1066 Redux

 

 England has gone through multiple "invasions". Initially the Celts and to some degree the Picts inhabited the island. Then came the Saxons. the Germanic invaders, and to some degree the Anglo tribes. Also from time to time Viking invaders. Then in 1066 William the Bastard and his clan crossed over from Normandy and battled in Hastings. Welcome to the Normans. Needless to say the Norman invasion has had lasting effects for almost 1,000 years, until now.

The Guardian notes;

 Keir Starmer has attacked Reform UK’s plan to deport thousands of people already legally living in the UK as “racist” and “immoral”, as he said that Labour had a generational struggle ahead with the populist right. The prime minister, in Liverpool for his party conference, said he did not think that Nigel Farage’s party was trying to appeal to racists, and that he understood people tempted to vote for Reform were frustrated and wanted change. But he said the rightwing party’s proposal to entirely abolish the main route for immigrants to gain British citizenship could “tear this country apart”.

 What then is it to be English? It was a religion for a while, a King or Queen, a history, etc. But these are going through massive changes.

One sees the same in Ireland, a massive change to a socialist Government with similar open borders. The Irish spent almost 800 years to be free from English domination only to possible see the influx dominate the new culture. 

But the habit of calling one's adversary violence inciting epithets  seems to be de regeur. 

The Normans had their own ways to do things. This small band of invaders in short order took over a nation, changed the laws,  overthrew the leadership and dominated for a thousand years. Perhaps the end is truly near.

The Incompetence of the USPS

 Again and again I have had to deal with the USPS incompetence. Welcome to the Government employee work ethic. To compound it I sent a Priority mail letter to Atlanta, the worst of the worst USPS sites. After a week it has arrived at Atlanta, NY, a small town near the Finger Lakes and no where near Georgia. Soon the letter will be lost!

Perhaps closing down the Government is a good idea, permanently! Amazon seems to get things done, they can do the mail! 

Fortunately General Sherman had a better sense of direction! 

AI, Medicare and Denial

 

 The boys in DC have selected NJ as one of six states to trial an AI based pre-approval for Medicare payments. They plan to use AI companies. The NYT states:

The A.I. companies selected to oversee the program would have a strong financial incentive to deny claims. Medicare plans to pay them a share of the savings generated from rejections. The government said the A.I. screening tool would focus narrowly on about a dozen procedures, which it has determined to be costly and of little to no benefit to patients. Those procedures include devices for incontinence control, cervical fusion, certain steroid injections for pain management, select nerve stimulators and the diagnosis and treatment of impotence. Abe Sutton, the director of the Center for Medicare and Medicaid Innovation, said that the government would not review emergency services or hospital stays.

Specifically they intend to review:

 

• Facet joint procedures for back pain

• Nerve and muscle tests (electrodiagnostic testing)

• TENS units and similar electrical stimulation devices

• Hyperbaric oxygen therapy

• Spinal cord stimulators

• Deep brain stimulation (commonly for Parkinson’s)

• Sacral neuromodulation (for urinary conditions)

• Transcatheter aortic valve replacement (TAVR)

• Arthroscopic knee cleaning or debridement

• Vertebroplasty/kyphoplasty for spine fractures

• Epidural steroid injections

• Non-emergency ambulance transport

• Botox injections for medical issues

• Negative pressure wound therapy pumps

• Hernia repairs

• Lumbar spinal fusion

• Skin graft substitutes for chronic wounds

 As my readers know I am a doubter in AI at this stage. Thus the application to millions of Medicare recipients is in my opinion grossly negligent. One should try at a lower level, not 15% of the US as a first bite. This is similar to the massive COVID vaccine program, just failing to test and just dumping on hundreds of millions.

One must ask who these "AI" companies are. What are their bona fides? Since we have no definition of what AI is it is likely that they will just be some friendly folks with the current Administration.  We should know these companies in detail. What is their technology, what is the basis for their decisions, what have they accomplished before? One suspects this will all be hidden behind some curtain of proprietary nonsense.

The test should be small, transparent and Congress should have a say as well as the Medicare recipients.

But alas, no one in DC gives a phenning! 

 

Swarming, Drones, and Warfare

 About 20+ years ago I wrote a paper on swarming warfare. As noted such warfare was characterized by:

Swarming has been characterized by Arqilla and Ronfelt as follows:

1. Autonomous or semi-autonomous units engaging in convergent assault on a common target

2. Amorphous but coordinated way to strike from all directions

3. “sustainable pulsing” of force or fire

4. Many small, dispersed, inter-netted maneuver units

5. Integrated surveillance, sensors, C4I for “topsight”

6. Stand-off and close-in capabilities

7. Attacks designed to disrupt cohesion of adversary

 Now with the use of drones and sophisticated netted multimedia communications one obtains a significant advance in this technique. 

DoD, now called War, should have been addressing this issue in detail. The PRC sure has been. Consider this as an attack by yellow jackets, before one knows it the swarm has in a coordinated manner attacked the poor victim.  

This is a new paradigm in warfare. Low costs attack platforms and counter persons destruction. Does the Russian forces have this? Not yet but the PRC may use this as a training opportunity. Beware!

One strategy for attack is the use of low yield neutron devices. A 5kT device can be tucked in a small drone, and such a device destroys living matter but leaves structures unharmed. It also can be readily accessed after deployment. This was a 1980s proposed strategy. However then there were no drones. Now the cost of deployment is low and the success ratio very high. Such a strategy can clear an enemy force in hours and allow re-entry the next day. Thus one asks; what is a counter-force strategy? 

March of the Turkeys

 

Fall is here and the turkeys are marching again.

Some say Larix some say Larch

 

The NY Times has an article about the larix, a tree indigenous to the White Mountains in New Hampshire and other similar locations. They note:

At least, it did. Since the late 2000s, about a quarter of Britain’s larch trees have been infected by Phytophthora (Greek for ‘plant-destroyer’) ramorum, a fungal-like pathogen that spreads via wind-blown spores and water in the soil. “Ramorum is so beautifully good at killing larch effectively,” Dr. Heather Dun, a scientist from Forest Research in Scotland who is studying the pathogen, told me. In the United States, it’s known as “sudden oak death,” targeting native trees like coast live oak and tanoak.

 The NH larix is a hardy tree if you grow it at 1,000 ft above sea level where the frost line in winter exceeds 1 foot! And the soil is very sandy. I tried one in New Jersey in clay soil and a frost line at best a few inches. No luck.

Trees need certain soil, certain moisture levels, and certain temperatures. My ginkgo loves clay soil in NJ but hates sandy soil in NH. My white pines are weeds in NH but struggle in NJ. 

Trees are very sensitive to location. White birch hate NJ but love NH. The list goes on.

Now for diseases, they all too often  result from some one bringing it into the region or country out of gross ignorance! Put it in their garden, wind blows and devastation occurs. 

Isolating the killing factors is complex but usually no single cause is present. 

 

JCP&L Is Collapsed Again!

 The local power distribution company has a long lasting record of failures and incompetence. It must, in my opinion and my experience, be run by a bunch of accountants who are clueless about electricity! Multiple times today power has been lost. The entire town seems to be down. 

They have bumped up the rates by 20% and reduced the service I fell by even more. Sounds like the local cable provider. It seems that any entity governed by a Utility Commission just does not give a damn.

Equipment fails, replacement parts are unavailable and repair crews are lost in translation. 

We are relying more and more on electricity. The companies are populated with less than average folks in an industry which will allegedly explode with AI. This will lead to total disasters! 

Pity!

AI in Medicine: GIGO?

 

The more I examine AI in medicine the more it appears to be very risky. In a Med City News piece they note:

Another healthcare executive — Jess Botros, vice president of IT strategy and operations at Ardent Health — noted that she wants the system’s clinicians to be able to spend as much time as possible with patients and have the right tools in hand. That said, there’s a lot of responsibility when it comes to deploying AI.

“In order to do this in the right way, you have to have your house in order from a data perspective, from a trust perspective,” she said. “You think about change management impacts and making sure that people are really along for the ride and really understand why we’re doing what we’re trying to do. It becomes super important.”

 My concerns are as follows:

1. Good medical practice is trying to understand the patient. Patients are often the main obstacle to good medical practice. They delay treatment, they often do not express all the symptoms, they try their own diagnosis thus adding noise to the process, and fundamentally they do not listen, often through fear, and the physician does not explain well enough.

2. Patient data is all too often in error. From time to time I examine my own data and see entries that make no sense and critical entries missing. For example I never have had GERD and my lipids are rock bottom. But both were listed otherwise on various reports. Thus if this data is entered into an AI system the AI doc will naturally come up with the wrong answer. Just try correcting these errors, impossible.

3. Does the AI doc need a license to practice? In what state? If I were to try practice in Georgia I would face a period in prison. But if the AI doc is in Montana can the patient in New York be diagnosed?

4. My best issue is who does a patient sue? The AI doc does not really exist.

5. The AI doc is really just a good and fast research librarian. Ask a question and get an answer based upon existing information. But what if this patient is a one off? Never seen this before. (98% of medicine is  rote, but the 2% is the challenge and most likely missing in the information fed to the AI system.

6. Patients are asked to fill out health forms. Many have no idea how to answer. Long lists of what a patient may have had get confusing answers. I am often reminded of Marty Samuels and his dizzy discussions. Trying to find out what type of dizzy and the cause may result in many unnecessary tests and may even miss a severe and immediate cause. 

Thus bad input data, unseen conditions, poor patient communications are just a few of the issues with AI docs. 

In a Bayesian world, and much of medicine is that way, diagnosis and treatment is often based upon pre-existing data. If that patient data is wrong, not current, then the results could be either unproductive or worse deadly! 

Plutarch is Worth a Read; The more things change the more they remain the same

 Plutarch and his live details the Roman Republic in its final days. Political enemies beheaded and oligarchs trying to become rulers. As Grant notes in his preface: 

Two elements perhaps stand out above all others in Plutarch's late republican Lives. The first is the unbridled pursuit of personal power. Every Life in this selection displays the incessantly disruptive and ultimately ruinous effects of competition and ephemeral collaboration for purely selfish ends between a handful of prominent individuals, none of whom was quite powerful enough to achieve sole supremacy until Caesar put an end to the dominance of the oligarchy that had spawned him in the last stage of its decline. The second is the amount of coverage that Plutarch sees fit to give to wars both foreign and civil. 

To a certain extent this need occasion no surprise. In the eyes of the Roman ruling class military glory was the highest form of distinction to which its members might aspire. The biographer of leading Romans could hardly avoid writing about war, and a man's conduct in the field might well provide illuminating insights into those recesses of his character that Plutarch sought to penetrate. Yet much of his military narrative seems, as observed earlier, to be there for its own sake, regardless of any light it might shed on the protagonists’ moral or psychological make-up.

The reason for both these features of Plutarch's work lies in the standard perception of the republic and its fall that quickly developed under the empire. Everyone knew that the republican ruling class, by its dedication to the quest for wealth and personal power, had destroyed itself and the system of government it claimed to cherish. That Plutarch should share this perception is not remarkable. Explanation would be needed only if he did not.

Plutarch. Fall of the Roman Republic: Six Lives (Penguin Classics) . Penguin Books Ltd. Kindle Edition. 
 

So  who is our ruling class today and given current events are they repeating themselves. It is truly worth understanding our history, it does repeat.

Cancer Resarch

 

The NY Times bemoans the reduction in support of cancer research, and they note:

Other countries are seeing opportunity in the chaos. Varmus is among a number of prominent U.S. scientists who have received solicitations from the governments of France and Spain to consider relocating there. America’s 80-year run as the world’s leader of biomedical research — and 50-year run as the global leader of cancer research — may very well be coming to a close, and for no apparent reason. Varmus seemed as puzzled as anyone by the development. “We are great in science,” he said. “Why would we want to destroy one of our greatest assets?”

 Yes the US has dominated research ut frankly I see China galloping along at a fair pace. So should we revamp the NCI? One may want to look at the web site of NCI. It tells a story in a rather politically correct manner. I will let you determine how. But frankly perhaps cancer research needs some restructuring.

Cancer is a complex disease with often no common thread even amongst the same cancers. One need look no further than lymphomas to see such variety.

That complexity is what has been studied over the past 50+ years. Gene after gene, pathway after pathway. From masses of cells to now cell by cell. 

We have two extremes in cancer research. At one end is the silo approach of gene after gene. PTEN, MYC, MTOR, and the list goes on. Then we have  clinical trials with some success. For example we see in cancer like melanoma that immune system control, PD-1 blockage, works in say 30-40% of the cases. Why not all? In hematological cancers with CD19 surface markers we have some success with CAR-T cells, but again not all. Why?

We are missing the middle state. Namely systems analysis of cancers. Looking at "all" the elements from genes to environment such as the tumor micro environment, to epigenetics, and the impact of the patient's other genetic factors. It is very complex and just being addressed.

Perhaps a good look as to how cancer research should evolve would be worthwhile. But one must be careful not to throw the baby out with the bathwater. 

Fall In New Hampshire

 As the summer ends the New England Asters are in full bloom. A beautiful blue color astride every roadside.

A Loss, A True Genius and Leader

 David Baltimore passes at the age of 87. Baltimore and his colleagues came to understand reverse transcription, the writing of DNA segments into our own DNA. That became the key element in understanding AIDS.

He was attacked without basis by the Congressman Dingell, a ruthless attack without merit, which may have very well set back AIDS work a decade.

Baltimore was a fantastic leader and scientist. 

Don't Know How Many Died

 RFK Jr responded to a question by stating he did not know how many died of COVID. At first glance that would be absurd. However after some thought it makes eminent sense. Why? Simple. Many of the nursing home patients for example had massive co-comorbidities. Namely they had cardiovascular issues, pulmonary issues, cancers, Diabetes, etc. So cause of death would be complex even with an autopsy. 

If they tested positive for COVID, the actual cause of death may have been a heart attack, a stroke, etc. At best COVID was a co-morbidity. In the long run, no "cause of death" could be attributed. It is like so many aged, cause of death, pneumonia! It would be simple. Death certificates are notoriously in error unless the patient has been tracked with the full extent of the disease. Pancreatic cancer, lung cancer, massive stroke validate by imaging, may satisfy. But COVID and co-comorbidities, not so much.

The CDC should have understood that but they seem not to. Thus understanding COVID is still a mystery! 

 

Natural Rights

 In the Daily Signal there is a piece detailing what a US Senator thinks of Natural Rights. Namely:

During a nominations hearing of the Senate Foreign Relations Committee on Wednesday, the former Democrat vice presidential candidate said, “The notion that rights don’t come from laws and don’t come from the government, but come from the Creator … that’s what the Iranian government believes. … So, the statement that our rights do not come from our laws or our governments is extremely troubling.” 

 Now I have written a short book on Natural Rights, a field of study going back centuries. This Senators if clueless.

As I stated:

Our argument is simple. The term Nature is an artifact of the past but it can now take on a reality in fact. Consider the statement; humans walk upright. The comparable statement is that; it is in the Nature of a human to walk upright. But as we know today, scientifically, the genetic structure of human genes results in processes, functions, and structures that make human walk upright. Namely the Nature of a human is to walk upright is the same as the genetic predispositions of humans to walk upright. Genetic structure and functioning are then the basis of the term Nature. We argue they are the sole basis.

It is in the Nature of a rose to have thorns. The genetic makeup of the rose is such that it has the persistent propensity to have thorns. Thus, Nature and Genetics are isomorphic and isometric. We often see various individuals opine on such things as justice and rights. The current milieu in these areas focuses on right and justice in the context of a society, not individuals. Moreover, we see the society broken down into identity group, identity politics if you will, where collectives of individuals who possess certain belief sets congregate to promote their specific interests in those belief sets, their assumed identities.

The two terms are our focus herein. Rights inure to an individual and place a demand on the society in which they exist. Justice on the other hand inures to the society and places a demand on the individuals in the society. In a sense they can be complementary and on the other hand they can be conflicting. We then take another step and examine the construct of Natural Rights and then its alternative Social Justice. Natural Rights we will argue is something emanating fromthe 14th century Franciscan Friars and in a way their women colleagues in the Franciscan orders,

the Poor Clares, and their battles with the rather arrogant Pope John XXII, in Avignon. From this battle emerged the rights of individuals. In contrast the construct of Social Justice emanates from the 19th century ideas of a state's responsibility to care for its citizens. Thus, we have two rather seriously conflicting principles; the rights of individuals, as stated in the US Bill of Rights, and the Social Justice movement which is the benchmark of 21st century Progressive politics.

 Thus Natural Rights is "natural" to the human, NOT granted by any Government. The literature on this is extensive. How do we have so uneducated a political class. This Virginian in my opinion disgraces the work of Jefferson, not to mention Paine.  

I am 82+, but MIT seems to think I should be incapacitated

 

The WSJ has a piece telling how MIT has an Age Lab and that they incapacitate a student to feel my age. They note; 

It took two people to make me feel like I was a woman in my 80s. At the MIT AgeLab, which works on finding ways to improve life for the elderly, a pair of researchers helped me put on their age-simulation suit. They started with a 15-pound weighted vest, tightening the straps around my body. They added more weights around my ankles and wrists, to replicate the sensation of the loss of muscle mass that accompanies aging. They pulled a blue jumpsuit up over the weights, helping me lift each leg and step into the suit without falling. They added a harness around my waist, and a bungee cord system that attached to different body parts including the back of the ankles and my wrists. The cords reduced my ability to reach up and shortened my stride. The get-up made it even more difficult to stand without a slouch. They put a padded neck collar on to limit my rotation and goggles to distort my vision. Foam-padded Crocs on my feet challenged my balance. The MIT designers call the outfit the “Age Gain Now Empathy System,” or Agnes for short. 

Now back in the 60s some clueless student like this would have most likely been a product of BU before Silber, but not MIT. This shows haw MIT has deteriorated  not me. Now my wife is a few years older than I but she spent the day hedge clipping and root pulling. I did some chain sawing and leaf collecting. 

Yes we both have had cataract replacement, but my wife resulting from her life as a chemist and mine from, get it, ageing.  Yes my knee is shot, but more from damage as a result of travel accidents and less just age. 

I still write more than any graduate student at MIT and my wife reads more than any Harvard undergrad. She spends the week bagging the plants at season's end to be collected so the garden is ready for Spring. We are headed for our home in New Hampshire to do the same there on the side on Mount Tecumseh.  

So yes, I hate many of the new packaging schemes but my wife has shown be how to bang open the pickles. 

Would it not have been better to collect a group of 80+ MIT grads like us and see what we have done. Instead money and time was wasted on what simpletons thought we should look like. This is just another sign of deterioration, not of 80+s but of what MIT allows to be foisted upon us as academic excellence. 

Told You So!

 

The NY Times has an article regarding the increased mortality of prostate cancer in American males. In 2012 the USPSTF stated that PSA testing should not be done in men over 70. They relied upon studies in NEJM based in Europe and the US. At the time I stated the studies were flawed. (Also see A, B, C) Finally, multiple studies supported my analysis back then,

PSA has problems but death from PCa also is a problem. In today's environment an elevated PSA would result in a multi parameter MRI. Even that has problems. For example the diffusion weighed scan can show positive result on scars from past prostate biopsies, Then the biopsies have some negative sequella such as infections but frankly at a well experienced site that is a very low risk.

The Times notes:

Many experts in the field say that reducing routine screening may have inadvertently led to a bump in severe disease. “It’s not easy to link a specific guideline to a worsening of disease, but it’s fairly convincing that the U.S. Preventive Services Task Force’s 2012 recommendations were very harmful,” said Dr. Jonathan S. Fainberg, a urologic surgeon at Memorial Sloan Kettering Cancer Center in New York who was not involved in the new report.

 But, it was clear to anyone who read the studies that they were flawed. I detailed that at the time. It took almost 15 years to seek a remedy.

Men over 70 have a high risk of PCa. The rule of thumb is that men of 70 have a 70% chance, men of 80 and 80% chance and so forth. But that change may mean an indolent and limited PCa presence. Thus for most 80+ men, if they have PCa then the PSA may be slightly elevated but it is not spreading.

In my opinion and my experience the USPSTF has issued multiple flawed recommendations. Breast cancer is also on their list of flaws. The recommend no mammograms after 75 but many women over 80 have BCa! So what do we do, just abandon them as well!

Perhaps we abandon the USPSTF!