Saturday, January 10, 2015

Employment January 2015


Let's start with the standard chart. Yes the DoL report says 5.6% but if one were to use the baseline of 2006 participation rates it is still above 8%. Although we see participation increasing.
The chart above should be the concern. We have a lower participation rate or higher gap, there are now millions permanently unemployed. That is and should be the concern. Frankly not only is there no change in that number but it appears to be increasing.
The above demonstrates that concern.

Thus overall things are getting better but the permanent gap is a real ongoing concern. It appears that at the older end we have lost people permanently and at the lower end the young millenials want meaningful work rather than a job. That is the real problem.


Sunday, January 4, 2015

Words Mean Something

From today's NY Times weather map of 2014 they make the following statement:

The average temperature for the year was 54.5 degrees, 0.5 degrees below normal, which makes 2014 tied for the 56th-warmest year since 1869.

Now just think a bit:

1. The temperature was 54.5 and that was 0.5 below normal, call that average.

2. Then 2014 is tied for the 56th warmest year since 1869.

3. If it is below normal, say average, median or mean, then it means that half are above.

4. If it is since 1869 we have 145 years of data and assume that there are other ties, possibly even triplets.

5. Then if all were ties there would be 72 years of data and being 59th makes sense but calling it the warmest in any measure is nonsense. The words just do not match.

6. How does it rank as coldest? I guess it is politically incorrect to ask such a question in front of the NYT readers?

This is a clear example of the duplicity in the discussion about climate, change or otherwise. Political correctness dominates facts. Pity.

Prostate Cancer Markers

The MAC, has just announced reimbursement for three prostate cancer genetic tests. As OncLive states: 

After months of delay, the Medicare Administrative Contractor (MAC), with jurisdiction over most molecular diagnostic tests used to treat cancer, made a series of decisions this fall that will allow Medicare reimbursement for several well-known tests, including 3 used in the treatment of prostate cancer.

Specifically the tests were:

1. ConfirmMDx by Oral Oncolytics which is a methylation test. We considered this in WP 116.

2. Prolaris by Myriad which is a complex gene test which we considered in WP 107.

3. Decipher by GenomeDx which is akin to Prolaris.

The methylation test has interesting merit and the others seem correlative at best. One of the problems of prognostic tests as to more aggressive PCa is just what does one do next?

Saturday, January 3, 2015

A Worthwhile Contribution


Medieval Christianity by Madigan is a very readable and comprehensive book covering Western Europe from about 500 AD until 1400 AD, albeit edging down to 150 and up to 1500 at its extreme. The book is well balanced, well researched and accessible to all readers. The title also states it as “A New History” but just what is “new” and “well known” is not as clear perhaps as the author may have desired. Notwithstanding, what the author has presented is useful for the newly informed as well as the “well informed”.

The author starts with a brief discussion of early Christianity from 150 to 600. This has as its center piece Augustine and his writings. One of the most difficult problems with early Christianity is the complexity of Greek thought and the Eastern Church and the slow evolution of a Western Church. Southern has examined this in detail and it is the complexity of Eastern thought which in many ways was a departing point for the west and it was it abandonment by Augustine via his Roman way of thinking that opened the Western Church and what we now think of Medieval Christianity. Augustine introduced many ideas in a manner that reformed Western beliefs. His battle with Pelagius is clearly one and his emphasis on grace another.

There is an interesting discussion on p 29-30 on when this stage of early Christianity ended. One way to pinpoint this change perhaps is the time of Gregory I. The reason is that at this time Gregory breached with Byzantium by severing with the ruler in Ravenna and taking both religious and political control in Rome.

The author’s discussion on Gregory is very limited in scope and here I would fault the author for an opportunity to use this figure as a major break point for the establishment of the Western Church (see pp 45-62). It can be argued that it was Gregory who de factor created Medieval Christianity.

The Bishop of Rome in 600 was still just that, the Bishop of Rome. The Emperor in Constantinople was a de facto head of the Church, calling various Councils to discuss major religious issues. Gregory had been in the court in Constantinople, had been Mayor of Rome, had come from an old line Roman family and desired to be a monk along the lines of Benedict. However he was drawn to the Bishop of Rome slot by the people of Rome who required his leadership.

Also Gregory was looking westward, seeing Constantinople as an aging confluence of political intrigue. Thus by looking west his communications with the Merovingian queen Brunhilda is a classic example of Rome becoming pari passu with leaders and influencing them via religion and charm. On the other hand the likes of Brunhilda were brutal to the point of savagery and Gregory seems in his writing to have avoided discussion of these facts. Likewise he dealt with the Lombards as well as sending the Italian Bishop Augustine to England. This latter act however can be viewed as an affront to the Irish who were still adhering to the Eastern Church ways and saw Gregory as an equal in debate. In essence Gregory set up the conflict between Ireland and England. But it was Gregory and his looking westward rather than Eastward that made for the seminal start of the Medieval Church.

In this section it would have been useful to explore in some detail the lengthy discussions between Columbanus and Gregory I. There was but a brief mention on p 48 of Columbanus. First the Latin of Columbanus, the Irish monk, was dramatically different from Gregory. Gregory had evolved to almost a koine type Latin while Columbanus seems to have retained almost Ciceronian Latin. The Irish monks had learned Latin almost independently from Rome based upon classic texts and this in a way strongly influenced their style. In addition Columbanus and all the Irish monks had never been under the Roman yoke and thus in dealing with Rome they dealt with them as almost an independent thinker. 

Chapter 4 introduces Charlemagne. Charlemagne was a follow on to the Merovingians, albeit the descendent of a Merovingian court official. Charlemagne in 800 gets coroneted by the Bishop of Rome, now viewed as both a religious figure and putative political player.

Chapter 5 deals with the parochial life. There was a local parish alongside the monastic monasteries. The local priests were typically less well educated that the monks who spent much of their time reading and writing. In contrast the local parish priest was dealing with local matters of lesser import. Chapter 6 deals with the Jews, an issue always made complex, especially in the West. Chapter 7 considers the Crusades and Islam. A great deal has been written on crusades and this presentation is brief. The complexity of the expansion and acceptance of Muslim beliefs was often seen by the Christians as another heretic sect, especially their belief in polygamy. There did not seem to be any attempt to “understand” their thought throughout this period.

Starting in Chapter 8 the author moves to what he calls the era of High Medieval Christianity. This is from 1050 through 1300. There is a discussion of the reforms to what had become a Church with many small faults, and this included Rome itself. By this time Rome had clearly become a Papacy in terms of its singular position. Chapter 10 discusses some of the heretical movements during this early period of the High Medieval Church.

Chapters 11 and 12 present the Dominicans and the Franciscans respectively. Whereas the Dominicans were always positioned as intellectually elite, Aquinas was a Dominican, the Franciscans presented a possible threat to Rome, and they advocated a return to early Christian belief of poverty. However Rome managed them quite well and the net result was a Franciscan order that was on a par with the Dominicans and in a sense often superior. One needs look no further than Ockham and his Franciscan followers.

The author then details many of the elements of religious life and affairs. At this time the Church was becoming a dominant part of the lives of the people.

On pp 262-266 the author presents Abelard and Heloise. This is one of the classic tales of this time. This is one of the best descriptions and one in context that I have seen. This alone is worth reading.

On pp 277-283 there is a brief discussion on Aquinas. I would have liked to see a more detailed presentation. Aquinas became a figure of the Aristotelian movement and after his death his works were banned by some but they came back in the 19th century and the basis of Church belief and doctrine. Some more detailed discussion of his work would have been useful. I felt his presentation was too brief in passing.

As noted, the author discusses Aquinas but fails to discuss Ockham, the Franciscan, albeit a brief note on the next to last page ((p434).Ockham was a nominalist, one who denied universals, and thus in contradistinction to Aquinas. Ockham also reinvigorated the idea of the Individual and as such was a catalyst for many works emanating from his. Also Ockham demonstrated confrontational intellectual opposition to the Avignon Popes resulting in his fleeing eastward and being supported by German Princes. Here is an example of quasi-national opposition to the non-Roman Pope, a conflict that was just starting to brew.

Late Medieval Christianity occurs from 1350 to 1500 and the author does a good job in details the key points. Again there are “heretical” movements such as Hus and Wyclif and the Lollards. He discusses the changes and discusses Prague in some detail. Prague was a cauldron of religious dissent, as the statue to Hus demonstrates in the square of present day Prague, a statue I passed daily on my way to my office, ironically across from the house of Kafka! Understanding central Europe more would have been helpful in explaining this effect.

The Avignon papacy from 1309-1378 (pp 374-378) blends Middle and High Medieval Christianity and represents a clear distortion of the Bishop of Rome and the attempted, and in many ways total, control by the French throne over the Pope. Here we have most likely the first instance of having a Pope as a separate entity from the Bishop of Rome. For centuries before this, when the Pope qua leader of the Church was mentioned, the position was synonymous with the Bishop of Rome. In fact the true title should be Bishop of Rome, since that is the position of such a leader. It would have been helpful to have an expanded discussion on this topic. This period of fighting Popes has in my opinion left an indelible scar on the Western Church.

Overall this is a superb book and worth reading and rereading. The author builds upon Southern and his work as he indicates. However there are many other views of the issue he presents and space being limited his presentation is fair, well balanced, and exceptionally readable. In contrast one might also read, if available, the works of Henri Daniel-Rops (a pseudonym for Henri Tetiot) who albeit an apologist for the Church, has added insight on many of these issues discussed by the author.

Friday, January 2, 2015

Cancer and "Bad Luck"

I commented yesterday on the brief Science piece by Vogelstein and colleagues. In the past twenty four hours I have seen over two dozen news pieces from every continent, except Antarctica, pitching the "bad luck" tale. Even China Daily had the story on its front page! This is unfortunately now a typical response, no analysis, just repetition. The "bad luck" was in the abstract and they could not have chose a better phrase to get picked up globally.

Now the results are not ground shaking and "bad luck" is not a scientific phrase. In reality the authors just observed that certain cancers are most likely driven by specific genetic changes already known or by such personal life choices like smoking. The rest are really unknown.

We are learning more and more of epigenetic effects, such as methylation, that result from inflammation, which may be a result of some life style choice such as obesity. That has not been factored in, especially since breast and prostate cancers were not considered.

Thus the term "bad luck" may just be a "bad choice" but it does get Press. But is that what science it meant to do?

Thursday, January 1, 2015

Cancer By the Numbers

There is always a novel attempt to garner information or patterns from data on cancer. In a recent Science paper Vogelstein and colleagues have done some interesting "back of the envelope" analysis. They did the following:

1. Collected data which provided the number of stem cells of a particular cells type in a typical lifetime of a person. For example they somehow determined from the literature the number of melanocyte stem cells in a lifetime. They did the same for many other cells. For example there are lots of basal cells per human lifetime, as one would expect. In contrast there were two orders of magnitude less melanocytes.

Let us call that NSC(i) where i equals a specific type of cell.

2. Then they plotted the incidence of cell related cancers versus the total lifetime stem cells by type. Thus we see that the incidence of basal cell cancer is high and so are the total number of lifetime stem cells of basal cells.

Let is call this INC(i) the incidence of a specific cancer related to the specific cell.

3. Then they created a normalized line through the incidence versus stem cell count curve and drew a chart of cancers how far below to how far above they were to the average line. This waterfall type chart then was the discussion point.

That is we have some generalized relationship:

INC(i)=K NSC(i)  where K is a common constant obtained from a regression type analysis. However the actual INC(i) may be above or below the regression line.

4. The cancers well above the norm were those driven by some putative genetic or environmental factor such as smoking and lung cancer. The rest are due the authors state to just having lots of stem cell mutations.

This if INC actual (i) > INC regression (i) we attribute this excess to some genetic or environmental/lifestyle condition.

Interesting concept, but there are some issues:

1. Do they really mean stem cells? Melanocytes do not reproduce as quickly but it is not clear just what a melanocyte stem cell is. We have seen this in prostate cancers.

2. The authors admit epigenetic factors as well and one suspects that they could dominate.

3. The excess cancers such as smoking and lung are clearly environmental effects.

4. Some how there is no discussion of breast and prostate. One wonders why since they are so prevalent.

Otherwise this is interesting and worth the read. Their conclusion is:

These results suggest that only a third of the variation in cancer risk among tissues is attributable to environmental factors or inherited predispositions. The majority is due to “bad luck,” that is, random mutations arising during DNA replication in normal, noncancerous stem cells. This is important not only for understanding the disease but also for designing strategies to limit the mortality it causes. 

That is worth exploring.But, and this is a classic case, the Press has latched on to the "bad luck" phrase. We really do not know from this study what is the issue. Thus again we have a confluence of words by authors and the explosion of the press to enhance the piece. Frankly it is interesting but hardly conclusive of anything!