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How Facebook got addicted to spreading misinformation

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Karen Hao writes in MIT Technology Review:

Joaquin Quiñonero Candela, a director of AI at Facebook, was apologizing to his audience.

It was March 23, 2018, just days after the revelation that Cambridge Analytica, a consultancy that worked on Donald Trump’s 2016 presidential election campaign, had surreptitiously siphoned the personal data of tens of millions of Americans from their Facebook accounts in an attempt to influence how they voted. It was the biggest privacy breach in Facebook’s history, and Quiñonero had been previously scheduled to speak at a conference on, among other things, “the intersection of AI, ethics, and privacy” at the company. He considered canceling, but after debating it with his communications director, he’d kept his allotted time.

As he stepped up to face the room, he began with an admission. “I’ve just had the hardest five days in my tenure at Facebook,” he remembers saying. “If there’s criticism, I’ll accept it.”

The Cambridge Analytica scandal would kick off Facebook’s largest publicity crisis ever. It compounded fears that the algorithms that determine what people see on the platform were amplifying fake news and hate speech, and that Russian hackers had weaponized them to try to sway the election in Trump’s favor. Millions began deleting the app; employees left in protest; the company’s market capitalization plunged by more than $100 billion after its July earnings call.

In the ensuing months, Mark Zuckerberg began his own apologizing. He apologized for not taking “a broad enough view” of Facebook’s responsibilities, and for his mistakes as a CEO. Internally, Sheryl Sandberg, the chief operating officer, kicked off a two-year civil rights audit to recommend ways the company could prevent the use of its platform to undermine democracy.

Finally, Mike Schroepfer, Facebook’s chief technology officer, asked Quiñonero to start a team with a directive that was a little vague: to examine the societal impact of the company’s algorithms. The group named itself the Society and AI Lab (SAIL); last year it combined with another team working on issues of data privacy to form Responsible AI.

Quiñonero was a natural pick for the job. He, as much as anybody, was the one responsible for Facebook’s position as an AI powerhouse. In his six years at Facebook, he’d created some of the first algorithms for targeting users with content precisely tailored to their interests, and then he’d diffused those algorithms across the company. Now his mandate would be to make them less harmful.

Facebook has consistently pointed to the efforts by Quiñonero and others as it seeks to repair its reputation. It regularly trots out various leaders to speak to the media about the ongoing reforms. In May of 2019, it granted a series of interviews with Schroepfer to the New York Times, which rewarded the company with a humanizing profile of a sensitive, well-intentioned executive striving to overcome the technical challenges of filtering out misinformation and hate speech from a stream of content that amounted to billions of pieces a day. These challenges are so hard that it makes Schroepfer emotional, wrote the Times: “Sometimes that brings him to tears.”

In the spring of 2020, it was apparently my turn. Ari Entin, Facebook’s AI communications director, asked in an email if I wanted to take a deeper look at the company’s AI work. After talking to several of its AI leaders, I decided to focus on Quiñonero. Entin happily obliged. As not only the leader of the Responsible AI team but also the man who had made Facebook into an AI-driven company, Quiñonero was a solid choice to use as a poster boy.

He seemed a natural choice of subject to me, too. In the years since he’d formed his team following the Cambridge Analytica scandal, concerns about the spread of lies and hate speech on Facebook had only grown. In late 2018 the company admitted that this activity had helped fuel a genocidal anti-Muslim campaign in Myanmar for several years. In 2020 Facebook started belatedly taking action against Holocaust deniers, anti-vaxxers, and the conspiracy movement QAnon. All these dangerous falsehoods were metastasizing thanks to the AI capabilities Quiñonero had helped build. The algorithms that underpin Facebook’s business weren’t created to filter out what was false or inflammatory; they were designed to make people share and engage with as much content as possible by showing them things they were most likely to be outraged or titillated by. Fixing this problem, to me, seemed like core Responsible AI territory.

I began video-calling Quiñonero regularly. I also spoke to Facebook executives, current and former employees, industry peers, and external experts. Many spoke on condition of anonymity because they’d signed nondisclosure agreements or feared retaliation. I wanted to know: What was Quiñonero’s team doing to rein in the hate and lies on its platform?

But Entin and Quiñonero had a different agenda. Each time I tried to bring up these topics, my requests to speak about them were dropped or redirected. They only wanted to discuss the Responsible AI team’s plan to tackle one specific kind of problem: AI bias, in which algorithms discriminate against particular user groups. An example would be an ad-targeting algorithm that shows certain job or housing opportunities to white people but not to minorities.

By the time thousands of rioters stormed the US Capitol in January, organized in part on Facebook and fueled by the lies about a stolen election that had fanned out across the platform, it was clear from my conversations that the Responsible AI team had failed to make headway against misinformation and hate speech because it had never made those problems its main focus. More important, I realized, if it tried to, it would be set up for failure.

The reason is simple. Everything the company does and chooses not to do flows from a single motivation: Zuckerberg’s relentless desire for growth. Quiñonero’s AI expertise supercharged that growth. His team got pigeonholed into targeting AI bias, as I learned in my reporting, because preventing such bias helps the company avoid proposed regulation that might, if passed, hamper that growth. Facebook leadership has also repeatedly weakened or halted many initiatives meant to clean up misinformation on the platform because doing so would undermine that growth.

In other words, the Responsible AI team’s work—whatever its merits on the specific problem of tackling AI bias—is essentially irrelevant to fixing the bigger problems of misinformation, extremism, and political polarization. And it’s all of us who pay the price.

“When you’re in the business of maximizing engagement, you’re not interested in truth. You’re not interested in harm, divisiveness, conspiracy. In fact, those are your friends,” says Hany Farid, a professor at the University of California, Berkeley who collaborates with Facebook to understand image- and video-based misinformation on the platform.

“They always do just enough to be able to put the press release out. But with a few exceptions, I don’t think it’s actually translated into better policies. They’re never really dealing with the fundamental problems.” . . .

Continue reading. There’s much more.

Later in the article:

With new machine-learning models coming online daily, the company created a new system to track their impact and maximize user engagement. The process is still the same today. Teams train up a new machine-learning model on FBLearner, whether to change the ranking order of posts or to better catch content that violates Facebook’s community standards (its rules on what is and isn’t allowed on the platform). Then they test the new model on a small subset of Facebook’s users to measure how it changes engagement metrics, such as the number of likes, comments, and shares, says Krishna Gade, who served as the engineering manager for news feed from 2016 to 2018.

If a model reduces engagement too much, it’s discarded. Otherwise, it’s deployed and continually monitored. On Twitter, Gade explained that his engineers would get notifications every few days when metrics such as likes or comments were down. Then they’d decipher what had caused the problem and whether any models needed retraining.

But this approach soon caused issues. The models that maximize engagement also favor controversy, misinformation, and extremism: put simply, people just like outrageous stuff. Sometimes this inflames existing political tensions. The most devastating example to date is the case of Myanmar, where viral fake news and hate speech about the Rohingya Muslim minority escalated the country’s religious conflict into a full-blown genocide. Facebook admitted in 2018, after years of downplaying its role, that it had not done enough “to help prevent our platform from being used to foment division and incite offline violence.”

While Facebook may have been oblivious to these consequences in the beginning, it was studying them by 2016. In an internal presentation from that year, reviewed by the Wall Street Journal, a company researcher, Monica Lee, found that Facebook was not only hosting a large number of extremist groups but also promoting them to its users: “64% of all extremist group joins are due to our recommendation tools,” the presentation said, predominantly thanks to the models behind the “Groups You Should Join” and “Discover” features.

In 2017, Chris Cox, Facebook’s longtime chief product officer, formed a new task force to understand whether maximizing user engagement on Facebook was contributing to political polarization. It found that there was indeed a correlation, and that reducing polarization would mean taking a hit on engagement. In a mid-2018 document reviewed by the Journal, the task force proposed several potential fixes, such as tweaking the recommendation algorithms to suggest a more diverse range of groups for people to join. But it acknowledged that some of the ideas were “antigrowth.” Most of the proposals didn’t move forward, and the task force disbanded.

Since then, other employees have corroborated these findings. A former Facebook AI researcher who joined in 2018 says he and his team conducted “study after study” confirming the same basic idea: models that maximize engagement increase polarization. They could easily track how strongly users agreed or disagreed on different issues, what content they liked to engage with, and how their stances changed as a result. Regardless of the issue, the models learned to feed users increasingly extreme viewpoints. “Over time they measurably become more polarized,” he says.

The researcher’s team also found that users with a tendency to post or engage with melancholy content—a possible sign of depression—could easily spiral into consuming increasingly negative material that risked further worsening their mental health. The team proposed tweaking the content-ranking models for these users to stop maximizing engagement alone, so they would be shown less of the depressing stuff. “The question for leadership was: Should we be optimizing for engagement if you find that somebody is in a vulnerable state of mind?” he remembers. (A Facebook spokesperson said she could not find documentation for this proposal.)

But anything that reduced engagement, even for reasons such as not exacerbating someone’s depression, led to a lot of hemming and hawing among leadership. With their performance reviews and salaries tied to the successful completion of projects, employees quickly learned to drop those that received pushback and continue working on those dictated from the top down.

One such project heavily pushed by company leaders involved predicting whether a user might be at risk for something several people had already done: livestreaming their own suicide on Facebook Live. The task involved building a model to analyze the comments that other users were posting on a video after it had gone live, and bringing at-risk users to the attention of trained Facebook community reviewers who could call local emergency responders to perform a wellness check. It didn’t require any changes to content-ranking models, had negligible impact on engagement, and effectively fended off negative press. It was also nearly impossible, says the researcher: “It’s more of a PR stunt. The efficacy of trying to determine if somebody is going to kill themselves in the next 30 seconds, based on the first 10 seconds of video analysis—you’re not going to be very effective.”

Facebook disputes . . .

And there’s more.

Written by LeisureGuy

12 March 2021 at 12:20 pm

Whatever Happened to the War Against Terrorism?

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Kevin Drum has a good post:

In a post that happens to include a bit of mulling over the fate of Western civilization, Jay Nordlinger adds this aside:

(Want to know some good news? The threat of radical political Islam receded faster than many of us expected. It still lurks, of course — what doesn’t? But I well remember the concerns of the first decade of this century. Many of us were settling in for a long twilight struggle. In any event . . .)

This reminds me of something to brag about. Several years ago I predicted that the region from north Africa to the Mideast to central Asia would soon see a substantial decline as a source of terrorism. The reason was simple: . . .

Continue reading.

Written by LeisureGuy

8 March 2021 at 2:29 pm

Covid infections still are around the number at the second peak

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And note that these are confirmed cases, a subset of total cases since many are not tested. You can clearly see the lack of reporting at Thanksgiving and Christmas (and the Labor Day holiday).

Now that Texas and Mississippi and some other states have flung caution to the winds, it will be interesting to see how that affects case rates — and, following a week or two later, death rates.

Written by LeisureGuy

8 March 2021 at 11:22 am

Posted in Daily life, Medical

What the Coronavirus Variants Mean for the End of the Pandemic

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Illustration by Timo Lenzen

Dhruv Khullar has a good article in the New Yorker, which begins:

Last March, during the first wave of the pandemic, Adriana Heguy set out to sequence coronavirus genomes. At the time, New York City’s hospitals were filling up, and American testing capacity was abysmal; the focus was on increasing testing, to figure out who had the virus and who didn’t. But Heguy, the director of the Genome Technology Center at N.Y.U. Langone Health, recognized that diagnostic tests weren’t enough. Tracking mutations in the virus’s genetic code would be crucial for understanding it. “No one was paying attention to the need for sequencing,” Heguy told me recently. “I thought, I can’t just sit here and not do anything.” Within weeks, her team had sequenced hundreds of samples of the virus collected in New York City and published a paper with three key findings: the virus had been circulating in the city for weeks before the lockdown; most cases had come from Europe, not China; and the variant infecting New Yorkers carried a mutation, D614G, that scientists soon confirmed made it far more contagious than the original virus isolated in Wuhan.

Heguy’s efforts were prescient. The world is now confronting a growing number of coronavirus variants that threaten to slow or undo our vaccine progress. In recent months, it’s become clear that the virus is mutating in ways that make it more transmissible and resistant to vaccines, and possibly more deadly. It’s also clear that, at least in the United States, there is no organized system for tracking the spread or emergence of variants. As Heguy sees it, the U.S. has more than enough genome-sequencing expertise and capacity; the problem is focus. “Efforts in the U.S. have been totally scattered,” she said. “There’s no mandate to do it in a timely fashion. The government is kind of like, Let us know if you find something.” Funding has also been a major constraint. “It boils down to money,” Heguy said. “With money, I could hire a technician, another scientist, get the reagents and supplies I need.” Because of their better-organized efforts, other countries have been more successful in identifying new versions of the virus: “The reason the U.K. variant was identified in the U.K. is that the U.K. has a good system for identifying variants.” The U.K. has, for months, sequenced at least ten per cent of its positive tests. “If you’re doing ten per cent, you’re not going to miss things that matter,” Heguy said. “If a variant becomes prevalent, you’ll catch it.”

Heguy’s lab sequences ninety-six samples a week—as many as will fit onto a single sample plate, which has eight rows and twelve columns. The process—receiving, preparing, sequencing, and analyzing samples, then reporting the results—takes time and resources, and diverts attention from other research. “Mostly we do this out of a sense of moral obligation,” Heguy told me. “This feeling that the country shouldn’t be left in the dark.” As we enter what seems to be the endgame of the pandemic, tracking and analyzing variants—which could fill hospitals and reduce the effectiveness of therapies and vaccines—is more important than ever.

To understand coronavirus variants, you need to understand a little about viral biology and, more specifically, about how the fragments of RNA and protein from which viruses are made go about replicating. sars-CoV-2, the coronavirus that causes covid-19, has about thirty thousand letters of RNA in its genome. These letters, or “bases,” are like the architectural plans for the virus’s twenty-nine proteins, including the “spike” protein that it uses to enter cells. Once inside a cell, the virus hijacks the cellular machinery, using it to make copies of itself. Because the machinery is good but not perfect, there are occasional errors. sars-CoV-2 has a mechanism that checks the new code against the old code; still, it’s possible for the substitution, deletion, or addition of an amino acid to evade this proofreading. If the errors don’t arrest the replication process completely, they sneak into the next generation. Most mutations don’t meaningfully change a protein’s structure or function. Sometimes, however, one of these accidental experiments “works.” A variant has been created—a virus with a slightly different design.

In the time that sars-CoV-2 has troubled humans, it’s accumulated innumerable mutations. Those that matter have one of two key features: they either help the virus latch onto and enter cells more easily, or they allow it to better evade tagging and destruction by the immune system. Today, scientists are following three variants of particular concern: B.1.1.7, originally detected in the U.K.; B.1.351, from South Africa; and P.1, from Brazil. Predictably, variants seem to have emerged more quickly in countries with rampant viral spread—places where the virus has had more chances to replicate, mutate, and hit upon changes that confer an evolutionary advantage. The U.K.’s B.1.1.7 variant has spread to more than eighty countries and has been doubling every ten days in the U.S., where it is expected to soon become the dominant variant. Its key mutation is called N501Y: the name describes the fact that the amino acid asparagine (“N”) is replaced with tyrosine (“Y”) at the five-hundred-and-first position of the spike protein. The mutation affects a part of the spike that allows the virus to bind to cells, making the variant some fifty per cent more transmissible than the original; new evidence also suggests that people infected with it have higher viral loads and remain infectious longer, which could have implications for quarantine guidelines.

Both the B.1.351 and P.1 variants carry the N501Y mutation. They also have another, more dangerous mutation, known as E484K: a substitution of glutamate (“E”) for lysine (“K”) at the spike protein’s four-hundred-and-eighty-fourth position. This mutation diminishes the ability of antibodies—both naturally acquired and vaccine-generated—to bind to and neutralize the virus. Last month, South Africa halted use of the vaccine produced by AstraZeneca, citing evidence that it offers minimal protection against the B.1.351 variant that is now dominant in that country; a monoclonal antibody drug from Eli Lilly is also inactive against it. In the U.S., a number of homegrown variants are beginning to circulate, including some with the antibody-evading E484K mutation; in the U.K., B.1.1.7 has, in some cases, also acquired the mutation, becoming more like the South African and Brazilian variants.

There’s growing concern that B.1.351 and P.1 can infect people who’ve already had covid-19. The city of Manaus, in Brazil, has faced a viral surge this winter, even though some three-quarters of its population is thought to have been infected by the original virus in the fall—a level at which herd immunity is believed to settle in. This suggests that the antibodies produced by the original virus have struggled to neutralize its successor. Lab tests examining blood from immunized people have shown that the Pfizer-BioNTech and Moderna vaccines—which are effective against the U.K. variant—tend to produce fewer antibodies that fight the South African and Brazilian variants. It’s not yet clear how this will affect real-world protection: the vaccines still elicit huge numbers of antibodies—probably more than enough to neutralize the virus—and they stimulate other parts of the immune system, such as T cells, that weren’t assessed in the blood tests. At least for now, a degree of uncertainty is inevitable.

How worried should we be about the variants? They pose  . . .

Continue reading. There’s much more.

Written by LeisureGuy

7 March 2021 at 12:31 pm

What about too little salt?

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I have prided myself on my low sodium intake, which I achieve through observing just a few rules:

  1. Eating whole foods, not processed foods, which almost always contain a heft amount of salt — thus no bread (high in sodium), cheese (likewise), cured meats, sauerkraut, pickles, chips, and so on.
  2. Buying only no-salt-added canned foods: tomatoes, tomato paste, beans, vegetable stock, and so on.
  3. Using no salt in cooking and adding no salt at the table.

I fairly easily maintained a level of about 1100mg/day of sodium, but now I’m thinking I may have gone overboard on my sodium-reduction program. This article in Healthline sets out 6 dangers of too low a sodium intake. It begins:

This article discusses sodium restriction in the general population. If you have been prescribed a low-sodium diet by your healthcare professional, or need to adhere to a low-sodium diet to manage a condition, the following information may not apply to you.

Sodium is an important electrolyte and main component of table salt.

Too much sodium has been linked to high blood pressure, and health organizations recommend that you limit your intake (1Trusted Source2Trusted Source3Trusted Source).

Most current guidelines recommend eating less than 2,300 mg per day. Some even go as low as 1,500 mg per day (4Trusted Source).

However, even though too much sodium causes problems, eating too little can be just as unhealthy.

Here are 6 little-known dangers of restricting sodium too much.

1. May increase in insulin resistance

A few studies have linked low sodium diets to increased insulin resistance (5Trusted Source6Trusted Source7Trusted Source).

Insulin resistance is when your body’s cells don’t respond well to signals from the hormone insulin, leading to higher insulin and blood sugar levels.

Insulin resistance is believed to be a major driver of many serious diseases, including type 2 diabetes and heart disease (8Trusted Source9Trusted Source).

One study involving 152 healthy people found that insulin resistance increased after only 7 days on a low sodium diet (5Trusted Source).

Yet, not all studies agree. Some have found no effect, or even a decrease in insulin resistance (10Trusted Source11Trusted Source12Trusted Source).

However, these studies varied in length, study population, and degree of salt restriction, which may explain the inconsistent results.

SUMMARYLow sodium diets have been associated with increased insulin resistance, a condition that causes higher blood sugar and insulin levels. This may lead to type 2 diabetes and other seriousdiseases.

2. No clear benefit for heart disease

It’s true that reducing your sodium intake can reduce your blood pressure.

However, blood pressure is only a risk factor for disease. What’s really significant is hard endpoints like heart attacks or death.

Several observational studies have looked at . . .

Continue reading. There’s more.

Right off the bat, I see one thing that might affect me, and might explain why my fasting BG readings might have been slightly higher the past 6 months — not by much but noticeable. Until about 6 months ago, my readings were around 5.8 to 5.9, and now they run around 6.3 to 6.4. Still controlled, but not so well.

So I’m going to introduce a little salt into my diet — baby steps, though. When I roast vegetables, I’ll salt them, and also use a little salt when I make hummus or guacamole. I also will add a little salt to my salad dressing. But for now I’ll limit added salt to those four things, and see how that goes.

Written by LeisureGuy

6 March 2021 at 3:19 pm

When Identity Politics Turns Deadly

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Paul Krugman puts a current controversy into a new context in his column in the NY Times:

Relieving yourself in public is illegal in every state. I assume that few readers are surprised to hear this; I also assume that many readers wonder why I feel the need to bring up this distasteful subject. But bear with me: There’s a moral here, and it’s one that has disturbing implications for our nation’s future.

Although we take these restrictions for granted, they can sometimes be inconvenient, as anyone out and about after having had too many cups of coffee can attest. But the inconvenience is trivial, and the case for such rules is compelling, both in terms of protecting public health and as a way to avoid causing public offense. And as far as I know there aren’t angry political activists, let alone armed protesters, demanding the right to do their business wherever they want.

Which brings me to my actual subject: face mask requirements in a pandemic.

Wearing a mask in public, like holding it in for a few minutes, is slightly inconvenient, but hardly a major burden. And the case for imposing that mild burden in a pandemic is overwhelming. The coronavirus variants that cause Covid-19 are spread largely by airborne droplets, and wearing masks drastically reduces the variants’ spread.

So not wearing a mask is an act of reckless endangerment, not so much of yourself — although masks appear to provide some protection to the wearer — as of other people. Covering our faces while the pandemic lasts would appear to be simple good citizenship, not to mention an act of basic human decency.

Yet Texas and Mississippi have just ended their statewide mask requirements.

President Biden has criticized these moves, accusing the states’ Republican leaders of “Neanderthal thinking.” But he’s probably being unfair — to the Neanderthals. We don’t know much about our extinct hominid relatives, but we have no reason to believe that their political scene, if they had one, was dominated by the mixture of spite and pettiness that now rules American conservatism.

Let’s start with the objective realities.

We’ve made a lot of progress against the pandemic over the past couple of months. But the danger is far from over. There are still substantially more Americans hospitalized with Covid-19 now than there were, say, last June, when many states were rushing to reopen and Mike Pence, the vice president then, was assuring us that there wouldn’t be a second wave. Roughly 400,000 deaths later, we know how that worked out.

It’s true that there is now a bright light at the end of the tunnel: The development of effective vaccines has been miraculously fast, and the actual pace of vaccinations is rapidly accelerating. But this good news should make us more willing, not less, to endure inconvenience now: At this point we’re talking about only a few more months of vigilance, not a long slog with no end in sight.

And keeping infections down over the next few months will also help rule out a potential epidemiological nightmare, in which new, vaccine-resistant variants evolve before we get the existing variants under control.

So what’s motivating the rush to unmask? It’s not economics. As I said, the costs of mask-wearing are trivial. And basic economics tells us that people should have incentives to take into account costs they impose on others; if potentially exposing those you meet to a deadly disease isn’t an “externality,” I don’t know what is.

Furthermore, a resurgent pandemic would do more to damage growth and job creation, in Texas and elsewhere, than almost anything else I can think of.

Of course, we know what’s actually going on here: politics. Refusing to wear a mask has become a badge of political identity, a barefaced declaration that you reject liberal values like civic responsibility and belief in science. (Those didn’t used to be liberal values, but that’s what they are in America 2021.)

This medical version of identity politics seems to trump everything, up to and including belief in the sacred rights of property owners. When organizers at the recent Conservative Political Action Conference asked attendees to wear masks — not as a matter of policy, but simply to abide by the rules of the hotel hosting the meeting — they were met by boos and cries of “Freedom!” Do people shriek about rights when they see a shop sign declaring, “No shoes, no shirt, no service”? . . .

Continue reading.

Written by LeisureGuy

5 March 2021 at 2:14 pm

The Black Death: A New Culprit?

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Alexander Lee writes in History Today about a new player in the Black Death story:

When it comes to the Black Death, rats are usually cast as the villains of the piece – and with good reason. After all, it was most likely thanks to them that the plague (Yersinia pestis) was reintroduced to Europe. Though there has been some debate about how and where the original infection occurred, there is little doubt that Italian traders caught the disease from rat fleas in Black Sea ports before taking it back to Messina aboard Genoese galleys in October 1347. Granted, rats were probably not solely responsible for the speed with which the pestilence spread in the weeks that followed. In 2018, researchers from the universities of Ferrara and Oslo demonstrated that human fleas and lice played at least as important a role in transmission between people. But because rats can tolerate higher concentrations of the bacillus in their blood, and tend to live in close proximity to humans, they greatly amplified its virulence. Exactly how many people died is difficult to establish, but it is estimated that, in the period 1347-53, the plague killed 30-50 per cent of the European population. Understandably, rats have borne most of the blame.

But is this really fair? A recent study suggests marmots might have been just as guilty.

Lost origins

It all boils down to where the plague came from. This is a notoriously tricky issue. Although we know a great deal about the course of Y. pestis after its arrival in Europe, we are much less well informed about the route it followed before reaching the Black Sea. There are no narrative accounts comparable to Giovanni Boccaccio’s Decameron or Ibn Khaldun’s Kitāb al-ʻIbar for regions further east; references to outbreaks of sickness in local sources are often lacking in detail; and Gabriele de’ Mussis’ Istoria de morbo sive mortalitate quae fuit anno domini MCCCXLVIII – which contains perhaps the most vivid description of the plague’s Asian trajectory – appears to have been written without the author ever having left his home in Piacenza.

This has not stopped historians speculating, of course. For many years, it has been assumed that, since the plague was certainly present in the Caucasus in 1347, it most probably began its journey somewhere in Central Asia around 1331-32, before spreading south to China and India and west through Persia. But the exact site of its birth and the reasons for its sudden dispersal have proved elusive. There have been plenty of theories. In the mid-1970s, for example, William McNeill speculated, rather fancifully, that it originated in the Himalayas. By contrast, in the 1990s, Rosemary Horrox placed its beginnings in the eastern steppe and argued that unspecified ‘ecological changes’ drove infected rodents closer to human settlements. But, in the absence of documentary evidence, it has been impossible to say which, if any, of these is right.

The new discipline of palaeogenetics has changed everything, though. In the 1980s, scientists discovered how to recover ancient DNA (aDNA) from archaeological remains – and it was quickly realised that this had the potential to revolutionise the study of the Black Death. The technique was first brought to bear on a piece of housekeeping. Using samples from an unusually well-dated mass grave in London’s Smithfield, it was possible to confirm beyond any doubt that Y. pestis was indeed the causative agent of the 1347-53 epidemic in Europe. But in recent years, it has been used to shed light on the origins and trajectory of the bacillus itself.

The idea behind this is relatively simple. As we all know, DNA is a double helix, consisting of two connected strands, which resemble a twisted ladder. Each ‘rung’ on the ladder consists of a pair of bonded nucleotides. These come in four varieties: cytosine (C), guanine (G), thymine (T) and adenine (A). The combinations in which these occur is distinctive, but over time, the DNA of a micro-organism like Y. pestis will undergo a certain amount of random mutation. An A-T pair in one generation might become a C-T pair in the next. Of course, not all mutations will lead anywhere. Most will simply be outcompeted by the original version and disappear from the gene pool. But, every now and then, a mutation wins out. Either it will give one of the organisms an advantage over the others or – more often – it will be transplanted to another area, where there is less competition and it can establish itself more easily. Once it is dominant, the process can start again.

This means that, for any organism, we should be able to draw a kind of family tree (known as a phylogenetic tree) showing how mutations relate to each other and when a new branch breaks off from the main trunk. The easiest way to do this is by observing the changes as they happen. But it can also be done retrospectively by comparing modern DNA with aDNA. It is not easy, of course. The great difficulty with aDNA is that remains have not always survived for every mutation; and, the further back in time you go, the more gaps there are in the genetic record. But, because mutations occur in sequence, it is possible to identify how many took place between two particular samples – and, by extension, how and when different varieties branched off from one another.

Enter the marmot

This is where marmots come in. As well as rats, . . .

Continue reading.

Written by LeisureGuy

5 March 2021 at 1:16 pm

How to Cope with Teen Anxiety

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It’s been a while since I was a teen, but you may know teens. (I strongly suspect that the teen readership of this blog is zero.) And in any even, anxiety is anxiety, and Cognitive Behavioral Therapy (CBT) is a good approach. CBT is as effective as medication in treating depressing (and lacks the invidious side-effects that medications often include). This article describes how CBT is a good approach to treating anxiety, teen or not.

Regine Galanti, a clinical psychologist and founder of the cognitive behavioural therapy practice Long Island Behavioral Psychology and the author of Anxiety Relief for Teens (2020), writes in Psyche:

Most people are afraid of something, whatever age they are. But the teenage years definitely have their fair share of challenges. Maybe you’re anxious about being judged in class, going off to college, getting good grades or being separated from the people you love. The list can go on and on because anxiety is a normal part of being human, especially in adolescence.

But though it can be uncomfortable, anxiety can actually be helpful. It’s what keeps us from jumping off buildings, or running in front of moving cars. It prompts us to focus on potential dangers and respond to them in a way that keeps us safe. This system works pretty well at protecting us most of the time – which is great, if and when you’re in actual danger. Anxiety becomes a problem if it raises the alarm when there isn’t really any actual danger around. In fact, you can think of problematic anxiety as being like a false or overly sensitive alarm – a smoke detector going off when there’s no fire.

As a clinical psychologist, I meet a lot of teenagers with anxiety. I emphasise to them that anxiety-free living might sound amazing, but it would in fact be dangerous because you’d miss out on cues that something is actually wrong. So instead, I use an approach called cognitive behavioural therapy (CBT) to help teens learn tools to manage their anxiety so that it doesn’t get in the way of their lives; in this Guide, I’m going to share some of these tools with you.

Before getting to the practical exercises, it helps to know a little about how your anxiety system works in terms of your thoughts, feelings and behaviour, which all contribute to the emotions you experience at any given time. Let’s look at these three components in the context of a tiger walking into the room you’re in right now. (Unlikely, I know, but bear with me!)

What you think

Your thoughts influence your emotions. So if, as the tiger starts getting closer, you think to yourself Hey, I love tigers, you probably won’t feel very anxious. If on the other hand you think Woah, that tiger wants to eat me for lunch, you’ll probably feel super-scared. In this way, thoughts are like sunglasses: you can change them or take them off, and the world will look different. Here’s a more realistic example: if you think to yourself If I fail this exam, I’ll never get into college, and my whole life will fall apart, you’ll probably feel anxious and hopeless before and during the exam. If instead, you had the thought It’s a good thing this exam is worth only 5 per cent of my grade. I can always recover any lost marks on the next exam, you probably wouldn’t feel so anxious.

What you feel (in your body)

Anxiety includes a physical reaction called the ‘fight or flight response’. When you feel anxious, your body kicks into high gear. The hormone adrenaline starts to flow, and a host of other things happen as well, such as your heart racing, your breathing speeding up and your pupils enlarging. This reaction gets your body ready to move away from danger, or fight the enemy if you can’t run (hence the name, ‘fight or flight’). You might also feel your muscles tense up, feel shaky, have headaches or nausea. This might feel natural or appropriate if you were running a marathon or fleeing a tiger that had just wandered into the room, but when you’re anxious in a more ordinary situation, you might find these bodily sensations not only unpleasant, but experience them as further ‘proof’ that something is wrong, even if it isn’t! Although these physical changes might feel dangerous, they’re harmless. It’s just your body’s natural way of trying to get you out of harm’s way.

What you do

This third part of anxiety involves how you behave in response to your thoughts and physical sensations. If you think That tiger wants to eat me, and you feel your heart pounding out of your chest, you’ll probably want to run away. It’s perfectly normal to try to escape situations that make you anxious. This is a great plan for actual danger, but it can become problematic in the context of false alarms. Avoidance not only causes practical problems, it often fuels more anxiety in the future.

These three parts of anxiety – your thoughts, your physical feelings, and your behaviours – impact on each other, and form an anxiety ‘cycle’. Anxious thoughts can bring on a physical response, which makes you want to run or avoid.

Here’s an example: . . .

Continue reading. There’s much more. The key points:

  • Emotions have three parts: thoughts, physical feelings, and behaviours. These parts are interconnected, and any of those parts can be a trigger that starts the anxiety cycle.
  • Anxiety, like all emotions, can be adaptive. It protects us from harm in dangerous situations. But, sometimes, the system goes off in the absence of real danger. This feels uncomfortable but is actually harmless as long as you don’t start actively avoiding it.
  • Anxiety fades if you let it. Emotions are like a wave – they peak, and then recede, even if you don’t do anything to control or manage them.
  • Managing anxiety is about building strategies to change your thoughts (eg, by reality-checking them), calming your physical reaction (eg, via breathing exercises), and facing your fears. These strategies are part of cognitive behavioural therapy (CBT), a type of therapy that research shows helps to manage anxiety.
  • One of the best ways to manage anxiety is to face the things you fear using a strategy called ‘exposure’: break down your feared situation into small steps, and practise facing them bit by bit. This helps you cut out avoidance, which feeds anxiety long-term.

Caveat: Something that works well for oone may not work for another, and somethign that works for many may not work for a few. That is why medical and psychological research uses a multitude of subjects and statistical methods. If all responded the same way, such research would be much simpler, since studying a single individual would suffice.

So CBT is an approach worth trying. It is as effective as medication, which means that it will work for many but not for all.

Written by LeisureGuy

3 March 2021 at 11:32 am

Like Sheep: On Translating a Literary Plague in a Time of Pandemic

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This is probably a good time to read the literature of pandemics — surprisingly vast (or not so surprisingly, given that pandemics have plagued humanity (literally) from time immemorial (thus one of the Four Horsemen of the Apocalypse rides the pale horse of plague)). A.E. Stallings writes in the Hudson Review:

Plagues, real and imaginary, spread like viruses through literature. The Iliad starts with one. It’s right there in line 10, a disease sent by far-shooting Apollo, god of music and medicine, plague and archery, because Agamemnon has snatched the girl Chryseis from her father, Chryses, one of Apollo’s own priests. The god shoots his arrows of contagion, striking first at the mules and dogs (it is interesting that the poet seems to be aware of zoonosis, pathogens that jump from animals to people), and then at men, so that the funeral pyres are crowded and burn without ceasing. The first deaths of the poems are not from war, but disease. Agamemnon, compelled to give the girl back to her father, takes Achilles’ “spear-bride” Briseis instead, setting in motion all of the tragic events to follow.

It is a plague too, this time in the city of Thebes, that sets Oedipus on the path to knowledge that will reveal the enigmatic and devastating truth of his birth and his marriage. When Oedipus asks the priest of Zeus what is wrong with his people, he answers (Sophocles, Oedipus Tyrannus, lines 25–30, translation by Sir Richard Jebb):

A blight has fallen on the fruitful blossoms of the land, the herds among the pastures, the barren pangs of women. And the flaming god, the malign plague, has swooped upon us, and ravages the town: he lays waste to the house of Cadmus, but enriches Hades with groans and tears. . . .

Notice it is the crops and the herds that are first affected. The priest concludes dryly with the sentiment, as Jebb has it, “Neither walled town nor ship is anything, if it is empty and no men dwell within.”

Mythological plagues are often indications that something is very wrong, an invitation to look more closely at assumptions and injustice, a judgment. It is worth remembering that Sophocles’ famous play debuted in 429 BC. The plague of Athens had broken out the previous year, and 429 saw a second wave. The references to a plague, in combination with a criticism of state leadership, would have been eerily topical and resonant for the audience in a time of war and pandemic, for all that the play is set in a legendary past and another city.

Thucydides’ prose account of the Athenian plague in his history of the Peloponnesian Wars describes not legend, but events Thucydides had experienced firsthand: the first outbreak of plague in 430 BC, when nearly one in three residents of Athens perished. (A mass grave of plague victims was excavated by archaeologists in 1994 in the Kerameikos, the potters’ quarter, of the city.) Thucydides is a survivor and describes the symptoms both as an eyewitness and a former sufferer. Even Pericles, the leader of Athens, will succumb to the disease. According to Thucydides, the contagion arose in northern Africa and entered Athens by the bustling port of Piraeus. The symptoms begin with fever and red eyes, a swollen and bloody tongue, but go on to include a cough, and an assortment of other effects: the genitals can be affected, and sometimes a sufferers lose their extremities, their eyesight or even their memory. In describing the horror of mass civilian deaths, Thucydides uses the phrase “dying like sheep.”

Thucydides’ plague has a moral dimension: some people are afraid to do the right thing by caring for the sick (it is the health workers, in fact, who are hardest hit); worship of the gods falls by the wayside as prayer proves ineffectual, and people immerse themselves in pleasures, vices and crimes, excesses of the moment, not knowing what tomorrow will bring, and confident they will not be brought to justice. The proper disposal of the dead—religious observations as well as cremation—one of the most sacred aspects of ancient life, is abandoned. People toss a corpse on top of funeral pyres already in progress or set fire to a pyre painstakingly arranged by others to cremate their own dead. The plague becomes a symptom for a societal breakdown, a society with a weakened immune system that is slipping into decline and will lose the war as well as its hegemony and status.

Lucretius, the 1st century BC Roman poet who would be such an important model for Virgil in turn takes up Thucydides’ plague. In his didactic epic, De Rerum Natura, “On the Nature of Things,” a poem about life, the universe, and everything, that lays out tenets of the atomic theory and Epicurean philosophy, Lucretius ends the poem—at least as the version of the poem has come down to us, supposedly edited by Cicero—on a Latin versification of Thucydides’ prose eyewitness account of the Athenian plague. Some of it is almost straight translation. Consider (translation mine):

At no time did the greedy disease let up. It caught and spread
From one man to another, as though they were so many head
Of fleecy sheep and cattle. . . .

Yet here as elsewhere Lucretius elaborates, inventing more lurid detail about the disease itself—not only are the genitals affected, for instance, but desperate victims even castrate themselves—and also expanding on the suffering of animals, such as noble dogs. In a 7,000-plus-line poem whose purpose is purportedly to free its readers from the fear of death, there is something counterintuitive about ending on this terrifying plague, on death coming alike to sinner and saint, weak and strong. The poem ends on the scene of people coming to bloodshed over funeral pyres, where others might try to throw random corpses:

Squalid Poverty and Sudden Disaster would conspire
To drive men on to desperate deeds—so they’d place on a pyre
Constructed by another their own loved ones, and set fire
To with wails and loud lament. And often they would shed
Much blood in their struggle rather than desert their dead.

That is the poem’s unsettling conclusion. Because of the nature of Latin syntax, the whole poem ends, or perhaps is abandoned, on the verb “desererentur.”

***

Virgil’s Georgics is his poetic masterpiece (John Dryden famously called it “the best Poem of the best Poet”), composed between his debut Eclogues and his grand epic project, the Aeneid; Virgil would die before the last was finished, and supposedly ordered it to be burned. The Georgics hits a sweet spot in both effervescent accomplishment and achieved ambition, the poet at the apogee of his powers. In four “books,” it purports to be advice to the Italian farmer, with a chapter on ploughing and crops, a chapter on vines and orchards, a chapter on animal husbandry, and a chapter on apiculture; but these topics seem to be pretexts for a discursive poem of natural history, learned allusion, the beauties of Italy, philosophical explorations of man’s essential condition, and exploration of the nature of civilization. Somehow the section about tending bees culminates in an exquisite retelling of the myth of Orpheus and Eurydice.

The plague section comes at the very end of Book Three, the one on animal husbandry. After elucidating how to deal with common ailments of sheep, the poem goes on to recount a plague from some previous era that wiped out cattle, sheep, and even wild animals. This is  . . .

Continue reading.

I found the essay quite interesting, and I hope you do as well.

Written by LeisureGuy

2 March 2021 at 7:31 pm

How to reduce your chances of heart failure, kidney failure, atherosclerosis, heart attacks, and strokes

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Dr. Michael Greger describes several options:

Should we be concerned about high-choline plant foods such as broccoli producing the same toxic TMAO that results from eating high-choline animal foods such as eggs?

Choline- and carnitine-rich foods—meat, eggs, and dairy—can be converted by our gut flora into trimethylamine, which in our livers is then turned into TMAO, a toxic compound that may increase our risk of heart failure, kidney failure, and atherosclerosis, or heart attacks and strokes. The good news, though, is that this “opens up exciting new nutritional and interventional prospects” for prevention, as I discuss this in my video How to Reduce Your TMAO Levels.

Okay, so how do we do it? Well, if our gut bacteria can take meat, dairy, and eggs and turn them into TMAO, all we have to do is…destroy our gut flora! We could give people antibiotics to eliminate the production of TMAO. However, that could also kill our good bacteria and “facilitate the emergence of antibiotic-resistant bacterial strains.”

What about probiotic supplements? Maybe if we add good bacteria, they will crowd out the ones that take the meat, egg, and dairy compounds and turn them into the TMA that our liver turns into TMAO. But, that doesn’t work. Adding good bacteria doesn’t seem to get rid of the bad. What if we added new bacteria that could somehow siphon off the TMA made by the bad bacteria? Well, there’s a bacterium inside the guts of cows and sheep that turns trimethylamine into methane. Could we use that bacterium to get rid of some of the trimethylamine from our gut, like a cow fecal transplant? There’s a problem with that. If it didn’t take, you’d have to keep giving it to people: “Continuous administrations may be necessary if subjects do not become colonized.” So, might the fact that Consumer Reports found fecal contamination in every sample of beef it tested be a good thing? No. Methane-producing bacteria may be able to eat up our TMAO, but, unfortunately, these bacteria may be associated with a variety of diseases, from gum disease down to colorectal cancer, as you can see at 2:15 in my video.

If antibiotics and probiotics aren’t going to work to prevent gut bacteria from taking meat, dairy, and eggs and turning them into the trimethylamine, which our liver makes TMAO out of, I guess we have no choice but to cut down on…our liver function!

That was the billion-dollar answer to cholesterol. The same foods—meat, dairy, and eggs—raise our cholesterol, but dietary change isn’t very profitable. So, the drug industry developed statin drugs that cripple the liver’s enzyme that makes cholesterol. Could “pharmacologic inhibition” of the enzymes in our liver that make TMAO “potentially serve as a therapy for CVD [cardiovascular disease] risk reduction”? Trimethylaminuria is a genetic condition in which this enzyme is naturally impaired, in which there is a build-up of trimethylamine in the bloodstream. The problem is that trimethylamine is so stinky it makes you smell like “dead fish.” So, “given the known adverse effects…from sufferers of fish odor syndrome, the untoward odorous side effects of inhibiting this enzyme make it a less attractive [drug] target.”

Do we have to choose between smelling like dead fish or suffering from heart and kidney disease? If only there were some other way we could stop this process from happening. Well, what do those with trimethylaminuria often do to cut down trimethylamine levels? They stop eating animal products.

About a third of those who complain of bad body odor despite good personal hygiene test positive for the condition, but reducing or eliminating meat, egg, and dairy intake can be a real lifesaver. But, given what we now know about how toxic the end product TMAO can be for normal people, cutting down on animal products may not just save the social lives of people with a rare genetic disorder, but help save everyone else’s actual lives.

The “simplest point of intervention” is to simply limit the consumption of foods rich in choline and L-carnitine, which “can be an effective strategy to limit circulating TMAO.” But, wait! We could always try to genetically engineer a bacterium that eats up trimethylamine, but “the simplest and safest recommendation” may just be to eat more healthfully. You can completely eliminate carnitine from the diet, since our body makes all we need, but choline is an essential nutrient so we do need some. Thankfully, we can get all we need in fruits, vegetables, beans, and nuts. “However excess choline, such as that found in eggs, may be worth avoiding.”

Need we worry about high-choline plant foods, like broccoli? Consumption of cruciferous vegetables is associated with a significantly longer life and less cardiovascular disease mortality, as you can see at 5:34 in my video. To see what was going on, researchers took the vegetable highest in choline, brussels sprouts, and had people eat two cups a day for three weeks. What happened? Their TMAO levels actually went down. It turns out that brussels sprouts appear to naturally downregulate that TMAO liver enzyme—not enough to make you stinky, but just enough to drop TMAO.

And, people who eat completely plant-based may not make any TMAO at all—even if you try. You can give a vegan a steak, which contains both choline and carnitine, and there will not even be a bump in TMAO because vegetarians and vegans have different gut microbial communities. If we don’t eat steak, then we don’t foster the growth of steak-eating bacteria in our gut. So forget the cow—how about getting a fecal transplant from a vegan? From a TMAO standpoint, we may not have to eat like a vegan as long as we poop like one.

Written by LeisureGuy

2 March 2021 at 9:55 am

First vaccine to fully immunize against malaria builds on pandemic-driven RNA tech

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Monisha Ravisetti writes in The Academic Times about some very good news indeed:

Consistently ranked as one of the leading causes of death around the world, malaria doesn’t have an eective vaccine yet. But researchers have invented a promising new blueprint for one — with properties akin to the novel RNA- based vaccine for COVID-19.

Making a vaccine for malaria is challenging because its associated parasite, Plasmodium, contains a protein that inhibits production of memory T-cells, which protect against previously encountered pathogens. If the body can’t generate these cells, a vaccine is ineective. But scientists recently tried a new approach using an RNA-based platform.

Their design circumvented the sneaky protein, allowed the body to produce the needed T-cells and completely immunized against malaria. The patent application for their novel vaccine, which hasn’t yet been tested on humans, was published by the U.S. Patent & Trademark Oce on Feb. 4.

“It’s probably the highest level of protection that has been seen in a mouse model,” said Richard Bucala, co-inventor of the new vaccine and a physician and professor at Yale School of Medicine.

The team’s breakthrough could save hundreds of thousands of lives, particularly in developing nations. In 2019 alone, there were an estimated 229 million cases of malaria and 409,000 deaths worldwide. Of those deaths, 94% were in Africa, with children being the most vulnerable.

“It aects societies and populations that have the least amount of resources and expertise to manage these infections well,” Bucala told The Academic Times. “We need new vaccines, and we need more tools.”

Novartis Pharmaceuticals and the National Institutes of Health funded the work. GlaxoSmithKline is an assignee on the patent, which if approved, will allow the company to produce the vaccine and make it available to the public.

At present, the only vaccine to prevent malaria is called RTS,S. Approved two years ago, this vaccine is the result of nearly two decades of research, but is only about 30% eective. And after four years, that gure drops to 15%.

“It doesn’t work very well,” Bucala said. “And the research studies all have the conclusion that the people who fail to mount a vaccine response, or who get reinfected, have poor memory T-cell responses.”

Along with Andrew Geall, a pharmaceutical researcher who developed the RNA platform that the duo used, Bucala found a way to prevent the unwanted protein in Plasmodium, called PMIF, from inhibiting T-cell generation.

“Our research studies indicate that . . .

Continue reading.

Written by LeisureGuy

1 March 2021 at 5:18 pm

No, the Tuskegee Study Is Not the Top Reason Some Black Americans Question the COVID-19 Vaccine`

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April Dembosky reports for KQED:

As more surveys come out showing that Black Americans are more hesitant than white Americans to get the coronavirus vaccine, more journalists, politicians and health officials — from New York Gov. Andrew Cuomo to Dr. Anthony Fauci — are invoking the infamous Tuskegee syphilis study to explain why.

“It’s ‘Oh, Tuskegee, Tuskegee, Tuskegee,’ and it’s mentioned every single time,” says Karen Lincoln, a professor of social work at the University of Southern California. “We make these assumptions that it’s Tuskegee. We don’t ask people.”

When she asks the Black seniors she works with in Los Angeles about the vaccine, Tuskegee rarely comes up. People in the community are more interested in talking about contemporary racism and barriers to health care, she says, while it seems to be mainly academics and officials who are preoccupied with the history of Tuskegee.

“It’s a scapegoat,” Lincoln says. “It’s an excuse. If you continue to use it as a way of explaining why many African Americans are hesitant, it almost absolves you of having to learn more, do more, involve other people – admit that racism is actually a thing today.”

It’s the health inequities of today that Maxine Toler, 72, hears about when she talks to her friends and neighbors in LA about the vaccine. Toler is president of her city’s senior advocacy council and her neighborhood block club. She and most of the other Black seniors she talks to want the vaccine, but are having trouble getting it, she says, and that alone is sowing mistrust.

Those who don’t want the vaccine have very modern reasons for not wanting it. They tell Toler it’s because of religious beliefs, safety concerns or distrust for the former U.S. president and his relationship to science. Only a handful mention Tuskegee, she says, and when they do, they’re fuzzy on the details of what happened during the 40-year study.

“If you ask them what was it about and why do you feel like it would impact your receiving the vaccine, they can’t even tell you,” she says.

Toler remembers, and says the history is a distraction; it’s not relevant to what’s happening now.

“It’s almost the opposite of Tuskegee,” she says. “Because  . . .

Continue reading.

Written by LeisureGuy

27 February 2021 at 12:16 pm

The power of capitalism: Private equity ownership is killing people at nursing homes

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The power is not so much that capitalism kills people for the sake of profits (cf. Texas power grid, pollution from industry, the requirement for government laws to keep workplaces safe (and the endless efforts of corporations to repeal or evade those laws)), but that capitalism is able to continue the practice without encountering more effective opposition.

Dylan Scott reports in Vox:

When private equity firms acquire nursing homes, patients start to die more often, according to a new working paper published by the National Bureau of Economic Research.

Private equity acquisitions of nursing homes is a pressing topic: Total private equity investment in nursing homes exploded, going from $5 billion in 2000 to more than $100 billion in 2018. Many nursing homes have long been run on a for-profit basis. But private equity firms, which generally take on debt to buy a company and then put that debt on the newly acquired company’s books, have purchased a mix of large chains and independent facilities — making it easier to isolate the specific effect of private equity acquisitions, rather than just a profit motive, on patient welfare.

Researchers from Penn, NYU, and the University of Chicago studied Medicare data that covers more than 18,000 nursing home facilities, about 1,700 of which were bought by private equity from 2000 to 2017, the sample period they studied.

Their findings are sobering.

The researchers studied patients who stayed at a skilled nursing facility after an acute episode at a hospital, looking at deaths that fell within the 90-day period after they left the nursing home. They found that going to a private equity-owned nursing home increased mortality for patients by 10 percent against the overall average.

Or to put it another way: “This estimate implies about 20,150 Medicare lives lost due to [private equity] ownership of nursing homes during our sample period,” the authors — Atul Gupta, Sabrina Howell, Constantine Yannelis, and Abhinav Gupta — wrote. That’s more than 1,000 deaths every year, on average.

What accounts for such a significant loss of life when private equity takes over a nursing home? The researchers advance a few possible explanations.

For one, they note, the increased mortality is concentrated among patients who are relatively healthier. As counterintuitive as that may sound, there may be a good reason for it: Sicker patients have more regimented treatment that will be adhered to no matter who owns the facility, whereas healthier people may be more susceptible by the changes made under private equity ownership.

Those changes include a reduction in staffing, which prior research has found is the most important factor in quality of care. Overall staffing shrinks by 1.4 percent, the study found, but more directly, private equity acquisitions lead to cuts in the number of hours that front-line nurses spend per day providing basic services to patients. Those services, such as bed turning or infection prevention, aren’t medically intensive, but they can be critical to health outcomes.

“The loss of front-line staff is most problematic for older but relatively less sick patients, who drive the mortality result,” the authors wrote.

The study also detected a 50 percent increase in the use of antipsychotic drugs for nursing home patients under private equity, which may be intended to offset the loss in nursing hours. But that introduces its own problems for patients, because antipsychotics are known to be associated with higher mortality in elderly people.

The combination of fewer nurses and more antipsychotic drugs could explain a significant portion of the disconcerting mortality effect measured by the study. Private equity firms were also found to spend more money on things not related to patient care in order to make money — such as monitoring fees to medical alert companies owned by the same firm — which drains still more resources away from patients.

“These results, along with the decline in nurse availability, suggest a systematic shift in operating costs away from patient care,” the authors concluded.

The researchers make a point in their opening to stipulate that private equity may prove successful in other industries. But, they warn, it may be dangerous in health care, where the profit motive of private firms and the welfare of patients may not be aligned:

For example, patients cannot accurately assess provider quality, they typically do not pay for services directly, and a web of government agencies act as both payers and regulators. These features weaken the natural ability of a market to align firm incentives with consumer welfare and could mean that high-powered incentives to maximize profits have detrimental implications for consumer welfare. . . .

Continue reading.

Written by LeisureGuy

22 February 2021 at 1:53 pm

What Are Sperm Telling Us? Not Good News.

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Nicholas Kristof’s column in the NY Times points out that trashing the environment brings unexpected payback:

Something alarming is happening between our legs.

Sperm counts have been dropping; infant boys are developing more genital abnormalities; more girls are experiencing early puberty; and adult women appear to be suffering declining egg quality and more miscarriages.

It’s not just humans. Scientists report genital anomalies in a range of species, including unusually small penises in alligatorsotters and minks. In some areas, significant numbers of fishfrogs and turtles have exhibited both male and female organs.

Four years ago, a leading scholar of reproductive health, Shanna H. Swan, calculated that from 1973 to 2011, the sperm count of average men in Western countries had fallen by 59 percent. Inevitably, there were headlines about “Spermageddon” and the risk that humans would disappear, but then we moved on to chase other shiny objects.

Now Swan, an epidemiologist at Mount Sinai Medical Center in New York, has written a book, “Count Down,” that will be published on Tuesday and sounds a warning bell. Her subtitle is blunt: “How our modern world is threatening sperm counts, altering male and female reproductive development, and imperiling the future of the human race.”

Swan and other experts say the problem is a class of chemicals called endocrine disruptors, which mimic the body’s hormones and thus fool our cells. This is a particular problem for fetuses as they sexually differentiate early in pregnancy. Endocrine disruptors can wreak reproductive havoc.

These endocrine disruptors are everywhere: plastics, shampoos, cosmetics, cushions, pesticides, canned foods and A.T.M. receipts. They often aren’t on labels and can be difficult to avoid.

“In some ways, the sperm-count decline is akin to where global warming was 40 years ago,” Swan writes. “The climate crisis has been accepted — at least by most people — as a real threat. My hope is that the same will happen with the reproductive turmoil that’s upon us.”

Chemical companies are as reckless as tobacco companies were a generation ago, or as opioid manufacturers were a decade ago. They lobby against even safety testing of endocrine disruptors, so that we have little idea if products we use each day are damaging our bodies or our children. We’re all guinea pigs.

Aside from the decline in sperm counts, growing numbers of sperm appear defective — there’s a boom in two-headed sperm — while others loll aimlessly in circles, rather than furiously swimming in pursuit of an egg. And infants who have had greater exposures to a kind of endocrine disruptor called phthalates have smaller penises, Swan found.

Uncertainty remains, research sometimes conflicts and biological pathways aren’t always clear. There are competing theories about whether the sperm count decline is real and what might cause it and about why girls appear to be reaching puberty earlier, and it’s sometimes unclear whether an increase in male genital abnormalities reflects actual rising numbers or just better reporting.

Still, the Endocrine Society, the Pediatric Endocrine Society, the President’s Cancer Panel and the World Health Organization have all warned about endocrine disruptors, and Europe and Canada have moved to regulate them. But in the United States, Congress and the Trump administration seemed to listen more to industry lobbyists than to independent scientists.

Patricia Ann Hunt, a reproductive geneticist at Washington State University, has conducted experiments on mice showing that the impact of endocrine disruptors is cumulative, generation after generation. When infant mice were exposed for just a few days to endocrine disrupting chemicals, their testes as adults produced fewer sperm, and this incapacity was transmitted to their offspring. While findings  . . .

Continue reading. There’s more, and it looks bad.

Seafood is now contaminated with microplastics, which are endocrine disruptors, because humans use the oceans as a big garbage dump. Take a look at some of these brief videos’

How Much Microplastic Is Found in Fish Fillets?
Are Microplastics in Seafood a Cancer Risk?
Microplastic Contamination & Seafood Safety
BPA on Receipts: Getting Under Our Skin
Why BPA Hasn’t Been Banned

Written by LeisureGuy

20 February 2021 at 8:58 pm

‘This Crap Means More to Him Than My Life’: When QAnon Invades American Homes

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Anastasia Carrier reports in Politico:

For months, Emily has been married to a ghost. The trouble began last summer, when her husband Peter, the man who once showered her with affection and doted on their kids, started to spend all of his free time online, watching videos and reading message boards. He skipped the family activities they had once enjoyed, like watching football and playing outdoor sports. The couple, she recalled, stopped laughing together; everything suddenly turned serious with him. The pandemic had forced Peter to work from home, but it didn’t feel like he was there.

Before long, there were further turns. Peter started saying things that bordered on “bigoted and xenophobic,” Emily told me. Most shocking to her, Peter made her feel like an enemy for disagreeing with him. When she pushed back on his new strange ideas, like Tom Hanks being a pedophile, he answered her with disdain and treated her as if she were stupid.

“I was told that I buried my head in the sand and couldn’t see the ‘real’ problems,” said Emily, who shared her story under the condition of anonymity because she fears Peter’s retaliation and feels disloyal for speaking up. (Emily and Peter are not their real names.) Sometimes he undermined her this way in front of their kids.

Emily knew her husband was wrapped up in something called “QAnon.” She had heard the term before—Peter, prior to his conversion, had once dismissed it as “nuts”—but she didn’t fully grasp what QAnon was until early October, when she watched a few of the videos Peter kept talking about. That was when she learned that her husband had been consumed by a complex and false conspiracy theory that accuses “deep state elites” of running a secret pedophile ring. By then, it was too late to pull him out.

That month, Emily read an article online about “QAnonCasualties”—a Reddit forum for people like her, whose loved ones had also been drawn in by the bogus conspiracy theory. Suddenly, she didn’t feel so alone. For the next four days she watched the forum closely until she gathered the courage to post about her husband. “It’s exhausting loving someone and watching them get sucked into this cycle you can’t break,” she wrote.

“Thank you all for responding. Just knowing others are going through this disaster is relieving,” Emily replied.

Emily is just one of thousands who have found their way to r/QAnonCasualties. Started in 2019 by a Reddit user whose mother was a part of the “Qult,” the subreddit has ballooned in popularity over the past year, growing from less than a thousand followers in February 2020 to more than 133,000 in February 2021. The group’s followers more than doubled in the weeks following the Capitol riot alone. And as QAnon continues to spread—about 30 percent of Republicans have favorable views about the conspiracy theory, according to a January poll by YouGov—so does the forum’s reach.

As American politics scrambles to deal with this fringe ideology and its followers—a set of people seemingly impervious to facts, some committed enough to assault the U.S. Capitol—the country might learn a few things from the people who have to grapple with QAnon in their very homes, and who live with it every day. And what their stories tell us is unsettling. In post after post on r/QAnonCasualties, fathers and daughters, wives and husbands, best friends and colleagues describe their inability to get through to the people they are closest to. There are stories of marriages and friendships torn asunder, estranged siblings, parents and children severing ties. There are occasional accounts of success. But more often the stories end with people giving up trying to reach their radicalized loved ones. Sometimes, they walk away entirely.

After Emily found the board in October, the tone of her posts quickly went from hopeful to defeated. She began to accept that she might have to leave her husband. One day she wrote: “I would have never married this person, yet somehow, I am [married to him]. I wouldn’t wish this on my worst enemy.”

Peter has stopped treating the pandemic seriously, and Emily, who is in a high-risk group, can’t understand. They are both in their early 40s, and over the two decades that they’ve known each other Peter has always been protective of her fragile health. Now he thinks the pandemic is a hoax and doesn’t wear a mask, putting Emily in danger.

So Emily continues to avoid talking about politics and opts to do all of the house chores like groceries herself because she can’t trust Peter to be careful. As she wrote in one post: “This crap means more to him than my life.”

The QAnonCasualties subreddit came to life on July 4, 2019, when user Sqwakomodile shared a story about their mother being consumed by QAnon.

“The ignorance, bigotry, and refusal to question ‘the plan’ have only gotten worse over time,” Sqwakomodile wrote. The user barely talked to their mother anymore, but felt guilty about it. “It only seems to make me feel terrible and feeling like it’s my responsibility to try to lead her back to reality. Having a loved one involved in QAnon is an exhausting, sad, scary, demoralizing experience.”

At the time, QAnon had already made its way out of the far-right chat rooms where it was born and begun to spread via mainstream social media sites like Facebook and Twitter. The conspiracy could be traced back to 2017, when  . . .

Continue reading. Needless to say, there’s much more.

Written by LeisureGuy

19 February 2021 at 7:18 pm

The dilemma presented when a deplorable creator produces an admirable creation

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Woody Allen of course springs to mind, but take a look at Patricia Highsmith, described in the New Criterion by Brooke Allen as she reviews Devils, Lusts and Strange Desires, a book by Richard Bradford. Her review begins:

It’s a well-known principle that if you admire certain writers’ work, maybe you’d be better off not meeting them in the flesh. Good writers are often surprisingly unpleasant people—no one can quite figure out why, but it’s true. And never has there been a writer I’m so glad not to have known (though I very much enjoy her fiction) as Patricia Highsmith (1921–95). To use a non-PC term—I think I can get away with it in these pages—she was a predatory lesbian, in addition to being a professional homebreaker; a nasty drunk; an emotional sadist; and an equal-opportunity bigot who seems to have detested every group except the American and European gratin. Arabs, Jews, the French, Catholics, evangelicals, Latinos, blacks, Koreans, Indians both dot and feather . . . the list goes on and on.

Richard Bradford, Highsmith’s most recent biographer, observes, in his book Devils, Lusts and Strange Desires, her carryings-on with a sort of horrified fascination.1 “Compared to Highsmith, the likes of Casanova, Errol Flynn and Lord Byron might be considered lethargic—even demure. She seemed to enjoy affairs with married women in particular, but breaking up lesbian couples was a close second.” “An insatiable appetite for things, and people, stolen from or denied to others, seemed to have become her modus operandi.” She had an urgent and insatiable need for high drama ending in ruined lives, and if a relationship did not provide her with such fodder she soon moved on.

The question of mental illness of course arises, though Highsmith was never diagnosed. Bradford cites a psychiatrist, unacquainted with the writer, who passed her in a hotel corridor and noted that her facial expression was one he had never witnessed outside of an insane asylum. She herself speculated that she might have been bipolar, but to me (amateur psychologist that I am) her behavior seems more in keeping with borderline personality disorder. But we will never know.

What makes all this interesting, aside from the reader’s prurience and the perverse fascination involved in watching a train wreck in progress? It is, Bradford demonstrates, that Highsmith’s personality is so closely interwoven with those of her characters, her pathologies so allied with theirs, that a knowledge of her life truly expands the imaginative exercise of reading the fiction—which is not always the case with biographies. But how much do we actually know, and how much of what she tells us can be trusted? From adolescence on she recorded her life, thoughts, and fantasies in a series of “cahiers,” now assembled in the Swiss Literary Archives at Bern. Bradford has clearly spent a long and frustrating time in those archives, trying to differentiate truth and fantasy, fact and fiction. He admits that the attempt was often vain—but that fact in itself tells us much about Highsmith’s odd psyche. “As well as writing books featuring invented characters,” he tells us, “she decided that her own life should become the equivalent of a novel, a legacy of lies, fantasies and authorial inventions.” She apparently did this for several reasons: to create a life she desired rather than the one she lived, shaping her own life as fiction; to transpose her own experiences imaginatively into those of her characters; and, mischievously, to confuse scholars and biographers, poor saps like Bradford who, she knew, would scrutinize her papers after her death.

Much of her childhood and early life can be ascertained, however. Was there anything there to have caused the extreme behaviors of later years? . . .

Continue reading.

Written by LeisureGuy

17 February 2021 at 4:51 pm

This town of 170,000 replaced some cops with medics and mental health workers. It’s worked for over 30 years.

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The question that immediately came to mind: Given that it worked, why has the approach not been widely replicated over that 30-year period? What are the barriers to learning? It’s a good model and a successful model, but people did not learn from it. Resistance to learning strikes me as a serious problem, one for which solutions should be found — and quickly.

Update: Resistance to change is an old problem. An example: After it was discovered that patients did much better after surgery (that is, they did not sicken and die nearly so often) when the surgeon washed his hands before performing surgery, the practice did not become common until an entire generation of surgeons of non-hand-washing surgeons had been replaced by a new generation for whom washing hands before surgery was normal. /update

Scottie Andrew reports for CNN:

Around 30 years ago, a town in Oregon retrofitted an old van, staffed it with young medics and mental health counselors and sent them out to respond to the kinds of 911 calls that wouldn’t necessarily require police intervention.

In the town of 172,000, they were the first responders for mental health crises, homelessness, substance abuse, threats of suicide — the problems for which there are no easy fixes. The problems that, in the hands of police, have often turned violent.

Today, the program, called CAHOOTS, has three vans, more than double the number of staffers and the attention of a country in crisis.

CAHOOTS is already doing what police reform advocates say is necessary to fundamentally change the US criminal justice system — pass off some responsibilities to unarmed civilians.

Cities much larger and more diverse than Eugene have asked CAHOOTS staff to help them build their own version of the program. CAHOOTS wouldn’t work everywhere, at least not in the form it exists in in Eugene.

But it’s a template for what it’s like to live in a city with limited police.

It’s centered on a holistic approach

CAHOOTS comes from White Bird Clinic, a social services center that’s operated in Eugene since the late 1960s. It was the brainchild of some counterculture activists who’d felt the hole where a community health center should be. And in 1989, after 20 years of earning the community’s trust, CAHOOTS was created.

“CAHOOTS” stands for “Crisis Assistance Helping Out On The Streets” and cheekily refers to the relationship between the community health center that started it and the Eugene Police Department.

Most of the clients White Bird assisted — unsheltered people or those with mental health issues — didn’t respond well to police. And for the many more people they hadn’t yet helped, they wanted to make their services mobile, said David Zeiss, the program’s co-founder.

“We knew that we were good at it,” he said. “And we knew it was something of value to a lot of people … we needed to be known and used by other agencies that commonly encounter crisis situation.”

It works this way: 911 dispatchers filter calls they receive — if they’re violent or criminal, they’re sent to police. If they’re within CAHOOTS’ purview, the van-bound staff will take the call. They prep what equipment they’ll need, drive to the scene and go from there.

The program started small, with a van Zeiss called a “junker,” some passionate paraprofessionals and just enough funding to staff CAHOOTS 40 hours a week.

It always paired one medic, usually a nurse or EMT, with a crisis responder trained in behavioral health. That holistic approach is core to its model.

Per self-reported data, CAHOOTS workers responded to 24,000 calls in 2019 — about 20% of total dispatches. About 150 of those required police backup.

CAHOOTS says the program saves the city about $8.5 million in public safety costs every year, plus another $14 million in ambulance trips and ER costs.

It had to overcome mutual mistrust with police

White Bird’s counterculture roots ran deep — the clinic used to fundraise at Grateful Dead concerts in the West, where volunteer medics would treat Deadheads — so the pairing between police and the clinic wasn’t an immediately fruitful one.

There was “mutual mistrust” between them, said Zeiss, who retired in 2014.

“It’s true there was a tendency to be mistrustful of the police in our agency and our culture,” he said. “It was an obstacle we had to overcome.”

And for the most part, both groups have: Eugene Police Chief Chris Skinner called theirs a “symbiotic relationship” that better serves some residents of Eugene.

“When they show up, they have better success than police officers do,” he said. “We’re wearing a uniform, a gun, a badge — it feels very demonstrative for someone in crisis.”

It seeks to overturn a disturbing statistic

And a great many people in Eugene are in crisis. . .

Continue reading. There’s much more.

Later in the article:

Most of CAHOOTS’ clients are homeless, and just under a third of them have severe mental illnesses. It’s a weight off the shoulders of police, Skinner said.

“I believe it’s time for law enforcement to quit being a catch-base for everything our community and society needs,” Skinner said. “We need to get law enforcement professionals back to doing the core mission of protecting communities and enforcing the law, and then match resources with other services like behavioral health — all those things we tend to lump on the plate of law enforcement.”

Written by LeisureGuy

15 February 2021 at 1:17 pm

Interesting difference in blood pressure recommendations between US and UK/Canada

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The American Heart Association (US) recommends that blood pressure be less than 120/80.

The National Institute for Health and Care Excellence (UK) recommends that blood pressure be less than 135/85 (PDF).

That seems like a big difference to me. Some of it might be because NICE is looking at norms (i.e., averages) and not at the optimal. Example: In the US, the normal BMI for adult men — the norm — is 26.6, whereas the ideal is around 22.

Update: See also this brief video. FWIW, after I switched to a whole-food plant-only diet and was Nordic walking an hour a day six days a week and was close to my minimum post-middle-age weight, my blood pressure was 115 over 71 — with no medication.

Written by LeisureGuy

12 February 2021 at 9:43 pm

In the first six months of health care professionals replacing police officers, no one they encountered was arrested

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The police chief likes the program because it frees officers to fight crime. David Sachs reports in Denverite:

A young program that puts troubled nonviolent people in the hands of health care workers instead of police officers has proven successful in its first six months, according to a progress report.

Since June 1, 2020, a mental health clinician and a paramedic have traveled around the city in a white van handling low-level incidents, like trespassing and mental health episodes, that would have otherwise fallen to patrol officers with badges and guns. In its first six months, the Support Team Assisted Response program, or STAR, has responded to 748 incidents. None required police or led to arrests or jail time.

The civilian team handled close to six incidents a day from 10 a.m. to 6 p.m., Monday through Friday, in high-demand neighborhoods. STAR does not yet have enough people or vans to respond to every nonviolent incident, but about 3 percent of calls for DPD service, or over 2,500 incidents, were worthy of the alternative approach, according to the report.

STAR represents a more empathetic approach to policing that keeps people out of an often-cyclical criminal justice system by connecting people with services like shelter, food aid, counseling, and medication. The program also deliberately cuts down on encounters between uniformed officers and civilians.

“This is good stuff, it’s a great program, and basically, the report tells us what we believed,” said Chief of Police Paul Pazen. Pazen added that he doesn’t want to sound flippant, but the approach was somewhat of a known quantity because he’s been talking about it with advocates for mental health and criminal justice reform for years. Denver just so happened to launch the program in the middle of a movement against police violence.

Pazen’s goal is to fill out the alternative program so that every neighborhood can use its services at all hours, instead of just weekdays during normal business hours. Nearly $3 million for more social workers and more vans should help Denver move toward that “North Star” this year, Pazen said. The money is expected to come from the city budget and a grant from Denver’s sales-tax-funded mental health fund.

Carleigh Sailon, one of two civilian social workers on the team, said more vans — and more food and blankets to go with them — as well as weekend and after-hour shifts will do big things for the program.

“We run an unbelievable amount of calls for such a limited pilot program and have had some really good outcomes on those calls,” Sailon said.

The policing alternative empowers behavioral health experts to call the shots, even when police officers are around.

Sailon said she remembers a call last year in which a woman was experiencing mental health symptoms at a 7-Eleven. The clerk had called the police — the woman was technically trespassing — but when the police arrived, they called Sailon.

“We got there and told police they could leave,” Sailon said. “We didn’t need them there.”

The woman, who was unhoused, was upset about some issues she was having on her prepaid Social Security card. Sailon helped her into the van where the two “game-planned” a solution before the STAR crew drove her to a day shelter for some food, she said.

“So we were sort of able to solve those problems in the moment for her and got the police back in service, dealing with a law enforcement call,” Sailon said.

The fact that the police officers even called the STAR team tells Dr. Matthew Lunn, who is in charge of DPD’s strategic initiatives, that the program is working (Lunn has a PhD but is not a medical doctor). About 35 percent of calls to STAR personnel come from police officers, according to the report. . . .

Continue reading. There’s more, iincluding more charts.

Written by LeisureGuy

12 February 2021 at 1:51 pm

The Vaccine Had to Be Used. He Used It. He Was Fired.

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The decision to fire the doctor — and moreover to charge him with a crime — strikes me as quite clearly racist. Dan Barry reports in the NY Times:

The Texas doctor had six hours. Now that a vial of Covid-19 vaccine had been opened on this late December night, he had to find 10 eligible people for its remaining doses before the precious medicine expired. In six hours.

Scrambling, the doctor made house calls and directed people to his home outside Houston. Some were acquaintances; others, strangers. A bed-bound nonagenarian. A woman in her 80s with dementia. A mother with a child who uses a ventilator.

After midnight, and with just minutes before the vaccine became unusable, the doctor, Hasan Gokal, gave the last dose to his wife, who has a pulmonary disease that leaves her short of breath.

For his actions, Dr. Gokal was fired from his government job and then charged with stealing 10 vaccine doses worth a total of $135 — a shun-worthy misdemeanor that sent his name and mug shot rocketing around the globe.

“It was my world coming down,” Dr. Gokal said in a telephone interview on Friday. “To have everything collapse on you. God, it was the lowest moment in my life.”

The matter of Dr. Gokal is playing out as pandemic-weary Americans scour websites and cross state lines chasing rumors, all in anxious pursuit of a medicine in short supply. The case opens wide to interpretation, becoming a study in the learn-as-you-go bioethics of the country’s stumbling vaccine rollout.

Late last month, a judge dismissed the charge as groundless, after which the local district attorney vowed to present the matter to a grand jury. And while prosecutors portray the doctor as a cold opportunist, his lawyer says he acted responsibly — even heroically.

“Everybody was looking at this guy and saying, ‘I got my mother waiting for a vaccine, my grandfather waiting for a vaccine,’” the lawyer, Paul Doyle, said. “They were thinking, ‘This guy is a villain.’”

Dr. Gokal, 48, immigrated from Pakistan as a boy and earned a medical degree at SUNY Upstate Medical University in Syracuse. After working at hospitals in Central New York, he moved to Texas in 2009 to oversee the emergency department at a suburban Houston hospital. His volunteer work has included rebuilding homes and providing medical care after Hurricane Harvey in 2017.

. . . On Dec. 22, Dr. Gokal joined a conference call in which state health officials explained the protocols for administering the recently approved Moderna vaccine. The 10 or 11 doses in a vial are viable for six hours after the seal is punctured.

Dr. Gokal said the advice was to vaccinate people eligible under the 1(a) category (health care workers and residents in long-term-care facilities), then those under the 1(b) category (people over 65 or with a health condition that increases risk of severe Covid-related illness).

After that, he said, the message was: “Just put it in people’s arms. We don’t want any doses to go to waste. Period.”

On Dec. 29, a mild Tuesday, Dr. Gokal arrived before dawn at a park in the Houston suburb of Humble to supervise a vaccination event intended mostly for emergency workers. In part because of minimal publicity, the pace was slow, with no more than 250 doses administered. But this was the county’s first public event, he said. “We knew there would be hiccups.”

Around 6:45 at night, as the event wound down, an eligible person arrived for a shot. A nurse punctured a new vial to administer the vaccine, which activated the six-hour time limit for the 10 remaining doses.

The chances of 10 eligible people suddenly showing up were slim; by now, workers were offsetting the darkness with car headlights. But Dr. Gokal said he was determined not to waste a single dose.

He said he first asked the event’s 20 or so workers, who either refused or had already been vaccinated. The paramedics on site had left, and of the two police officers, one had been vaccinated and the other declined the doctor’s offer.

Dr. Gokal said he called a Harris County public health official in charge of operations to report his plans to find 10 people to receive the remaining doses. He said he was told, simply: OK.

He said he then called another high-ranking colleague whose parents and in-laws were eligible for the vaccine. They weren’t available.

The hours were counting down.

The doctor figured that if he returned the open vial to his department’s almost certainly empty office at this late hour, it would go to waste. So as he started the drive to his home in a neighboring county, he said, he called people in his cellphone’s contact list to ask whether they had older relatives or neighbors needing to be immunized.

“No one I was really intimately familiar with,” Dr. Gokal said. “I wasn’t that close to anyone.”

When he reached his home in Sugar Land, waiting outside were a woman in her mid-60s with cardiac issues, and a woman in her early 70s with assorted health problems. He inoculated both.

Eight doses to go.

The doctor got back in his car — his wife insisted on going with him — and drove to a Sugar Land house with four eligible people: a man in his late 60s with health issues; the man’s bed-bound mother, in her 90s; his mother-in-law, in her mid-80s and with severe dementia; and his wife, her mother’s caregiver.

He then drove to the home of a housebound woman in her late 70s and administered the vaccine. “I didn’t know her at all,” he said.

Three doses remained, but three people had agreed to meet the doctor at his home. Two were already waiting: a distant acquaintance in her mid-50s who works at a health clinic’s front desk, and a 40-ish woman he had never met whose child relies on a ventilator.

As midnight approached, Dr. Gokal said, the third would-be recipient called to say that he wouldn’t be coming: too late.

Tired and frustrated, Dr. Gokal said that he turned to his wife, whose pulmonary sarcoidosis made her eligible for the vaccine. “I didn’t intend to give this to you, but in a half-hour I’m going to have to dump this down the toilet,” he recalled telling her. “It’s as simple as that.”

He said his hesitant wife asked whether it was the right thing to do. “It makes perfect sense,” he said he answered. “We don’t want any doses wasted, period.”

With 15 minutes to spare, Dr. Gokal gave his wife the last Moderna dose.

The next morning, he said, he submitted the paperwork for the 10 people he had vaccinated the previous night, including his wife. He said he also informed his supervisor and colleagues of what he had done, and why.

Several days later, the doctor said, that supervisor and the human resources director summoned him to ask whether he had administered 10 doses outside of the scheduled event on Dec. 29. He said he had, in keeping with guidelines not to waste the vaccine — and was promptly fired.

The officials maintained that he had violated protocol and should have returned the remaining doses to the office or thrown them away, the doctor recalled. He also said that one of the officials startled him by questioning the lack of “equity” among those he had vaccinated.

“Are you suggesting that there were too many Indian names in that group?” Dr. Gokal said he asked.

Exactly, he said he was told. . . .

It seems clear that if the names had been “white” names, there would not have been a problem, especially since the guidelines and protocols had been followed.

But it gets worse:

On Jan. 21, about two weeks after the doctor’s termination, a friend called to say that a local reporter had just tweeted about him. At that very moment, one of his three children answered the door to bright lights and a thrust microphone. Shaken, the 16-year-old boy closed the door and said, “Dad, there are people out there with cameras.”

This was how Dr. Gokal learned that he had been charged with stealing vaccine doses.

Harris County’s district attorney, Kim Ogg, had just issued a news release that afternoon with the headline: “Fired Harris County Health Doctor Charged With Stealing Vial Of Covid-19 Vaccine.”

It alleged that Dr. Gokal “stole the vial” and disregarded county protocols to ensure that vaccines are not wasted and are administered to eligible people on a waiting list. “He abused his position to place his friends and family in line in front of people who had gone through the lawful process to be there,” Ms. Ogg said.

But Dr. Gokal said that no one from the district attorney’s office had ever contacted him to hear his version of events. And when his lawyer requested copies of the written protocols and waiting list referred to in the complaint, a prosecutor told him by email that there were no written protocols from late December; nor had a written wait list yet been found.

Harris County had received the vaccine faster than anticipated, the email said, and public health officials “immediately jumped from testing to vaccinating.”

As news of his alleged crime spread, Dr. Gokal heard from relatives and friends in Singapore, the United Arab Emirates and Pakistan. “Many were calling me for support, telling me, ‘We know you better than that,’” he said. “But there were a lot of people who didn’t call.”

Days later, a criminal court judge, Franklin Bynum, dismissed the case for lack of probable cause.

“In the number of words usually taken to describe an allegation of retail shoplifting, the State attempts, for the first time, to criminalize a doctor’s documented administration of vaccine doses during a public health emergency,” he wrote. “The Court emphatically rejects this attempted imposition of the criminal law on the professional decisions of a physician.”

Both the Texas Medical Association and the Harris County Medical Society recently issued a statement of support for physicians like Dr. Gokal who find themselves scrambling “to avoid wasting the vaccine in a punctured vial.”

“It is difficult to understand any justification for charging any well-intentioned physician in this situation with a criminal offense,” the statement said.

Dane Schiller, the district attorney’s director of communications, declined to answer questions about the case . .

Read the whole thing. The US is still a racist nation. No wonder Donald Trump appeals to so many.

Written by LeisureGuy

11 February 2021 at 1:40 pm

Posted in Daily life, Law, Law Enforcement, Medical, Politics

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