Quotulatiousness

February 19, 2015

When you “believe” in science

Filed under: Media, Religion, Science — Tags: , , , — Nicholas @ 04:00

In last week’s Goldberg File newsletter, Jonah Goldberg looked at the odd situation of people who “believe in” science:

When I hear people talk about science as if it’s something to “believe in,” particularly people who reject all sorts of science-y things (vaccines, nuclear power, etc. as discussed above), I immediately think of one of my favorite lines from Eric Voegelin: “When God is invisible behind the world, the contents of the world will become new gods; when the symbols of transcendent religiosity are banned, new symbols develop from the inner-worldly language of science to take their place.” This will be true, he added, even when “the new apocalyptics insist that the symbols they create are scientific.”

In other words, the “Don’t you believe in evolution!?!” people don’t really believe in science qua science, what they’re really after is dethroning God in favor of their own gods of the material world (though I suspect many don’t even realize why they’re so obsessed with this one facet of the disco ball called “science”). “Criticism of religion is the prerequisite of all criticisms,” quoth Karl Marx, who then proceeded to create his own secular religion.

This is nothing new of course. This tendency is one of the reasons why every time Moses turned his back on the Hebrews they started worshipping golden calves and whatnot.

At least Auguste Comte, the French philosopher who coined the phrase “sociology,” was open about what he was really up to when he created his “Religion of Humanity,” in which scientists, statesmen, and engineers were elevated to Saints. As I say in my column, the fight over evolution is really a fight over the moral status of man. And, if we are nothing but a few bucks worth of chemicals connected by water and electricity, than there’s really nothing holding us back from elevating “science” to divine status and in turn anointing those who claim to be its champions as our priests. It’s no coincidence that Herbert Croly was literally — not figuratively, the way Joe Biden means literally — baptized into Comte’s Religion of Humanity.

Personally, I think the effort to overthrow Darwin along with Marx and Freud is misguided. I have friends invested in that project and I agree that all sorts of terrible Malthusian and materialist crap is bound up in Darwinism. But that’s an argument for ranking out the manure, not burning down the stable.

February 17, 2015

QotD: Psychology as the modern civic religion

Filed under: Quotations, Religion, Science, USA — Tags: , — Nicholas @ 01:00

There’s a certain sense in which psychology has taken the place of religious faith for many in the western world. When people seek answers for the bad that we do, how we can deal with our faults, motivation for a better life, and deeper questions of meaning and purpose, psychologists and psychology are where modern westerners tend to turn.

Where previous cultures saw acts of evil as evidence of internal sin against an external code of righteousness, psychologists tend to explain this as the product of environment and upbringing, external pressures causing improper behavior.

Even many otherwise religious people have so embraced this system of understanding. Many mainstream churches every Sunday have content very similar to the latest psychological teachings and popular psychology with a few religious themes thrown in. Popular teachers and writers such as Rick Warren are less minister of the gospel than motivational speaker, with more in common with Dr Phil than Jesus Christ.

Christopher Taylor, “COMMON KNOWLEDGE: Psychological myths”, Word Around the Net, 2014-05-28

February 13, 2015

QotD: The Nazi leadership, Aleister Crowley and the occult

Filed under: Books, History, Media, Quotations, Science, WW2 — Tags: , , , — Nicholas @ 01:00

During the past four centuries, we have seen the world in semi-Epicurean terms as a great and internally consistent machine. To understand it, we observe, we question, we form hypotheses, we test, we measure, we record, we think again. The results have long since been plain. In every generation, we have added vast provinces to the empire of science. We do not yet perfectly understand the world. But the understanding we have has given us a growing dominion over the world; and there is no reason to think the growth of our understanding and dominion will not continue indefinitely.

We reject supernatural explanations partly because we have no need of them. The world is a machine. Nothing that happens appears to be an intervention into the chains of natural cause and effect. We know that things once ascribed to the direct influence of God, or the workings of less powerful invisible beings have natural causes. Where a natural cause cannot be found, we assume, on the grounds of our experience so far, that one will eventually be found. In part, however, we reject the supernatural because there is no good evidence that it exists.

[…] It seems that Hitler was a convinced believer in the occult. He took many of his decisions on astrological advice. It did him no visible good. He misjudged the British response to his invasion of Poland. He was unable to conquer Britain or to make peace. His invasion of Russia, while still fighting Britain, turned his eastern frontier from a net contributor of resources to a catastrophic drain on them. He then mishandled his relations with America. So far as he was guided by the astrologers, I hope, before he shot himself, that he thought of asking for a refund. It was the same with Himmler. Despite his trust in witchcraft, he only escaped trial and execution by crunching on a cyanide capsule made by the German pharmaceutical industry.

Turning to practitioners of the occult, I see no evidence of special success. They do not live longer than the rest of us. However they begin, they do not stay better looking. Any success they have with money, or in bed, is better explained by the gullibility of their followers than by their own magical powers.

So it was with Aleister Crowley (1875-1947) — the “Great Beast 666,” or “the wickedest man alive.” He quickly ran through the fortune his parents had left him. He spent his last years in poverty. Long before he died, he had begun to resemble the mug shot of a child murderer. Whether his claims were simply a fraud on others, or a fraud on himself as well, I see no essential difference between him and the beggar woman who cursed me in the street. He had advantages over her of birth and education. But he was still a parasite on the credulity of others.

Sean Gabb, “[Review of] Crowley: Thoughts and Perspectives, Volume Two“, Libertarian Enterprise, 2014-05-18.

February 11, 2015

Everything the government has told about “healthy diets” is wrong

Filed under: Food, Government, Health, Science — Tags: , , — Nicholas @ 07:01

Well, maybe not everything, but a lot of government advice — which may well have been a major factor in the rise of obesity — was based on very little empirical evidence:

Whenever standard nutritional advice is overturned — as it has been this week by a study which effectively rubbished government guidelines limiting the intake of dietary fat — I am instantly reminded of a scene in the Woody Allen film Sleeper, first released when I was 10. I expect a lot of people my age are.

In the film Allen plays Miles, a cryogenically frozen health food store owner who is revived 200 years later. Two scientists are puzzling over his old-fashioned dietary requirements, unable to comprehend what passed for health food back in 1973. “You mean there was no deep fat?” says one. “No steak or cream pies, or hot fudge?”

“Those were thought to be unhealthy,” says the other scientist. “Precisely the opposite of what we now know to be true.”

This was meant to be a joke rather than a prediction, but it’s beginning to look as if we may not have to wait until 2173 to see it validated.

[…]

Of course the new study isn’t comprehensively refuting the association between high saturated fat intake and heart disease; it’s just pointing out that dietary guidelines first adopted in the mid-1970s were not, on reflection, based on any real evidence. In terms of what one should and shouldn’t be eating, I sometimes feel as if I’ve spent the past 30 years in a freezer.

February 9, 2015

Paradoxically, rising cancer deaths are a form of good news

Filed under: Britain, Health, Science — Tags: , , , , , — Nicholas @ 03:00

Last month, in his Times column, Matt Ridley explained why — until we discover a treatment for aging itself — rising cancer rates are a weird form of good news:

If we could prevent or cure all cancer, what would we die of? The new year has begun with a war of words over whether cancer is mostly bad luck, as suggested by a new study from Johns Hopkins School of Medicine, and over whether it’s a good way to die, compared with the alternatives, as suggested by Dr Richard Smith, a former editor of the BMJ.

It is certainly bad luck to be British and get cancer, relatively speaking. As The Sunday Times reported yesterday, survival rates after cancer diagnosis are lower here than in most developed and some developing countries, reflecting the National Health Service’s chronic problems with rationing treatment by delay. In Japan, survival rates for lung and liver cancer are three times higher than here.

Cancer is now the leading cause of death in Britain even though it is ever more survivable, with roughly half of people who contract it living long enough to die of something else. But what else? Often another cancer.

In the western world we’ve conquered most of the causes of premature death that used to kill our ancestors. War, smallpox, homicide, measles, scurvy, pneumonia, gangrene, tuberculosis, stroke, typhoid, heart disease and cholera are all much rarer, strike much later in life or are more survivable than they were fifty or a hundred years ago.

The mortality rate in men from coronary heart disease, for instance, has fallen by an amazing 80 per cent since 1968 — for all age groups. Mortality rates from stroke in both sexes have halved in 20 years. Cancer’s growing dominance of the mortality tables is not because it’s getting worse but because we are avoiding other causes of death and living longer.

It is worth remembering that some scientists and anti-pesticide campaigners in the 1960s were convinced that by now lifespans would be much shorter because of cancer caused by pesticides and other chemicals in the environment.

In the 1950s Wilhelm Hueper — a director of the US National Cancer Institute and mentor to Rachel Carson, the environmentalist author of Silent Spring — was so concerned that pesticides were causing cancer that he thought the theory that lung cancer was caused by smoking was a plot by the chemical industry to divert attention from its own culpability: “Cigarette smoking is not a major factor in the causation of lung cancer,” he insisted.

In fact it turns out that pollution causes very little cancer and cigarettes cause a lot. But aside from smoking, most cancers are indeed bad luck. The Johns Hopkins researchers found that tissues that replicate their stem cells most run the highest risk of cancer: basal skin cells do ten trillion cell divisions in a lifetime and have a million times more cancer risk than pelvic bone cells which do about a million cell divisions. Random DNA copying mistakes during cell division are “the major contributors to cancer overall, often more important than either hereditary or external environmental factors”, say the US researchers.

(Emphasis mine.)

To sum it up, until or unless medical research finds a way to stop the bodily effects of aging, cancer becomes the most likely way for all of us to die. Cancer is a generic rather than a specific term — it’s what we use to describe the inevitable breakdown of the cellular division process that happens millions or even trillions of times over our lifetime. As Ridley puts it, “even if everybody lived in the healthiest possible way, we would still get a lot of cancer.” I’m not a scientist and I don’t even play one on TV, but I suspect that the solution to cancers of all kinds are to boost our immune systems to more quickly identify aberrant cells in our bodies before they start reproducing beyond the capability of the immune system to handle. The short- to medium-term solution to cancer may be to make us all a little bit cyborg…

QotD: The hyper-rich are not like you and I

Filed under: Environment, Europe, Media, Quotations — Tags: , , , , , , — Nicholas @ 01:00

Convening to ring the alarm about global warming, our putative betters and would-be rulers gathered in Davos, Switzerland, filling the local general-aviation hangars with some 1,700 private jets. Taking an international commercial flight is one of the most carbon-intensive things the typical person does in his life, but if you’re comparing carbon footprints between your average traveler squeezed into coach on American and Davos Man quaffing Pol Roger in his cashmere-carpeted intercontinental air limousine, you’re talking Smurfette vs. Sasquatch. The Bombardier’s Global 6000 may be a technical marvel, but it still runs on antique plankton juice. The emissions from heating all those sprawling hotel suites in the Alps in winter surely makes baby polar bears weep bitter and copious baby-polar-bear tears.

The stories add up: Jeff Greene brings multiple nannies on his private jet to Davos, and the rest of the guys gathered to talk past each other about the plight of the working man scarf down couture hot-dogs that cost forty bucks. Bill Clinton makes the case for wealth-redistribution while sporting a $60,000 platinum Rolex.

The hypocrisy of our literally (literally, Mr. Vice President!) high-flying crusaders against fossil fuels — who overlap considerably with our high-living crusaders against economic inequality — is endlessly annoying if frequently entertaining. And there is something unseemly about enduring puritanical little homilies on how we need to learn to live with less from guys wearing shoes that cost more than the typical American family earns in a quarter. When that obnoxious Alec Baldwin character from Glengarry Glen Ross informs that sad-sack real-estate salesman that his watch costs more than that guy’s car, he was trying to provoke him into getting richer, to the tune of a Cadillac Eldorado or, if not that, at least the second-prize set of steak knives. But our modern progressive versions of that guy are even more obnoxious: They demand that we lower our expectations while they live lives of opulence that would have embarrassed the Count of Monte Cristo.

Out-obnoxious-ing a guy with Alec Baldwin’s smirking mug takes a lot of brass.

Kevin Williamson, “Davos’s Destructive Elites: ‘None of us is as dumb as all of us'”, National Review, 2015-01-25.

February 7, 2015

Is there a relationship between physical illness and depression?

Filed under: Health, Science — Tags: , , , — Nicholas @ 02:00

Last month, Scott Alexander tried to show the evidence, pro and con, on whether we have detected a causal relationship between physical ailments and depression:

Start with From inflammation to sickness and depression [PDF], Dantzer et al (2008), who note that being sick makes you feel lousy [citation needed]. Drawing upon evolutionary psychology, they theorize this is an adaptive response to make sick people stay in bed (or cave, or wherever) so the body can focus all of its energy on healing. A lot of sickness behavior – being tired, not wanting to do anything, not eating, not wanting to hang around other people – seems kind of like mini-depression.

All of this stuff is regulated by chemicals called cytokines, which are released by immune cells that have noticed an injury or infection or something. They are often compared to a body-wide “red alert” sending the message “sickness detected, everyone to battle stations”. This response is closely linked to the idea of “inflammation”, the classic example of which is the locally infected area that has turned red and puffy. Most inflammatory cytokines handle the immune response directly, but a few of them – especially interleukin-1B and tumor necrosis factor alpha – cause this depression-like sickness behavior.

[…]

Here are some other suspicious facts about depression and inflammation:

– Exercise, good diet and sleep reduce inflammation; they also help depression.

– Stress increases inflammation and is a known trigger for depression.

– Rates of depression are increasing over time, with the condition seemingly very rare in pre-modern non-Westernized societies. This is commonly attributed to the atomization and hectic pace of modern life. But levels of inflammation are also increasing over time, probably because we have a terrible diet that disrupts the gut microbiota that are supposed to be symbioting with the immune system. Could this be another one of the things we think are social that turn out to be biological?

– SSRI antidepressants, like most medications, have about five zillion effects. One of the effects is to reduce the level of inflammatory cytokines in the body. Is it possible that this is why they work, and all of this stuff about serotonin receptors in the brain is a gigantic red herring?

– It’s always been a very curious piece of trivia that treating depression comorbid with heart disease significantly decreases your chances of dying from the heart disease. People just sort of nod their heads and say “You know, mind-body connection”. But inflammation is known to be implicated in cardiovascular disease. If treating depression is a form of lowering inflammation, this would make perfect sense.

– Rates of depression are much higher in sick people. Cancer patients are especially famous for this. No one gets too surprised here, because having cancer is hella depressing. But it’s always been interesting (to me at least) that as far as we can tell, antidepressants treat cancer-induced depression just as well as any other type. Are antidepressants just that good? Or is the link between cancer being sad and cancer causing depression only part of the story, with the other part being that the body’s immune response to cancer causes inflammatory cytokine release, which antidepressants can help manage?

– Along with cancer, depression is common in many other less immediately emotion-provoking illnesses like rheumatoid arthritis and diabetes. The common thread among these illnesses is inflammation.

– Inflammation changes the activity level of the enzyme indoleamine 2,3 dioxygenase. This enzyme produces kynurenines which interact with the NMDA receptor, a neurotransmitter receptor implicated in depression and various other psychiatric diseases (in case your first question upon learning about this pathway is the same as mine: yes, kynurenines got their name because they were first found in dog urine).

– Sometimes doctors treat diseases like hepatitis by injecting artificial cytokines to make the immune system realize the threat and ramp up into action. Cytokine administration treatments very commonly cause depression as a side effect. This depression can be treated with standard antidepressants.

– Also, it turns out we can just check and people with depression have more cytokines.

There’s also some evidence against the theory. People with depression have more cytokines, but it’s one of those wishy-washy “Well, if you get a large enough sample size, you’ll see a trend” style relationships, rather than “this one weird trick lets you infallibly produce depression”.

[…]

So in conclusion, I think the inflammatory hypothesis of depression is very likely part of the picture. Whether it’s the main part of the picture or just somewhere in the background remains to be seen, but for now it looks encouraging. Anti-inflammatory drugs do seem to treat depression, which is a point in the theory’s favor, but right now the only one that has strong evidence behind it has side effects that make it undesirable for most people. There’s a lot of room to hope that in the future researchers will learn more about exactly how this cytokine thing works and be able to design antidepressant drugs that target the appropriate cytokines directly. Until then, your best bets are the anti-inflammatory mainstays: good diet, good sleep, plenty of exercise, low stress levels, and all the other things we already know work.

February 6, 2015

QotD: Listerine

Filed under: Business, Health, Humour, Quotations — Tags: — Nicholas @ 01:00

The stuff had an unpalatable reputation — no one likes the taste of Listerine, which is why Listerine had to come up with Flavored Listerine. Perhaps people respected it because it did taste so horrid; you could well imagine it was killing germs by the millions, because it tasted like death in your mouth. If Listerine Toothpaste had been flavored with mint or Pepsin! or Iridium! or some other brand-new ingredient, surely they would have told you up front. Unmodified “Listerine” is a warning.

James Lileks, The Bleat, 2015-01-20.

February 4, 2015

The theory of electromagnetism doesn’t look a day over 149

Filed under: History, Science, Technology — Tags: , — Nicholas @ 02:00

Robyn Arianrhod on the sesquicentential one of the most important discoveries that helped create the world we live in today:

It’s hard to imagine life without mobile phones, radio and television. Yet the discovery of the electromagnetic waves that underpin such technologies grew out of an abstract theory that’s 150 years old.

Our knowledge of the existence of such waves is a direct result of James Clerk Maxwell’s theory of electromagnetism which was first published in January 1865.

Electromagnetism itself was discovered physically rather than theoretically. Some time around 1820, the Danish physicist Hans Oersted noticed that when you switch on an electric current, a nearby magnet – such as the needle of a compass – actually jumps, as if the changing electric current was itself a magnet.

Then, in 1831 (the year Maxwell was born in Edinburgh) the English physicist and chemist Michael Faraday discovered that if you move a magnet through a coil of wire, you create an electric current in the wire without the aid of batteries or other electricity supply.

Faraday was so intrigued by the surprising ability of moving magnets to create electricity that he created a tiny prototype of the electric generator. He also created a prototype of the electric motor, but it would take decades before engineers were able to develop working motors and generators.

Nevertheless, basic technologies had begun to flow almost immediately after the phenomenon of electromagnetism was discovered: in particular, the telegraph – the first high-speed global telecommunications system.

February 3, 2015

To some, it’s worse to be a “lukewarmer” than a full-blown “global warming denier”

Filed under: Environment, Media, Science — Tags: , , — Nicholas @ 04:00

Matt Ridley on the trouble with only agreeing somewhat with the “scientific” “consensus”:

I am a climate lukewarmer. That means I think recent global warming is real, mostly man-made and will continue but I no longer think it is likely to be dangerous and I think its slow and erratic progress so far is what we should expect in the future. That last year was the warmest yet, in some data sets, but only by a smidgen more than 2005, is precisely in line with such lukewarm thinking.

This view annoys some sceptics who think all climate change is natural or imaginary, but it is even more infuriating to most publicly funded scientists and politicians, who insist climate change is a big risk. My middle-of-the-road position is considered not just wrong, but disgraceful, shameful, verging on scandalous. I am subjected to torrents of online abuse for holding it, very little of it from sceptics.

I was even kept off the shortlist for a part-time, unpaid public-sector appointment in a field unrelated to climate because of having this view, or so the headhunter thought. In the climate debate, paying obeisance to climate scaremongering is about as mandatory for a public appointment, or public funding, as being a Protestant was in 18th-century England.

Kind friends send me news almost weekly of whole blog posts devoted to nothing but analysing my intellectual and personal inadequacies, always in relation to my views on climate. Writing about climate change is a small part of my life but, to judge by some of the stuff that gets written about me, writing about me is a large part of the life of some of the more obsessive climate commentators. It’s all a bit strange. Why is this debate so fractious?

Rather than attack my arguments, my critics like to attack my motives. I stand accused of “wanting” climate change to be mild because I support free markets or because I receive income indirectly from the mining of coal in Northumberland. Two surface coal mines (which I do not own), operating without subsidies, do indeed dig coal partly from land that I own. They pay me a fee, as I have repeatedly declared in speeches, books and articles.

Senator Elizabeth Warren doesn’t really understand what “public goods” are

Filed under: Government, Science, USA — Tags: , , — Nicholas @ 02:00

Tim Worstall on what’s wrong with Senator Warren’s most recent proposal to claw back profits that are derived from government-sponsored research:

The answer being that finding out basic knowledge is something we call a public good. This has a specific economic meaning and it really means that private actors, whether people or companies, will do too little of this whatever it is. Because it’s just simply too difficult to make money out of having done this whatever it is. That’s really what “public good” means. It doesn’t mean goods supplied to the public nor even things that it is good for the public to have.

So, given that private actors won’t do these things but we also think that it would be just great for lots of these things to be done, well, we’ve got to do something about it then. And the answer to that is government. Even the most minarchist of us (although perhaps not the anarchists) would agree that some of the public goods provided by government are pretty good. A military to defend us from the ravening Canadian hordes, a criminal justice system to protect us from crime, a Constitution to protect us from politicians. All seem pretty good to me. The answer really is government in those cases.

The argument gets extended: that basic research is a public good. It’s very difficult to make a profit from it therefore not enough of it gets done in the private sector. So we should get government to go do it for us. Excellent, so, when we get that research being done then we’re getting what we pay our taxes to get government to do. We’ve got our public good.

What both Warren and Mazzucato are arguing is that government should then come back for a second bite of the cherry. They should get some of the profits from that basic research. But there aren’t any profits from that basic research: that’s why we’re getting government to do it because you can’t make a profit from having done the research. If we can make a profit from having done this research then government shouldn’t be doing it because it’s not a public good.

January 26, 2015

Balancing the art and the science in winemaking

Filed under: Australia, Science, Wine — Tags: , , — Nicholas @ 03:00

In Cosmos, Andrew Masterson investigates what is still an art and what has been codified as science:

“With commercial yeast you get certainty – you can sleep at night,” says Bicknell. “But how do you make wine more interesting? You exploit the metabolic processes of different yeast species.”

Bicknell’s faith in wild yeasts adds stress at fermentation time, but the pay-off is multi-award-winning wines regularly acknowledged as some of the best in Australia. “The wines do taste different, even if there’s no way you can show that statistically,” Bicknell says. “The only way to really know is to taste.”

Exploiting the diverse and fluctuating populations of wild yeasts found on the plants, fruit and in the air of vineyards is “the new black” (not to mention red and white) in oenology. The practice is becoming more commonplace among artisan winemakers. Even some of the giant commercial wine corporations are investing in the method.

Wild fermentation, says Bicknell, represents the intersection of science, craft and philosophy. But it could also form the basis of a profound shift in the narrative of wine. The more we study winemaking’s microbes, the more it appears they might explain one of the wine industry’s most beloved, but vaguest, terms: terroir.

“Terroir is a wonderful marketing term,” says David Mills, a microbiologist at UC Davis, who studies microbes in wine. “But it’s not a science.”

The French word terroir is difficult to translate. The closest translation is “soil”, but that is just one of its components. Terroir connotes the unique sense of place – the soils, the topography and the microclimate. It’s what makes the wines of Bordeaux or Australia’s Coonawarra so distinctive, and so inimitable.

Sommeliers like Ren Lim, former captain of the Oxford University Blind Tasting Society (and a PhD biophysics student) will tell you merely from swirling a mouthful of Cabernet Sauvignon which Australian winery produced it.

“The ones from Margaret River often give off a more pronounced green pepper note, a note found commonly in Cabernets grown in regions which experience pronounced maritime influences. Coonawarra Cabernets are somewhat different and unique in their own way. They are often minty and have a eucalyptus or menthol note in addition to the usual ripe blackcurrant notes. The green pepper note is often suppressed under the menthol notes. Nonetheless, the Cabernet structure remains in both these wines.”

It’s a feat that Mills does not question. “I don’t doubt regionality exists, but what causes it is a whole other set of issues.”

January 25, 2015

Prescribing modern drugs for Richard III

Filed under: Britain, Health, History, Science — Tags: , , , — Nicholas @ 02:00

In Richard Lehman’s BMJ journal review, there was an amusing bit of interest to Ricardians:

King Richard III of England was 32 when he died at Bosworth and then famously suffered the indignity of being buried in a Leicester car park. I think I probably drew your attention to this account of his post-mortem examination when it appeared online last September. Had Richard III been spared avoidable mortality in the form of a bashed-in skull and a spear through his spine, he would probably have needed a walking frame by the age of 70. He was never in the best shape:

I, that am curtail’d of this faire Proportion,
Cheated of Feature by dissembling Nature,
Deform’d, unfinish’d, sent before my time
Into this breathing World, scarse halfe made up,
And that so lamely and unfashionable,
That dogges bark at me, as I halt by them.
(from The Tragedy of Richard the Third: with the Landing of Earle Richmond , and the Battell of Boʃworth Field by Wm Shakespeare c.1592, First Folio text 1623)

With his nasty scoliosis and his habit of moving around castles with smoky rooms and no hand rails on the stairs, Richard III would have needed an OT assessment and a dosset box containing all the drugs which are now compulsory for elderly people in the UK:

simvastatin 40mg to add 2 days to life and cause muscle aches
tramadol 50mg to fail to ease pain & cause dependency, falls, confusion
naproxen 500mg to cause GI bleeds and fluid retention
furosemide 20mg to reduce fluid retention due to naproxen
omeprazole 20mg to prevent GI bleeds, encourage C diff
senna 7.5mg to counter tramadol constipation
citalopram 20mg to cause serotonin syndrome with tramadol
trazodone 50mg for agitation due to serotonin, to worsen it & cause falls
gababentin MR 800mg to see if it will help pain
paracetamol 500mg because it hasn’t helped the pain
tamsulosin 400mcg for nocturia due to age and furosemide
lisinopril 5mg for “grade 2 CKD” due to furosemide & naproxen
Seretide inhaler for low FEV1 due to scoliosis
etc.

My kingdom for a bit of horse-sense.

January 24, 2015

Problems besetting the British health system

Filed under: Britain, Bureaucracy, Health — Tags: , , — Nicholas @ 04:00

At Samizdata, Natalie Solent shares a post written by “ARC” discussing why the National Health Service seems to be under such pressure lately:

1) Flow-though is crucial to A&E: you must get people out the back-end of the process to maintain your rate of input to the front-end. However ever-increasing regulations mean a patient without family cannot be released until a boat-load of checks have been done. This is clogging up the back end. It may be preventing the release of a few who had better not be sent home yet (not much and not often, is the general suspicion) but it is definitely delaying hugely processing the release of all others who could be. All this admin takes time and effort — delaying release and also using up time of staff in non-health work — and costs money.

This effect needs to be understood in the context of the 15-years-older story of the destruction of many non-NHS nursing homes by galloping regulation. These homes were mostly owned and operated by senior ex-NHS nurses and provided low-grade post-operative care. The NHS relied on them as half-way houses to get patients out of NHS hospitals when they no longer needed intensive care but were not yet recovered enough to go home. These nurses did not want to spend time form-filling instead of caring for patients, and for each home there was always one of the 1000+ rules that was particularly hard for that given home to meet without vast expense or complication. So they died one by one. The ‘waiting times have increased’ story of Tony Blair’s early-2000 years — “If the NHS were a patient, she’d be on the critical list” — was caused by this and the resultant bed-blocking more than any other one cause.

The problem with waving the regulatory wand to “solve” a problem like this is that it tends to create perverse incentives so that the artificial target can be achieved — like this post from a couple of years back where the regulators dictated a maximum time a patient could be kept waiting for admission to A&E. The reaction of the people running the system was to change the definition of “admission” so that now patients’ timers don’t start running until they’re unloaded from the ambulance … so the end result is people are spending more time in the back of ambulances waiting outside the hospital until there’s an open slot. This meets the artificial target, but creates a worse situation because patients are still waiting as long (or longer), but now they’re also tying up ambulances from attending other emergency situations.

Back to ARC’s list of NHS problems:

2) The new 111 service is sending many more patients to A&E.

2.1) The service’s advice is very risk averse. The people who set up the process were afraid of the consequences of the statistical 1-in-a-million time when anything other than mega-risk-averse advice would see some consequence that would become a major news story blaming them.

2.2) Thanks to the post-1997 reforms, GPs work less hours on-call but the doctors are not just slacking off and doing nothing. The huge growth in regulation means they are in effect putting in as many hours as before, but on form-filling and admin to provide all the info the NHS and other government demand, to ensure they tick every box, etc. The out-of-hours on-call time they used to have is now swallowed by this work. So they are not in fact working less; it is the balance of what they are working on that has changed: less on healthcare, more on admin. Thus 111 must send people to A&E, not an on-call GP (and, of course, fewer on-call GPs mean more people phone 111).

From context, I assume the 111 service is a telephone health advisory service like Telehealth Ontario.

January 21, 2015

“Sir, please put the Sriracha down. Now!”

Filed under: Cancon, Food, Health, USA — Tags: — Nicholas @ 04:00

Megan McArdle worries that the otherwise welcome introduction of spice to the awesomely bland North American diet of yesteryear may have gone just a tad too far:

It has come to my attention that some of you are becoming unable to eat good food unless it is spiced to within an inch of its life.

I’ve been noticing this for a while. It started with friends who put hot sauce on everything, even on dishes that were perfectly good without hot sauce. With dinner party hosts who proudly declared that the secret to good cooking was just to douse something in Cajun spices until you noticed the powder forming drifts on the side of the pan. With people who reported that an Asian restaurant was “good” because it had left their taste buds numb for hours.

Then, during the holiday season, I saw a Slate food writer declare that American apple pie is not as good as French apple pie because it is “bland and goopy,” and I began to suspect that something had gone seriously wrong with our food culture. When I saw an article on restaurant chefs who are daring to bring back prime rib, I became sure of it.

I’m as excited as anyone about the majestic spread of foreign food throughout our nation’s urban downtowns, its strip malls and cookbook aisles, its fruited plains and amber waves of grain. I can’t think of a national cuisine I don’t like, and that includes foods that will sear the taste buds off a water buffalo’s tongue at 20 feet.

I love me some spices … but I also like the idea of not feeling my tongue in pain for hours after I’ve finished eating my meal.

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