In praise of cardiac risk calculators

I've always had annoyingly high cholesterol levels, but I recently hit both age 50 and a new high cholesterol (though also a new high HDL). I figured it was time to bite the Statins.

First, though, I made the rounds of the risk calculators. I stuck with those on US and Canadian government and educational sites. The results varied depending on where the modeling data was taken from, but I generally fell between a 5% and 7% 10 year risk of a cardiac event (Said even is not necessarily fatal, but certainly unpleasant).

Even more significantly the only thing that really shifted my risk was to change gender. Even a fantastic statin effect, such as taking my cholesterol below 190, didn't change my risk much (from 6% to 4%, for a 33% relative risk reduction but a mediocre absolute risk reduction).

Considering that the statins are unlikely to be risk free [1] I decided to wait until my personal risk tops an arbitrary 10% threshold. In the meantime I'll continue to focus on diet and (especially) exercise.

The key lesson here is the value of these dynamic, personalized, risk calculators. They drive home the lessons we were taught in the 90s about the difference between statistical and clinical significance and they are an early and practical application of the principals of "personalized medicine".

Now if we could only apply these basic principles to airplane security planning...

See also:

• Gordon's Notes: Lipid guidelines: Sometimes the emperor really is starkers
• Gordon's Notes: The 2004 national cholesterol guidelines have no clothes

[1] We have good reason to believe that the published literature has a systematic bias understating the risks of high value medications. We also know these are powerful medications that act on a wide variety of lipid receptors. On the other hand studies of absolute mortality risk in the last decade have been encouraging -- but those studies were done on persons with much higher risks of cardiac disease than mine.

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Google Health and my Google password

Google is infamous for not providing direct customer service. If you lose control of your Google Account you can be in deep trouble very quickly.

I thought of that as I experimented with entering my recent (yechy) lipid results into Google Health. Google Health is a part of my suite of Google services; if I lose control of my Google Account I also lose control of my personal health record (PHR).

How long will Google be able to provide a "PHR" without support services? Will they run into regulatory issues now that legislators threaten to extend HIPAA rules into the PHR domain?

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Tech Churn: OS X Server, MobileMe and the Cloud

I've been gradually working through all the expected and unexpected* consequences of moving in a new machine and sunsetting my 6+ year old XP box.

Along the way I've run into another example of technology churn.

In our home we have 5 users and a guest account that are distributed across four Macs - an iMac i5, MacBook dual core, iMac G5, and a surprisingly functional though immobile iBook G3 running Camino. Each machine has its own uses, and most have six accounts.

It's a furball. It doesn't work well, for example, to put all personal files on an AFP share (Spotlight doesn't readily index shares, Mail and Aperture have issues with shares, there's no trash recovery post delete, etc). It's a pain to distribute passwords (keychain), credentials, desktops, etc. Let's not discuss our modern backup mess, shall we?

Once upon a time the answer would have been reasonably straightforward. I'd buy a used Mac Mini, stick OS X server and two 2TB firewire drives (one backup and one local) and do manage desktops.

Except Apple's iCal server fiasco tells me their server team is in disarray. There's also a relatively modern alternative to consider; at one time this is what MobileMe was marketed for. It was have been kind of OS X server in the Cloud, accessible both from the home firewall and from remote clients. (As of 10.6, incidentally, I think a MobileMe user name/pw associated with a user account in the Accounts Preference Pane acts like a kind of (undocumented) alternative global user identifier.)

So should I make good user of our family MobileMe account? Well, I'm kind of doing that, but there's churn there too. MobileMe has been caught in the iPhone, photo sharing, Google Apps and Facebook swhirlpool. Nobody, not even Steve Jobs, seems to know what the heck to do with it.

Or maybe we could extend what we've been doing for 3 years, and move more of our family functions into the gCloud? If Google does deliver a $150 Chrome OS netbook then each child will have one. Maybe we should start now.

Or maybe, because there's so much technological uncertainty, we should stall for time.

I think we're going to stall for time -- which means some combination of an AFP share, a backup server, MobileMe synchronization and continued use of our successful family Google Apps domain. That means OS X Server stays on the shelf for at least another six months.

Tech churn is a pain.

See also:

• Gordon's Tech: The MobileMe Massacre begins
• Gordon's Tech: MobileMe: Perspective of a crusty Palm veteran
• Gordon's Tech: MobileMe, Microsoft Outlook, Exchange, iTunes and yes, sync Hell
• Gordon's Tech: Google Apps for our family
• Gordon's Notes: Shared family calendars, PDAs and Google Android
• Gordon's Tech: Reaching for Nerdvana: Integrating family and work calendars
• Gordon's Tech: Big switch on my iPhone sync: CalDAV and Exchange server
• Gordon's Tech: Using OS X 10.5 iCal with Google CalDAV - cleaning up import disasters

Update 10/4/09: A positive review of OS X 10.6 server convinced me that I really don't want to go that route! If Apple does make MobileMe a sort of "OS X Server Lite" for that masses, however, I'd find value there.

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* Such as the 27" iMac's notorious flicker problem (which has been very mild for us), discovering the human factors limits of screen height, and unexpected software incompatibilities with 10.6.
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Amazon holiday

It's getting hard for me to remember pre-Amazon. I know I bought books in the first few months of operation, when that was all they sold.

For our children, Amazon is eternal.

This holiday the Amazon boxes made one heck of a pile. Between the things we bought and Amazon gift certs from aunts and uncles the store in the cloud provided over 80% of the kid stuff (including things like the scope that came from Orion via the Amazon storefront).

We're clearly not typical of anything, but I'm looking forward to seeing how they did against the competition (though I expect nobody did great this year).

Incidentally, one fringe benefit of Amazon is that the gifts are concealed. Prying eyes are much less of a problem.

PS. Not that Amazon is perfect. In theory you can cancel mistaken orders even after they've been placed. In practice that doesn't work for affiliates, the orders still get processed. I didn't say I loved Amazon.

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The health care bill

Odds are something like the Senate bill passed today will become law.

I didn't hope for much, but I did have one selfish desire. I hoped we'd get alternatives to employment based healthcare. I hoped individuals would be able to purchase insurance with large group pricing. It looks like we won't even get that. Instead the cost of open market insurance is expected to increase. Subsidies will offset those costs, but they will have an income cap.

Oh, and we'll be paying for the benefit expansion too - since costs won't be significantly contained.

Sigh.

On the other hand the current debauched system will be shaken up. I think, on balance, we'll move closer to what we need, even though that won't be the fantasy most Americans expect. We'll take two steps backward, 3 steps laterally, and 2 steps forward and we'll make progress. Given how stunned and confused Americans are and the state of the GOP this is probably the best we can do.

We need a better American citizen.

Update: Joe Paduda is even bleaker than I, but still thinks this bill is worth doing.
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Coldest major cities?

A biking book I was reading claimed Minneapolis (meaning St Paul) was the coldest major city on earth. That might be true of the US if you exclude cities with metro areas under 1 million ...

USATODAY.com

... The coldest major city in the USA is Minneapolis, which has an annual average temperature of 45.2 F. However, several other smaller cities are much colder, including Fairbanks, Alaska (26.7 F), Anchorage (36.2 F), International Falls, Minn. (37.4 F), Duluth, Minn., (39.1 F), and Caribou, Maine (39.2 F)...

There's no way it's true of the world however. Edmonton is insanely colder, and their metro population is now over 1 million very tough people. Montreal is slightly warmer than us -- though the weather there is far more miserable (gloomy, slushy, thaw, freeze - yech). Winnipeg is colder than Minneapolis, but it doesn't make the 1 million cut (they claim to the coldest western hemisphere city over 600,000 people).

Google has only one list and it omits Edmonton (but includes Minneapolis) ...

harbin: -13 C/ 8 F (the 10th largest city in China with 9.8 million residents)

qiqihar: -13 C/9 F
urumqi: -8 C/18 F
changchun: -10 C/14 F
minneapolis: -6 C/22 F
montreal: -6 C/22 F
moscow: -6 C/22 F
shenyang: -6 C/22 F

So even on this list, we tie for 5th place with 3 others -- and this informal list omits Edmonton. I suspect if we use St Paul's post global warming temperatures (1990 on) we might fall out of the top 10.

We're definitely not the coldest "major" city on earth -- though we might make the top 3 of coldest wealthy city.

Incidentally, Harbin once had a Jewish population of 20,000 - in the 1920s.

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Alzheimer's, cancer and aging

Alzheimer's syndrome is associated with reduced risk of cancer. I'm not surprised, I wrote about this sort of thing back in 2006.

What we call "Alzheimer's" is probably a variety of disparate processes that lead, over time, to brain failure. The most common of these processes is probably above average aging of the brain. In other words, "Alzheimer's" is what you find in aged brains, it's where we're all going. Some get it sooner, others later.

Those whose brains age faster, or who start with less capacity, get demented sooner. Since accelerated aging seems to be inversely associated with malignancy risk, those who get demented earlier are less likely to get cancer.

Scylla and Charybdis: Corruption, health care reform and climate change.

A combination of flawed institutional practices, the nihilistic devastation of the Party of Beck and Limbaugh, and the political, economic and social importance of health care reform have made corrupt Democratic party senators immensely powerful.

Since these people care about nothing but their own power and privilege, and because they hold millions of Americans hostage, they can extort a heavy price from far more honorable people. They make the Beckians seem almost respectable.

It’s a tooth grinding time for compassionate rationalists. We know the historic price of failure. We know the GOP is ever more the party of unreason. We know too, the deep cost of social and institutional corruption.

Knowing all this, for the sake of health care “reform” we’ve eroded our enamel. Do we go to dentures for the sake of senate action on climate change?

I don’t think we can afford it, and I don’t think it will work. American support for climate policy is as fickle as the weather – by comparison support for health care action is relatively strong. Even if we continue to feed the leeches we still won’t get meaningful senatorial action.

We’re going to have to find ways to act on climate change through a combination of Presidential powers, EPA regulatory authority, and state policy (California still matters – just as in the days of Silent Spring). Perhaps international CO2-based trade tariffs will cause enough American corporate pressure to bring pet Senators into line.

No, it’s time to stop feeding the leeches. We’ve given up a lot, and the price continues to rise.

This is the time to change course. The midterm elections are ahead, and the party of relative reason is almost certain to lose its Senatorial supermajority. Even if nothing else happens, Robert Byrd will expire.

Losing the supermajority means we can now open yet another front against political corruption in America. No, not against Lieberman – that corrupt sod is safe until 2012 and will be well rewarded thereafter. Forget mere justice, this is about survival.

We need to resurrect old ideas about campaign finance reform and start the long, hard fight against a culture of corruption that has grown up in so many aspects of American life – in politics, professional societies, physicians, the judiciary, corporate governance, the media, and in finance and regulatory authorities.

Personally, I’ll be writing more on this topic in the months to come under a new tag of “corruption”. To start with I’ve asked the Center for Public Integrity to make it easier to find the feed for their latest from the center page. I’ve also become a Facebook fan of the CPI (yeah, there’s irony in using FB to fight corruption).

I’ll be pointing to similar organizations and making some donations*. I’ll even be consorting with the enemy; although the GOP is merely seeking to advance their own immense corruption their attacks on corrupt Dems do provide valuable intelligence we can use.

We’ve given a lot of ground for the millions of Americans held hostage to health care reform. We’re at the cliff’s edge now, we’ve got no more ground to give. We need to push back.

Take your anger against Lieberman, Nelson, and the like – and use it. Not against them – forget ‘em. They’re history. Use your anger against their kin everywhere.

Fight.

* If you donate to any of these groups, you will be spammed mercilessly. Yeah, that’s kind of corrupt too. It ain’t a sweet world out there. Don’t give them a phone number, do give them your spam-only Yahoo email account.

Google vs. Apple - Stross on the phone wars

Charlie Stross is a literate geek who makes a living inventing plausible worlds. That's why he can write one of the best tech posts of 2009 ...

Charlie's Diary: Gadget Patrol: 21st century phone

... I think Google is pursuing a grand strategic vision of destroying the cellco's entire business model — of positioning themselves as value-added gatekeepers providing metered access to content — and their second-string model of locking users in by selling them premium handsets (such as the iPhone) on a rolling contract.

They intend to turn 3G data service (and subsequently, LTE) into a commodity, like wifi hotspot service only more widespread and cheaper to get at. They want to get consumers to buy unlocked SIM-free handsets and pick cheap data SIMs. They'd love to move everyone to cheap data SIMs rather than the hideously convoluted legacy voice stacks maintained by the telcos; then they could piggyback Google Voice on it, and ultimately do the Google thing to all your voice messages as well as your email and web access...

Please go now and read the entire essay ...

... Fun, isn't it? Charlie can write.

Charlie compares Apple to high end and luxury auto companies. It's an old metaphor, but it works. Extending that metaphor, what Google wants to do is deliver the Model T platform -- a super-cheap internet-connected phone and netbook for use in Detroit, Seoul, Kabul and Kampala.

2010 will be a very interesting tech year.

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Copenhagen - Better than I'd expected

If the UN's 2009 Climate Change Conference (Copenhagen) had reaffirmed the Kyoto Accord, or committed the world to saving Tuvalu, or promised to limit temperature rises to 1-2 degrees C, it would have been a disaster for humanity.

Instead we saw desperate back stabbing, dodging and weaving. That's a good thing.

No, I haven't turned into a Republican. The rise of China made the Kyoto accord absurd; affirming it would have a been a form of mockery. Similarly saving Tuvalu would require Americans to make radical lifestyle changes this month, and China to shut down its development. Not going to happen, so that kind of commitment would be a promise to do nothing.

We can't save Tuvalu.

A trillion dollars to offset the harm global warming causes developing nations? From the country that reelected George Bush? Puh-lease.

We've gotten about as much as humanity can produce. Colin Blakemore, a neuroscientist writing for The Guardian, put it well (emphases mine) ...

Copenhagen summit: This marked a turning point in human nature | Colin Blakemore | The Observer

.... Copenhagen may mark a turning point in human nature, when the global village acquired a global mind.

What we have just witnessed is delegates from 192 countries talking about making sacrifices, slowing their development, constraining their industry, taxing their citizens, in a collective bid to stifle climate change. Those nations included virtually every race, every religion, every style of government – from monarchy to dictatorship, from constitutional democracy to communism.

For the past 5,000 years, agreements between nations have been determined by military or economic power, by political ideology or religious dogma. What Copenhagen has established, even if the final agreement fudges and procrastinates, is that a new force is at work in international diplomacy. A force that does not speak in terms of faith and conviction, that is not even absolutely certain about what it has to say. That force is science....

... In his first major speech after winning the presidential election, Barack Obama said of the value of science: "It's about listening to what our scientists have to say, even when it's inconvenient – especially when it's inconvenient." And in his inaugural address, he promised "to restore science to its rightful place". Even with its flaws, what Copenhagen suggests is that the rightful place of science is at the heart of policy for a threatened world. The oceans are already rising. Either we sink, separately, or swim, together.

The leaders at Copenhagen, by and large, took the science of climate change seriously -- even though it's saying things they don't want to hear, and that their citizens often disbelieve.

That won't be enough to save Tuvalu, but it's more than I expected. The game is far from done.

Update 12/20/o9: Similar perspective, from the NYT

Update 12/22/09: A relatively neutral observer tells us that China's goal was to sabotage the meeting and that Obama did yeoman's work: "I saw Obama fighting desperately to salvage a deal, and the Chinese delegate saying "no", over and over again..."

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Prague as seen by superman

In addition to his well known x-ray vision, Superman could use his super-vision to zoom into small details. Details such as this teeny-tiny spot on a monstrous 360 degree panorama of Prague ...



The Panoramic photo site (w/ blog) describes the photo ...

... This is a super high resolution photo. Use your mouse to zoom in and see a startling level of detail. This image is currently (as of 12/2009) the largest spherical panoramic photo in the world. ... When it’s printed, it will be 16 meters (53 feet) long at regular photographic quality (300dpi). It was shot in early October 2009 from the top of the Zizkov TV Tower in Prague, Czech Republic. A digital SLR camera [jf: Canon 5D] and a 200mm lens were used. Hundreds of shots were shot over a few hours; these shots were then stitched together on a computer over the following few weeks...

It seems inevitable that one day, when we look something up on our phone, we'll be able to pan these photos as quickly as my relatively modern (new) machine does today. It's mind-boggling to zoom around Prague on a 27" monitor.'

The image creation used surprisingly average technology ...

...Canon 5d mark 2 and a 70-200mm lens, set to 200mm. The camera was mounted on a robotic device which turned the camera in tiny, precise increments, in every direction....a four year-old windows PC with two single-core 3ghz xeon processors and 8GB of RAM... .... The final image exists as a 120 gigabyte photoshop large (PSB) file. It cannot exist as a TIFF or JPEG file because of their size constraints. The panorama online exists as a few hundred thousand small tiles (in JPEG format), and they take up about 1 gigabyte of disk space.....

The tiled JPGs sum to only 1GB. That would fit on an iPhone.

I'm going to be following the site blog from now on.

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Why mad cow? Against cannibalism.

It's not yet freely available online, but the Scientific American Origins issue has a nice short summary of the origins of bovine spongiform encephalopathy, aka "Mad Cow disease".

Turns out Mad Cow is now thought to be related to President Jimmy Carter's sweater. The first (prodromic) energy crisis led President Carter to wear a sweater in the chillier White House, and changed animal rendering from boiling to centrifugal separation. The centrifuges were kind to prions, so millions of cattle, uncounted small animals, and about 200 humans died a miserable death.

The true root cause, however, was cannibalism. Rendered cows were largely fed to non-rendered cows.

Eating one's own species turns out to be quite unhealthy - despite the compatible food stock. Prions are therefore a de facto form of species-specific poison, and they would contribute to natural selection against conspecific cannibalism.

Prions are presumably a relatively small contributor to the contra-cannibalism trend, but this is an odd upside to the otherwise blameworthy prion.

Update: The 200 dead number will grow. Sadly.

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The ChromeBook rumors grow

We've been expecting this, though we thought it would be earlier ...

Get Ready For The Google Branded Chrome OS Netbook

... Google has, according to multiple sources, been talking to at least one hardware manufacturer about building a netbook for Google directly. As in Google gave the company a RFP with quite detailed technical specifications and has begun discussions on building it.

They’re not in any particular hurry and seem to be aiming for the 2010 holiday season, a full year from now. Our understanding is that Google intends to have the devices built, branded with Google, and then sell them directly to consumers. The only firm tech spec we’ve heard is that they’ll be mobile enabled, and likely tied to one or more carriers with a subsidy.

... I’d even go out on a limb and suggest that they may very well be targeting Nvidia’s Tegra line. Those chips are outperforming Atom in every way, say some of the hardware guys we know. HD Flash video no problem (something the Atom can’t do), and at a fraction of the power usage.

What does that mean? It means next Christmas you may be getting a high performance Google branded netbook running Chrome OS for next to nothing. And if it’s running ARM, Intel is going to be freaking the hell out about it...

I speculated last February that Google would eventually have to split the company if this takes off. I think it will be huge.
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Google's IQ boost is only beginning

AltaVista was really pretty useful (it's still around - owned by Yahoo! now), but the first time I used Google, in early 1999, I knew AltaVista was history.

It's been almost 11 years since that day, and my brain's been following the usual middle aged fail. On the other hand, Google keeps getting smarter. So my brain + Google isn't doing as badly as my brain alone.

Take yesterday, for example. I asked Google for help with an esoteric Excel problem, and it told me how to use matrix operations to sum a range of inverted numbers. I didn't even know Excel had matrix operators.

It took minutes to answer that problem, and to acquire a new set of skills. There's no way I could have answered the problem 10 years ago.

Even though Google has its weaknesses (see also), it's only begun to get smart. Imagine what search will be like in 10 years.

Vinge's Rainbow's End classroom is feeling familiar, even as more of my brain is outsourced to the House of Google.

See also:

• Gordon's Notes: Strange loops: Google custom and customized search - and a memory blog
• Gordon's Notes: Full text search and digital prostheses: new email, new mind
• Gordon's Notes: memory management

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Lieberman explained: He's a lot like Bush

This explains a lot.

Gail Collins - Sorry, Senator Kerry - NYTimes.com

... my favorite explanation comes from Jonathan Chait of The New Republic, who theorized that Lieberman was able to go from Guy Who Wants to Expand Medicare to Guy Who Would Rather Kill Health Care Than Expand Medicare because he “isn’t actually all that smart.”

It’s certainly easier to leap from one position to its total opposite if you never understood your original stance in the first place, and I am thinking Chait’s theory could get some traction. “When I sat next to him in the State Senate, he always surprised me by how little he’d learned about the bill at the time of the vote,” said Bill Curry, a former Connecticut comptroller and Democratic gubernatorial nominee."...

Lieberman is a dull man who's not that interested in understanding the world. He's dull enough to be profoundly corrupted by his insurance company donors, yet still imagine that he's an honest man.

A lot like George Bush Jr.

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