Wednesday, November 25, 2015

Newspapers Should Not Give Medical Advice

In an editorial, yes an editorial, in the NY Times they state:

An editorial in the journal (JAMA)  suggested that the pendulum has swung too far against prostate cancer screening and that it is time to focus on ways to use the screening test more effectively, perhaps by reserving it for men at high risk based on such factors as race, ethnicity, age, family history and the results of rectal exams. Men facing only an average risk of dying from prostate cancer might simply have blood tests and possibly biopsies every other year and undergo surgery or radiation only if there is evidence that they have a tumor that is growing and becoming more aggressive.

The problem is identifying risk.  We try Bayesian risk analyses. Namely if a patient has a family member with an aggressive form of PCa and that is a first degree relative then we assign that patient as high risk. Sometimes that works, but not always. The real risk is the genetic profile of the cancer cells distant from the prostate. But how do we find them, and in fact what specific profiles are we looking for? Frankly there are no answers.

Recently we examined a patient profile that was confusing to any Bayesian, and I am one. Let me reiterate it simply:

1. The Pt had a father with a highly aggressive form leading to death. From a Bayesian perspective this gave the Pt a 20-30% chance.

2. The Pt had a biopsy with HGPIN. This raised the risk to 50%.

3.  The HGPIN was no longer apparent on a second 24 core US biopsy. This lowered the risk to 20-30% again.

4. The Pt saw a PSA velocity well above the maximum, now raising PCa risk to 50%+.

5. The Pt was assayed with a 4K test which resulted in a <1 a="" bayesian="" p="" risk.="" say="" then="" would="">
6. However a concomitant MRI in anticipation of a biopsy revealed 3 small lesions. This raised it to 75%.

7. An integrated MRI/US 24 core biopsy was all normal and this reduced it back to <1 p="">
This Bayesian approach shows the problems, not only with PSA but what we understand. The suggestion above:

Men facing only an average risk of dying from prostate cancer might simply have blood tests and possibly biopsies every other year and undergo surgery or radiation only if there is evidence that they have a tumor that is growing and becoming more aggressive.

is in my opinion based upon years of extensive review and analysis a nonsense proposal. Why? Simply, the literature is full of the complexity of PCa genomics. PCa can metastasize in less than three months in certain cases. It can enter the blood stream and seek a nice home in the bone. Then the game is lost. Why is an editorial board even suggesting this without any detailed evidence. In fact the evidence is still conflicted. So it is best to keep quiet or follow a conservative path, even for a liberal paper.

Wilson and History

My grandmother, Hattie Kruger, is shown above just prior to her arrest and incarceration without trial by Woodrow Wilson and his minions. They became the Lorton 7, jailed for demanding the vote, force fed with rubber hoses, and watered down with fire hoses. Left to rot until Wilson in his regal manner decided to send them on their way.

So I am amazed to find the Times finally coming to the realization that this dyed in the wool Virginian from 19th Century roots may have had a checkered past as far as it goes. One wonders where the women have been for the past fifty years and why now it come to light that perhaps he is not the type of person one may want to honor.

History has a way of slowly getting to the point. And one of the points is that Wilson was not a really nice person. Hopefully Princeton gets the point.

Unlike some, I never thought there could be a for and against Princeton or any other institution keeping a Wilson accolade. His actions with women and African Americans are the antithesis of what American stands for, or at least should. Removal is the only alternative and it is an imperative.

Oh and yes, Happy Thanksgiving!

Saturday, November 21, 2015

Guest Blogger 2

Hello I'm Bella I've blogged on here before. Today I spent a day with my wonderful grandfather, we made molecules and did spectro photography. Spectro photography is measuring the color. We measured the color of some of the day lilies he owns. We wanted to see what the day lilies absorbed. We put the methanol and the daylily pigment in to a machine which measured the pigment which is in the graph below.

The higher the bar the more absorption. The Indian Giver below absorbs a lot of purples, blues, yellow, and green. It then goes down hill and does not absorb much red, this is why it was a dark red. Thanks for reading my guest blog.

Tuesday, November 10, 2015

Getting Out of Hand

The Inquirer remarks about the EU now investigating Google about Google Maps. They remark:

Brussels asks Google's mapping rivals whether they feel bullied. EUROPEAN REGULATORS are investigating whether Google has been supplanting native mapping applications and devices with its own Google Maps, thus causing a competition vacuum. A questionnaire obtained by Bloomberg has been sent to rival companies asking for any evidence that the prevalence of Google Maps has damaged sales of rival devices such as TomTom, Garmin and HERE. Officials will also be looking for data on user numbers, preinstallation of mapping apps and the costs faced by cartographers to make mobile-ready versions of their work.

You really can't make this up. This is what happens when people have too much time on their hands. They should be out shearing sheep or something. One wonders how an entity providing a free service that works well can threaten others. Now I use Garmin as a GPS device, refuse to get an android phone and pay Verizon an exorbitant amount. But if one wants to then go use Google and not Garmin. But then why not feel bullied by Verizon, sorry it would be BT, or DT, or whatever other state entity controls the phone systems.

But no, get those nasty Americans, after all they are free! Perhaps not for long, depends on the elections.

Friday, November 6, 2015

Employment November 2015: Not Really That Good

If we look at the most recent numbers we see a 5% unemployment but a still weak participation rate. Seven years later we are seeing the Romer predictions of January 2009. So much for economists.
The participation rate is still bottomed out and we really see little movement. This is a structural problem.
Although Government employment remains flat as a percent we see Education and Health keep climbing. This is a real problem since they are now paid more and more by the taxpayer.
The plot above is core vs Government by people and the ratio of core to Govt is flattening.
The above shows the percent change over the last ten years and E&H has the largest percent and Manufacturing the greatest decline. This is the concern that few mention. It was manufacturing that paid for H&E and this switch is also a systemic problem.
The above is the comparison between now and ten years ago. Again Ed and Health shows a great pop up.
Finally the above shows the current details.

Overall the 5% is nice but participation is too low and the growth is in the wrong places. Why we get no discussion of this is amazing! There is still a very rocky road.

Tuesday, November 3, 2015

Get a Job!

Institutions like Harvard and Princeton were originally founded to train people for the Ministry and Law. It was not until almost 200 years later that Hopkins started in Medicine. MIT, yes a Technical Institute in 1865 started as a Land Grant school to train in the sciences and technology.

Liberal Arts education was not something for the masses. After WW II most of the men going to college did so to get a job, to improve themselves and their families in an economic sense.

In a recent speech at Stanford the individual states:

The original rationale behind an American liberal arts education – to play a vital role in democratizing privilege – "is under attack, or is being forgotten," Robinson said. Now, universities by and large do not attempt to "prepare people for citizenship and democracy." Instead, they educate them to be members of a "docile, most skilled, working class."

Frankly that illusion is one reason why we may have so many unemployed. Many who have the chance to go to College think they must be broadly educated. Then they become aware after graduation that they are unemployable. Studying Medieval History is enlightening and entertaining but as we have seen it may not prepare you well to manage a multi-billion dollar high tech company.

Stanford, MIT, and other technically focused institutions hardly put out docile anything. Look around and what do you see? Creative and questioning but technically competent and productive creators of value.

What is under attack is the idea that going to college is an interlude in life, that it should be some mind exploring period between adolescence and adulthood. In reality it is a training ground for life, highly competitive and a means to an end, namely a job. Sorry about that but the illusion is why we have some many disappointed and unemployed kids at home.