Tuesday, November 10, 2009

The ultimate take down of the disgraced Levitt and Dubner

The intelligentsia have been engaged for weeks in a ferocious competition to best capture the intellectual and moral vacuity of Levitt and Dubner's latest money churner.

Today, by acclaim, we have a winner -- “SuperFreakonomics” and climate change : The New Yorker - Elizabeth Kolbert. The smashing finale left no doubt ...
... To be skeptical of climate models and credulous about things like carbon-eating trees and cloudmaking machinery and hoses that shoot sulfur into the sky is to replace a faith in science with a belief in science fiction. This is the turn that “SuperFreakonomics” takes, even as its authors repeatedly extoll their hard-headedness. All of which goes to show that, while some forms of horseshit are no longer a problem, others will always be with us.
These men traded their reputations for wealth. A worthy trade for them, but they're not paying for the collateral damage

Next up: AAFP to endorse e-cigarettes

I had a real bad feeling when the American Academy of Family Physicians closed our once excellent web site to public access. So I wasn’t all that surprised by their latest move …

How the World Works – Family Doctors go better with Coke - Salon.com

… directed to this story from the Cleveland Plain Dealer reporting that the American Association of Family Doctors has "a six-figure grant from the Coca-Cola Co. to create content about beverages and sweeteners for the academy's consumer Web site, FamilyDoctor.org."

From the AAFP press release: “The Consumer Alliance program is a way of working with interested companies to develop educational materials to help consumers make informed decisions so they can include the products they love in a balanced diet and healthy lifestyle," said AAFP President-elect Lori Heim, M.D., of Vass, N.C…

…The Consumer Alliance program also will create a new source of funding for AAFP, which, in recent years, has broadened its search for funding outside the pharmaceutical industry…”

I just sent these guys over $600 for my 1 year membership – to find out that the AAFP’s consumer health site is doing covert marketing. Next up – the health benefits of e-cigarettes.

Worst bit? Maybe this is an improvement over pharmaceutical funding.

I expect this will be my last year of AAFP membership.

Update: I received a standard response letter signed by AAFP President Lori Heim when I wrote the academy. It included a bit of further context ...

... I would finally note that this is not new territory for the AAFP. Over the past 4 years we have had funding relationships with Pepsi and McDonald's for support of the AIM program - and we have managed them very well in maintaining a positive image for the Academy while advancing our message about fitness, activity, and healthy choices. And Coca-Cola has been a corporate member of our Foundation for several years as well which is why we reached out to them initially.
So why not Philip Morris? These are publicly traded companies -- their mission is not public health. Their mission is to make money from people who buy Pepsi, Coke and McDonald's products.

The AAFP needs a reform agenda. It can't afford to live in the style it's grown accustomed to, so the AAFP needs to radically downsize.

Monday, November 09, 2009

Dems for a rationalist GOP - is there somewhere to donate?

Krugman is very worried about the 2010 triumph of the Tea Party ...
Op-Ed Columnist - Paranoia Strikes Deep - NYTimes.com

Last Thursday there was a rally outside the U.S. Capitol to protest pending health care legislation, featuring the kinds of things we’ve grown accustomed to, including large signs showing piles of bodies at Dachau with the caption “National Socialist Healthcare.” It was grotesque — and it was also ominous. For what we may be seeing is America starting to be Californiafied...

...In fact, the party of Limbaugh and Beck could well make major gains in the midterm elections. The Obama administration’s job-creation efforts have fallen short, so that unemployment is likely to stay disastrously high through next year and beyond. The banker-friendly bailout of Wall Street has angered voters, and might even let Republicans claim the mantle of economic populism. Conservatives may not have better ideas, but voters might support them out of sheer frustration.

And if Tea Party Republicans do win big next year, what has already happened in California could happen at the national level. In California, the G.O.P. has essentially shrunk down to a rump party with no interest in actually governing — but that rump remains big enough to prevent anyone else from dealing with the state’s fiscal crisis. If this happens to America as a whole, as it all too easily could, the country could become effectively ungovernable in the midst of an ongoing economic disaster...
Krugman is not always right. Unfortunately, he's the best prognosticator we've got, even if he's better at forecasting doom than at coming up with practical alternatives (perhaps because we don't have a lot of practical options).

We can't make Palin/Bachman go away, because their constituency is right be afraid. Even if Bachman had lost her Minnesota seat (she almost did, it was surprisingly close) someone else would have taken her raving loon position.

Instead of focusing on the crazies we should be trying to build a Reason-based GOP. Liberal democracies need a dynamic tension between the genetically gifted and the neurotypical, between those who inherit wealth and those who inherit struggle, between the market and the wise, between the thrusting and the compassionate. If the powerful do not get their extra votes, they will crash the system (to their own detriment, but the powerful are not often insightful).

A rationalist GOP won't have my values of tolerance and compassion. It will, however, have a calculated interest in the survival of American (if not human) civilization, in educating productive workers, in reducing unprofitable and uncontrollable wars, and in clean air, water, and even beautiful spaces.

I wouldn't vote for or admire a rationalist GOP, but I would understand and respect its necessity. Without this kind of opposition, without the struggle for power, my Dem party will become a sewer of corruption (No, it's not a sewer yet. If you think it is you've led a protected life).

Today Newt Gingrich is the closest thing to a rationalist GOP -- which is pathetic. As feeble in Reason as he is, he's also powerless and all but forgotten.

We need to rebuild a post-Reagan rationalist GOP -- or we'll be governed by the likes of Palin and Bachman and human civilization will be a smoldering wreck.

Where do we start donating?
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Smart Smoker e-cigarette: From China without regulation

In the past 2-3 days I've noticed advertisements for "smart smoker" in several of the media sources I read including the NYT.

I haven't seen anything like this for years. Heck, I'd thought these ads were disallowed in the US.

Turns out these are "e-cigarettes", a drug delivery system that's marketed as reducing second hand smoke and as "legal to smoke anywhere". They are currently legal to advertise in the US, but not legal to import.

They are manufactured in China, and first become popular in the UK, where they've emerged from a "regulatory gap". The vendor web sites strongly imply these are "safer" than traditional cigarettes; that's not implausible per nicotine dose unit but it's certainly untested. They don't claim that they're "safer" than bungee jumping.

So how does one figure out who's behind these expensive ads (and, as it turns out, huge lobbying, marketing and legal initiatives)? In this case, Google is not a friend. Simple searches turn up vast numbers of results from a mixture of pro-smoking groups, retailers and spam blogs. A smoke screen, as it were.

On the other hand, scholar.google.com and PubMed have almost nothing on "e-cigarette" or "electronic cigarette". This has come on too quickly for public health and research to respond.

My best source to date has been a single June 2009 NY Times article, which I only found by restricting my Google search to site:nytimes.com. That's where I learned this innovation was made in China. The "smoke" is inhaled propylene glycol, an antifreeze component (see also poisoned toothpaste (Chinese diethylene glycol). Emphases mine:
Cigarettes Without Smoke, or Regulation - June 2, 2009 - NYTimes.com
FALL RIVER, Mass. — During 34 years of smoking, Carolyn Smeaton has tried countless ways to reduce her three-pack-a-day habit, including a nicotine patch, nicotine gum and a prescription drug. But stop-smoking aids always failed her.

Then, having watched a TV infomercial at her home here, Ms. Smeaton tried an electronic cigarette, which claimed to be a less dangerous way to feed her addiction. The battery-powered device she bought online delivered an odorless dose of nicotine and flavoring without cigarette tar or additives, and produced a vapor mist nearly identical in appearance to tobacco smoke.

... the Food and Drug Administration has already refused entry to dozens of shipments of e-cigarettes coming into the country, mostly from China, the chief maker of them, where manufacture began about five years ago. The F.D.A. took similar action in 1989, refusing shipments of an earlier, less appealing version, Favor Smoke-Free Cigarettes.

“These appear to be unapproved drug device products,” said Karen Riley, a spokeswoman for the agency, “and as unapproved products they can’t enter the United States.”

But enough of the e-cigarettes have made their way into the country that they continue to proliferate online and in the malls.

For $100 to $150 or so, a user can buy a starter kit including a battery-powered cigarette and replaceable cartridges that typically contain nicotine (though cartridges can be bought without it), flavoring and propylene glycol, a liquid whose vaporizing produces the smokelike mist. When a user inhales, a sensor heats the cartridge. The flavorings include tobacco, menthol and cherry, and the levels of nicotine vary by cartridge.

Propylene glycol is used in antifreeze, and also to create artificial smoke or fog in theatrical productions. The F.D.A. has classified it as an additive that is “generally recognized as safe” for use in food. But when asked whether inhaling it was safe, Dr. Richard D. Hurt, director of the Nicotine Dependence Center at the Mayo Clinic, said, “I don’t think so, but I’m not sure anyone knows for sure.”

Of the e-cigarettes themselves, Dr. Hurt added: “We basically don’t know anything about them. They’ve never been tested for safety or efficacy to help people stop smoking.”

Public health officials also worry that the devices’ fruit flavors, novelty and ease of access may entice children.

“It looks like a cigarette and is marketed as a cigarette,” said Jonathan P. Winickoff, an associate professor at the Massachusetts General Hospital for Children and chairman of the American Academy of Pediatrics Tobacco Consortium. “There’s nothing that prevents youth from getting addicted to nicotine.”

Sales and use of electronic cigarettes are already illegal on safety grounds in Australia and Hong Kong, and some other countries regulate them as medicinal devices or forbid their advertising. So far the United States has focused only on stopping them at the border, although Senator Frank R. Lautenberg, Democrat of New Jersey, has asked the drug agency to take them off the market until they can be tested.

Distributors of electronic cigarettes fear that a bill making its way through Congress that would give the F.D.A. the authority to regulate tobacco could be used to put them out of business as well. The bill has passed the House and could be taken up by the Senate this week.

The only American study of electronic cigarettes, now under way at Virginia Commonwealth University and financed by the National Cancer Institute, deals not with the kind of safety questions raised by propylene glycol but rather with the amount of nicotine processed by the bodies of the products’ users.

Another study, conducted this year at the University of Auckland in New Zealand and financed by Ruyan, an electronic cigarette company, shows that users typically receive 10 percent to 18 percent of the nicotine delivered by a tobacco cigarette...
So what we have here is a novel unregulated drug delivery system involving inhaled propylene glycol that is manufactured in China, a nation famous for the quality and regulation of its regulated Heparin supply. It is perfectly designed for sale to children and to Darwin award wannabes.

The good news is that the GOP no longer controls the FDA. That doesn't mean we can go back to sleep. The GOP will be back, and with Palin and Bachman in control it will be worse than ever. This beast needs to be driven back into its cage.

See also:
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Forgotten things - Gypsies and Indians

My father remembers Indians in the 1920s rowing from Oka across the Lake of Two Mountains in birch canoes to sell small handmade toy birch canoes in Regaud Quebec.

My mother remembers Gypsies selling handmade clothes pegs in Manchester in the 1930s. Once she and her sister were home alone when the Gypsies called. They hid beneath a table, for they knew the Gypsies stole children and raised them as their own.
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Sunday, November 08, 2009

Angela Merkel's second crossing

I don't often wish for access to a TV, but this I'd like to see ...
Berlin's moment of freedom that turned world history | World news | The Guardian
...Later that night, a young East German scientist called Angela Merkel walked across the same crossing. Now the chancellor of united Germany, she will do the same again this afternoon, accompanied by a group of East German opposition activists, Mikhail Gorbachev, Lech Walesa and doubtless a media scrum."...
I knew Angela Merkel was Chancellor of course, but I'd forgotten that she was born in East Germany. She crossed over on the day East Germany was freed.

Saturday, November 07, 2009

Bad back better


It makes for a good family story, but really nobody was very happy with me. After a nearly 30 year run my strategy of ignoring my back pain wasn't working. I'd gotten pretty good with ice packs, advil, canes and early inline skating, but I'd advanced from an every 8 months problem lasting 3-5 days to every 4 months lasting 14-21 days.

Every doc knows where that story goes. So I bit the bullet, and I saw a doctor (other than myself and my wife that is). Specifically, I signed up with the marines of back rehab - Minnesota's Physicians Back and Neck Clinic (PNBC).

It worked. My back is better now than it's been for at least twenty years. That was probably the last time I went this long without a 'stuck to the floor' acute exacerbation.

It's been long enough now that I know they did right by me. My doc was a bit crispy after decades of doing bad back work, and I was a bit surprised he didn't even bother with a plain film (these guys do very little imaging), but the program he and his buddies established worked. I did about 2 months of PT driven core muscle training and eternal daily stretching routines. I'm still religious about the 10 minute daily stretching regimen. As per my colleague BF's husband, I do them before I get out of bed.

I haven't been as diligent with the maintenance Roman Chair back extensions they prescribe, so I know what I'll have to change if my pain returns. That's my problem though, not a problem with the PBNC program.

Yeah, it's n of 1, but these guys are pretty much smack in the center of evidence-based back pain management -- they're just meaner about it. For n of 2 I'll mention that my buddy ZH was facing grim cervical spine surgery when he went there. They fixed him good - no surgery, full activity, he's a fan.

It's perhaps not for everyone, but if you're in MN, and you've got a really bad back or neck problem, chronic or acute, this is the team to see. Just remember when they want 10 more reps - "Pain is weakness leaving the body".

See also:
Update 11/21/09: Something I'd forgotten when I wrote this post. For the first few months after treatment began my back often ached. I felt as though I'd spread the severe pain over time, as though the total had not changed but the distribution had improved. I was fine with that, it didn't stop me doing anything. It is only now that I realize that my tolerable legacy symptoms, slowly and without my notice, went away.

Update 7/3/2013 - six years after my summer 2007 injury

Around 2010 I had another episode of reasonably severe back pain and I returned to PNBC for another rehab session. In retrospect that was probably unnecessary, but it proved I'd done a bad job of maintaining my muscle tone.

I have been utterly reliable at my morning stretching exercises, which I credit for 60% of my prolonged remission. The rest is core muscle; I've done better at maintaining that, but it is possible to have too much of a good thing.  In June of 2013, while engaged in an arguably insane level of physical activity for non-elite 54 yo at CrossFit St Paul, I injured my back when I lost form doing my 16th front squat with a 120+ pound bar. (More on CrossFit in a 2013 post I think). Clean and jerk and squats likely voided my PNBC warranty. That pain resolved in about 24 hours, and 48 hours later the discomfort is mild.

It must be noted PNBC's aggressive strengthening program doesn't make one completely invulnerable. (That's a joke.) I'll go easy for the next six weeks, then keep my free weights under 90lbs for the next six months and focus on reps.

After 2009 PNBC was acquired by a local healthcare enterprise; I suspect it's lost a bit of the old intensity. Sadly, their 2009 approach to managing back pain is still radical.

Update 12/24/2015 - 8+ years later.

Over the past 4 years I've had 2-3 back strains related to pushing the envelope while weight lifting, most recently on the dead lift. I don't think one can complain about this sort of thing! So far they've all resolved fairly quickly with nothing like the severe pain I once new. So far :-).

Further notes:

Friday, November 06, 2009

How business stories are made - the inside scoop

Dan Lyons, writing as his alter ego "fake steve jobs", tells us how big glossy business magazine stories are made. It's a story everyone should know. (The "filthy hack" is Dan Lyons of course, and he's getting some revenge served cold ...)
The Secret Diary of Steve Jobs: Exclusive Story Opportunity...

...One of the filthiest hacks on the beat has been trying to curry favor with Katie, and she's playing along, pretending to be his friend, hoping we can maybe use him for something at some point. Katie calls this her "back pocket strategy," meaning it's always good to keep a few of these frigtards in your back pocket in case you need them someday....

...If you want to see the full version of the pitch letter you can find it here. I didn't want to fill up this post with the whole thing because it's pretty long. But it's also pretty hilarious reading, especially if you've ever wondered how those big features on giant companies end up in your magazine.

Little hint: The companies think them up themselves, and put together a complete package, with charts and statistics, phone numbers for analysts and "independent observers" (all of them fully prepped and totally on message) -- and then, when they've got the whole thing wrapped up with ribbons and bows, they go looking for a hack to write it up for them.

What makes this case especially ridiculous is that the hack who passed us this pitch has had a somewhat rocky relationship with the Original Borg. In fact, this hack was once on an O.B. blacklist...
Another time the two top flacks at IBM actually met with the top two editors at this hack's publication and demanded that the editors remove this hack from the IBM beat. Another times, an O.B. exec and his minions orchestrated letter-writing campaigns against this hack, bombarding the hack's publications with letters denouncing him. The O.B. exec wrote his own letters to the publication, too, and in his he demanded that the hack should be terminated...

Now they want a favor. Funny how that shit comes around, isn't it?
IBM won't be trying pitches to Lyons for a while. Must have been someone who didn't know the back story.

I gave up on business magazines decades ago. I haven't noticed their absence. Incidentally, Microsoft's effective ownership of the 1980s and 90s industry trade magazines was much more important than is remembered now.

Death by rosary bead - poisonous plants

I love the web.

When my science kid asked me about the deadliest plant, I asked Google. Google sent me to the "five most poisonous plants". Plant #3 was used to make Rosaries. I have a strong suspicion that the rosary my mother had 40 years ago was made with this seed ...
HowStuffWorks "Rosary Pea"
.... rosary pea seeds contain the poison abrin. The seeds are only dangerous when the coating is broken -- swallowed whole, the rosary pea doesn't present any danger. But if the seed is scratched or damaged, it's deadly. The rosary pea poses greater danger to the jewelry maker than to the wearer. There are many reported cases of death when jewelry makers prick a finger while handling the rosary pea...
Wikipedia has more on abrin, which, unlike its cousin ricin, has not been weaponized. It's impressive how many of these very poisonous plants are fairly common.

Great material for one of those medical mystery TV shows.

Note mushrooms are fungi, not plants. So they didn't make the list.

Why are automotive web sites so ugly and disorganized?

We need to replace our decrepit 12 yo Subaru Legacy wagon. It's done well -- geeky, plain, does the job. It'd be perfect but for the cup holders (problem with manual trans) and the mileage.

It's not easy. I can't find anything like it on the market today (all wheel drive wagon); if the 2005 Outback were still sold I'd buy it immediately (the 2010 model is awful).

So we've been visiting lots of automotive web sites, like Toyota's. As a rule, they're remarkably lousy in a remarkable number of ways. Aesthetically, they're ugly. Poor layout, weak icons, muddy fonts, garish colors, clashing boxes -- the web equivalent of geek clothing. Functionally they're mostly missing the kind of information we're looking for, and few have useful imaging (ex: would need to include human forms to provide scale information).

Why is this? The auto industry may be troubled, but it's a trillion dollar worldwide business. Surely they could afford a few million to hunt down the people who do Apple's web site* and hire them away.

Most large traded companies make very odd choices. Apple is the bizarre exception, probably because Jobs is a force of nature.

* Heck, they could just point someone at the site for the latest iMac, steal everything and paste in some auto images and text.

Update: In a weird bit of synchronicity, within hours of writing this, Daring Fireball linked to an explanation of why American Airlines web site design sucks. It's exactly what I imagine is true of most corporate web sites -- huge teams, lots of hands, lots of politics, lots of executives deciding aesthetics.
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Thursday, November 05, 2009

Eye Glasses and other iPhone health care related apps

I was sure someone would do this (blogged about it) but missed it was out ..
Medical Apps for the iPhone - Pogue’s Posts
... Eye Glasses. As an over-40-year-old, I’ve become addicted to this app. It simply turns the iPhone 3GS into a magnifying glass. Hold it in front of some tiny type—on a menu, a receipt, a ticket, a medicine bottle—and Eyeglasses, after a moment of autofocusing, shows you a magnified version of it on the screen. Keeping your hand steady is tough, and the 6X and 8X images sort of fall apart—but the 2X and 4X views have saved me more than once. ($3)...
I'll buy a copy for the fun factor alone. Nice job.

Pogue tells us there are 7,000 health care related apps, but he didn't find much of interest. The "Anatomy Lab" app might be worth some med school nostalgia points. (Update: Looking at the reviews it's nowhere near the level med students are tortured at.)

Wednesday, November 04, 2009

The magical bomb detecting wand saves Iraqi police

When you read this story, there are 3 things to keep in mind.

The first is that US money, directly or indirectly, pays for these “wands”.

The second is that policemen who discover explosives have a high risk of sudden death.

The third is that Iraqis don’t, by and large, like dogs.

Emphases mine.

Iraq Swears by Bomb Detector U.S. Sees as Useless – Rod Nordland - NYTimes.com

BAGHDAD — … Iraq’s security forces have been relying on a device to detect bombs and weapons that the United States military and technical experts say is useless.

The small hand-held wand, with a telescopic antenna on a swivel, is being used at hundreds of checkpoints in Iraq…

… the Iraqi government has purchased more than 1,500 of the devices, known as the ADE 651, at costs from $16,500 to $60,000 each. Nearly every police checkpoint, and many Iraqi military checkpoints, have one of the devices, which are now normally used in place of physical inspections of vehicles

… The Iraqis, however, believe passionately in them. “Whether it’s magic or scientific, what I care about is it detects bombs,” said Maj. Gen. Jehad al-Jabiri, head of the Ministry of the Interior’s General Directorate for Combating Explosives…

… Aqeel al-Turaihi, the inspector general for the Ministry of the Interior, reported that the ministry bought 800 of the devices from a company called ATSC (UK) Ltd. for $32 million in 2008, and an unspecified larger quantity for $53 million. Mr. Turaihi said Iraqi officials paid up to $60,000 apiece, when the wands could be purchased for as little as $18,500. He said he had begun an investigation into the no-bid contracts with ATSC.

Jim McCormick, the head of ATSC, based in London, did not return calls for comment.

The Baghdad Operations Command announced Tuesday that it had purchased an additional 100 detection devices, but General Rowe said five to eight bomb-sniffing dogs could be purchased for $60,000, with provable results.

Checking cars with dogs, however, is a slow process, whereas the wands take only a few seconds per vehicle. “Can you imagine dogs at all 400 checkpoints in Baghdad?” General Jabiri said. “The city would be a zoo.”..

… ATSC’s promotional material claims that its device can find guns, ammunition, drugs, truffles, human bodies and even contraband ivory at distances up to a kilometer, underground, through walls, underwater or even from airplanes three miles high. The device works on “electrostatic magnetic ion attraction,” ATSC says.

To detect materials, the operator puts an array of plastic-coated cardboard cards with bar codes into a holder connected to the wand by a cable.

… the operator must walk in place a few moments to “charge” the device, since it has no battery or other power source, and walk with the wand at right angles to the body. If there are explosives or drugs to the operator’s left, the wand is supposed to swivel to the operator’s left and point at them.

If, as often happens, no explosives or weapons are found, the police may blame a false positive on other things found in the car, like perfume, air fresheners or gold fillings in the driver’s teeth…

Effective dog teams: $60,000. Plastic wands: $60,000,000. A thousand fold cost difference, and the wands, of course, do nothing.

It is very likely that good portion of that $60 million sits in the bank accounts of “Maj. Gen. Jehad al-Jabiri” and other Iraqi decision makers. Assuming the wands cost $100 each to make (probably much less) ASTC’s owners must also be rather wealthy now.

On the other hand, use of these wands must have reduced the death rate of Iraqi police over the past year or two. The police may not be as gullible as one might think.

The worst is that this is probably not the worst.

Update: The Onion's monument to human stupidity.

Monday, November 02, 2009

Marcia Angell on the corruption of physician expertise

I missed this Jan 2009 quote when it came out. I tracked it down after reading a post Jacob Reider shared (emphases mine, I remember that she was the Editor in NEJM's glory days) ...
Drug Companies & Doctors: A Story of Corruption - The New York Review of Books - Marcia Angell

... The problems I've discussed are not limited to psychiatry, although they reach their most florid form there. Similar conflicts of interest and biases exist in virtually every field of medicine, particularly those that rely heavily on drugs or devices. It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.

One result of the pervasive bias is that physicians learn to practice a very drug-intensive style of medicine. Even when changes in lifestyle would be more effective, doctors and their patients often believe that for every ailment and discontent there is a drug. Physicians are also led to believe that the newest, most expensive brand-name drugs are superior to older drugs or generics, even though there is seldom any evidence to that effect because sponsors do not usually compare their drugs with older drugs at equivalent doses. In addition, physicians, swayed by prestigious medical school faculty, learn to prescribe drugs for off-label uses without good evidence of effectiveness...
I've been long away from the world of practice, but my recollection is that there were very good thinkers on groups like the US Preventive Services Task Force. On the other hand, confident experts ruled the big panels, and they were as predicted, often confidently wrong. (The American Cancer Society was infamous for this, but lately they've surprised.)

Angell may be too harsh, but the reversals of the past ten years (estrogen therapy being only one) should humble all physicians. I'd suggest starting with humility and seeing where we go.

See also:

The hero of the marketarians ...

Any Rand is the heroine of the marketarians ...
Two biographies of Ayn Rand. - By Johann Hari - Slate Magazine

... In her 70s Rand found herself dying of lung cancer, after insisting that her followers smoke because it symbolized "man's victory over fire" and the studies showing it caused lung cancer were Communist propaganda. By then she had driven almost everyone away. In 1982, she died alone in her apartment with only a hired nurse at her side...
I can see why.
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