Archive for the ‘Uncategorized’ Category

100 years after the Spanish flu, virology still has far to go

October 4, 2020

Medical science does wonders. From amazing surgical procedures to an incredible variety of drugs and a fantastic array of tools and equipment, medicine, as it is practiced today, is light years ahead of where it was in 1918 at the time of the Spanish flu. Yet, medical science has not been capable of quickly defeating the current Wuhan virus pandemic. Health care has improved beyond recognition. Compared to 100 years ago, health services can deploy a bewildering variety of drugs and equipment and therapies to treat the infected.

The effects of the current pandemic are most often compared with the effects of the Spanish flu in 1918. The flu virus was identified in 1933 and the first flu vaccine came out in 1942. However, even today the flu vaccine is thought to be effective only in a little over 50% of cases. It is estimated that the Spanish flu, over a period of 3 years killed between 25 and 39 million people and that about 500 million were infected when the global population was only about 1,800 million. Today with a global population of 7, 200 million it is estimated that at least 35 million have been infected and, so far, over 1 million are thought to have died. The pandemic has lasted 6 months and is still ongoing. The virus was identified very quickly – perhaps one month – but only after the data repressed by the Chinese government and the WHO – leaked out.

The hunt for a vaccine is only 6 months old. There are at least 300 groups actively searching for one. Around 30 proposed vaccines have entered some kind of clinical trials. Estimates of when a vaccine could be readily available range from 6 months to 2 years to never. Money is being thrown at vaccine development at unprecedented levels. Certainly some of the groups chasing a vaccine have zero chance of success but cannot resist the temptation of huge amounts of easy money.

But virology is far from a settled science. In fact, there is still debate on whether a virus is living or not. That there are 300 different groups seeking a vaccine is, itself, evidence of 300 different opinions. During the past 6 months a bewildering variety of suggestions have been made for prophylactics, remedies and cures. Every single one has come from a “medical specialist”. The best advice is still “avoid infection” (by social distancing and masks which may or may not work), and hope. There are no preventive drugs and there are no cures (beyond treating symptoms). If and when vaccines are found, they will vary in how effective they are. Estimates of how expensive a vaccine may be range from 30$ to 300$ per dose for either a one-dose or a two-dose vaccine, with immunity available for periods ranging from 3 months to 1 year after vaccination.

Everyday new “experts” are trotted out on TV. But the science is not settled and there are no experts. The simple reality is that compared to 100 years ago, this pandemic has medical science just as stymied as the Spanish flu did – but at a very much higher level of knowledge.


Does the WHO chief add any value?

August 7, 2020

Below its political management the WHO does seem to add some value – though not anything much better than could be achieved without the WHO.

But the role of “WHO chief” adds no value that I can perceive (except perhaps to Chinese geopolitical aims). He (or his Press Corps) seem unable to avoid the obvious or the nonsensical.

 


 

Sol Invictus 2019

December 31, 2018

 


 

Diwali break

November 3, 2018

This year Diwali falls on 7th November.

 


 

Population decline will cause more misery than population increase ever could (or did)

August 6, 2018

Global population will decline from about 2100 onward. That demographic is already written in stone. For some countries the decline has already started.

By 2100 the global population will have reached about 10.5 billion. It is already too late for the subsequent decline to be completely averted, but it is the experience of countries such as those above over the next 5 decades or so which will be key in determining how the challenge is to be met. Declining fertility rate is now a global phenomenon but it is the rate at which population declines locally that will be the determining factor if, and to what extent, societal collapse occurs. The more interconnected and interdependent a society is, the more traumatic a collapse will be.

In well developed societies (and using Japan as an example) the first stress-point will come with the ratio of those in productive work (16 – 70 years) to those in need of societal support (<16 and >70 years). At some point the cost of this support will become prohibitive for the public purse. The support will not end abruptly but will become increasingly a function of the availability of private resources. Even within the last decade I have observed that public health care in Europe is now trying to reduce the number of hip and knee replacements for the elderly. For patients beyond a certain age, public health care now tries to avoid the more expensive procedures (cancer treatment, complex surgery ….. ). A new measure is now coming into play in decision making for public health care – YPPL (Years of Potential Life Lost). Once a patient is over 80, the YPPL is too low to justify the more expensive procedures.

The effects of depopulation would first be felt in rural areas where communities, which once were largely self-sufficient, become under-critical. These effects are already being seen in rural Japan where public transport is reducing, houses, schools and clinics are being abandoned and what little manufacturing industry was present has vanished. Those left in the rural areas are the elderly who have not the wherewithal to move. In central Europe it is the young, and especially young women, who move away from rural areas.

Japan Times:

The effects of a population decrease are already being felt. Cases in which road bridges have been closed to traffic because of a lack of funds for maintenance and a drop in the number of users are increasing. Forests exist whose owners are now unknown. The number of vacant houses are increasing. Some municipalities have passed by-laws under which they will demolish vacant houses that have become dangerously dilapidated.

In the countryside, traffic consists mainly of privately owned vehicles. As the population grays, however, more and more elderly people will be unable to drive, making it difficult for them to buy food and other essentials or to receive medical care. In local communities in mountainous areas in particular it is becoming extremely difficult to maintain a suitable level of social services for residents. It will become necessary for local governments to concentrate essential facilities such as medical institutions and administrative organizations in certain areas and take administrative steps to relocate elderly people who need such services so they can be close to them.

Paradoxically, cities could become inundated with populations moving in from rural areas which have become under-critical. The city services would be over-extended but without the labour force to be able to provide increased services. Misery would increase in both rural areas and in the cities.

The great mitigating hope is the development of AI and robots. However a fully automated society will also need much infrastructure investment and automation will not be able to stop the abandonment of rural areas. Driver-less buses and robot-manned clinics are entirely feasible but these will be solutions that will need a critical mass of population. Services for children and the elderly will be increasingly automated but will necessarily be concentrated in the cities.

I have no doubt that the challenges will be met. I suspect that automation and AI will be of greater value than mass migration. But the transition may take several decades and perhaps even a hundred years. Even though some central European countries are seeing a more rapid population decline, I expect that Japan will lead the way in finding the new solutions. By 2060 the Japanese population will be just two-thirds of what it was in 2010. Forests and farms will have to be automated to a much higher degree. Small, family-run rice production will shift to larger, automated farms. Rural areas will still be productive – but they will be unmanned. Growth will no longer be driven by population growth.

The transition to a much more automated society will come, but with a cost. That cost will be an increase in the misery index. The elderly in rural areas will be the first to experience an increase of misery. Longevity increase will level off and may even reverse. Public health care for the elderly will have to meet cost benefit criteria. Voluntary euthanasia for the elderly will become normal. There will be tax incentives for having children. Any need for an increase in children services will be met by automation rather than by humans. The success of automation will reduce the pool of routine, unskilled jobs available. Unemployment for the less-educated and the less-skilled will increase. The social rift between the unemployable and the more intelligent, skilled or creative could increase.

The increase of misery seems inevitable. But it will not last for ever. Population will probably stabilise but there will be a strong pressure for ensuring the long-term employability of those being born. A much greater degree of genetic screening of fetuses will result. Downs Syndrome and other genetic conditions will be eliminated. Humans may well be on the way to evolving to be more cerebrally capable and less capable physically.

Artificial selection will have arrived.


 

A day like any other – but Happy New Year anyway

December 31, 2017

The genocide paradox: Would you now prevent the dinosaurs from extinction then?

December 15, 2017

The genocide paradox is just another version of all the temporal paradoxes (grandfather paradoxes) about any historical event. Would you, in the now, take any action which will prevent something from having happened in the past, then? Knowing that some change to the past could make the present different? In all of these paradoxes, the inconsistency comes when the causal link with the past is broken.

We can only make judgements about the past. But the judgement itself is rooted in the now and cannot be applied to the past. If we, now, could take some action which will prevent the dinosaurs from having been extinguished 65 million years ago, would we? Of course, if the dinosaurs had not become extinct there would have been no room for many mammals or the great apes or humans to have evolved. If we could take actions in the now which will prevent any of the genocides of the past, we inevitably invalidate all that is in the present which is causally linked to that past. And so we have the Genocide Paradox. If we take actions now which will result in the Holocaust never having occurred, then we destroy our own existence and the entire causal chain which lies in our history.

The paradoxes arise because causality and the arrow of time are two sides of the same coin (and this coin may have more than two sides). You could argue that time is causality. We can make judgements today about how bad Hitler or Pol Pot were but their badness itself is an existential foundation for our own existence. In my own case I can make the causal link with Hitler quite easily.

For want of a nail image: grandmasnurseryrhymes

For want of a Hitler, the war was not,
For want of the war, Changi was not,
For want of Changi, an escape was not,
For want of an escape, a marriage was not,
For want of a marriage, a son was not,
For want of a Hitler, I was not.

So I can no more wish Hitler and the Holocaust away than I can wish away my existence.

Would the world be a better place today if all the great genocides through history had not taken place? That the world would be different is without doubt. There would be different people alive today even if the numbers of people alive would not – perhaps – be so different. The genetic mix of the people alive today would be different. But would the world be a better place?

We may regret the past, we may rewrite the past and we may think we would have behaved differently, but we cannot change it and we cannot wish it away.

It has become fashionable to revile figures from the past and their actions, but those figures and their deplorable actions are causal to the existence of those doing the reviling today. Reviling Hitler or Pol Pot or Genghis Khan or the slave traders or the colonists of the past is all the rage. But precisely those people and their despicable actions are our existential foundations of the present.


 

Misleading science: How a 1980 publication led to US opioid crisis

August 14, 2017

Not all of science is built on the shoulders of giants.

Sometimes science stumbles when it is based on political agendas, on fake science, on exaggerations and even – in this case – on mistaken conclusions.

Eventually science gets corrected, but much damage can be done till then.

In January 1980, the New England Journal of Medicine published this letter from scientists at the Boston University Medical Center (Vol 302, No 2).

This “letter” has been cited extensively in justifying the use of opioids and in the assumption that this would be non-addictive.

Now the same journal has published a new study (Vol 376, June 2017) which traces the current opioid crisis to this letter which has been “heavily and uncritically cited as evidence that addiction was rare with long-term opioid therapy”.

Leung et al, A 1980 Letter on the Risk of Opioid Addiction, N Engl J Med 2017; 376:2194-2195, June 1, 2017, DOI: 10.1056/NEJMc1700150

The prescribing of strong opioids such as oxycodone has increased dramatically in the United States and Canada over the past two decades.1 From 1999 through 2015, more than 183,000 deaths from prescription opioids were reported in the United States,2 and millions of Americans are now addicted to opioids. The crisis arose in part because physicians were told that the risk of addiction was low when opioids were prescribed for chronic pain. A one-paragraph letter that was published in the Journal in 19803 was widely invoked in support of this claim, even though no evidence was provided by the correspondents (see Section 1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org).

We performed a bibliometric analysis of this correspondence from its publication until March 30, 2017.  …….. 

In conclusion, we found that a five-sentence letter published in the Journal in 1980 was heavily and uncritically cited as evidence that addiction was rare with long-term opioid therapy. We believe that this citation pattern contributed to the North American opioid crisis by helping to shape a narrative that allayed prescribers’ concerns about the risk of addiction associated with long-term opioid therapy. In 2007, the manufacturer of OxyContin and three senior executives pleaded guilty to federal criminal charges that they misled regulators, doctors, and patients about the risk of addiction associated with the drug. Our findings highlight the potential consequences of inaccurate citation and underscore the need for diligence when citing previously published studies.

Without skepticism there is no science.


 

Would religions survive if children were not brainwashed into them?

May 25, 2017

Whether “indoctrination” of an empty child’s mind is less reprehensible than the “brainwashing” of an adult mind that has existing beliefs is not the point.  At issue is whether beliefs, which, by definition, exist outside the realm of knowledge, can be force-fed. No religion allows its followers to develop their own beliefs. All religions presume to instill their standard beliefs onto their own adherents and onto potential converts. Can beliefs be externally imposed or must they be developed internally? My own “belief” is that an idea, which is not the result of an individual’s own cognitive processes but is externally imposed, cannot be a true “belief”. All societies permit, and most approve, the indoctrination of children into the religions of their parents (or guardians). Apart from coerced conversions (which are still going on), I would guess that over 95% (and perhaps 99%) of all those who follow a religion, follow that of their parents.

Human behaviour has effectively made religion hereditary. Religion is not controlled by our genes except in that our genes may determine how susceptible we are to indoctrination. Yet our religious beliefs are determined by who our parents are. Unfortunately parents have not succeeded as well in indoctrinating children away from other undesirable behaviour. The growth or decline of religions across the world simply mirrors fertility on the one hand and the coercive conversion of peoples into the religion.

If a group of children were brought up in isolation on a desert island, by robotic instructors confined to teach only in the area of knowledge, and to answer any question in the space of ignorance with a “don’t know”, some of the children may well develop “religious” beliefs with divine power being attributed to the sun and the moon and the winds and the waves. But for there to be war between the sun-worshipers and the wind-worshipers there would first need to be those arrogant enough to anoint themselves as priests. There would be no organised religions without priests appointing themselves as special messengers of the divine powers. There would be no religious wars without “turbulent priests” bent on religious expansion. If every child was allowed, as it felt necessary,  to develop its own religious beliefs, organised religions would never catch hold. And if organised religions did exist they would merely wither and die without a continuous stream of new adherents in the form of brain-washed children growing up.

The problem lies not in whether one believes in gods or not, but in that organised religions exist and that they compete. They compete by claiming that one set of beliefs in the space of ignorance are superior or better than another set, also in the space of ignorance. The claims for the one or for the other are made by turbulent priests. It has been so ever since organised religions came into being. It is still so today, whether it is a mad mullah pronouncing a fatwa or a Hindu God-man calling for the destruction of a mosque or a Buddhist monk attacking unbelievers or a “celibate” Pope pronouncing on family values.

Who will rid us of these turbulent priests?


 

A politically correct distribution of the seven vices

December 25, 2016

political-vices


 


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