Medicine by Mandate

 Prostate Cancer is the most common cancer in men. It can occur at almost any stage in the adult and is most common in elderly men. Most PCa are indolent, not resulting in death. Yet some are highly aggressive and result in death in a horrific manner. Unfortunately one does not have means to differentiate well. 

The PSA test is one simple test that can help. Yet a single PSA sample may be useless. In addition free PSA is also required. Then using time gathered PSA and free PSA can be dispositive in many cases. 

Yet many want to eliminate PSA altogether. We have seen since the USPSTF suggested this a decade ago PCa deaths skyrocketed. Perhaps it tells something. Now we have another group:

A new strategy proposed by an international team of experts would limit the use of the prostate-specific antigen (PSA) test for screening tor prostate cancer to men who are younger than 70 years and who are at high risk or symptomatic. This would reduce potential harms from overdiagnosis and overtreatment, the risk for which is high with the on-demand screening that is the current standard of care in most wealthy nations. In a paper published online on May 17 in the BMJ, the panel recommends instead a comprehensive nationwide program that would base PSA testing on individual patient risk and direct those with abnormal results to a managed system of imaging, targeted biopsy only if indicated, and subsequent active monitoring or treatment for those with more aggressive disease features. Alternatively, government health programs could actively discourage widespread PSA testing and implement policies that would effectively limit PSA-based screening only to men with urologic symptoms warranting further exploration, say the authors, led by Andrew Vickers, PhD, a research epidemiologist at Memorial Sloan Kettering Cancer Center in New York, New York.

In my opinion and in my experience,  this is grossly wrong. Gathering and comparing temporal data on PSA and free PSA is a highly useful tool. If necessary follow this up with MRI before invasive. Yet even MRI has problems if there were previous biopsies since scar tissue from the previuos tests may appear as lesions with diffusion analysis. 

Ultimately a biopsy is needed. Yet even then we know that the Gleason biopsy is almost lower than the biopsy after prostatecomy. That is always the challenge. Namely an one get better results from tests looking for markers?

PCa treatment is about thirty years behind that of breast cancer. Men just die off I guess.

Gas, the Next Evil Element of Nature

 The gas stove uses methane to create heat. Just a note, so do cows when passing their gas. Lots of it. But alas, this is about stoves and not cows. 

It appears that some group of environmentalists from Stanford have created a new career for themselves bemoaning methane stoves. The NY Times reports that this band of methane stove destroyers are measuring willy nilly various gasses in apartments with gas stoves.

Now the problem is that methane, CH4, burning with the air, mostly nitrogen, and some oxygen, creates some outgasses like nitrous oxide etc. Also a small amount of cyanide gas if you will. 

I found the paper referenced above at best a shabby attempt to create a problem where there very well may be none. Outgassing occurs from hundreds of factors, especially in old poorly ventilated and unclean living circumstances. The Times shows an apartment which contains many sources of outgassing besides a gas stove.

The Stanford team appears in my opinion  as a 21st century set of Ghost Busters. Their approach in my opinion is not at all scientific since there are some many exogenous factors that attributing a gas to any one source is near impossible.

This is what "science" has become. In medicine we would call it witch doctoring. In engineering it could lead to real problems.

The Times states:

Change could be on the horizon. More than 60 percent of American households already use electricity to cook, and the Biden administration has proposed to expand gas stove efficiency rules, with an estimated $100 million in energy savings for people on top of the climate and health benefits. Several cities in mostly blue states have passed or considered bans on new gas hookups, effectively requiring electric cooking and heating in new construction, though some red states have moved to pre-empt such bans.

 The estimate is truly baseless in my opinion and based upon any real analysis. This is a quasi-religious movement driven by belief not science. Welcome to what we seem to be teaching students today.

Birds

 There is an interesting article by a birder in the NY Times today. I am not a birder but I have a close knit bird family. When I come down for breakfast each day and open the curtains, my collection of birds see that I am awake and ready to feed and water them. So each day before I can eat I go out to the deck, and there above me are blue jays, wood peckers, black birds, sparrows and more watching for me to deposit the days load of peanuts. A chipmunk or two wait on the ginkgo branches. Once I turn to the door the blue jays descend en masse. 

I then eat my breakfast watching my dependents .

Lifeguards in NYC

 

I was a NYC Lifeguard for 4 years. First for a short time at Coney Island and then on Staten Island. In those days one had to pass an annual test. 440 yards in a NYC pool and the top 4 qualified. You could keep taking the test until positions ran out. That means the top 900 or so swimmers in the city were lifeguards.

The pool was on 54th street between 2nd and 1st avenue. It was across the street from the El Morocco. Boxing was on the first floor and pool in basement. Lou Lipsky was the NYC Chief Lifeguard. A short burly guy who was slightly gruff but supportive. 

There was no union. The lifeguards were generally tall and muscular. We doubled as police on the beach. The cops did not want to get sand in their shoes. There was no union. We worked 8 hour days six days a week. We got paid $60 a week. 

The lifeguards were a brilliant group. They became billionaires, world famous doctors, lawyers, scientists, playwrights. It was a group par excellence.

The above is a picture of my most famous save. A young woman had a seizure some 40 yards out. She was aggressive and it was a difficult save. Thus the picture. 

Recently I went back to Midland Beach on Staten Island. The lifeguards were short, somewhat dumb, and not ones I would remember from a Sunday at Coney Island keeping 1 million people controlled.

The NY Times has a piece on why the NY lifeguards are so short in supply. They note:

Parks officials had sought to gain more new guards this summer by simplifying the rigorous test prospective lifeguards take to qualify for the 16-week, 40-hour training course. The test weeds out many potential recruits largely through its 50-yard swim, which prospects historically had to finish in 35 seconds. Faced with high failure rates — last year, of 900 applicants, only about 26 percent passed the test — and complaints from applicants, parks officials extended the acceptable time for this summer’s applicants to 45 seconds. They also pushed for more transparency by mandating that applicants be notified of their swimming times, as opposed to merely whether they had passed or failed. Howard Carswell, a former rescue diver with the city’s Police Department, said his 16-year-old son, a competitive swimmer, withdrew from lifeguard training this year because the officials overseeing it were surly and “generally giving the kids trying to get the certificate a hard time.” He said his son had opted to spend the summer lifeguarding at an upstate lake for better pay. “It wasn’t worth the aggravation,” he said. “It was just a generally depressing environment for kids that are looking to become New York City lifeguards.”

 Now the 50 yard vs 440 yard says a great deal. The 440 was a demonstration of endurance, my save demands endurance. It was not how fast I got there but haw well I did after that. Second, unions now control the process, Lou Lipsky went for quality, unions in my opinion and in my experience collect small minded control freaks. 

It is a shame that the band of brothers who were lifeguards has become a collection of union hacks.

Drugs and Saving Lives

 The FDA lists some 207 drugs that are or have recently been unavailable. Some of these are quite common and life saving such as mannitol. Or IV lorazapam. 

One would think we should have this under better control. Yet the fundamental issue is that market structures are created to maximize profit based upon Government rules. That process just makes things worse.

More EV Analysis

 The following are some calculation regarding the EV demands and performance.

First the Blocking Probability versus offering traffic load. This is the chance that there is no available EV charger at a station. Once in say 100 or even 50 times is not bad. However half the time is a mess.

This is the required number of locations versus the offered load per site. It explodes at we demand better performance.

One wonders if anyone in DC has even considered this issue. Now the costs of this is massive! If we have 1 million sites at say 0.5 million per site we get 0.5 time 10 to the 12th. Just for site development!

A Simple Calculation

 I did a quick calculation. Here we go. Assuming to have near zero blocking at stations we get:

Number Servers	5
Arrival Rate	0.02
Block Probability	0.002
Holding Time	45
E	0.9
US Autos	150,000,000
Number Sites	1,953,125
Miles per Car	200
Miles per day	50
Days per charge	4
Hours per day	16
Arrival rate per car	0.000260417
Cars per site	76.8

 

To handle the cars in US with no significant delay per site you need about 2 million charging sites with 5 chargers per site! At 10,000 sq feet per site, 100x100 ft, you need 20 billion sq feet of new space! 

 

A Queuing Problem

 Queues are waiting lines. For example boarding a plane or buying coffee. Now if one has a gas powered car, the typical queues at a gas station is zero, namely you pull up to a pump and fill the tank. Why? Simple, the arrival rates are low, cars can drive long distances between fills, the number of servers or gas pumps is very large and the holding time or time to fill a tank is at best a couple of minutes.

Now if we move to electrical vehicles we have the following problem:

1. The arrival rate is high due to low distance capacity of batteries. Namely a gas vehicle goes say 400 miles on a tank, 18 gallons and say 25 mpg.

2. The holding time is at least an order of magnitude longer. Typically 45 minutes with a fast charger or 8 hours if a slow charger.

3. Thus having the arrival rate, holding time we can find the number of servers needed for zero queue length. 

The answer is staggering. We need millions of charging stations to assure an available one for every car without any delay. 

It is clear that no one has analyzed this simple problem. The DC characters are totally clueless and have not even examined the simple ones. This also opens up the need for a dramatically expanded grid, redundancy, security etc. 

For those of us who lived through the oil embargoes of the 70s they will seem like the good old days!

Now Let Me see who is paying for this?

 Nature notes a revitalization of the entity tied in with the COVID mess. The article states:

Researchers who spoke to Nature applaud the renewal, adding that this type of research is essential to avert the next pandemic. They claim that the NIH’s termination and subsequent suspension were politically motivated, and that although long overdue, this renewal ends – for now – a drama-filled exchange between the agency and EcoHealth. “It’s about goddamn time,” says Gerald Keusch, associate director of the National Emerging Infectious Diseases Laboratory Institute at Boston University in Massachusetts who organized researchers to push back against EcoHealth’s grant termination in 2020. “The integrity of science requires a barrier against political interference,” he says.

 In my opinion if this academic says we, the taxpayer, must fund their ideas no matter what I suggest that they may find it better elsewhere. But alas this is why the public view academics as worse than politicians...and that is really pushing the envelope.

Thank God I left all that behind.

Electricity, NOT!

 We have argued again and again that an all electric society if a recipe for catastrophe. It seemed that few understood. So I was shocked, shocked, to see the NY Times detail the problem. They note:

The old, the frail and people who live in homes that are not well protected or insulated are most vulnerable, along with those who rely on electrically powered medical equipment or take medications that need to be refrigerated. Power outages make heat, already a major cause of avoidable deaths, even more of a threat, said Brian Stone Jr., a professor at the Georgia Institute of Technology. He has done research estimating how many people in Atlanta, Detroit and Phoenix would be exposed to extreme temperatures during power outages.

Namely the grid is grossly unreliable.  So the morons in NY banning gas have provided a plan to impale older folks and poorer folks on the spear of useless electrical grids. It is akin to the first steps in COVID, sending the frail to virus ridden homes to die.

I suspect that not one competent legislator in NY has a clue.