Quotulatiousness

April 10, 2021

Galen of Pergamon

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

Scott Alexander asked some of his readers to submit book reviews that he’ll be publishing anonymously to allow the rest of the readership to vote on. Friday’s submission was a review of the work of Galen of Pergamon … to help determine if he deserves all the kicks he’s received from other writers over the last two millennia:

Portrait of Galen from The Lancet.
Engraving by Georg Paul Busch via Wikimedia Commons.

Aelius Galenus or Claudius Galenus (henceforth “Galen”) was born in Pergamon, a town in modern-day Turkey, in 129 CE. At the time, it was a part of the Roman empire, and a major intellectual center. Galen’s father was an architect; while rich, he was not considered to be particularly high status. Since there was little pressure for his son to go into a traditional career, instead of the “safe” subjects of literature and rhetoric that most Romans studied, Galen got an unusual education in mathematics and geometry.

(His father’s patient encouragement has its foil in his mother, who “flew into rages and bit her servants, a practice of which Galen disapproved.”)

When Galen was a teenager, however, his father had a dream where the god of medicine appeared and told him that his son should study medicine, so Galen started training as a doctor.

During this training Galen became familiar with the writings of Hippocrates, who had lived about 600 years earlier. Hippocrates had introduced the idea of the four humors to medicine — four fluids that congeal together to form our flesh and organs, and which co-mingle in our veins in their liquid form. Hippocrates came up with this system, but Galen would be the one to make it world-famous.

I could try to describe the theory myself, but actually Hippocrates does a great job on his own:

    The Human body contains blood, phlegm, yellow bile and black bile. These are the things that make up its constitution and cause its pains and health. Health is primarily that state in which these constituent substances are in the correct proportion to each other, both in strength and quantity, and are well mixed. Pain occurs when one of the substances presents either a deficiency or an excess, or is separated in the body and not mixed with others.

All disease and illness, in this system, were the result of an imbalance in the four humors. From this perspective, treatments like bloodletting make perfect sense. By opening up the veins, the excessive humors drain away, leaving the patient more balanced — in better humors.

Long-term trends towards any of the humors were responsible for what we would call personality. Hence the terms sanguine, phlegmatic, melancholy and so on for different personal traits and emotional conditions.

This is the theory that he would put his weight behind, and which he would eventually be responsible for bringing to the majority of the western world.

When Galen was 19, his father died, leaving him independently wealthy. Hippocrates wrote that a good doctor should travel, so Galen ended up spending a decade studying with medical experts from various schools in cities all around the Mediterranean, including Alexandria.

After this, he came back to Pergamon where he got a job as the doctor treating the gladiators of the city. This was an unusual step for someone of his wealth and education, because despite their popularity as a form of entertainment, gladiators at the time were considered extremely low-class.

It’s not clear why he took this job, but it seems likely that it influenced how he thought about medicine. Spending long hours stitching gladiators back together gave him a detailed knowledge of human anatomy, which other doctors of the time lacked. It sounds like he did a great job, too, because only five of the gladiators died during his time there — compared to 60 under the guy who had the job before.

Eventually all roads lead to Rome, of course, and Galen arrived in 162 CE. His lectures and demonstrations made such an impression, and ruffled so many feathers, that he was afraid of getting poisoned by the Roman doctors and eventually left to save his life. In 169 CE, however, a great plague (probably smallpox) broke out, and Marcus Aurelius summoned him back to Rome to serve as court physician. Marcus Aurelius died the next year (according to some sources, of the plague), but Galen ended up with a longterm post in Rome as physician to the new Emperor, Commodus.

Galen himself died some time between 199 and 216 CE, at the the ripe old age of between 70 and 87.

February 6, 2021

“WebMD is the Internet’s most important source of medical information. It’s also surprisingly useless”

Filed under: Bureaucracy, Health, Technology, USA — Tags: , , , , — Nicholas @ 05:00

Scott Alexander discusses why WebMD is not the be-all and end-all of internet medical resources:

WebMD is the Internet’s most important source of medical information. It’s also surprisingly useless. Its most famous problem is that whatever your symptoms, it’ll tell you that you have cancer. But the closer you look, the more problems you notice. Consider drug side effects. Here’s WebMD’s list of side effects for a certain drug, let’s call it Drug 1:

    Upset stomach and heartburn may occur. If either of these effects persist or worsen, tell your doctor or pharmacist promptly. If your doctor has directed you to use this medication, remember that he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor right away if you have any serious side effects, including: easy bruising/bleeding, difficulty hearing, ringing in the ears, signs of kidney problems (such as change in the amount of urine), persistent or severe nausea/vomiting, unexplained tiredness, dizziness, dark urine, yellowing eyes/skin. This drug may rarely cause serious bleeding from the stomach/intestine or other areas of the body. If you notice any of the following very serious side effects, get medical help right away: black/tarry stools, persistent or severe stomach/abdominal pain, vomit that looks like coffee grounds, trouble speaking, weakness on one side of the body, sudden vision changes or severe headache.

And here’s their list of side effects for let’s call it Drug 2:

    Nausea, loss of appetite, or stomach/abdominal pain may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. This medication can cause serious bleeding if it affects your blood clotting proteins too much. Even if your doctor stops your medication, this risk of bleeding can continue for up to a week. Tell your doctor right away if you have any signs of serious bleeding, including: unusual pain/swelling/discomfort, unusual/easy bruising, prolonged bleeding from cuts or gums, persistent/frequent nosebleeds, unusually heavy/prolonged menstrual flow, pink/dark urine, coughing up blood, vomit that is bloody or looks like coffee grounds, severe headache, dizziness/fainting, unusual or persistent tiredness/weakness, bloody/black/tarry stools, chest pain, shortness of breath, difficulty swallowing.

Drug 1 is aspirin. Drug 2 is warfarin, which causes 40,000 ER visits a year and is widely considered one of the most dangerous drugs in common use. I challenge anyone to figure out, using WebMD’s side effects list alone, that warfarin is more dangerous than aspirin. I think this is because if WebMD said “aspirin is pretty safe and most people don’t need to worry about it”, people might use aspirin irresponsibly, die, and then their ghosts might sue WebMD. Or if WebMD said “warfarin can be dangerous, be careful with this one”, people might refuse to take warfarin because “the Internet said it was dangerous”, die of the stuff warfarin is supposed to treat, and then their ghosts might sue WebMD. WebMD solves this by never giving the tiniest shred of useful information to anybody.

This is actually a widespread problem in medicine. The worst offender is the FDA, which tends to list every problem anyone had while on a drug as a potential drug side effect, even if it obviously isn’t. This got some press lately when Moderna had to disclose to the FDA that one of the coronavirus vaccine patients got struck by lightning; after a review, this was declared probably unrelated. For the more serious version of this, read Get Ready For False Side Effects. Why does the FDA keep doing this if they know it makes their label information useless? My guess is it’s because they don’t want to look like cowboys who unprincipledly consider some things but not other things. What if someone accused the person deciding what things to consider of being biased? So the FDA comes up with a Procedure, and once you have a Procedure it has to be “take everything seriously”, and then it falls on random small-fry people who aren’t the FDA to pick up the slack and explain which side effects are worth worrying about or not, and then those small fries don’t do that, because they could get sued.

I think the same concern motivates WebMD diagnosing everything as cancer. If they said something other than cancer, then people might sigh with relief, not bother to get a cancer screening, die from some weird cancer that doesn’t present the way normal cancers do, and then their ghosts might sue WebMD.

Of course, WebMD and other online medical information sites didn’t invent hypochondria, they merely made it easier to do to yourself what Jerome K. Jerome did one fine London morning in 1888:

I remember going to the British Museum one day to read up the treatment for some slight ailment of which I had a touch — hay fever, I fancy it was. I got down the book, and read all I came to read; and then, in an unthinking moment, I idly turned the leaves, and began to indolently study diseases, generally. I forget which was the first distemper I plunged into — some fearful, devastating scourge, I know — and, before I had glanced half down the list of “premonitory symptoms,” it was borne in upon me that I had fairly got it.

I sat for awhile, frozen with horror; and then, in the listlessness of despair, I again turned over the pages. I came to typhoid fever — read the symptoms — discovered that I had typhoid fever, must have had it for months without knowing it — wondered what else I had got; turned up St. Vitus’s Dance — found, as I expected, that I had that too, — began to get interested in my case, and determined to sift it to the bottom, and so started alphabetically — read up ague, and learnt that I was sickening for it, and that the acute stage would commence in about another fortnight. Bright’s disease, I was relieved to find, I had only in a modified form, and, so far as that was concerned, I might live for years. Cholera I had, with severe complications; and diphtheria I seemed to have been born with. I plodded conscientiously through the twenty-six letters, and the only malady I could conclude I had not got was housemaid’s knee. […] I had walked into that reading-room a happy, healthy man. I crawled out a decrepit wreck.

February 4, 2021

QotD: The (as-yet-unfulfilled) promise of “personalized medicine”

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

A more useful lesson might be skepticism about personalized medicine. Personalized medicine – the idea that I can read your genome and your blood test results and whatever and tell you what antidepressant (or supplement, or form of therapy) is right for you has been a big idea over the past decade. And so far it’s mostly failed. A massively polycausal model would explain why. The average personalized medicine company gives you recommendations based on at most a few things – zinc levels, gut flora balance, etc. If there are dozens or hundreds of things, then you need the full massively polycausal model – which as mentioned before is computationally intractable at least without a lot more work.

(You can still have some personalized medicine. We don’t have to know the causes of depression to treat it. You might be depressed because your grandfather died, but Prozac can still make you feel better. So it’s possible that there’s a simple personalized monocausal way to check who eg responds better to Prozac vs. Lexapro, though the latest evidence isn’t really bullish about this. But this seems different from a true personalized medicine where we determine the root cause of your depression and fix it in a principled way.)

Even if we can’t get much out of this, I think it can be helpful just to ask which factors and sciences are oligocausal vs. massively polycausal. For example, what percent of variability in firm success are economists able to determine? Does most of the variability come from a few big things, like talented CEOs? Or does most of it come from a million tiny unmeasurable causes, like “how often does Lisa in Marketing get her reports in on time”?

Maybe this is really stupid – I’m neither a geneticist or a statistician – but I imagine an alien society where science is centered around polycausal scores. Instead of publishing a paper claiming that lead causes crime, they publish a paper giving the latest polycausal score for predicting crime, and demonstrating that they can make it much more accurate by including lead as a variable. I don’t think you can do this in real life – you would need bigger Big Data than anybody wants to deal with. But like falsifiability and compressability, I think it’s a useful thought experiment to keep in mind when imagining what science should be like.

Scott Alexander, “The Omnigenic Model As Metaphor For Life”, Slate Star Codex, 2018-09-13.

January 30, 2021

Obey your technocratic elites, peasant!

Filed under: Bureaucracy, Education, Government, History, Liberty, Technology, USA — Tags: , , , , , , — Nicholas @ 05:00

Scott Alexander considers some historical (and current) examples of you peasants being steamrolled by the powers of the government at the behest of the technological elites of the day:

I am not defending technocracy.

Nobody ever defends technocracy. It’s like “elitism” or “statism”. There is no Statist Party. Nobody holds rallies demanding more statism. There is no Citizens for Statism Facebook page with thousands of likes and followers.

[…] it worries me that everyone analyzes the exact same three examples of the failures of top-down planning: Soviet collective farms, Brasilia, and Robert Moses. I’d like to propose some other case studies:

1. Mandatory vaccinations: Technocrats used complicated mathematical models to determine that mass vaccination would create a “herd immunity” to disease. Certain that their models were “objectively” correct and so could not possibly be flawed, these elites decided to force vaccines on a hostile population. Despite popular protest (did you know that in 1800s England, anti-smallpox-vaccine rallies attracted tens of thousands of demonstrators?), these technocrats continued to want to “arrogantly remake the world in their image,” and pushed ahead with their plan, ignoring normal citizens’ warnings that their policies might have unintended consequences, like causing autism.

2. School desegregation: Nine unelected experts with Harvard and Yale degrees, using a bunch of Latin terms like a certiori and de facto that ordinary people could not understand let alone criticize, decided to completely upend the traditional education system of thousands of small communities to make it better conform to some rules written in a two-hundred-year-old document. The communities themselves opposed it strongly enough to offer violent resistance, but the technocrats steamrolled over all objections and sent in the National Guard to enforce their orders.

US Highway System needs in 1965 from “Needs of the Highway Systems 1955-1984”, a letter from the Secretary of Commerce to the House Committee on Public Works, approved May 6, 1954.
US Government Printing Office via Wikimedia Commons.

3. The interstate highway system: 1950s army bureaucrats with a Prussia fetish decided America needed its own equivalent of the Reichsautobahn. The federal government came up with a Robert-Moses-like plan to spend $114 billion over several decades to build a rectangular grid of numbered giant roads all up and down the country, literally paving over whatever was there before, all according to pre-agreed federal standards. The public had so little say in the process that they started hundreds of freeway revolts trying to organize to prevent freeways from being built through their cities; the government crushed these when it could, and relocated the freeways to less politically influential areas when it couldn’t.

4. Climate change: In the second half of the 20th century, scientists determined that carbon dioxide emissions were raising global temperatures, with potentially catastrophic consequences. Climatologists created complicated formal models to determine how quickly global temperatures might rise, and economists designed clever from-first-principle mechanisms that could reduce emissions, like cap-and-trade systems and carbon taxes. But these people were members of the elite toying with equations that could not possibly include all the relevant factors, and who were vulnerable to their elite biases. So the United States decided to leave the decision up to democratic mechanisms, which allowed people to contribute “outside-the-system” insights like “Actually global warming is fake and it’s all a Chinese plot”.

5. Coronavirus lockdowns: The government appointed a set of supposedly infallible scientist-priests to determine when people were or weren’t allowed to engage in normal economic activity. The scientist-priests, who knew nothing about the complex set of factors that make one person decide to go to a rock festival and another to a bar, decided that vast swathes of economic activity they didn’t understand must stop. The ordinary people affected tried to engage in the usual mechanisms of democracy, like complaining, holding protests, and plotting to kidnap their governors – but the scientist-priests, certain that their analyses were “objective” and “fact-based”, thought ordinary people couldn’t possibly be smart enough to challenge them, and so refused to budge.

Nobody uses the word “technocrat” except when they’re criticizing something. So “technocracy” accretes this entire language around it – unintended consequences, the perils of supposed “objectivity”, the biases inherent in elite paradigms. And then when you describe something using this language, it’s like “Oh, of course that’s going to fail – everything like that has always failed before!”

But if you accept that “technocracy” describes things other than Soviet farming, Brasilia, and Robert Moses, the trick stops working. You notice a lot of things you could describe using the same vocabulary were good decisions that went well. Then you have to ask yourself: is Seeing Like A State the definitive proof that technocratic schemes never work? Or is it a compendium of rare man-bites-dog style cases, interesting precisely because of how unusual they are?

I want to make it really clear that I’m not saying that technocracy is good and democracy is bad. I’m saying that this is actually a hard problem. It’s not a morality play, where you tell ghost stories about scary High Modernists, point vaguely in the direction of Brasilia, say some platitudes about how no system can ever be truly unbiased, and then your work is done. There are actually a bunch of complicated reasons why formal expertise might be more useful in some situations, and local knowledge might be more useful in others.

January 13, 2021

QotD: Bureaucracy as a filter

Filed under: Bureaucracy, Economics, Health, Quotations — Tags: , , , — Nicholas @ 01:00

Imagine there’s a new $10,000 medication. Insurance companies are legally required to give it to people who really need it and would die without it. But they don’t want somebody who’s only a little bit sick demanding it as a “lifestyle” drug. In principle doctors are supposed to help with this, but doctors have no incentive to ever say no to their patients. If the insurance just sends the doctor a form asking “does this patient really need this medication?”, the doctor will always just check “yes” and send it back. Even if the form says in big red letters PLEASE ONLY SAY YES IF THERE IS AN IMPORTANT MEDICAL NEED, the doctor will still check “yes” more often than a rational central planner allocating scarce resources would like. And insurance companies are sometimes paranoid about refusing to do things doctors say are important, because sometimes the doctor was right and then they can get sued.

But imagine it takes the doctor an hour of painful phone calls to even get the right person from the insurance company on the line. Now there’s a cost involved. If your patient is going to die without the medication, you’ll probably groan and start making the phone calls. But if your patient doesn’t really need it, and you just wanted to approve it in order to be nice, now you might start having a heartfelt talk with your patient about the importance of trying less expensive medications before jumping right to the $10,000 one.

Organizations have a legal incentive not to deny people things, because the people involved can sue them. But they have an economic incentive not to say yes to every request they get. Seeing how much time and exasperation people are willing to put up with in order to get what they want is an elegant way of separating out the needy from the greedy if every other option is closed to you.

This story makes sense and would help explain why bureaucracy gets so bad, but I’m not sure it really fits the evidence. People complain a lot about bureaucracy in places like the Department of Motor Vehicles, but the DMV doesn’t lose anything by giving you a drivers license and isn’t interested in separating out people who really want licenses from people who only want them a little. If the DMV can be as bureaucratic as it is without any conspiratorial explanation, maybe everything is as bureaucratic as it is without any conspiratorial explanation.

Scott Alexander, “Bureaucracy as Active Ingredient”, Slate Star Codex, 2018-08-31.

August 13, 2020

QotD: The discovery of anaesthesia and antisepsis

Filed under: Health, History, Quotations, Science — Tags: , , — Nicholas @ 01:00

The first demonstration of the ether gas was performed at Massachusetts General Hospital in October, 1846, by a Boston dentist, William T. G. Morton. For the first time, surgical operations could be performed painlessly. Within two months, the invention was known and being applied in every capital of Europe, and in little more time it became commonplace internationally. The number of surgical operations vastly increased, as it was no longer necessary to hold patients down, and act very quickly.

Joseph Lister first used carbolic acid (phenol) to perform sterile surgery at the Glasgow Royal Infirmary, in August, 1865. This would have the effect of vastly increasing the survival rate from these now commonplace surgical operations. But the news took years to circulate, and by the twentieth century surgeons were still working with infected equipment in filthy environments. Indeed, I have read accounts of the horrors of battlefield medicine in the First World War: men with survivable injuries, lost by the hundred thousands from ignorant, unnecessarily unhygienic medical procedures.

As Dr Gawande points out — in passing — both advances made life easier on patients. But the second saved lives on a — vastly — greater scale. The first was unique, in making life easier for doctors, who no longer had to operate on screaming, writhing customers. This also, incidentally, hugely increased their trade, and thus their income. Washing up, effectively, only added nuisance.

I already knew this history — my mommy was a ward matron, after all — but until the comparison was spelt out, the full significance was lost on me. I had read the “official” versions in several standard medical histories. They assume the slow spread of antisepsis was a problem of communications. Gentle reader will note that this is a lie. Methods of communication did not slow in the generation between the two inventions.

David Warren, “Heaven, Hell, & Alder Hey”, Essays in idleness, 2018-05-09.

July 20, 2020

History Hijinks: Plague

Filed under: China, Europe, Health, History, Humour — Tags: , , , , — Nicholas @ 06:00

Overly Sarcastic Productions
Published 17 Jul 2020

Escape the worries of our modern world by visiting the high middle ages and learning about something esoteric and irrelevant: Plague!

In this video, I attempt to actually teach you something about how the medieval world worked and how it responded to this existential threat, rather than dredging up 3rd grade plague facts for easy views. Oops, did I say that out loud?

SOURCES & Further Reading: The Black Death: The World’s Most Devastating Plague via The Great Courses by Dorsey Armstrong, “From Plague Doctor to PPE” by Bernadette Banner (https://youtu.be/ZniriC-jTHg), “Biological Warfare at the Siege of Caffa” from the CDC (https://wwwnc.cdc.gov/eid/article/8/9…)

This video was edited by Sophia Ricciardi AKA “Indigo”. https://www.sophiakricci.com/

Our content is intended for teenage audiences and up.

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June 17, 2020

“We don’t need no stinkin’ badges!”

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

Theodore Dalrymple on the use of badges within the NHS to virtue signal and compel compliance in the unwilling:

Not actually the official symbol of Britain’s National Health Services … probably.

In Britain’s highly-centralized, almost Soviet-style healthcare system, the National Health Service, staff are being encouraged all over the country to wear little rainbow-coloured metal badges to show that they are homosexual, bisexual, and transsexual-friendly, and do not discriminate against them. The wearing of these badges is voluntary, but about 3,000 of the staff of Guy’s and St Thomas’ Hospitals, for example, now wear them. The self-congratulatory website of those ancient hospitals — St. Thomas’ is over 800 years old and Guy’s was founded in 1721, now combined into one administrative unit — says:

    The badges are just one way to show that Guy’s and St Thomas’ is an open, non-judgmental and inclusive place for people that identify as LGBT+ [which] stands for lesbian, gay, bisexual and transgender). The + simply means we are inclusive of all identities, regardless of how people identify themselves.

This language, which combines the unctuous with the bureaucratic, is typical of the way British hospital administrators express themselves nowadays. And if, as Buffon said, the style is the man himself, we may justly fear for a semi-totalitarian future.

By implication, the badges bully the staff, for if any of them refuse to wear one, their refusal is likely to be taken to mean that their minds are closed, judgmental (in the sense of being censorious, for even the attempt to avoid making judgments is itself based on a judgment), and exclusionary. It is to imply that they would deliberately treat any patients in the above mentioned categories differently and worse from all other patients. Wear the badge or declare yourself to be a bigot.

This is an insult to all those people who worked before the advent of the badges (or who now refuse to wear them) who strove and continue to strive always to treat patients to the best of their ability, irrespective of the many categories into which any individual patient falls. In my experience, the great majority of doctors have always tried to do this.

Let me give an example. Working as I did as a doctor in prison, I met many men who had done terrible things. I treated them, as a matter of course, to the best of my ability. I remember, for example, a man who had strangled three children and then impaled them on railings. Though I did not think he was a good man, and in that sense passed a judgment on him within the privacy of my mind, I treated him for his bronchitis exactly as I would have treated anyone else with bronchitis. I did not find this difficult in the least and do not claim any special merit for having done so, for it is only what all my colleagues in the profession did — as a matter not only of course, but of principle.

A couple of years ago, I read the diary of one of Marshal Pétain’s doctors during the latter’s imprisonment after World War II. The doctor had been a member of the Resistance and had no reason to love Pétain, to say the least: Pétain’s supporters would have had not a second thought about killing him if he had fallen into their power. Yet, as the diary makes clear, the doctor treated Pétain, who by then was demented, with the greatest humanity. Moreover, the doctor refused to publish his diary, despite the financial advantage of doing so, because he thought that publishing it would be to break patient confidentiality. It was only after his death, and more than half a century after Pétain’s, that the diary was published. The doctor’s adherence to his medical ethics was impressive, and he needed no badge to proclaim his virtue.

April 8, 2020

Debunking the claim that “80% of America’s drugs come from China”

Filed under: Business, China, Health, Media, USA — Tags: , , , , — Nicholas @ 03:00

Eric Boehm tries to sort out where the startling claim came from … because it’s not true:

While reading about the COVID-19 outbreak, you’ve probably encountered this particularly shocking statistic at one time or another: 80 percent of America’s pharmaceutical drug supply comes from China.

It’s a statistic that has made the rounds in right-wing publications for a while — offered as proof that China-heavy global supply chains are putting Americans at risk — but it has also popped up in mainstream outlets, including in pieces published in Politico and The Atlantic. Wherever it is deployed, the stat carries an unstated implication: What if China decides to cut us off in the middle of a pandemic? Could America face a dramatic shortage of key pharmaceutical drugs at the moment when we are most in need? And that distorted claim that says America has been too reliant on China has been seized by politicians like Sen. Josh Hawley (R–Mo.) as evidence that globalization has undermined America’s pandemic response.

[…]

How much is a lot? “In all, 80 percent of the U.S. supply of antibiotics are made in China,” [Politico contributors Doug Palmer and Finbarr Bermingham] wrote, linking back to a press release from Sen. Chuck Grassley (R–Iowa).

But that’s not what the press release says.

Grassley’s statement was publicizing a letter Grassley sent on August 9 to the Department of Health and Human Services (HHS) and the FDA, asking them to conduct more inspections of foreign drug manufacturing facilities to make sure they meet American standards.

“Unbeknownst to many consumers … 80 percent of Active Pharmaceutical Ingredients are produced abroad, the majority in China and India,” Grassley wrote.

There’s the first bit of context collapse: the authors of the Politico piece merged Grassley’s “80 percent … are produced abroad” into “80 percent … are made in China.”

All of this also raises another question: Where is Grassley getting that information? His letter sources that claim to a 2016 Government Accountability Office report which itself cited FDA data on pharmaceutical manufacturers around the world. And that report makes it clear that the U.S. has a diverse supply chain for drugs that goes well beyond India and China.

“Nearly 40 percent of finished drugs and approximately 80 percent of active pharmaceutical ingredients (API) are manufactured in registered establishments in more than 150 countries,” is how the GAO summed up America’s pharmaceutical supply chain.

In two jumps, we’ve gone from “80 percent of American drugs are manufactured in more than 150 countries around the world” to “80 percent of drugs come from two countries” to “80 percent of drugs come from China.”

Now, a further complication. The FDA only tracks drug manufacturing facilities — not the supply chains of specific drugs.

That “lack of structural transparency and available supply chain data about drugs,” researchers at the University of Minnesota researchers wrote last month, is one of the reasons why making accurate assessments about potential drug shortages is difficult. Indeed, it was this same bit of missing information that Grassley was encouraging the FDA to address back in August.

Source: FDA; Safeguarding Pharmaceutical Supply Chains in a Global Economy, October 2019.

January 18, 2020

The innovative 1720s

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

In the latest Age of Invention newsletter, Anton Howes says the real Roaring Twenties were back in the eighteenth century:

Last week I called the 1720s an era of schemes. 1720 was the year of the South Sea Company’s crash, as well as the collapse of John Law’s Mississippi Company in France. But the decade saw some oft-neglected innovations too. As I never tire of saying, Britain’s extraordinary acceleration of innovation was about all industries, not just the famous ones of cotton, coal, iron, and steam — a point that the 1720s demonstrate perfectly.

For a start, it was the decade in which smallpox began to be systematically eradicated through inoculation. Lady Mary Wortley Montagu, having observed the procedure in the Ottoman Empire, had her daughter inoculated in London following an outbreak in 1721. The same epidemic prompted the trialling of inoculation in New England, and the reports of these successes provided the statistical evidence for it to be more widely spread. Soon, through Lady Montagu’s aristocratic connections, even the royal children were being inoculated. Inoculation was still dangerous — it was decades before non-deadly cowpox was discovered to also confer immunity to smallpox — but the 1720s marked the beginning of the end for one of humanity’s greatest killers.

[…]

Most famous, however, was the search for longitude. When at sea, it was relatively easy to tell how far north or south you were, but not how far east or west. The implications for navigation were immense. William Whiston, a protégé of Newton, was in 1714 instrumental in lobbying for the creation of a substantial government prize for a solution, and spent much of the following decades trying to win it. His earliest proposal, along with the mathematician Humphrey Ditton, was for ships anchored at fixed locations to essentially shoot fireworks at fixed intervals. By comparing the difference between seeing and hearing the flashes, you might calculate your longitude (it’s actually not that dissimilar to the principle that underlies GPS).

Marine chronometer “Copie No. 18″, Thomas Mudge, Jr., Robert Pennington, Richard Pendleton, et al, London, 1795 – Mathematisch-Physikalischer Salon, Dresden.
Photo by Daderot via Wikimedia Commons.

But unlike with the medical advances, the poets were having none of it. As one of them rather crudely put it:

    The longitude miss’d on
    By wicked Will Whiston;
    And not better hit on
    By good master Ditton.
    So Ditton and Whiston
    May both be bepist on;
    And Whiston and Ditton
    May both be beshit on.

Whiston and the other longitude-searchers also investigated using the earth’s magnetic variation — he produced perhaps the first map with isogonic lines, indicating where compass needles dipped — as well as solar eclipses. And as longitude could be found on land by looking at the eclipses of Jupiter’s moons, he tried to develop telescopes so that they could observe such events on the unsteady sea.

Nonetheless, the solution came from one of George Graham’s friends, the clockmaker John Harrison. Starting in the 1720s, Harrison developed a timekeeping device — the marine chronometer — that would keep its accuracy despite the rocking and rolling and atmospheric changes from being at sea. By comparing your local time with the time at Greenwich shown on the chronometer, you could calculate your longitude. (Though by the time his device came into use in the 1770s, another method had been discovered that involved observing the moon).

And of particular interest to woodworkers who also have historical interests:

While scientific minds sought the longitude, consumer items were also being transformed. In the 1720s, a ship’s carpenter to Jamaica, Robert Gillow, was among the first to import mahogany to Britain, creating a tradition of furniture-making in Lancaster that even the fashion-conscious French would come to regard jealously.

November 18, 2019

Fungus rock – the great placebo treasure (and the Mujahideen)

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

Lindybeige
Published 5 Jun 2015

Support me on Patreon: https://www.patreon.com/Lindybeige

The things that people valued and fought over in the past were not as they are now. You might not guess the tremendous significance of one tiny island off the coast of Gozo.

NEWS FLASH (March 8th 2017): the Azure Window, featured in this video, has collapsed into the sea.

More videos from Malta to follow.

Lindybeige: a channel of archaeology, ancient and medieval warfare, rants, swing dance, travelogues, evolution, and whatever else occurs to me to make.

▼ Follow me…

Twitter: https://twitter.com/Lindybeige I may have some drivel to contribute to the Twittersphere, plus you get notice of uploads.

website: http://www.LloydianAspects.co.uk

Fungus rock – the great placebo treasure

April 30, 2019

You Will Never Do Anything Remarkable

Filed under: Health, History, Humour, Space — Tags: , , , , — Nicholas @ 06:00

exurb1a
Published on 28 Apr 2019

Illegitimi non carborundum, yo.

So.
The original line was, “If they give you ruled paper, write the other way.” As far as I can tell it’s Juan Ramón Jiménez’s.

I am also now painfully aware I’ve written a half as ‘2/1’. Sorry maths.

Please note that this wasn’t intended to be a diatribe against critics or experts. They obviously play an important role. It was more directed at the recreational cynicism one comes across in daily life from time to time, generally pointed at young artists. I have had the privilege to meet plenty of people 1000x more talented than me, who are simultaneously doubting their abilities because of some stupid comment made by an unpleasant teacher or jaded family member.

If you are that artist, I really just wanted to say: You’re in good company; the Greats doubted themselves too. Don’t let the bastards get you down and I hope you make all manner of interesting and fantastic things.

The music is the 3rd movement of Big Baus Brahms’ Violin Concerto in D Major: https://youtu.be/Ev45Knhdlp8

I like that piece lots. I hope you do too.

Again, all the very best of luck in your projects.

February 11, 2019

Tuberculosis – A Ten-Thousand Year Battle – Extra History – #2

Filed under: Health, History, Science — Tags: , , — Nicholas @ 04:00

Extra Credits
Published on 7 Feb 2019

Tuberculosis couldn’t be cured and eliminated by just one person like Dr. Robert Koch, but thanks to the collective efforts of the medical community since Koch’s time — including public health initiatives and the introduction of randomized clinical trials — TB is steadily being wiped out.

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February 2, 2019

Curing Tuberculosis – The Hero Koch – Extra History – #1

Filed under: Germany, Health, History, Science — Tags: , , — Nicholas @ 04:00

Extra Credits
Published on 31 Jan 2019

Fascinatingly enough, tuberculosis was actually considered “trendy” in the Victorian era of Europe — but Dr. Robert Koch, hero of the German Empire, was convinced that he could cure it. A British writer named Arthur Conan Doyle, however, was a little skeptical, and for good reason…

Enjoy today’s extra-Extra History! Dr. Robert Koch was going to save Germany, and the rest of Europe, from tuberculosis. Maybe he would even get his own institute, like his medical rival Louis Pasteur. He knew for sure he was on to something…

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October 22, 2018

QotD: Aging gracefully

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

Last year, for the first time, a young girl, French, offered me her seat on a crowded bus. I was surprised at how deeply I resented her. Health looms over the elderly like a threatening monsoon. No ache is innocuous. No lump or discoloured, sagging patch of body is ignorable except our toenails, which become the most sordidly repellent things in all nature. We covertly examine ourselves and our effluvia for the premonition of the dark humour that will carry us away. There is no such thing as a routine checkup. They are all life-or-death appointments.

Doctors start all their sentences with “It’s only …” But we’re not fooled. This generation is also the one that lingers longest over its departure. Death came to our grandparents with a clutched chest and a searing pain. For us it’s a slow, humiliating series of it’s onlys. What we worry about is dementia, a condition that did not exist in the popular lexicon when I was a child. Mind you, we also thought cancer was as shaming as divorce. Now Alzheimer’s is our abiding fear, the thing we can’t forget.

My chats with contemporaries are like bridge games where we try to fill in the gaps in each other’s sentences to make one coherent conversation. My dad died of Alzheimer’s. I once asked him how he was feeling: “Oh, quite well, except you know I’ve got this terrible disease, what’s its name?” So we go to the gym, we have trainers, I do Pilates. But it’s only maintenance. I’m not looking for a beach body, there’s no New Me in the cupboard; I just want one that’s supple enough to put on my own socks.

After giving up drink and drugs, I continued to smoke about 60 a day until 12 years ago and then I stopped. And people said, “Well done! How did you manage it? What willpower!”

It didn’t feel like well done. It felt like a defeat — the capitulation to fear. When I started smoking at 14 I was golden, immortal. I smoked around the world; I took pride in my ability to smoke with elegance, panache and skill. Smoking was my talent and I gave it up because I lost my nerve.

I don’t miss the cigarettes, but I do miss the me that smoked so beautifully.

A.A. Gill, “Life at 60”, Sunday Times, 2014-06-29.

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