Saturday, June 17, 2017

PSA Testing

I bought my first copy of Scientific American in early May of 1960 on a news stand on Lexington and 52nd Street. I had just returned from my NYC Lifeguard course, and also awaited my being sent to Coney Island. But now I had this window to science. Each article was an opening to some new state of the art discussion. Written by the best of the best and in a manner which assumed you had some reasonable basis to understand. I worked really hard to meet the demands of the authors. I read and reread each article to understand it. I took what little money I had from being a Lifeguard and bought a subscription. I kept it until the magazine turned into something just worse than Time. It became, about in the year 2000, a rag, at least in my opinion. Too bad, it was a window to science, but along came the Internet so who really needed it anyhow.

So I ran across a rant by some person in Scientific American bemoaning the PSA test. He states:

I recently had an awkward conversation with my doctor. I was getting a routine physical, and he recommended that I get a PSA test for prostate cancer. I’m 63. I told him the PSA test harms more men than it helps. He acknowledged that PSA tests produce false positives, but he insisted that follow-up tests and biopsies will determine whether you really have a life-threatening cancer. He knew someone whose life had just been saved by the test. When I still declined to get tested, he looked as though he felt sorry for me. He should feel sorry for the millions of men who have gotten unnecessary biopsies, surgery and radiation as a result of taking the PSA test.

Having written and done work in this area, yes go check me out if you don't believe me, I see that the PSA has substantial merit. The harms are all too often in ones head. A bit of hematuria,  some slight discomfort, but overall not that bad. My dentist is worse! Really worse.

He continues:

Just to be clear: you are 240-120 times more likely to misdiagnosed as a result of a positive PSA test and 80-40 times more likely to get unnecessary surgery or radiation than you are to have your life saved.

I do not know where this came from. It seems to imply that of the 240 high PSA tests and PSA velocities done only one in 240 yields a positive PCa. Not in any tests I have seen, and no basis for the claim.

He also states:

In 2012, the U.S. Preventive Services Task Force, a federally funded panel of experts, recommended against the PSA test, saying the cons outweighed the pros. The decision was based primarily on data from two large studies, one done in the U.S., which found that screening did not reduce mortality, and the other in Europe, which showed a modest reduction.

Well first, the two trials had fatal flaws which we and others have discussed at length. Second, the USPSTF is NOT a panel of experts on PCa. They are what I would call a "fishing, drinking and smoking" club of  some physicians and others politically connected who have been allowed to opine and now control our health care! There was not a single urologist on the panel.

I would suspect that some sixty years ago Scientific American would have had some set of experts opine. Now they have some fellow with an attitude. Good luck young man!

Sur Le Pont d'Avignon, tout le monde y danse, danse!

It is most likely the case that any child who learned French also learned this little ditty. All the world danced across the bridge in Avignon. And at the heart of the dance was John XXII, the Bishop of Rome, And at the heart of the juristic proceedings coming from Avignon, the New Babylon, were those that inspired William of Ockham and Marsilius of Padua. It was the arrogance of the then Bishop of Rome which led to the development of Individualism and the ideas that lent substance to Montesquieu.

For some reason the current Bishop of Rome is celebrating the 700th anniversary of this event. As the Vatican notes:

Pope Francis has appointed Cardinal Paul Poupard as his special envoy to the celebrations of the 700th anniversary of the enclave of the Popes in Avignon, France. Cardinal Poupard is the president-emeritus of the Pontifical Council for Culture. He will be accompanied at the 23-25 June event by Msgr. Jean-Marie Gérard, vicar general of Avignon, and Rev. Canon Daniel Bréhier, rector of the Cathedral of Avignon.

 Celebrating this event is rather strange since it precipitated the revolt of Luther and all that followed.

What is even more ironic is that it was John XXII who attacked the Franciscans and the Spirituals who felt a need for poverty. After all how could John live in such a lavish castle while the Franciscans alleged the Apostles owned nothing.

This is a celebration of the Papacy leaving Rome and commencing its accumulation of massive wealth and its persecution of the Franciscans and other intellectuals. I would have thought that this would be a time for reflection and not one of celebration. Especially for one named Francis.

Tuesday, June 13, 2017

You Don't Need Instruments in your Car (Airplane, whatever)

I noted a piece today about monitoring blood sugar for people with Type 2 Diabetes. Frankly it can be "cured" in almost 90% of the cases by loosing wight and keeping BMI less than 23. But who cares, most physicians send the patient off with meds, and let the patient think that if they take the meds they are fine. High blood glucose causes inflammation and inflammation is a major cause of cancer. Thus pushing down the HgA1B is a bit deceptive. The weight is still there. the fat is the inflammatory cause, and off we go.

In a WebMD piece the author states:

People with type 2 diabetes who aren't taking insulin don't necessarily need to check their blood sugar levels, a new study contends. Many of these patients use "finger prick" blood sugar monitors, but "testing blood sugar didn't have any impact on their blood sugar," said study author ......... "The best way to control blood sugar is to take your medication the way your doctor asks you to and to take good care of yourself," she said. "The key is really taking your medications." Monitoring might be helpful when starting a new medication or changing doses, Young said.

Monitoring blood sugar should be the best early warning sign. Even before one starts taking meds. Fasting blood sugar is a red light for improper diet. Those late night cookies, ice cream, soda, cake, etc drive up the FBS. So why not start before one needs meds. It tells you if your oil pressure is dropping, if you are running out of gas, or the altitude is too low.

Pilots make mistakes when the do not pay attention to instruments. The instrument is an early warning signal. Meds are just wearing blinders and hoping for the best. It does not happen.

Monday, June 12, 2017

FED Balance Sheet

Every once in a while it is worth looking at the FED Balance Sheet. Here is the core values.
This is what it would look like if the FED just did FED business, BUT!
We still have this mess. $@.5 trillion or so of normal like stuff and $2 trillion of that old mortgage backed securities the FED soaked up. They may be really worth nothing!

So what does it add up to. This is a Bernake, Yellen, Obama ticking time bomb on the financial markets. Could this $2 trillion in junk be sold for anything? They have never even asked. So who will?

Employment

The above is a summary of the recent employment. The following curve is of interest.
It says that based on 2006 stats we have some 3 million plus still not even counted! The actual unemployment using 2006 base of workers is 6.5%. The decrease is constant but we have a long way to go.

Next we will look at the mix.

Sunday, June 11, 2017

Science and Engineering vs Religion?

Carbon dioxide is emitted by a variety of natural and man made systems. Energy generation as currently deployed uses a great deal of CO2 producing sources such as coal. In a recent Science piece there is an alternative proposed to recycle the CO2 for zero emissions.

They state:

In contrast, NET Power, the startup backing the new plant, says it expects to produce emission-free power at about $0.06 per kilowatt-hour. That's about the same cost as power from a state-of-the-art natural gas-fired plant—and cheaper than most renewable energy. The key to its efficiency is a new thermodynamic cycle that swaps CO2 for the steam that drives turbines in conventional plants. Invented by an unlikely trio—a retired British engineer and a pair of technology geeks who had tired of their day jobs—the scheme may soon get a bigger test. If the prototype lives up to hopes, NET Power says, it will forge ahead with a full-scale, 300-megawatt power plant—enough to power more than 200,000 homes—which could open in 2021 at a cost of about $300 million. Both the company and CCS experts hope that the technology will then proliferate. “This is a game-changer if they achieve 100% of their goals,” says John Thompson, a carbon capture expert at the Clean Air Task Force, an environmental nonprofit with an office in Carbondale, Illinois.

If this works it is a great step forward and involves no Carbon tax or belief in world ending events.

I guess something else will come along. Some people need to have an event to end the world and somehow scientists and engineers always burst their balloon. Who was that guy who said population would end life as we know it?

The only real ender is a bunch of nuclear weapons...remember that!

Wednesday, June 7, 2017

Public Private Partnerships

I have considered these several time with ultimately no positive results. The mindset of the civil servant is orthogonal to that of the business person, especially an entrepreneur.

An entrepreneur will take risks, their own time and money, and seek a return on that investment if possible. A civil servant is risk averse. They want to get as much as they can for nothing and never want to endanger their pensions. An entrepreneur has no pension and does not get paid.

A decade ago I tried this with a town in New Hampshire and the result was a loss of many dollars and time. The town could never agree to anything. In fact the Board demanded free service for its "poor" residents, and my comment was "show me one and I will pay personally for their service". Needless to say it went no where.

The NY Times discusses this concept and the article states:

 Whether through fees like parking meters and tolls on a road, or through government payments to the contractors, such projects are ultimately supported by taxpayers.

Now read this statement very carefully. Taxpayers support it even if there are tolls or meters!  Now just think, yes think, what the words mean and are saying. If the user is paying, which is what we see in a real economy, then the taxpayer pays only as a user, NOT as a taxpayer. That is basic logic. But somehow the writer states the opposite, namely the statement is at face wrong! The writer in my opinion must be clueless!

Hugs?

The Guardian has an interesting piece in "hugs". They note:

When will Jerry Seinfeld learn about hugging? Given that his celebrated sitcom’s unsentimental tone was based on their “no hugging, no learning” writers’ room maxim, possibly never. And, clearly, time is running out if a recent encounter with Kesha is anything to go by. Seinfeld was being interviewed by US radio host Tommy McFly at an event in Washington DC on Tuesday, when the pop star interrupted them to announce: “Oh my gosh, I love you so much.” “Oh, thanks,” said Jerry.
”Can I give you a hug?” asked Kesha. “No, thanks,” Seinfeld said.

This is interesting since I spent last weekend at one of my grandson's graduations where the Episcopal, read Church of England, Oxford educated, headmaster hugged each and every graduate! It would have been child abuse a decade ago!

Now I am from the older generation where even "kissing" was frowned upon, germs I was told. Hugs! Why the other fellow could stab you in the back, especially if you were in Washington. Professional full time GS-12 backstabbers all over!

The first time I cam to this hugging thing was a friend who lives in San Francisco who came to New York and greeted me with a hung, in the middle of Manhattan. Yes the crowd around look at bit askance, it was an investment bank after all. But in San Francisco one is expected to do the extreme. New York on the other hand is truly a social conservative holdout. We do not even acknowledge others on an elevator!

ASCO and PCa

In an ASCO report commenting on the USPSTF D rating for PSA testing the report states:

In 2012, PSA screening for prostate cancer (CaP) detection was given a “Grade D” recommendation for all men by the USPSTF. Recent U.S. studies report declines in PSA screening with concomitant increases in advanced CaP at diagnosis. This study examined the association between PSA screening history and CaP aggressiveness in a racially diverse, military cohort with equal health care access.... In this RP cohort, higher risk stratum, increased GU, and poorer BCR-free survival were associated with no PSA screening history. BCR-free survival was incrementally worsened by less PSA screening. A complete absence of PSA screening may lead to more aggressive disease at presentation and poorer clinical outcomes.

This was a Government conducted study, by  people apparently competent in the field. This is just another study confirming the deadly results of following USPSTF.

Tuesday, June 6, 2017

Treasury Spreads June 2017

Treasury spreads are flattening out again. Look at the one above for yesterday and it seems to be as flat as one can get before the FED increases the short term rate. Note if the FED does increase the short term we may eventually get to an inverted curve again. The concern should be the long term and the fact that the FED is trying to unload the $4 trillion of junk on its books!
The above provides a good look over the past ten years. Worth thinking about!


Monday, June 5, 2017

In the Old Days, or "When I was your age"

The NY Times has posted a piece from a Campus Security Guard in England. Now my first cut at undergraduate school was in New York City, not London and it was decades ago. My two grandsons are off to college, one going as far as the nearest stop light, the other going halfway cross country. It really is different for them than it was for me.

Back in 1960 I had three roommates, O'Malley, Driscoll, and Gallagher, we could have been an Irish Law Firm, but each was different. We rented a two bedroom apartment on Broadway, nice, new, and $120 per month! That was $30 each per month. Then food was what you collected, and security? There was none. The closest I got was the fact that my father was in the NYPD as was my grandfather and so I had a "cop network" if necessary.

We walked to class and took the subway at odd hours, the Broadway line. One night I met Malcolm X on the train with his group. Said hello, and he got off at 42nd Street. Sort of a Forest Gump moment.

The Brit notes:

Before I started in the job, I had the same image of the campus guard in my head as you did: a bloke too fat for the cops, or a mixed martial-arts nerd. Guards like that exist, but they don’t tend to last. Once they realize you do more talking in this job than throwing punches, and take one look at the salary, they check out. It’s true, the money’s not fantastic, but I wouldn’t want to do anything else. The buzz I get from helping people is up there with scoring a football goal, or perhaps, remembering a password I thought I’d forgotten. Plus, I get to see people shaping their futures every day. Who’d want to swap that for breathing office air?

When I spent a decade or so at MIT, during the Viet Nam war riots, I never saw a Campus Cop, but now they are everywhere. I wonder what has happened. Has crime increased or are we becoming global helicopter parents. Sixty years ago you got a $20 bill and a cardboard suitcase. You better have a job or find one, the campus did not give you one out the gate. Today? Kindly Campus Cops!

More on CAR-T Cells

We have been following the progress on CAR-T cells over the past few years. The recent result reported in Science Daily is of special import. Namely:

In an early clinical trial, 33 out of 35 (94 percent) patients had clinical remission of multiple myeloma upon receiving a new type of immunotherapy -- chimeric antigen receptor (CAR) T cells targeting B-cell maturation protein or BCMA. Most patients had only mild side effects. 

Namely, find a target on the desired cell and then create a "smart bomb" the CAR-T cell, and then set it loose. It seems to be working much more effectively now. It still has some "carpet bombing effects" but this may very well change the paradigm for cancer treatment.

Namely, find a surface target, then construct a patient specific attack element, then let the immune system loose. Very worth while to follow!

Friday, June 2, 2017

Fair Use and the EU

The EU/EC seems to be an ever expanding set of rules and regulations that at to control people's lives. Fundamentally it represents an entity which denies fundamental American values. The EUs stance as exemplified all too often by the German state, an entity which believes that its policies are all too often to dominate and control.

The most recent example is the intent to control free speech. We in the US have a mandated right to free speech. In the EU it is severely curtailed and controlled.

The EFF just recently notes:

This week, EFF joined Creative Commons, Wikimedia, Mozilla, EDRi, Open Rights Group, and sixty other organizations in signing an open letter [PDF] addressed to Members of the European Parliament expressing our concerns about two key proposals for a new European "Digital Single Market" Directive on copyright. These are the "value gap" proposal to require Internet platforms to put in place automatic filters to prevent copyright-infringing content from being uploaded by users (Article 13) and the equally misguided "link tax" proposal that would give news publishers a right to compensation when snippets of the text of news articles are used to link to the original source (Article 11).

Namely if one is analyzing a work which has been posted and one desires to refer to what was said and then in any way comment, that would be a breach of the proposed law. At best one could refer to the source and then let the reader go and try to find it. Frankly that defeats the ability to have free and open discourse and also makes a mockery of the very essence of the Internet.

The filter proposal also makes the Internet facilitators entities who must on their own filter and control. Pravda did that a while back and you know how that worked.

I suspect it is a mind set. We Americans do not understand Europeans and Europeans do not understand Americans. Both all too often look down on the other and I suspect the gap is widening. One could as if the Paris Accord was reflective of that?

Thursday, June 1, 2017

The USPSTF

Over the last ten years we have commented upon what we feel is the generally inappropriate direction from the USPSTF. This is the collection of folks who thought that it was fine to do away with PSA testing.

Urotoday has a fantastic video describing the USPSTF and its failings. It is truly worth watching. The first slide shown below is what is iitruly terrifying.
 

USPSTF - ISSUES

           Proceedings are not required to be made  public
           Exempt from FACA review process
           Exempt from the Administrative Procedures Act (APA)
           Requires public disclosure and participation in activities
           Defines scope of judicial review
           Encompasses:
           The Freedom of Information Act (FOIA)
           The Privacy Act

           USPSTF is only Federal Agency which can set payment policy exempt from FAPA/APA


Note that the ACA, known as Obamacare, allows this group of what in my opinion are less than truly qualified folks, to mandate what is proper care. The second slide shown below:



USPSTF - ISSUES

           Proceedings are not required to be made  public
           Exempt from FACA review process
           Exempt from the Administrative Procedures Act (APA)
           Requires public disclosure and participation in activities
           Defines scope of judicial review
           Encompasses:
           The Freedom of Information Act (FOIA)
           The Privacy Act

           USPSTF is only Federal Agency which can set payment policy exempt from FAPA/APA

shows that they do so without any accountability.

If one were to have followed the PSA debate, in the professional media or in my writings as noted herein, one would see that the mortality from PCa has exploded since the USPSTF mandated no coverage of PSA testing and its sequellae.

These folks are in my opinion one of the many "Death Panels" established under the ACA. Yes, they denied coverage and people died.

Hopefully Congress will eliminate this, in my opinion, "mad dog" group as well as many others formed under the aegis of the ACA such as PCORI!