Since President Obama’s speech to/about the Middle East it has become more apparent than ever that both the Palestinians and the Israelis are insincere about negotiating their differences.
Netanyahu has publicly rejected any moves that might negotiate away some of the land won in the 1973 war, pretending that Obama’s offer represents a return all the way to the borders that existed from 1949 to 1967 (an admittedly indefensible dumbbell-shaped territory). Abbas continues to ignore Israel’s need for existential security by winking at Hamas while it continues its call for the obliteration of Israel.
On the Palestinian side, Hamas still refuses to recognize the “right of Israel to exist” and produces propaganda picturing the Israelis as inhuman devils. The propaganda incites Arabs to senseless violence against Jewish people. On the Israeli side, the government continues to expand Jewish settlements within areas that are nominally Palestinian, and oppresses its Arab citizens as well as the people under occupation. The behavior of the Israeli government merely confirms Arab feelings that they are considered less than human.
Since Arafat walked away from negotiations under Clinton’s auspices, neither side has taken honest steps to reduce tensions. More than ten years have passed since any real negotiation has taken place. It is clear that the Israeli strategy has been to temporize while settling more and more Zionists on previously Palestinian lands. The Palestinian strategy has been one of mindless, frequently violent opposition to all things Israeli combined with attempts to achieve nominal statehood by joining the United Nations.
There seems to be no leverage available to force either side to negotiate. When will the belligerents relent? The cost in human lives and suffering has been enormous on both sides, and it is inexcusable to allow the current situation to continue. We should condemn the positions of both sides in the strongest terms. We should demand the immediate and permanent suspension of Israeli settlement expansion and the public acknowledgement by all Palestinian organizations of Israel’s right to exist within mutually agreed secure borders. Propagandizing on both sides must stop; in particular, the absurd and hateful propaganda put out by Palestinian organizations and Arab outlets is obscene and unacceptable. Only then can honest negotiations proceed.
If reasonable demands are ignored, then it is time for economic pressure. Surely the threat of suspension of foreign aid to Israel if it refuses to desist from expansionism, combined with the offer of aid to Palestinians in return for pledges of nonviolence must have some effect. If there is no response to economic pressure, then at least we will no longer be in the hypocritical position of supporting an oppressive Israeli regime and failing to support nonviolent Palestinian aspirations to universal human rights.
This post was first drafted May 22, 2011…
Reviewed December 22, 2015…
I have reviewed this post repeatedly and have chickened out every time. It is now time to publish it, regardless of the cost. Remember, I am not Jewish nor Arab, nor am I a typical know-nothing American. I love both Israelis and Palestinians, but I feel their governments are letting their people down. December 28, 2015 2:09 PM
An article in the New York Times (NYT) describes the perverse incentives that make it more profitable for private drug companies to produce drugs that improve survival marginally in late-stage cancers than to produce drugs that prevent cancer in the first place.
It is a medical axiom that the best way to cure a disease is to prevent it from occurring in the first place (“an ounce of prevention is worth a pound of cure.”) However, when we survey the medical literature, we find very few studies of drugs that prevent disease, especially cancers. The reason for this is the perverse incentives of patent exclusivity.
The developers of a drug are given 20 years to exclusively produce (or license others to produce) that drug. On average, after clinical studies are complete, there are 12.5 years left of exclusivity for the company to profitably sell a drug. This incentive works against clinical studies that take many years to complete. By definition, a drug that prevents disease will take much longer to show significant results than a drug which treats the disease after it has already appeared. In many cases, prevention lasts a lifetime: 70 years or more, much longer than the patent exclusivity period.
The article refers to research done by Eric Budish, Benjamin N. Roin, and Heidi Williams that shows how this works for cancer drugs. The abstract of the study concludes:
… we document several sources of evidence that together show private research investments are distorted away from long-term projects. The value of life-years at stake appears large. We analyze three potential policy responses: surrogate (non-mortality) clinical-trial endpoints, targeted R&D subsidies, and patent design.
A good example (in a non-cancer context) is the case of Lipitor, formerly a widely advertised and popular drug that had patent exclusivity for Pfizer and made them a great deal of money. It took many years for a study to appear that had adequate statistical strength to prove that it lengthened lives. By the time this information was available and accepted by a preponderance of medical doctors, the patent had expired and there was no longer any financial incentive for Pfizer to advertise it or to sponsor studies of its use.
Despite the loss of patent protection, atorvastatin has come to be used for many other things than hyperlipidemia (high cholesterol and high fats in the blood): for example, atorvastatin has been used for progeria, polycystic ovary syndrome, transient ischemic attacks (mini-strokes), type 2 diabetes (the most common type), coronary artery disease (obstruction of the arteries that supply the heart muscle with blood, that leads to heart attacks), peripheral artery disease (obstruction of peripheral arteries), arteriosclerosis and atherosclerosis generally, after a heart attack to prevent further damage, and so on. Most of these diseases are directly related to hyperlipidemia, but polycystic ovaries and progeria are not.
Studies of high doses of atorvastatin given to patients with severe coronary artery disease, especially after heart attacks, have already shown that it lengthens the life span of people who take it. The main side effects, muscle pain and weakness, may require a patient to discontinue the drug, but most patients tolerate it extremely well with no side effects. It will take many more years to prove that atorvastatin lengthens the lives of people who merely have high cholesterol; some studies already suggest that administration of the drug to otherwise normal individuals has advantages.
One approach that reduces this problem is to look for “surrogate end points”, a method that has helped in the development of drugs for AIDS. In this approach, blood tests or other tests, even symptoms and signs, are used to determine if the drug shows any indications that it may improve survival in the long run. For AIDS, the surrogate end points are such things as the number of T cells in the blood. Very low numbers are associated with severe, end-stage AIDS, and drugs that can increase the number of T cells will usually improve survival, despite unpleasant side effects. Drugs that improve the patient’s weight, strength, and other outward signs of illness can also be used as surrogate markers.
The article discusses other approaches that may improve the incentives to produce drugs that prevent cancer, but it concludes:
Drug patents incentivize innovation, and F.D.A. approval is a check regarding drug safety and efficacy. The way they work together affects the incentives for research and could reduce something many would view as highly valuable: cancer prevention.
The approach that is not discussed in the article is the only one that is certain to improve incentives: government sponsorship of drug development for specific long term purposes. If the federal government were to set up a program that looked for and developed drugs that improve long term survival and well-being, the problem of perverse incentives would be overcome with a single stroke.
This idea is sure to be controversial because it sets up the government in competition with private drug companies; if it can be made clear that development will proceed in parallel and that the government will only develop drugs with long term benefit, drugs in which the private companies have no financial interest, it may be possible to further proceed in this direction.
The only alternative, the condition that exists today, is for naturopaths and other “quacks” to produce and sell drugs that have anecdotal evidence for benefits, hardly a productive state of affairs.
57-year-old Barbara Dawson died Monday at the Calhoun Liberty Hospital (25 beds) in Blountstown , Florida (population 2,500) (25 miles from the next hospital) at around 6:24 AM. She had been discharged from the hospital but refused to leave. She was using an oxygen tank, but the hospital staff refused to return it to her and called the police when she would not leave. A policeman put her in handcuffs and escorted her to his patrol car, but she collapsed while waiting for him to unlock the door. He removed her handcuffs and staff put her on a gurney to return her to the hospital. Supposedly her vital signs were OK when she was returned, but two hours later she was dead. A bystander, related to her, claims that she had no pulse after she collapsed in the parking lot, but CPR wasn’t started until she was back in the hospital.
According to the Talahassee Democrat (a Gannett company), Ms. Dawson had been admitted Sunday evening around 10:30 PM after arriving by ambulance, complaining of stomach pain. She was discharged early the next morning; in fact, she was thrown out for supposedly causing a disturbance. She refused to leave and demanded further medical care, complaining of shortness of breath and “not feeling well.”
Apparently Ms. Dawson was disturbing because she was complaining loudly and questioning her care.
Ms. Dawson was a “frequent flyer”; according to the article, she had been in Talahassee hospitals 22 times since 1987, and apparently other hospitals as well. No other details of her medical condition were given in that article. She had been ordered to leave the hospital in the past, and police had been called to remove her before.
The hospital’s chief administrator and CEO is Ruth Attaway. She gave the following statement to reporters later:
Attaway said blot clots in the lungs are hard to detect, often result in immediate death and are nearly impossible to treat.
The decision to remove her form the hospital was out of safety for the other patients in the 25-bed hospital.
As a matter of fact, the treatment required for a potentially fatal pulmonary embolism that is obstructing the flow of blood from the heart through the lungs is emergency cardiopulmonary surgery, an heroic procedure beyond the resources of any but the largest hospitals. The diagnosis of a pulmonary embolism that is not immediately fatal requires a high index of suspicion and ventilation-perfusion radioscintiscanning, another facility that is only available in large hospitals. Treatment of a nonfatal embolism is simple: large doses of heparin (requiring close observation and blood testing) for ten days, followed by coumadin for six months.
The most likely source of a pulmonary embolism is spontaneous clotting within the venous system, particularly the veins of the legs. These veins are frequently enlarged and obstructed, particularly in obese individuals.
The local chapter of the NAACP has become involved, and lawyers are preparing a case against the hospital and the police. It is unlikely that the policeman did anything untoward, but it is certain that the hospital staff failed to meet the standard of care, even for such a small hospital.
A side note about the hospital:
The Florida Department of Law Enforcement is investigating the hospital’s former CEO Phillip Hill in connection with a more than $1 million fraud scheme. Hospital officials have accused Hill of creating between 50 and 100 fake invoices for medical supplies the hospital never received.
There is nothing new about the observation that people who have repeated concussions eventually develop brain damage, altered personalities, mood changes, and mental deterioration. This is encapsulated in the word “punch-drunk.” What is new is that the National Football League (NFL) has seen its financial viability threatened by the repeated diagnoses of chronic traumatic encephalopathy in some of its most colorful and high-salaried players.
The NFL’s response to this potential threat has been inconsistent, beginning with denial and attempts to marginalize the first pathologist who published these diagnoses: Dr. Bennet Omalu. The diagnostic process and the league’s reaction has been dramatized in a movie, Concussion, with Will Smith in the lead role. Mr. Smith is well-practiced in this role, having done a realistic and appealing portrayal of a fictional doctor who diagnoses and treats a fictional epidemic of vampirism in New York City. That movie was a remake of the Charlton Heston classic, The Omega Man, and was titled after the original book: I am Legend. The Charlton Heston movie was actually the second adaptation of the book written by Richard Matheson, the first being The Last Man on Earth, with Vincent Price in the title role.
This post is not about Concussion, which I haven’t seen yet. It is about chronic (post)traumatic encephalopathy (CTE) and football. By the time Junior Seau killed himself with a shot to the chest, the problem was well known to football players, and Junior himself thought that he might have it. He didn’t specifically request that his brain be studied, but considering the method he used to kill himself, it is likely that he did want that to be done.
ESPN published an article about the struggle over Junior Seau’s brain in 2013, entitled Mind Control. By the time of Junior’s death on May 2, 2012, the NFL had designated Boston University (BU) as the site for CTE research that it would support. However, several researchers and medical examiners were involved in the work, and an unseemly competition developed between the separate researchers over possession and control of the brain tissue. Junior’s family members were approached more than once by different people requesting permission to take Junior’s brain tissue for study.
The National Institutes of Health was designated as the recipient organization. The NFL had a large part in that final decision, having disbanded its original concussion committee and forming a new committee. The NFL’s original stance has been radically changed, an improvement over a policy that the ESPN article described in this way:
The players charge that the league’s original concussion committee, which was disbanded in 2009, conducted fraudulent research to hide the connection between football and brain damage. That 15 years of research has been largely discarded, even by the league.
Dr. Rich Ellenbogen is the new committee’s co-chairman. The ESPN article states that although the NFL had designated BU as its “brain bank” there were complaints that BU had refused to share its tissue samples with other researchers. Because of these complaints, Ellenbogen and the committee had already tried to steer tissue from the brain of former Chicago Bears safety Dave Duerson to the NIH (unsuccessfully.) In the Seau case, the article describes Ellenbogen’s reasoning:
Asked in an interview why they suggested the NIH, Ellenbogen said, “We had been talking about it for a while. My point, for a long time I’ve been saying … if you’ve got a problem you want to solve, do you put one university on it or have multiple studies done? The federal government is very good, in some ways, really good about doing this. They don’t have an agenda.”
When they received Junior Seau’s brain, the NIH decided to direct samples to five different research institutions, including BU. This approach ensured immediate replication of the findings by independent groups, none of whom knew at the time the source or name of the deceased. The final diagnosis was no surprise given Junior’s symptoms, but it gave vastly more weight to the finding of CTE to have several independent groups all come to the same conclusion. By contrast, a single diagnosis from BU would have been “just one more brain” since they had already made so many diagnoses in former football players.
Four months after Junior Seau’s autopsy, the NFL donated $30 million to the NIH, an “unrestricted” grant that was the largest it had ever given at that time.
Tyler Seau, Junior’s son, got no “closure” from the diagnosis of CTE. In some ways, it made him feel even worse. He had been stressed beyond his limit by his father’s erratic behavior; he was then contacted at a particularly sensitive time after his father’s death for the necessary procedure of obtaining the family’s consent for examination of his brain; and now, with the diagnosis, he realized that, if he had known before his father’s death what was happening to him, he could at least have had an understanding of what was going on, even if the condition was untreatable.
The NFL attempted to direct Junior Seau’s brain away from researchers who had previously made CTE diagnoses and threatened its livelihood: first, away from Dr. Omalu (by having Dr. Chao, Junior’s team physician, bad-mouth Omalu to Tyler Seau), and second, away from BU, which had made so many CTE diagnoses. The end result was the best from a scientific point of view, although to the NFL, it was no help and may have been even worse because it was independently confirmed by disinterested parties.
The NFL settled the player’s lawsuit in April 2015, offering a projected $1 billion in compensation for head injuries after it agreed to remove the $765 million cap in August 2014. Some parties immediately filed an appeal of the settlement. Others have opted out of the settlement process in advance. Arguments about the fairness or unfairness of the settlement continue, and it won’t be finalized until at least early 2016.
New data from PBS’ Frontline and BU were released in September, showing that of 91 former football players who donated their brains for study after death, 87 had signs of CTE. This is not a random sample, as it is likely that players who suspected they had CTE would donate their brains for study. Nonetheless, it is disturbing to see that so many had the condition, because it suggests that many, or possibly even most, football players have a least some degree of CTE. No further enhancement is likely to occur until a method for diagnosing CTE prior to death is developed. See this International Business Times article for more about the Frontline study.
Junior Seau’s symptoms were the most important problem, and this problem should be emphasized to all; a definite diagnosis is not necessary to be on one’s guard. First, he lost what control he had had over his anger and violent tendencies. Second, he became erratic and prone to mood swings from depression to elation and irritability. Third, he became inattentive to details that he had formerly taken care to arrange to his satisfaction. Another symptom that is not universal but frequent was his uncontrolled gambling and sexual behavior. He also was involved in a car crash in 2010 that some believe was a suicide attempt.
The development of these symptoms, particularly personality changes, is a sign of early CTE. People who have symptoms like these should be examined and considered for the diagnosis. Once CTE is suspected, it is possible to control the damage to a person’s life and the lives of his family by placing him under observation and using legal means to prevent him from spending all his money or signing contracts that are damaging to him. His driver’s license can be taken away; while this does not prevent him from driving, it may reduce the possibility of car crashes.
Some of the behavioral symptoms of CTE may be controlled through the sparing use of what are called “neuroleptic” drugs. This is a controversial practice; the use of drugs to keep patients docile in the nursing home has been shown to reduce their life expectancy, and it is unlikely that the drugs relieve any of the symptoms internally. They only prevent a patient from thinking and planning complex, dangerous behaviors, in my opinion. They likely do not make the patient feel any better.
Thus, the diagnosis of CTE is somewhat like the diagnosis of Alzheimer’s disease. There is no cure, not even any partially effective treatment. There are only custodial measures to limit the damaging effects of the patient’s behavior. Despite this, the advantages of identifying patients who have CTE are significant: the family can know what to expect and be alert to prevent some of the traumatic behaviors.
There was a curious case that occurred a year ago that has some bearing on the age of development of symptoms of CTE. A 22 year old football player and wrestler with a history of unreported concussions killed himself just before Christmas of 2014. An autopsy showed that he “did not have CTE” but evidence of prior concussions was found. The young man texted his mother just before he died: “I am sorry if I am an embarrassment but these concussions have my head all fucked up,” the text said. It is possible that “chronic traumatic encephalopathy” as a tissue diagnosis takes a lot longer to develop than the symptoms of post-concussive encephalopathy.
Further research may identify treatment, but in the meantime, prevention is the only effective approach. This is where the NFL comes in. We can understand their complaint that no-one knows what the incidence of CTE is, that is, how frequently it occurs in people exposed to concussions. This does not excuse the organization from trying to reduce concussions and reduce the forces to which the brain is subjected during the game of football.
At the same time, the way football is played and who plays it have to be changed. Small children to college players should not be subjected to full-contact head-butting without making it clear to the parents and the players that there is a significant risk. Football is not alone in facing this problem. Soccer is also the scene of serious head injuries and less obvious concussions. There is little reason for having soccer players wear helmets, but precautions such as increasing time off after a concussion are warranted.
A woman who collapsed after being arrested for refusing to leave a hospital when doctors discharged her died from a blood clot in her lung, officials said Wednesday. The woman, Barbara Dawson, 57, collapsed on Monday while being taken in handcuffs from the Liberty Calhoun Hospital, where she had gone for treatment for breathing difficulties, the police said. She was arrested for disorderly conduct and trespassing when she refused to leave, according to the police. The Blountstown police chief, Mark Mallory, said the medical examiner’s office found that Ms. Dawson had died from a blood clot caused by her being overweight. State law enforcement officials were called in to investigate.
via Florida: Woman Forced From Hospital Dies – The New York Times.
Just a line to let you know our medical services are still functioning well.
Brain Size and Cognitive Ability
Studies have been done on large populations of men, women, Europeans, Africans, Asians, adjusted by body size, and correlated, and have found that Asians have the largest brains on average (say, 1350 cc), Europeans in the middle (say, 1300 cc), and Africans the smallest(say, 1250 cc); while men have larger (say, 1300 cc) brains than women (say, 1200 cc.) Intelligence tests, again of large populations, show Asians to have the highest IQs (115), Europeans the middle (100), Africans the lowest (85); whereas women have, possibly, slightly lower (96) IQs than men (100).
If brain size is so closely correlated with intelligence, why do women have higher IQs than Africans, who have just as large brains? Remember, that supposedly close correlation is not 1 to 1, it is 0.44; that is less than half the variance.
For comparison, the brain size of a gorilla is roughly 500 cc, and a chimpanzee, 350 to 400 cc. Another comparison: bottlenose dolphins have brains about 1500 cc in size, with body weights not much bigger than human, say 110 kg. Finally, the Neanderthal pre-human had an average brain size of 1500-1600 cc.
One answer is the degree of cerebral folding in each brain; a more tightly folded cerebrum can accommodate more surface area, and thus more neurons than a less tightly folded cerebrum. With a cortical thickness of 2 mm in the cerebral column but more than 2 cm including the subjacent white matter containing the necessary connections to and from the cerebral column, there is a limit to the amount of folding that can be obtained in a given volume of skull. The brain stem and midbrain are probably at least a minimum size, so tightly folding the cortex is an advantage.
The studies on brain size are quoted by racists as indicating that Africans are really less intelligent, on average, than whites; and Asians are the smartest of all. The intelligence quotient studies also back this up. However, there is the curious fact that despite having smaller brains, women test out as nearly as intelligent as men; in fact, women’s brains are, perhaps, slightly smaller than African’s brains, yet they are clearly more intelligent on the tests. This suggests that intelligence is not that closely related to brain size, or else the tests really are biased against Africans.
There are also other factors that contribute to brain size other than intelligence such as relative myelinization, density of neural packing, size of neurons, number of glia relative to neurons, and so on. In addition, the differences in average size are rather small and really don’t account for the fairly dramatic apparent differences in average intelligence. That is to say, there is about one standard deviation’s worth of difference in intelligence test results between each of the three “races”– but there is only a five to ten percent difference in total brain size.
Obama’s Subtle and Maligned Foreign Policy
Obama’s choice is the best of a bad selection: first the imperatives: America must not be seen to be unresponsive to the needs of people seeking freedom anywhere, particularly in Syria. America has global reach, having the largest military budget by far of any in the world. But we must not get overly involved, whatever that implies (1,000 or 10,000) with minimal casualties and minimal stress on a military budget relatively weak in manpower. Therefore: the least we can do, and the most we can do, is send a few Special Forces, characters who are itching to go anyway. And the objective: hold the territory already taken, not gain any new territory, and especially not a military victory. Finally, the time frame: no deadline, because deadlines cause the enemy to bide their time. All the more important that the operations be “sustainable”, that is renewable from year to year. So your “realpolitik”: no victory, but a dynamic stalemate or “Mexican standoff.”
Putin’s aggressive measures should be seen as based on a perceived need to hold the allegiance of his people in difficult times. Thus the impulse to fascism, which is acceptable to American foreign policy as long as it is not aggressive. Opposition must not be seen to be too effective .
The historic increases in productivity, only partially related to automation, has resulted in imposed poverty instead of distributed benefits partially related to automation. Productivity improvements have resulted in the production of a larger quantity and better quality of finished goods with less labor. Instead of distributing productivity improvements by shortening worker’s hours and keeping the same number of workers, owners have kept the hours the same and reduced the number of workers, creating unemployment instead of prosperity, and hijacking the worker’s gains.
The important issue is one of distribution of productivity improvements. If the improvements in productivity were distributed in the form of shorter hours spent producing the same or better product, then the workers would benefit by the time saved. Instead, the employer receives all the benefit when the workers’ hours are kept the same and the number of workers needed to produce the same amount of product is reduced.
The attraction of using each worker to the maximum extent of which they are capable is obvious to the employer. The workers are kept working as much as possible and paid the same, while more product is realized. Otherwise they might start thinking too much during their rest periods. The workers who are dismissed become poorer and resent their former employer but there is nothing they can do (except commit workplace violence, which occasionally happens.) This is inequitable and exploitative.
There are indications that productivity improvements have not been reflected in increased pay or other compensation since 1973.
“The fundamental understanding that ISIS/ISIL is a barbaric enterprise is enough to know, in many ways. I spent nearly a year and a half working in the Middle East. Over that time, I often experienced a level of deceit, cowardice, and illogical thinking from my hosts and their Middle Eastern advisors that was the most baffling thing I’ve ever seen, and which thwarted progress on many fronts. And this was all coming from people whose intentions were often, or at least started out as good. ”
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My best friend in Lamu, Kenya, a Swahili-speaking Yemeni, once told me that I should be killed because I had inadvertently left a Quran on the floor and that the only reason why he or someone from the local mosque would not do it was that he was trying to protect his best friend. Twisted logic?
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These are comments from people who have worked in areas that are majority Muslim and Arab. What does this mean for the struggle against the Islamic State?
Conrad Theodore Seitz 