surprising that while Death is universal, Sex can be sacrificed even in multicellular organisms.

Buying Obama bumper stickers

Oddly, there's nothing on the front page of the official site about buying campaign paraphernalia. I had to go to the answers database and search ...

Answer Center Barack Obama

You can buy buttons, t-shirts, bumper stickers, lapel pins, and party packs here.

...yard signs will be available at the store.barackobama.com this summer...

Someone needs to put this stuff on page one.

The melamine is still coming from China ...

The report of this successful intercept was published on Dec 26, 2007:

FDA Says It Halted Melamine-Tainted Pet Treats

...Sampling by the FDA’s Los Angeles District showed that pet treats imported from China, including treat seed sticks for cockatiels and honey cakes for hamsters tested positive for melamine, according to a government report...

You gotta love those Google alerts -- a small release in a bird focused pet site shows up on my news page as though it were on the front page of the NYT.

This is not good news. Yes, it's nice to know the FDA is catching some melamine contaminated imports, but that's a bit like reading about the DEA making a big cocaine haul.

It just tells us that the supply lines are still running.

The one bright spot is that if the Dems hold the Senate and Obama takes the Presidency, then there's hope for a resurrected FDA and policies that hold importers liable for product defects. The FDA only has to hold on until then ...

Of course if McCain wins ...