West Virginia Teachers and the NY Times

Some New York City based NY Times reporter opined on the West Virginia teachers strike. Her comments notes:

As long as the teachers stay out, they serve as a symbol not just of a renascent labor movement, but of a citizens’ uprising that’s taking different forms throughout the United States. Fones-Wolf thinks the strike goes hand in hand “with a much more generalized discontent. You see evidence of it from these school kids in Florida, who are really quite amazing. Maybe we’re on the cusp of a time when people say, ‘enough.’” If that’s true — if a spirit of revolt really is sweeping across the country — it will be the one way Trump has helped make America great again.

Now I have a daughter who is one of the strikers and four grandchildren in the state. As such I have a rather personal nexus. I am not a New York City commentator, I have some pound of flesh in the battle.

The problem is simple. The Legislature is, in my opinion, in the pockets of the coal and gas owners. Labor has always been a second thought in West Virginia. Remember that the Democrat Senator has a daughter who runs the drug company that took epinephrine emergency units and raised the price more than 6 times! Then the teachers were getting one of the worst health plans in the nation and one of the lowest salaries. The unions from my understanding did nothing.  It was the teachers alone, doing it themselves, who pushed the issue.

It is not resolved. The pay increase is one thing, the health plan is a disaster! The Legislature wants to increase the monthly charge almost 12 fold while reducing the benefits to less that one would see in some forth world country. For example, if you have a child with cancer, you get to go to Morgantown, even if you are near Baltimore. Over the Cumberland gap, through snow and ice and pray your sick child is still alive. Then pay for your hotel and the list goes on! West Virginia, in my opinion, is the only state where Medicaid is better!

The issue is not unions, in my opinion, it is the gross disregard of state employees and the favoring of wealthy local interests.

The comfortable, and what seems in my opinion uninformed New York City big paper commentators know-it-all states:

Yet if the strike is rooted in the specific conditions and history of West Virginia, it’s also part of a nationwide upsurge in intense civic engagement by women. “As a profession, we’re largely made up of women,” Amanda Howard Garvin, an elementary school art teacher in Morgantown, told me. “There are a bunch of men sitting in an office right now telling us that we don’t deserve anything better.” In the wake of Donald Trump’s election, she said, women across the country are standing up to say: “No. We’re equal here.”

Well, there are still men going down into the mines, working crops, hauling loads across highways. Why everything gets turned into a women's issue when it is a global issue of the special interests and their money, not the workers and their horrible conditions. One should not bait one group of impressed by another and disregard the true oppressors.

The teachers are back, and as I am led to understand not due to any help from their "unions" who opposed their actions. Yet the health care issue is still a disgrace. Perhaps the NY Times can send someone down into West Virginia. I suspect they may not have done so since Kennedy ran for President!

Keep Your Head in the Sand: The NHS Saves Money

We all too often hear from those seeking better healthcare that we should follow the Brits NHS. Now perhaps we should spare a moment on understanding their approach. The best example is today in Cancer Research UK which tries to opine on the uselessness of cancer screening. As we have already noted the most recent attack was on PSA testing. The brilliant conclusion was that if you only tested a patient once, and if that test was positive you did a biopsy that was in my opinion useless, then the number of deaths was no different than if you did noting. In my opinion that equation leads to:

Nothing=Nothing

No surprise. I wonder what Lord Russell would have said?

Now to their other article:

Not all cancers are equal. Some grow fast and spread quickly, while others grow so slowly (or even not at all) that if they went undetected they wouldn’t cause any problems. Even if left untreated, a person wouldn’t be harmed by their cancer. When these harmless cancers are found they’re said to be ‘overdiagnosed’. This happens more often with certain types of cancer, and is usually tied to particular types of cancer screening that test people without symptoms, such as breast screening. The problem is that when these types of cancer are diagnosed early it’s impossible to tell the potentially harmful ones from the harmless ones. Everyone is then usually offered treatment. And this means that some will be exposed to the potential side effects of treatment, and worry of a cancer diagnosis, when they didn’t need to be. This is called overtreatment. Overdiagnosis is one of the key things to consider when working out the balance of possible benefits and harms of cancer screening. Keep in mind, overdiagnosed cancers aren’t the same as when a test finds something abnormal that turns out not to be cancer (so-called false positive test results), another risk of screening and many other types of test. An overdiagnosed cancer is a true cancer, but it’s one that wouldn’t have caused harm in that person’s lifetime.

So the Brits solution seems to be in my view; forget about screening. If you are going to die you are going to die, so live with it!

PSA, So What?

The PSA test is not liked by many. Why? Because it often finds indolent cancers. Thus many entities want to ban its use. Is that a good idea? Not really but here is the latest.

From Cancer Research UK they note:

The potential for blood tests that detect cancer is huge. But what if a test is, in some ways, too good? What if it finds cancers that if left undetected wouldn’t cause a person any harm? And what if it’s not possible to know for certain which cancers need to be treated, or who could avoid a life-altering diagnosis and potential long-term treatment side effects? This is the situation right now with prostate cancer. There’s no UK screening programme for prostate cancer. That’s because the blood test that would be used – called the PSA (or prostate specific antigen) test – isn’t reliable enough.
Men over the age of 50 with no symptoms of prostate cancer can still ask for the test in the UK. But its use is hotly debated around the world. Now, a new Cancer Research UK-funded study, from scientists at the Universities of Bristol and Oxford, sheds more light on how unreliable the test is. And it confirms that for men without symptoms, the PSA test doesn’t save lives.

 Now from the referrd to JAMA paper it notes:

In the intervention group, men aged 50 to 69 years received a single invitation to a nurse-led clinic appointment. At the appointment, men were provided with information about PSA testing. After giving consent, men were offered the PSA test. Men with PSA levels of 3.0 ng/mL or greater were offered a standardized 10-core transrectal ultrasound–guided biopsy. Those diagnosed with clinically localized prostate cancer and who met the eligibility criteria were recruited to participate in the ProtecT trial to receive treatment. The ProtecT trial compared radical prostatectomy, radical conformal radiotherapy with neoadjuvant androgen deprivation therapy, and active monitoring.⁵ In contrast, the control practices provided standard National Health Service management, and information about PSA testing was provided only to men who requested it. 

This procedure is akin to taking a single sample of blood pressure and assuming it is the same for ever! The fundamental approach to any patient is to see if anything changes over time. That was to have been the core of any electronic health record, never achieved however. A good physician looks for change, in a mole, in blood pressure, in weight, in vision, and yes in PSA!

The JAMA article concludes:

Among practices randomized to a single PSA screening intervention vs standard practice without screening, there was no significant difference in prostate cancer mortality after a median follow-up of 10 years but the detection of low-risk prostate cancer cases increased. Although longer-term follow-up is under way, the findings do not support single PSA testing for population-based screening.

 First a single measurement of anything is near useless! Second, PSA works only if measured over time and such measures as velocity and percent free are also measured. Thirdly, a ten core biopsy not guided by MRI is "shingling the roof in the fog". One has no idea what they are biopsying! No wonder there was no change in mortality.

In my opinion based upon a multiplicity of prior analyses and clinical studies, this result proves that a single PSA test is useless. That is all.

Choosing Winners and Losers

Starting a new company is a risky business. It requires many elements besides a good idea. It needs a team, experience, execution, persistence, money and yes also luck. The timing is critical as well as execution. Business is fundamentally a survival of the fittest, a matching of business expertise with market demands. Perfecting a good idea is at best a small first step.

Now comes the MIT Engine, a $200 million investment fund. It is not really a venture fund, it is something that is between a post-doc operation and what is called an incubator. As Technology Review states[1]:

Located behind an unassuming storefront in Cambridge’s Central Square, The Engine’s 26,000-square-foot headquarters is home to seven startups, including iSee, which is working on artificial intelligence to make self-driving cars more practical, and Analytical Space, which is planning to launch a network of low-orbit satellites to transfer large amounts of data from space using lasers—at speeds 10 times faster than radio for about the price of a cellular data plan. The Engine provides resources to help these startups develop their technologies, with investments to date of between $500,000 and $2 million and use of dedicated office space and shared lab and fabrication space for as long as they need it. Rae and her team also offer business advice and connections to help them find customers.

Now take the satellite case. This will require billions not to mention a global licensing effort. I have seen this done a few times before. Now one wonders if this is just a research effort pretending to be a venture fund. Is it fair to the students to have them believe they are building a business? As this is done under the rubric of MIT is it fair for an academic institution whose aim is leading edge research to choose winners and losers. Faculty compete in the open market of funding from third party entities. Why should the startups not do the same.

The article also notes:

The idea for The Engine emerged as MIT was finalizing real estate developments in the biotech and software hub of Kendall Square. “We were focused on what MIT could do that would be additive and beneficial,” says executive vice president and treasurer Israel Ruiz. In conversations with scientists and engineers, he learned that the biggest need was in bridging the “valley of death” between producing an innovation in the lab and getting it to market. That is particularly difficult in industries that require sophisticated hardware, such as alternative energy, transportation, space, and medical devices, and thus may need more capital investment up front than digital ventures. “They said, we need money, but we also need access to infrastructure and specialized equipment, and we need to create a community,” Ruiz says. “Those elements got put together in The Engine.”

The "valley of death" metaphor has merit. Universities get faculty and students to work on a multiplicity of leading edge ideas. They are research as they should be. They are not business ideas. They are driven by technological breakthroughs. Taking that and making a business is non-trivial. It requires a team, a market, financing, and good timing and execution. Those things are well beyond the ken of academics. They then continue:

The concept dovetailed with MIT president Rafael Reif’s vision of “innovation orchards,” an idea he expressed in a 2015 op-ed in the Washington Post. Such environments, he wrote, could “provide what universities alone cannot: the physical space, mentorship, and bridge funding for entrepreneurs to turn new science into workable products.” He added: “This would make investing in tangible or tangible-­digital hybrid innovations no riskier than investing in the purely digital.”

It is not the responsibility of a university to develop businesses. They train students and perform research. The vetting process of starting a business means breaking the academic umbilical and in the classic mode of "burning the boats", eschew all the comfort of the academic world and begin anew. Turning new science into workable products is but a small step. You have to have a product that someone wants. The dogs must eat the dog food! I have seen many good science projects turned into good products, which unfortunately no one wanted! You need a market and the MIT President's statement above reflects the insular mindset of the academic.

The article continues:

Yet another aim is to seed new industries that can diversify the Boston area’s portfolio of tech companies beyond biotech and medical. “Boston has had a seat in what we would call transformative technologies for a long time,” says Nashat. During the 1970s and 1980s, New England got an apparent head start in the electronics industry, only to see Silicon Valley become the center of that world. “To put it bluntly, the East Coast needs to up its game if it’s going to attract top young talent and industrial vitality,” Lassiter says. “We have that in biotech and the medical area, but we need more of it in more areas if Boston is going to be as important in the next 50 years as it was in the last 50. Ultimately, you need an economy that is more than professors and Uber drivers.”

I did my first start up, as a member of the team, in 1969. It was an EG&G funded effort to make an early version of a credit card validation system. It failed. But what I learned is that customers and attention to detail is a sine qua non. The "good idea" or even a "workable product" is a mere first step. One should ask why California got the start. My answer is a bot convolved. Because MIT and its surrounding companies had been feeding at the DoD trough for years and continued to do so. It was a one hour flight. California was six hours to DC and thus needed a Plan B. Boston forgot the Plan B and California won. Lesson, always have a Plan B and never rely upon a "sugar daddy".

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[1] https://www.technologyreview.com/s/610114/investing-in-tech-thats-worth-the-wait/

Textbooks

It is interesting to examine the evolution of textbooks, especially for colleges. I have taken the opportunity to examine chemistry for the freshman level. Specifically both what is presented, how it is presented, and how much it costs. I tried to examine texts from the 1960 period to the present. The time selection is based upon the Sputnik inflection point in 1957.

First of all, chemistry for college freshman is generally a collections of disconnected ideas. It does not build like calculus or physics. For example the typical course would include:

1.     Molecular and atomic structure, the periodic table

2.     Bonding, types and uses, basic quantum numbers

3.     Lewis bonds and structures

4.     Stoichiometry

5.     Reaction rates

6.     Reaction Kinetics

7.     Aqueous Solutions

8.     Acids and bases

9.     Thermodynamics of reactions

These topics seem to be covered in most books. Oftentimes these are separate and do not build upon the previous steps.

The trends seem obvious.

1. The CPI has gone from a normalized 1 to a current 8.5. Namely prices have gone from $1 to $8.50 approximately.

2. The current prices if about $160.00 or about $19.00 in 1960 levels.

3. In 1960 the price of such a book was about $9.50. Thus a doubling of the old price.

4. A massive introduction of color pictures. Just how many times must the student see Einstein!

5. The style has changed dramatically. The older books were fairly linear in presentation. The newer one seem to interject cultural, political, technical as well as chemistry related materials.

6. Besides the book one needs to purchase an equally costly book of problems. This doubles the price. Also some "on-line" purchase may be required.

Overall it seems that the publishers are just loading up on useless materials to get a greater price. The trends seem to be as follows:

1960-1980: Overview approach to the above topics, plus a few others with limited graphics and often limited experimental references.

1980-2000: More detailed material with reasonable numbers of worked examples and details on experimental efforts.

2000-2018: Explosion of useless details and confusing layouts. Near impossible to determine what is important and what is fill. Comes with costly separate problem and answer books almost always mandated.

Considering how this can be placed in an on-line mode, one wonders why this still prevails. Answer, publishers profits, at the costs of the students!

References (Prices are current from Amazon)

1.     Atkins, Chemical Principles: The Quest for Insight 7th Edition, Freeman, 2016, $177.93

2.     Averill and Eldredge, Chemistry, Pearson, 2006.

3.     Black and Conant, New Practical Chemistry, McMillan, 1936

4.     Brown et al, Chemistry: The Central Science (13th Edition), Pearson, 2014, $228.76

5.     Dickerson et al, Chemical Principles, 3^rd Ed, Benjaman, 1979.

6.     Gilbert et al, Chemistry: The Science in Context (Fifth Edition), Norton, 2017, $157.37

7.     Kennan and Wood, General College Chemistry, Harper Row, 1961

8.     Mahan and Myers, University Chemistry, 4^th Ed, Benjaman, 1987.

9.     Pauling, L., General Chemistry, Dover, 1988, $15.49

10.  Quagliano, Chemistry, Prentice Hall, 1958

11.  Sienko and Plane, Chemistry, 2^nd Ed, McGraw Hill, 1961

12.  Silberberg, Chemistry: The Molecular Nature of Matter and Change, McGraw Hill 2017. $138.95

Public Transportation

In the past two months on a single NJ Transit line there has been 167 breakdowns, delays (60 min or more) and absolute cancellations. That is just one of many lines. That does not include the NY subway disasters.

The problem is not infrastructure, alone. It is the gross incompetence of politically appointed individuals who have no capabilities to run a railroad. They get appointed by a Governor, Republican or Democrat, and then proceed to cause abject havoc.

There are solutions to this, one is to privatize it and make its failure a criminal act. Small chance that would happen!