Jan 19 2017

2016 Warmest Year on Record

giss-1880-2016It’s official – 2016 is the warmest year on record, since we have been tracking global temperatures since 1880. This is the third year in a row that the current year has been the warmest, 2014 and 2015 were also the warmest years on record. In fact, 15 of the warmest years on record have all been since 1998 inclusive. The last time we had a coldest year on record was 1911.

That the Earth is warming is now undeniable, but that does not stop people engaged in motivated reasoning from denying it. The graph to the right shows temperature variance from average since 1880. It is visually very compelling.

Here is how motivated reasoning works, however. Someone without ideological skin in the game would fairly assess all the data, acknowledge uncertainty and complexity, but arrive at the fairest conclusion. Motivated reasoning exploits uncertainty and complexity to deny the reality which is causing cognitive dissonance brought about by a conflict between reality and ideology.

As you might imagine, there is a lot of complexity in determining average global temperatures. It’s not as if the Earth has a magical thermostat. There are various places to measure temperature, from surface temperature, high altitude temperature, and ocean temperature. You can also use various methods, including ground stations and satellites. Further, you have to correct for any potential source of artifact. For example, there is the heat-island effect. As cities grow they generate more heat, and if you have a temperature measuring station near a city it will measure this heat.

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Jan 17 2017

Gene Cernan, Last Man to Walk on the Moon, Dies

Cernan-Apollo17“We leave as we came and, God willing, as we shall return with peace and hope for all mankind.”

Those were the last words that Eugene Cernan spoke while on the moon, the last person to step foot there. Twelve people total walked on the moon during the Apollo missions: Neil Armstrong, Buzz Aldrin, Pete Conrad, Alan Bean, Alan Shepard, Edgar Mitchell, David Scott, James Irwin, John Young, Charles Duke, Eugene Cernan, and Harrison Schmitt. Cernan was one of only three who went to the moon twice. Of the twelve, six are now still alive.

Cernan and Schmitt were the two astronauts of the Apollo 17 mission, the last mission of the Apollo program, to walk on the moon. They lifted off from the lunar surface on December 14, 1972. That means this year it will be 45 years since a person last walked on the moon. We are fast approaching half a century since the end of the Apollo missions.

I was only 8 years old in 1972, but I avidly followed the Apollo program. From my perspective at that age the Apollo program had existed my entire conscious life. To me it was just something that we did. I remained a fan of NASA, the space program, and all things having to do with space travel since then. I would have considered it unthinkable that we would not return to the moon in the next 50 years. Surely by 2001, which seemed far in the future, Kubrick and Clarke’s vision of a permanent moon base was likely a reasonable extrapolation.

So why haven’t we been back to the moon? Should we return to the moon?

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Jan 13 2017

Cognitive Biases in Health Care Decision Making

decision-makingThis was an unexpected pleasant find in an unusual place. The Gerontological Society of America recently put out a free publication designed to educate patients about cognitive biases and heuristics and how they can adversely affect decision making about health care.

The publication is aimed at older health care consumers, but the information it contains is applicable to all people and situations. It is a well written excellent summary of common cognitive biases with a thorough list of references. There are plenty of other resources that also review this material, including my own Teaching Company course, but this is a good user-friendly reference.

What is most encouraging about this publication is the simple fact that it recognizes that this is an issue. It is taking knowledge of psychology and applying it to the real world, recognizing the specific need for critical thinking skills in the public. This could have easily been produced in many different contexts – not only any medical specialty, but investing your money, buying a home, choosing a college, or evaluating news reports.

The report is aimed simultaneously at health care providers and patients. It is primarily a guide for providers for communicating with older adults, accounting for cognitive biases in decision-making, but at the same time will help consumers communicate with their providers and make better decisions.

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Jan 12 2017

Curcumin Hype vs Reality

CurcuminCapsA recent systematic review of the alleged health benefits of curcumin show that, yet again, hype based on “traditional use” is not a reliable guide.

Curcumin is a spice that makes up about 5% of turmeric, a yellow spice used in many curries. It is also a traditional herbal treatment. The health claims made for curcumin are numerous – WebMD has this entry:

Other preliminary lab studies suggest that curcumin or turmeric might protect against types of skin diseases, Alzheimer’s disease, colitis, stomach ulcers, and high cholesterol. Based on lab studies, turmeric and curcumin might also help treat upset stomach, scabies, diabetes, HIV, uveitis, and viral infections.

The systematic review had two main findings:

No double-blinded, placebo controlled clinical trial of curcumin has been successful. This manuscript reviews the essential medicinal chemistry of curcumin and provides evidence that curcumin is an unstable, reactive, nonbioavailable compound and, therefore, a highly improbable lead.

Let’s take the second point first, bioavailability. In order for a drug to be useful when taken orally it has to have adequate bioavailability. This means it needs to be relatively stable, it has to be absorbed in adequate amounts through the GI tract, and then it has to survive a first pass through the liver and be distributed in the body in such a way that it gets to its target tissue is sufficient concentration to have a clinical effect.

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Jan 10 2017

Cleveland.com Doubles Down on Fail

vaccine-shot-promoThere are several phases to a serious gaffe. First, there are the conditions which led to or allowed the gaffe to occur. Then there is the gaffe itself. There is then the response of the person or institution who committed the gaffe – which is perhaps the most important phase . Finally, there may or may not be a long term correction of the underlying conditions.

Over the weekend, as I discussed yesterday, Dr. Daniel Neides, Medical Director and Chief Operating Officer of the Cleveland Clinic Wellness Institute, published an anti-vaccine screed on cleveland.com. I won’t bother debunking the anti-vaccine pseudoscience again, just read my post from yesterday. You can also read David Gorski’s excellent take down at Science-Based Medicine.

Suffice it to say the column was full of misinformation and common anti-vaccine tropes that are long debunked. The publication of a dangerous anti-science rant by Cleveland Clinic’s Director of the Wellness Center was, of course, the gaffe.

The conditions that led to that gaffe are obvious, and something about which my SBM colleagues and I have complained for years- the infiltration of alternative medicine pseudoscience into academic medical institutions. Cleveland Clinic has an “integrative medicine” center headed by Mark Hyman, who co-authored an anti-vaccine book. The Wellness Center itself embraces all sorts of vitalistic nonsense and pseudoscience.

As David says – no one should be surprised when the director of a center that embraces quackery publishes an article that embraces quackery. Continue Reading »

Comments: 109

Jan 09 2017

Anti-vaccine Nonsense at Cleveland Clinic

This is what happens when you compromise your academic and professional integrity in order to embrace a popular fad. The Cleveland Clinic, which is historically an excellent medical institution, has the Cleveland Clinic Wellness Center, which is a center of so-called “alternative” medicine.

Such centers are a Trojan horse. They are sold to naïve academics as providing “patient centered” warm and fuzzy symptomatic treatments. Meanwhile they are really centers for pseudoscience and health fraud. They use the respected names of venerable institutions to legitimize nonsense.

The Cleveland Clinic now has to face the PR nightmare of allowing the foxes into the henhouse (actually they built a new henhouse just for the foxes).

On January 6th Dr. Daniel Neides, Medical Director and Chief Operating Officer of the Cleveland Clinic Wellness Institute, published an anti-vaccine screed on the institution’s blog. The article is full of typical anti-vaccine misinformation, and is a serious embarrassment to the Cleveland Clinic. It will also embolden the anti-vaccine movement, who can point to the article to make vaccines seem controversial and convince more confused parents not to vaccinate their children.

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Comments: 55

Jan 06 2017

Another Child Dies of Medical Neglect

seth-johnsonLast year 7-year-old Seth Johnson died of pancreatitis. His parents, Timothy and Sarah, are now on trial for one count of child neglect.

These are always heartbreaking stories, especially for a parent. Strong and conflicting emotions are stirred – on the one hand I feel anger and resentment toward the parents, who allowed their child to needlessly suffer and die. At the same time I also feel sorry for the parents. There is nothing worse than the death of a child, except feeling responsible for that death yourself. The state can add little to the emotional punishment they must be  already experiencing (although they should try damn hard).

Seeing such parents as victims is not a popular position. It is much easier to see them as villains, even demons. I always strive to see reality in all its complexity, and as a result I often conclude that such parents are some combination of villain and victim. My thoughts also come with the huge caveat that I am getting all my information from the media, and do not have direct access to the medical information or the parent’s story.

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Jan 05 2017

The Misinformation Wars

As we collectively try to climb out of the smouldering rubble that was “the truth” in 2016 (by which I mean basic intellectual integrity), many people are speculating and trying to wrap their brain around what exactly is happening. Of course, the arbitrary transition to a new calendar year changes nothing. We are still living in the same world that produced the 2016 election.

Many writers have characterized what happened as the “weaponization” of bullshit or misinformation. This is not entirely new, but it did seem to reach new heights, or to cross over some fuzzy threshold to a new level or prominence. The “weaponized” meme is also mainstream; Donna Brazile, for example, is saying that the hacked DNC e-mails were “weaponized” against them.

The two other similar memes that emerged this past year were “post truth” and “fake news.” These were added to older notions of “echochambers” or the fact that many people are living in information bubbles (whether they know it or not).

I think all of these concepts are essentially correct. We are in the midst of a misinformation war (actually many wars on many fronts). Unfortunately, it seems that the side which includes the mainstream media, the experts that provide them with information and analysis, professional journalists and academics, is losing. They are losing primarily because they have not yet adapted to the new battleground – social media. They are like the British fighting in neat rows with their visible red uniforms, while the rebels fire at them concealed behind trees and stone walls.

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Comments: 116

Jan 03 2017

More Evidence for Motivated Reasoning

motivated-reasoning-1A recent neuroscientific study looked at what happens in the brains of subjects when their beliefs were challenged. The study adds a new bit of evidence to our understanding of motivated reasoning.

Before we get to the details of the study, let’s review what we mean by motivated reasoning. Psychological studies have shown that people treat different beliefs differently. Specifically, there is one set of beliefs that are core to a person’s identity and to which they have an emotional attachment. We treat such beliefs differently than all other beliefs.

For most beliefs people actually are quite rational at baseline. We tend to follow a Bayesian approach, meaning that we update our beliefs as new information comes to our attention. If we are told that some historical fact is different than what we remember, we will quickly change our beliefs about that historical fact. Further, the more information we have about something, the more solid our belief is, the more slowly we will change that belief. We don’t just change from one thing to the next, we incorporate the new information with our old information.

This is actually a very scientific approach. I would not easily change my belief that the sun is at the center of our solar system. It would take a profound amount of very reliable information to counter all the solid scientific information on which my current belief is based. If, however, I was told from a reliable source something about George Washington I never heard before, I would accept it much more quickly. This is reasonable, and this is how most people function day-to-day.

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Comments: 54

Jan 02 2017

Are We Ready for a Flu Pandemic?

1918-fluIn 1918-1919 the world suffered its worst flu pandemic, with 20-40 million people dying (the CDC claims as many as 50 million). The pandemic resulted from the sudden emergence of a particularly virulent flu strain. In 2008 scientists reconstructed the exact strain, which was influenza A (H1N1).

The virus spread rapidly throughout the world, mostly through trade routes, but the mass movement of people resulting from World War I was thought to be a key factor as well.

Recently Bill Gates stated that he does not feel the world is ready if a similar flu pandemic struck. His foundation is concerned with global health, so he pays attention to such issues. He cited the recent Ebola and Zika outbreaks as evidence that our current preparedness is inadequate.

What are the chances of another pandemic similar to 1918-19? New strains of virulent viruses emerge all the time. It seems inevitable that a particularly bad one will appear at some point, but this is impossible to predict. The CDC states that it is unlikely the next bad flu pandemic will be H1N1 because since the 1918 flu strains of H1N1 have been circulating, and therefore there is decent immunity in the population. H1N1 is also included in the annual flu vaccine. (By the way, if you did not get your vaccine yet, it’s not too late. Do it now.)

But there are many strains of flu. Bird flu is an influenza A virus that mostly infects birds, but has started to cross over to human infections. There are also other viruses, like the SARS (severe acute respiratory syndrome) virus.

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