What Doesn’t Make You Stronger Can Kill You

Posted December 3, 2017 by Tom
Categories: Health Care, Republican follies, Republican knavery, Uncategorized

Tags: , ,

Bit of self promotion here:  I’ve got a piece in today’s Boston Globe, on one of the hidden consequences of failing to deal with the antibiotic crisis.  In it, I focus on the use of antibiotics as prophylactics in surgery. Nowadays, it’s standard procedure for a wide range of operations to dose the patient with antibiotics shortly before she or he goes under the knife; doing so has been shown to signficantly reduce the risk of post-surgical infections.

I took off from a study that modeled the consequences of increased microbial resistance for ten common procedures, mostly surgeries, along with chemotherapy for a particular set of cancers.

The results of that study were predictable:  more resistance leads to more post-op infections and to more deaths.  If the situation gets really dire, if common causes of infection associated with surgery become increasingly untreatable then the calculation behind all kinds of medical interventions will change:

That’s what scares Dr. James Maguire, an infectious disease specialist at Brigham and Women’s Hospital. “I think some of the worst feelings we have are when we have a problem with a patient and there’s nothing we can do.” Infections following joint replacements are bad enough. They are, Maguire says, “catastrophic in terms of what happens to the patient.” Were the risk of infection to go up enough, he adds, “having seen what an infected joint replacement is all about I would think twice.”

That’s a response to an operation that may be vitally needed to reduce pain and increase mobility — but, as Maguire went on…

…while someone contemplating a joint replacement can choose to forgo the risk, if they need a new heart valve or a ventricular assist device, “that’s potentially life and death.” In such circumstances, “if your life depending on having the device, even with great risk you’d do it. But more would die.”

Behind such specific possible horror stories, this is for me a deeply cautionary tale about the way choices our society — our politics — makes have much deeper effects than our usual debate admits.  Antibiotics are not just responses to disease; their use penetrates medical practice, to the point that basic expectations we may have about what how we can move through the stages of our life can be dashed, without our ever really grasping why.

That is:  joint replacements are part of our medical and mental landscape now.  There are over 330,000 hip replacements performed each year in the US.  We know (some of us, venerable as we are, more than others) that our knees, elbows, shoulders and so on won’t always work as well as they do today.  We know, most of us I’m sure, folks who’ve had the op and are now playing tennis again or whatever, and we have in the back of our minds (those of us fortunate enough to believe we’ll still have adequate health care available over time) that if and when that bit falls apart in our own bodies, we can look for the same outcome.

Except, of course, if the risks of surgery shift significantly in the meantime.

The last point I make in the piece, somewhat more gently than here, is that should the way we age, the way we give birth and so on deteriorates because of unchecked microbial resistance, that will be a more-or-less hidden consequence of political failure.

That’s because dealing with the antibiotic crisis boils down to doing two things:  regulating economic activity and funding research.  The GOP doesn’t want to do either.  And, as usual, people will die as a result.

So, on that note of cheer, a link, again, to the piece.

Oh…and open thread too.

Image: Follower of Jan Sanders van Hemessen, An Operation for a Stone in the Head, date unknown (to me).

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Apropos Of Not Much (Post-Prandial Rant)

Posted November 28, 2017 by Tom
Categories: Manic Despair, Republican knavery

Tags:

So I read the latest over at Talking Points Memo on the slow-rolling Republican “moderate” cave on the tax bill to Trump and the GOP’s I Got Mine/Tongue-Bath-A-Billionaire Caucus.  That led me to a Twitter rant born of despair and rage.

The TL:DR is that dominant-power decline has happened before, will happen to whoever comes next, and is well underway now.  None of this is new; none original.  It just bubbled up, and as misery loves company, I give you a slightly edited version of the rant below.

As the GOP prepares to transfer wealth up and gut national finances in the process, it’s worth reflecting a little on national power. US predominance is no law of nature. It emerged in specific historical circumstances, & it will erode (is eroding) within its historical moment.

Trump and GOP actions are powering that decline, from gutting US diplomacy to abandoning soft power/trade alliances to an over reliance on the trappings of military power on the international security side to an attack on the US’s domestic capacity to solve problems, propel economic growth, and secure good lives for the great mass of its people.

The attack on universities that is both part of GOP rhetoric and built into the tax bill, for example is an attack both on civic life (in the form of engaged and critical-thinking citizens) and on the dollars and sense of economic life. Universities are where research happens, ideas turn into companies and all that. Whack them and we become not just dumber, but poorer too.

More decline follows as the basic sequence of life gets made harder for more people. CHIP follies are making pregnancy and childhood more wretched and even deadly. Ongoing assaults on the ACA, Medicaid and Medicare do the same for all of us and if/when the GOP passes its tax bill, most Americans will see taxes and deficits go up, threatening Social Security and everyone’s old age.

This kneecapping of American well-being and power extends across the policy spectrum.  Crapping on the environment isn’t just a matter of not hugging trees.  Just ask the citizens of Flint, MI if bad water is just an aesthetic loss. Recall the LA of my childhood and consider whether air pollution is just a matter of obscured views and great sunsets, etc.

All of these (and many more) domestic policy choices actually make us poorer, as individuals and as a nation. One more example: we already have crappier infrastructure than many of our national competitors. Among much else, that means it can take us longer to get to work — which is both an individual cost and and a net weakening of the US economy as a whole.

These are such hidden taxes, charges we pay not in cash, but in our ability to choose how to spend our lives. That cuts US productivity as a matter of GDP, and our contentment as a matter of GHQ (Gross Happiness Quotient) (I made that up. I think.)

None of this means American will (necessarily) collapse entirely. It just means we will be less well off and, in the context of national power, less able to act in the world as a whole. We won’t be able to afford as much (see Britain, post 1918), and…we will — we already — find ourselves with less moral capital, less ability to persuade and encourage fidelity and emulation abroad. (Again, see Britain, post 1918).

There’s real danger ins such decline.  See Putin’s post Soviet Russia for one approach to the loss of economic, military and ideological/moral power.

In that context, it wouldn’t surprise me in the least to see Trump, backed by the GOP, launch into a second war of choice in an as many decades, with similarly awful consequences.

But, that said, even though nations find it hard enough just to muddle through a relative decline in international stature, the world goes on, in somewhat different order. That’s happening now. We can’t really stop it.

We do have a choice though — we can accept a relative decline that still has the US eagerly pursuing a rich and just future…

Or we can dive further the implications of the current GOP program, and watch as our politics become yet more of a zero sum game in which those with the most grab all the crumbs they can, leaving the rest of us to our own devices, while US power dwindles.

And that, by way of the long road home, leads me here: Trump’s GOP* is a fundamentally anti-American party. It is workign as hard as it can to deliver wealth and power to a small constituency to the detriment of our national interest. That’s how an organized crime ring acts, not a party of government.

*And it is his party, or, if you prefer, he’s the predictable face of what that party has long been becoming.

Images: J. W. M. Turner, The Fighting Temeraire tugged to her last Berth to be broken up1839.

after Hieronymous Bosch, The Hay Wain (central panel of a tryptich), between 1510-1520.

Happy Birthday, John Prine

Posted October 10, 2017 by Tom
Categories: Music, Uncategorized

Tags:

It’s this master of the American song’s 71st today. Meant to post earlier, but Prine’s good for a couple of lullabyes too.

I’ve seen him live only once, decades ago. A great time then.  His music has only grown on me.  His songs appear simple, and some of them actually are; they’re all reach deep.

Here are a couple of favorites; add your own below.

 

And, of course:

I could go on, but no need. Fill in the many gaps I’ve left…

I wish we lived in a better led, better spirited time and place. Listening to this helps me believe that might yet come to us all.

Cosmic Goodness (Immigrant Edition)

Posted October 3, 2017 by Tom
Categories: Science, Uncategorized

Tags: ,

Here’s a welcome respite from the ongoing hellscape of GOP-dominated America:

Three American physicists have won the Nobel prize in physics for the discovery of gravitational waves, ripples in the fabric of spacetime that were first anticipated by Albert Einstein a century ago.

Rainer Weiss has been awarded one half of the 9m Swedish kronor (£825,000) prize, announced by the Royal Swedish Academy of Sciences in Stockholm today. Kip Thorne and Barry Barish will share the other half of the prize.

If you want to listen to a gravitational wave — the sound of two black holes colliding — here you go:

For more detail on what the prize is for, here’s a lovely, relatively brief lecture — very accessible — on gravitational waves and what it took to detect them, delivered by my MIT colleague Nergis Mavalvala:

And if you want to go a bit deeper, MIT’s Rainer Weiss, one of the three laureates, offers longer, somewhat more technical account:

You can follow this prize — as so many before it — back to Albert Einstein.  As Mavalvala explains, the concept of the gravitational wave emerges directly from Einstein’s theory of gravity, the General Theory of Relativity.

To say “directly” is, as usual, a bit of misrepresentation.

Yes: calculation within Einstein’s 1915 theory does end up at a prediction of gravitational waves, but neither the history of that calculation nor the human story moved down anything like a straight path.  First, in 1905, Henri Poincare suggested that gravity waves might exist.  Then, in 1915, with his new mathematics of gravity, Einstein began to wonder if his theory would yield such waves, soon concluded it would not, then revisited the question, still during WW I, and proposed that three different examples of gravitational oscillations might actually be real.  Then, 1922, Arthur Eddington (who had led the eclipse expeditions that confirmed the underlying general theory three years before) showed that two of the three forms Einstein had proposed were mathematical mistakes, born of the choice of coordinate system Einstein used for his earlier calculation.

Einstein pursued other projects for a while, returning to gravitational waves in the 1930s, after emigrating to the US.  Working with an assistant, Nathan Rosen (of the Einstein-Podolsky-Rosen paradox-that-isn’t), he wrote a paper concluding that gravitational waves do not exist, full stop.  The two men submitted the paper to Physical Review, which then sent it on for review.  The reviewer, Howard Percy Robertson, found a confounding error. On being informed,  Albert Einstein was not amused:

Einstein’s reaction was anger and indignation; he sent the following note to [PR editor John] Tate [10]:

July 27, 1936
Dear Sir.
“We (Mr. Rosen and I) had sent you our manuscript for publication and had not authorized you to show it to specialists before it is printed. I see no reason to address the—in any case erroneous—comments of your anonymous expert. On the basis of this incident I prefer to publish the paper elsewhere.”
Respectfully
Einstein
Still, Robertson was right, as Einstein’s next assistant, Leopold Infeld confirmed.  He told Einstein what he’d learned, and the older scientist listened:
Infeld refers to the day before a scheduled talk that Einstein was to give at Princeton on the “Nonexistence of gravitational waves”. Einstein was already aware of the error in his manuscript, which was previously pointed out by Infeld. There was no time to cancel the talk. The next day Einstein gave his talk and concluded, “If you ask me whether there are gravitational waves or not, I must answer that I don’t know. But it is a highly interesting problem
Einstein had already resubmitted his original paper to another journal, and the work was in proofs, which led to a scramble, and the final outcome:
“…After finding relationships that cast doubt on the existence of gravitational fields rigorous wavelike solutions, we have thoroughly investigated the case of cylindrical gravitational waves. As a result, there are strict solutions and the problem is reduced to conventional cylindrical waves in Euclidean space”.
Einstein was often swift to annoyance. He could, though, on reflection, be corrected — as he was here.
“I want to thank my colleague Professor Robertson for their friendly help in clarifying the original error.”

The issue remained, though, that gravitational waves were complicated to model, and hence even to imagine detecting.  The article linked above and again here is a history of the idea, and it shows how much thinking and doing — for decades — went into the moment of discovery this prize celebrates.

And that just gets us to the gate of the work behind this year’s physics Nobel.  Weiss first came up with the idea for the detector that ultimately heard two black holes colliding almost exactly fifty years ago, after teaching MIT’s introduction to general relativity. The next decade, he began the collaboration with fellow laureate Kip Thorne, the near legendary Caltech general relativist to advance the idea of a large-scale interferometer as a gravity wave observatory.  The next key collaborators, Ronald Drever, who died last year, and the third prize-winner, Barry Barish, credited with the transformation of Weiss’s original notion into a full fledged and ultimately enormous lab, joined soon after.  The actual detection took place a mere four decades on.

And it’s beautiful — as Einstein once said of other work, an example of “the highest form of musicality in the sphere” of scientific endeavor.  The scale, the unholy precision, and the extraordinary extension of human perception into the most forbidding recesses of the universe are simply sublime, glorious and terrifying.  In these wretched political times, the notion that some of our species can create on such an encompassing canvas is…a balm, at least.

And, not to harsh that mellow, but because everything is political to me these days, a final thought.  Einstein, an immigrant, discovered the underlying concept.  Rai Weiss, born in Berlin in 1932, escaped with his family from the Nazis first to Prague and then New York.  Mavalvala, featured above, a key contributor to the ultimate instrument that made the detection, came to the US to pursue knowledge at the highest level from her home in Turkey Pakistan [apologies for the error].  Many, many more people from all over dedicated days and nights and years of their working lives to making this happen.

This is the intellectual and cultural capacity the GOP seeks to erode.  That makes them philistines, and worse: saboteurs of the American capacity to create both basic science and all the expected and unanticipated possibilities for human well being that flow from “musicality in scientific thought.”

Stupid Idea For Readers To Destroy

Posted September 12, 2017 by Tom
Categories: Health Care, Uncategorized

Tags:

David Anderson’s post at Balloon-Juice got me thinking on single payer vs. universal coverage — I’m with David (and Elie). Don’t care how we get to health care for all Americans, as long as we get there.

So here’s my stupid idea: a move in stages.*

Stage one: Medicare For All Kids.  Same program, just for every kid up to the age of 18–or 26, to match current ACA practice.

The reasoning in my wholly non-expert addled brain being twofold: first, kids are, as a group, cheap to cover, so the financial lift here is presumably manageable.  Second: this has an aspirational frame that can be used to persuade.  I don’t know about you, but I’ll take (I took) risks on my own behalf I would never have done had I my son to keep safe when I started my own small business.  I don’t know how many people have deferred or abandoned dreams because they couldn’t go insurance-naked for their kids.

That’s anecdata, but David Leonhardt made much the same argument way back in 2010 in defense of the bill that became Obamacare. Medicare For All Kids, presented as a way to unleash Americans’ entrpreneurial spirit, would be a proposition on which I think Democrats could go to town.

The next stage is to take the step that didn’t find our David’s 218-51-5 support in the last go-round:  Medicare (buy-in?) For All Over 55.  This is a form of public option, and it would expand the single-payer approach to more and more of those either utterly unable to take on health risk themselves (kids, the post-work elderly) and those whose age-adjusted risk is growing to the point where it threatens to become unmanageable.   Again, this would require persuasion, but the idea that older but not old folks who might face, say, a 2008-like crisis of employment should find a ready avenue to coverage is, again, a case that can be made (by a better political rhetorician than me).

That leaves 27-55 year olds on their own — or rather, within the existing Obamacare/expanded Medicaid universe.  But it establishes a template for a single payer form of coverage without requiring a wholesale change over of a system with tons of interested parties and rent-seekers eager to defend their turf.

So — to steal Ta-Nehisi Coates’ old line: talk to me like I’m stupid.

What’s wrong with a crabwise walk towards increasingly universal health care, along these lines or better ones? For both politics and policy, what would be wrong w. introducing, say a Medicare For All  Kids bill in this Congress, just to get that ball rolling?

David? Anybody?

*”We shall fight in France, we shall fight on the seas and oceans, we shall fight with growing confidence and growing strength in the air, we shall defend our island, whatever the cost may be. We shall fight on the beaches, we shall fight on the landing grounds, we shall fight in the fields and in the streets, we shall fight in the hills; we shall never surrender.”

Image: Edvard Munch, The Sick Child, 1907

A Handful Of Quick DACA-Related Thoughts

Posted September 5, 2017 by Tom
Categories: Moral Trumpitude, Republican knavery, Stupidity, Things that actually matter, Two Parties -- Not the Same, Uncategorized, Who thought that was a good idea?, Why Do They Hate America So?

Tags: ,

 

Others have said what needs to be said about the Coward Trump and his DACA debacle.   Here’s my PGO addition:

1: To reinforce a point Charles Pierce made today: DACA folks are Americans. Full stop. They may not be citizens, but they are us; members of our society, our community.  They are not strangers.

Any attempt to frame them as aliens, or criminals — or as developmentally delayed moral agents who need (as John’s former elementary school teacher put it) being taught right from wrong — is both wrong and vile.

2: Task one is whatever we can do to “help” our Republican friends in Congress to fix the steaming pile of rodent droppings the leader of their party just dumped in their punchbowl

Task two, of course, is to teach every national Republican, no matter what goodness may reside in their hearts, bless their hearts, the lessons California GOPsters learned post Prop. 187.

To me that means that the first priority for any political action centers on voting.  I’m going to call my local town Democratic committee first, and see what I can do there to register folks.  Given that my town votes 2-1 D every election, with good turnout, I’m hoping they’re making the same connections they do every election with Ds who need help in New Hampshire.  If I get no joy there, I’ll contact folks directly in neighboring states.

After registration, it’s voter education and then turnout.  That’s it.  The unintended consequence of Trump’s reign of misrule is that a lot more people have become aware that politics does in fact matter where each of us live.  It’s incumbent on all of us to make sure that realization doesn’t go to waste.

Last: again, this isn’t an issue in my home town of Brookline, MA — but this is why we need Democrats running in every office, down to assistant dog catcher.  Neighbors seeking votes mobilize voters as no one else can; if we have people doing so for every office, that’s a big part of the battle right there.  So I’ll be doing what I can to tell those up the food chain in the party that we gotta do what the Republicans, to their tactical credit, have long understood to be vital.

That’s it.  My motto going forward: Get (Stay) Mad. Get (More Than) Even.

Over to y’all.

Caravaggio, Supper at Emmaus 1601.

Grifters All The Way Down

Posted September 3, 2017 by Tom
Categories: Republican follies, RICO Trump, ridicule, Thieves, Uncategorized

Tags:

Here’s what I don’t get.  Trump’s Treasury Secretary, Steve Mnuchin, is a rich guy. Seriously rich: on the order of a half a billion in net worth, w. a cool $70 million in 2016 earnings.  If he wants to check out a cool event — a total eclipse, say, a desire I wholly understnd — he can afford to do so at any level of comfort he chooses, and never miss the lucre.

Instead, he scams:

Last week, Treasury Secretary Steve Mnuchin took Mitch McConnell, some other Republican lawmakers, and his wife, Louise Linton, to Kentucky, ostensibly to touch large piles of gold at Fort Knox. Coincidentally, Kentucky also happened to be one of the best places to watch the total solar eclipse, which happened to occur on the day of their trip.

This trip had already attracted a bit of unwanted attention (back in those halcyon days before Melania’s stiletto adventures) after Linton instagramed the following:

“Great #daytrip to #Kentucky! #nicest #people #countryside,” Linton wrote, according to a screenshot of the now-private post, before tagging the labels she was wearing “#rolandmouret pants, #tomford sunnies, #hermesscarf #valentinorockstudheels #valentino #usa.”

Nothing says populist like that kind of fashion profile, eh?

Now, however, it turns out that drawing eyes to the family outing might have been more than a mere PR flub:

The U.S. Treasury’s Office of Inspector General is reviewing the flight taken by Treasury Secretary Steven Mnuchin and his wife, Louise Linton, last week to Louisville and Fort Knox, Ky., following criticism of their use of a government plane on a trip that involved viewing the solar eclipse.

“We are reviewing the circumstances of the Secretary’s August 21 flight . . . to determine whether all applicable travel, ethics, and appropriation laws and policies were observed,” counsel Rich Delmar wrote in a statement to The Washington Post late Thursday.

“When our review is complete, we will advise the appropriate officials, in accordance with the Inspector General Act and established procedures,” Delmar added.

Yo! Mnuchin! Pay attention here.  The Air Force is not your personal air taxi service. You want to take a day off? Fine. You’re the boss. You can play hooky to join millions jazzing on the sun’s waltz with the moon.  And you can pay for it your own damn self, just like I did, my brothers, and everyone I know.

More seriously:  someone who actually takes public service as service knows not to give even the appearance of putting one’s hand in the cookie jar.  And it’s not as if this puts Mnuchin through any hardship.  As noted above, he is far and away rich enough to pay for all his pleasures; there’s no meaningful gain to him to sleaze a little grift off the top.  But apparently, he can’t help himself.

These guys: scum floats — but how can you tell when it’s scum all the way down?

Image: Elihu Vedder, Corrupt Legislation (detail), mural in the Library of Congress, 1896.