The Genetic Lottery:

Ethical implications for policy.

 

 

I'd bought and begun Jennifer Hochschild's book Genomic Politics first, when I encountered Kathryn Paige Harden's then-upcoming work in a lengthy New Yorker article (probably paywalled).

Solely on the basis of that article, I subsequently downloaded it the day it was released and read it forthwith. She takes on a "radioactive" "3rd-rail" topic. Adroitly so.

That genetics would be useful at all for advancing the goals of social equality is a claim that is frequently met with skepticism. The potential dangers of eugenics loom large in the imagination. The potential benefits of connecting genetics to social inequalities, on the other hand, might seem slim. Even if a new synthesis of genetics and egalitarianism is possible, why take the risk? Given the dark legacy of eugenics in America, it might feel overly optimistic, even naïve, to imagine that genetic research could ever be understood and used in a new way.

What is missing from this consideration of risks and benefits, however, are the risks of continuing the status quo, where understanding how genetic differences between individuals shape social inequalities is widely considered, by both academics and the lay public, to be taboo. This status quo is no longer tenable...

Harden, Kathryn Paige. The Genetic Lottery (p. 21). Princeton University Press. Kindle Edition.

I thoroughly enjoyed it (heavily documented; more than 400 end-note citations). I'm now back onto Genomic Politics for comparisons and contrasts. I've riffed on "Omics" issues across the years (though mostly focused on clinical dx IT support and QA issues). apropos,

WBUR INTERVIEW

TEXAS MONTHLY ARTICLE

Tents, wheelchairs, and shopping carts piled with belongings sat baking in the sun next to the intersection where Kathryn Paige Harden pulled to a stop at a red light. She had driven past the homeless encampment, beneath an Austin freeway, often enough that she carried bottles of water to hand out through her car window to those who lived there. On this hot summer afternoon a couple years ago, her two young children voiced their concerns for the welfare of the camp’s residents. “Will ghosts get them at night?” the kids asked from the back seat. “Why don’t they have houses?”

Harden was struck by the range of potential answers to the latter question. They’d made bad choices? They didn’t work hard enough? The system was stacked against them? She gave her son and daughter the short version of what she believes: “Some people are unlucky in their lives.”

She offers a much longer, more complex answer in her new book, The Genetic Lottery: Why DNA Matters for Social Equality, published this September by Princeton University Press. A psychologist at the University of Texas at Austin, Harden studies how our genes influence the way we think, feel, and act—a field known as behavioral genetics. She writes that some people are born lucky, with DNA containing variants that predispose them to academic achievement, stable jobs, higher incomes, and greater well-being. Others inherit variants more likely to lead to mental illness, addiction, and poverty, as well as a greater risk of homelessness. While acknowledging the roles our environment and experiences play in shaping our lives, HardenBmakes the case that social scientists who want to address the roots of inequality must reckon with genetics.

That stance has made her something of a lightning rod. She’s been accused of promoting eugenics, the discredited pseudoscience of “improving” the human race through selective breeding. One colleague even likened her research to the claims of those who deny that the Holocaust occurred…

My typical book candidate vetting involves Amazon reviews (cogent low-rated reviews can be a show-stopper) and Google searches). In this case, I didn't look at anything beyond the New Yorker article prior to my purchase. But, post hoc,

PRINCETON UNIVERSITY PRESS BLURBS

"The ultimate claim of The Genetic Lottery is an extraordinarily ambitious act of moral entrepreneurialism. Harden argues that an appreciation of the role of simple genetic luck—alongside all the other arbitrary lotteries of birth—will make us, as a society, more inclined to ensure that everyone has the opportunity to enjoy lives of dignity and comfort."
—Gideon Lewis-Kraus, New Yorker

"The Genetic Lottery is a good read, peppered with relatable stories and examples. Harden pulls off the trick of simultaneously introducing a technical field to newcomers; addressing deep, specialist debates; and taking seriously the intersection of scientific and philosophical analyses of inequality."
—Aaron Panofsky, Science

"While acknowledging the roles our environment and experiences play in shaping our lives, Harden makes the case that social scientists who want to address the roots of inequality must reckon with genetics. . . . The more researchers understand about the myriad factors that influence how our lives turn out, the more they can help improve outcomes for everyone. Genetics is one of those factors, Harden argues: when we ignore it, the most vulnerable suffer."
—Jennifer Latson, Texas Monthly

"[An] outstanding new book. . . . It’s scientifically spot on, historically adroit, and excellently written. Required reading."
—Adam Rutherford

"Harden diligently fights a desperate battle to enlist science to serve progressive social reform."
—Kirkus Reviews

“This brilliant book is without a doubt the very best exposition on our genes, how they influence quite literally everything about us, and why this means we should care more, not less, about the societal structures in which we live.”—Angela Duckworth, author of Grit

“To me, the aim of genetic research should be threefold: to find out which differences between people are real, which of those matter, and how to use that knowledge to get the best outcomes for all people. This fascinating book is a step toward that goal.”—David Epstein, author of Range

“Harden expertly explains what we can—and importantly, can’t—take away from genetic research, and does so without shying away from the complexities or controversies. Nobody should be allowed to opine about genetics in public until they’ve read this book.”—Stuart Ritchie, author of Science Fictions

“A thoughtful, brave, and very engaging book. In contrast both to those who see genetic differences as justifying hierarchy and to those who reject the study of the influence of genes on social stratification, Harden argues that understanding the findings of behavioral genetics is essential if we are to create a more just society.”—Peter Singer, Princeton University

“The Genetic Lottery is a must-read for anyone who cares about understanding why humans differ from one another. Harden lights a clear path toward an anti-eugenic genetics that embraces human diversity and works toward equity for all humans.”—Russell A. Poldrack, author of Hard to Break

“Compelling and highly readable. Harden dispels the myths that genes are destiny, that their influence is all-or-none, and that those who work on genetics are eugenicists. She makes a persuasive case that if we understand genes this can help us work towards a fairer society.”—Dorothy Bishop, University of Oxford

“Harden skillfully integrates genetic research and social science to address inequality. She demonstrates that empirical advances in understanding the role of biology and social influence in life outcomes can productively inform our moral debates and public policy decisions, if only we can forthrightly address the blinkered generalizations of the past.”—Matt Grossmann, author of How Social Science Got Better

“In this thoughtful, important, and fascinating book, Harden presents a new synthesis of genetics and egalitarianism, showing how an appreciation of the power of genes is essential for moving us towards a good and just society. The Genetic Lottery is going to have a major impact on how everyone thinks about luck, merit, and human nature.”—Paul Bloom, Brooks and Suzanne Ragen Professor of Psychology, Yale University, author of The Sweet Spot: The Pleasures of Suffering and the Search for Meaning

Notwithstanding that there's obviously "confirmation bias" in the foregoing, I agree with all of those assessments. My blurb would simply say "She's right."

UPDATE: SO MANY STRAW MEN, SO LITTLE TIME

 

This commenter doesn't like "lefties."

“The hero of the [New Yorker] article is a young academic super-star lefty named Kathryn Paige Harden who, the New Yorker says, is almost single-handedly fighting a two-front war: “on her left are those who assume that genes are irrelevant, on her right those who insist that they’re everything.” No one — and I mean no one — thinks genes are “everything,” but that is the pose lefties strike. They believe only committed progressives can truly understand the policy implications of genetics.”

Unhappily, I find a lot of the ad hominem-laden criticism of Dr. Harden—amid the usual Straw Men—condescending and misogynistic. Calling her knowledge of psychology “sophomoric?“ Really (a psychology PhD tenured professor)? Dismissing her methodical, detailed argument as "nonsense" is itself nonsense. One (male) critic on Twitter (a Canadian "Labour Economist"**) called her work "asinine." How helpful.

** An economist is someone who encounters something that works in practice and tries to determine whether it will work in Theory.

MY AMAZON REVIEW

Click to enlarge.

 

"MAJOR SOCIETAL ISSUES?"

 

LOL.

Well, the latter one may be headed toward resolution.

 

More to come, particularly as I now finish Dr. Hochschild's book (I also have 3 others in the oven at the moment; keeps Grandpa off the streets).

________

 

   

Science.org OpEd:

Climate science speaks: “Act now”

Last month, one of the most remarkable scientific endeavors on the planet delivered a report to the world. Hundreds of international scientists volunteered thousands of hours to evaluate more than 14,000 scientific publications, respond to over 78,000 comments, and produce a comprehensive scientific assessment to inform government policy-makers. What topic could justify such an intense global effort? The crisis posed by climate change.

For over 30 years, the Intergovernmental Panel on Climate Change (IPCC) has been assessing the science of climate change. Each successive report has provided stronger evidence and deeper understanding, giving governments much of the information they need to develop a response. The fifth IPCC report, released in 2014, catalyzed the Paris Agreement, which aspires to limit the increase in average global temperature to well below 2°C above preindustrial levels, and preferably to 1.5°C.

The Working Group I contribution to the IPCC’s 2021 Sixth Assessment reflects our ever-growing understanding of the physical science basis of climate change, including advances that allow scientists to decipher the fingerprint of climate change in heat waves, heavy rainfall and floods, droughts, and wildfires. These increasingly frequent and severe events are dominating global headlines and stoking public awareness of the economic and humanitarian consequences facing the world because of climate change. The report is full of other noteworthy advancements—more observations of ocean heat waves, improvements in modeling ice sheet dynamics, greater appreciation of the role of short-lived greenhouse gases such as methane, more realistic scenarios of sea level rise, and an understanding of what remains unknown.

Two stark findings command attention. Some changes underway in the ocean and the Arctic are potentially irreversible on human time scales. And the pathway for limiting warming to 1.5°C is narrowing rapidly. These results underscore the urgency of vastly enhancing global ambitions to tackle this threat. Every bit of avoided warming matters…

Because no single nation can solve the crisis alone, the United States is working with other countries to lower their own emissions and improve their resilience while assisting those places already suffering from climate change. The next decade will be critical. To keep the 1.5°C target within reach, all major economies must do more, with immediate, robust, and sustained action to reach net-zero emissions by 2050. This means deploying technological and natural climate solutions, such as conserving and restoring terrestrial and mangrove forests, saltmarshes, and seagrass beds. It means focusing not only on terrestrial activities but also on ocean-based ones such as generating renewable wind, current, and tidal energy; decarbonizing shipping; and protecting existing stores of carbon on the seabed. It means becoming better at helping communities, economies, and ecosystems adapt to climate disruptions.

The world owes a huge debt of gratitude to the hundreds of contributors who labored during a global pandemic to bring the IPCC’s timely findings to policy-makers. Science has delivered the clarity of knowledge. It is now up to leaders in every country—but especially the major economies—to act boldly. This year’s United Nations Climate Change Conference (COP26) in November must be a turning point—the moment when the world heeds scientific findings and collectively rises to meet the greatest challenge of our time.

Adverse anthropocene climate change is a thing, whether we believe it or not. "Clarion Call?"

 

 

 

Climate-related disaster refugees from Central America—or, as Fox News put it, "the countries of Mexico"—are amassing at the U.S. southern border (now in addition to desperate Haitians displaced by their recent earthquake).

UPDATE

And, another new book pops up (Sept 21st release).

 

Came to me via a New Yorker article. e.g.,

Climate change hasn’t always been so divisive. In the late nineties, a Gallup poll found that forty-six per cent of Democrats and forty-seven per cent of Republicans agreed that the effects of global warming had already begun. “As recently as 2008, former speaker of the house Newt Gingrich, a Republican, and current House speaker Nancy Pelosi, a Democrat, cozied up on a love seat in front of the U.S. Capitol to film a commercial about climate change,” Hayhoe writes in her book. In the past decade, though, as the scope of the crisis became clear, Democrats began pressing for policies to cut U.S. reliance on fossil fuels, and Republicans were reluctant to commit. Energy companies stepped into the stalemate and began aggressively lobbying politicians, and injecting doubt into the public discourse, to stop such policies from taking effect. “Industry swung into motion to activate the political system in their favor,” Hayhoe said.

At its root, she notes, the climate-change divide isn’t a disagreement about facts. “In a study of fifty-six countries, researchers found people’s opinions on climate change to be most strongly correlated not with education and knowledge, but rather with ‘values, ideologies, worldviews and political orientation,’ ” she writes. One salient problem is an aspect of human behavior that researchers have termed “solution aversion.” Solving the climate crisis will require ending our reliance on fossil fuels, which people believe would involve major sacrifice. “If there’s a problem and we’re not going to fix it, then that makes us bad people,” Hayhoe said. “No one wants to be a bad person.” So instead people are happy to seize on excuses not to take action. Most are what she calls “science-y sounding objections, and, in the U.S., religious-y sounding objections.” Hayhoe often hears that the Earth has always heated and cooled according to its own intrinsic cycle, or that God, not humanity, controls the fate of the planet. These objections can then harden into aspects of our political identity…

Just released.

PREFACE
It took a pandemic to bring us together.

As coronavirus swept across the world, we saw country after country go into lockdown. Schools closed and places of work shut down. For a while, it seemed we were all united against a common threat.

As the pandemic wore on, this consensus started to disintegrate. Political leaders who’d been elected on waves of nationalist and populist rhetoric began to depict coronavirus precautions as more damaging to society than the disease itself. Supposedly reputable sources hyped false cures, and deliberately misrepresented the severity of the illness. In the U.S., going without a face mask became a badge of the conservative cause. While some continued to social distance, others held gatherings, some of which turned into superspreader events. The contrast between nations was stark—and the difference in infection and death rates equally so.

Sadly, none of this surprised me. I’ve spent my career studying climate change. The same techniques used to politicize coronavirus—promoting pseudoscience and fake experts, slandering the actual experts, valuing the economy over human life, even hiding or denying data to make the issue seem less urgent and less harmful than it is—have been applied to climate change for decades. Horrified, I’ve seen political biases drive people to reject simple facts: climate is changing, humans are responsible, the impacts are serious, and the time to act is now.

The U.S. is arguably home to the most extreme divisions between liberal and conservative, but I’ve seen these same divisions growing in recent years in my home country of Canada, in the U.K., in Australia, in Europe, and beyond. No matter where we live, the result is the same: as people identify with increasingly narrow tribes, they begin to view those with different views as alien, not worth respecting or even treating as human…

Hayhoe, Katharine. Saving Us: A Climate Scientist's Case for Hope and Healing in a Divided World (p. IX-X). Atria/One Signal Publishers. Kindle Edition

_________

 

As seen on LinkedIn, no less:

This kind of stuff makes me angry. 

You'd expect to see this kind of tripe on Twitter, Facebook, or Instagram, etc. But LinkedIn?

 

Real piece of work, this guy.

 

BTW,  saw my neurologist today. While I was there at KP, I got a flu shot, #comrade Michalski.

_________

 

Biofield “Science?” A “MeSH-mash" of Woo?

Stress-testing the Principle of Charity admonition.

 

Earlier in the week I got an email notifying me of the latest issue of Scientific American (I'm a subscriber). I cited one of the articles and an OpEd in my prior post. 

(BTW, “MeSH” is NLM-speak for “Medical Subject Heading.”)

I ran across this book ad as well.

Uh-oh...

Read the Amazon blurb, then did a bit of Googling, quickly found this (pdf):

ABSTRACT
Biofield science is an emerging field of study that aims to provide a scientific foundation for understanding the complex homeodynamic regulation of living systems. By furthering our scientific knowledge of the biofield, we arrive at a better understanding of the foundations of biology as well as the phenomena that have been described as “energy medicine.” Energy medicine, the application of extremely low-level signals to the body, including energy healer interventions and bio- electromagnetic device-based therapies, is incomprehensible from the dominant biomedical paradigm of “life as chemistry.” The biofield or biological field, a complex organizing energy field engaged in the generation, maintenance, and regulation of biological homeodynamics, is a useful concept that provides the rudiments of a scientific foundation for energy medicine and thereby advances the research and practice of it. An overview on the biofield is presented in this paper, with a focus on the history of the concept, related terminology, key scientific concepts, and the value of the biofield perspective for informing future research.

INTRODUCTION
Medicine is in transition. Conventional biomedicine is giving way to an expanded, integrative medical model that emphasizes healthcare as well as illness care, treats people not just diseases, and incorporates multiple therapeutic approaches, old and new, to offer patients greater choice…

CONCLUSIONS AND FUTURE PROSPECTS
The biofield concept, emerging initially from vitalist perspectives, offers an increasingly useful approach to explain a variety of physiological phenomena. Its applicability continues to evolve in terms of empirical inquiry. Endogenous biofield interactions with environ- mental, geocosmic, and other exogenous fields provide the rudiments of a scientific foundation for a holistic view of life and a modus operandi for numerous CAM modalities. The family of energy healing practices that have been widely practiced since antiquity, now called biofield therapies, may involve biocommunication and/ or energy transfer through the biofield. While the bio- field concept is a useful construct to guide new research on energy healing and other CAM modalities, it is also a requisite for a better understanding of contemporary developments in biophysics and biology. Moreover, information connected with the biofield may serve as a bridge between mind and body, which is fundamental to understanding mind-body interactions.

The biofield is also an important metaphor to guide further research. There are numerous examples from the history of science where metaphor and analogy have been key elements in the construction of successful theories. The use of metaphor in science is especially appropriate and critical for success in the exploratory phase of investigation when detailed descriptions and theories are unavailable. Metaphors provide foundational material for forming hypotheses, conducting studies, and eventually elucidating testable theories. Scientific metaphors can be key elements for posing truly novel questions, which upon experimental testing, advance our knowledge and understanding. The concept of the biofield, while still in its nascent stages, may well serve this purpose as biology moves from a local, chemistry-based model to an interconnected, information-based viewpoint. Further investigations in biofield science and healing, especially those involving multidisciplinary collaborations—including clinical and preclinical trials, physiology, biophysics, device technology, and theoretical and philosophical models—will guide the way to a new paradigm in biology and medicine.

"Emerging field of study?" "Principle of Charity?"

Hmmm... I've been having to parse the Woo for a long time. Let me rewind to nearly a quarter-century ago, excerpting my essay recounting my late elder daughter's terminal cancer ordeal.

ONE IN THREE
The search for survival and healing
Should you or a loved one be beset by advanced and life-threatening cancer, gird yourself for an overwhelming onslaught of information, much of it in conflict, all of it ostensibly requiring your immediate consideration and action lest you accede to fatal delay.

My empirical triage effort began within days of Sissy's admission to County. While we were still struggling to come to grips with everything coming fast and furious from the doctors and medical administration, well-meaning friends and acquaintances began peppering us with unsolicited advice and literature, some of it conveying a bizarre ignorance that would leave me floundering for the politic response that would not demean and offend. Pejorative retort suppression would become an ongoing emotional exercise (repeatedly aided by the quiet and gentle reproach of my saintly wife).

It commenced with a reprint of an "article" hawking a book wherein it would be recounted in further detail just why "all cancers" were caused by intestinal flatworms! (The author ended nearly every sentence with one or more exclamation marks!) The curative regimen would simply involve purging the gastrointestinal tract of these carcinogenic parasites through a regimen including colonics and herbal mixtures. The boyfriend delivering this wonderful news was utterly sold on its merit: Salvation was at hand!

Mercifully, Dr. Wren got me off the hook on this one with a diplomacy worthy of a Secretary of State.

Next would come the "Hoxsey" video, a slick production exuding first-class "documentary" production values--sinister in tone--detailing the history of the miraculous herbal anti-cancer "formula" purportedly discovered by one uneducated Harry Hoxsey decades ago while treating horse hide lesions on his father's farm. The video-- replete with ominous background music and newsreel headline cutaways-- recounts the foul banishment of this alleged "savior" to Mexico by the greedy and venal American Medical Association. The Hoxsey clinic in Tijuana today still attracts innumerable desperate cancer sufferers bereft of more conventional clinical options and ready with cash.

After close consideration, I had no choice but to count myself in the company of those regarding this stuff as the worst sort of quackery.

Essiac tea (brand name: Fluoressence). The story is told that a Canadian nurse--one Rene Caisse--was the recipient of a mysterious healing herbal recipe used by an Ojibwa tribal medicine man that caused all manner of malignancies to disappear in short order. It is predictably alleged that the Canadian counterpart to our A.M.A. in concert with Ottawa would see to the suppression of this wondrous substance.

Proponents of this beverage invariably mention that "Essiac" is "Caisse" spelled in reverse. In my case, no particular epiphany would be forthcoming in the wake of this "Sgt.-Pepper-Played-Backwards" intimation, and, after much digging concerning the ingredients and their asserted efficacy, I could find nothing clinically interesting in Essiac.

"Resonance" machines? What? Another phone number slipped to me at the hospital had me listening to a sales pitch extolling a $1,500 "radionics therapy" device used to destroy tumors by resonating with the electro-biological "cancer frequency" of malignant tissues.

Right.

Not flatworms! No, it was "bacteria in the blood," the result of diet, specifically consumption of items such as chicken, that was the source of all cancer, another "doctor" explained to me over the phone from his Tijuana clinic. "We can't get the docs in the States to understand this," he intoned with weary resignation. His methodology: purge the blood through a revised diet that, among other things, eschewed chicken and mandated the consumption of lamb. Why? A devotee of this practitioner had a ready retort: "Y'ever watch chickens eat? They peck at the ground, picking up all kinds of bacteria." Oh.
 
Lamb, on the other hand, came from "root-eating" livestock that, while foraging through the subterrain, ingested the beneficent, supposedly cancer-curing below-ground nutrients central to this serum antiseptic "therapy." We could come down to the Tijuana clinic for an initial two-week stay for blood assessment and initiation of therapy. $2,500 per week. But, according to our locally referred contact--'he'll work it out with you if money is a problem; he's a very compassionate man. He really cares for his patients, he takes the time to listen to their concerns.'
 
In contrast to the "arrogant, narrow-minded, greedy, and indifferent" American clinicians who controlled medical practice in The States (the oft-repeated mantra of the more strident segment of the "alternative healing" movement) clearly implicit in this appeal.

The foregoing comprise a more or less representative sampling of our experience thus far with the quackery end of the alternative therapy spectrum, a distribution of propositions whose opposite terminus abuts the breadth of mainstream clinical research and practice, where methods as yet "unproven" but more logically reasonable and promising vie for acceptance by the medical establishment. In the middle lie tougher calls: does shark cartilage really shrink tumors, functioning as an angiogenesis inhibitor? (one skeptical journal article called it "the laetrile of the 90's") Hydrazine sulfate? (also reported on extensively in the mainstream clinical literature and generally--though not uniformly--dismissed as 'ineffective.') Nucleotide Reductase? Plant oils? Blue-green algae?

All of these unconventional therapeutic assertions--many of which would prove to be merely unproductive, outlandish, maddening distractions--would have to be checked out while also slogging through the vast archives of mainstream clinical literature, a quest that would take me through the most recent three years of month-by-month National Cancer Institute (NCI) hepatoma citations…

'Arrogant, narrow-minded, greedy, and indifferent?'
Is science the enemy? To the extremist "alternative healing" advocate, the answer is a resounding 'yes'! A disturbing refrain common to much of the radical "alternative" camp is that medical science is "just another belief system," one beholden to the economic and political powers of establishment institutions that dole out the research grants and control careers, one that actively suppresses simpler healing truths in the pursuit of profit, one committed to the belittlement and ostracism of any discerning practitioner willing to venture "outside the box" of orthodox medical and scientific paradigms.
 
One e-mail correspondent, a participant in the internet newsgroup alt.support.cancer, vented splenetic at length recently regarding U.S. authorities' alleged hounding, arrest, and imprisonment of alternative healers. He railed that law enforcement, at the behest of the AMA/FDA Conspiracy (a.k.a. the "corrupt AMA/FDA/NCI/ACS cartel"), had made the practice of alternative medicine illegal in the U.S. Moreover, he considered the fact that medical science can only claim "cures" for approximately 10% of the roughly 10,000 classified human diseases an a priori indictment of the mainstream profession.

I know: this is akin to the U.N. Black Helicopters/One-World-Government Conspiracy stuff of the not-too-tightly-wrapped. Still, I couldn't resist--pointing out in (no doubt futile) reply that no one came with guns drawn and cuffs at the ready the night at Brotman Rehab when "Healing Angelite Crystals" practitioners--devotees of India's Sai Baba--came from Topanga Canyon to hover for hours in ceremony over Sissy (to the curious and wary befuddlement of the night shift nurses); neither did Security nor the medical staff at Brotman confiscate the goopy-looking herbal tonic we brought in, an elixir prescribed for Sissy by a Chinese herbal pharmacist doing business quite openly in Chinatown near downtown L.A.; nor would SWAT teams pounce on the backyard in the Valley where we took part in evening-long Lakota Souix "healing sweat lodge" ceremonies conducted by the venerable Wallace Black Elk; and finally, Wyndie, one of Sissy's highly skilled and effective physical therapists at Brotman did not have her certification revoked for counseling my daughter on the Hindu principles of the Chakras and efficacy of aromatherapy.

Moreover, I had to respond, the fact that we can only cure 10% of known diseases implies nothing regarding the quality of mainstream medical research and practice, unless the alternatives industry can provide hard, "case-mix adjusted," scientifically valid data showing their methods to effect consistently and significantly better outcomes-- which they cannot (a dearth of peer-reviewed studies being a central characteristic of "alternative" practice). Additionally, I asked, can anyone even cite historical curative percentages from 30, 50, or perhaps 100 years ago? Indeed, even such statistics would prove problematic--"shooting at a moving target," as it were--in that more subtle and clinically unresponsive maladies continue to be discovered and classified while the easier to treat are dealt with more readily. And, classificatory observation is easy compared to the work and resources required to effect cures; we should expect that identification will outpace remedy. Finally, 50 years ago death certificates listing demise from "natural causes" would today likely have identifiable diseases recorded as the cause of death.

Purveyors of medical quackery should fear the hot breath and hard heel of competent authority, but I see no evidence of suppression of alternative therapy methods that are not certifiably fraudulent. All manner of "unproven" substances are sold quite openly at retail, both in the health food stores and in the national chain outlets; all that need accompany the product is the legal boilerplate disclaimer acknowledging an absence of FDA blessing, along with the inoculating phrase 'dietary supplement.’…

For the bulk of the alternative healing industry, the real frustration has nothing whatever to do with clinical and political repression, and everything to do with lack of access to the pockets of third-party payers. While such may be a very real economic problem for health care consumers and the vendors of alternative products and services, it has little to do with clinical "narrow-minded arrogance." Peer-reviewed studies of the unpatentable epigallocatechin alone have, after all, somehow found funding hundreds of times thus far….

Every discipline has its share of the "arrogant and narrow-minded," but I have mostly found mainstream health care professionals to be a dedicated, unpretentious, and self-deprecating lot quite aware of the limits of their knowledge and the risks of presumption. Once, during a series of health care quality improvement seminars I attended at Intermountain Health Care in Salt Lake City during my Peer Review tenure, a speaker--himself a noted pediatric surgeon--wryly observed that "the best place to hide a hundred dollar bill from a doctor is inside a book." The Director of the seminar series, Dr. Brent James of IHC (and a Fellow of the Harvard School of Public Health), noted in our opening session that physicians would probably admit--off the record, of course--that perhaps only 10% of their clinical decisions made during daily practice could be traced to the peer-reviewed scientific literature. Dr. James also made the droll observation that, were you to walk into the typical medical adminstrator's office, "you'd be much more likely to see copies of the Wall Street Journal rather than the New England Journal strewn about."

What can one take away from such remarks? First, the many physicians I have come to know in the past few years are in the main acutely sensitive to the problems of clinical conceit and "paradigm blinders." Indeed, the Utah pediatrician's"$100 bill" wisecrack was offered to an audience of doctors and their allied health personnel during quality improvement training. Second, the body of peer-reviewed medical literature does not constitute a clinical cookbook; even "proven" therapies--particularly those employed against cancers--are generally incremental in effect and sometimes maddeningly transitory in nature. The sheer numbers of often fleeting causal variables to be accounted for in bioscience make the applied Newtonian physics that safely lifts and lands the 747 and the space shuttle seem child's play by comparison. Astute clinical intuition is a necessary component of a medical art that must, after all, act and act quickly--so often in the face of indeterminate, inapplicable, or contradictory research findings.

Finally, with respect to Dr. James' Wall Street Journal quip, the capitalist imperatives within which health care clinicians must operate are, in the aggregate, neither of their making nor under their control. Moreover, blanket indictment of the profit motive as necessarily inimical to optimum medical care and research is a rather simplistic notion. Strategies aimed at maximizing investors' net returns probably spur at least as many medical advances as they inhibit...

A Healing Burger
Or, the "healing pizza/chocolate shake/friesî? One day not long ago, after we'd visited with a pleasant, seemingly intelligent woman of recent acquaintance who had also endured a long struggle with cancer and was committed to a "holistic healing" regimen, I ribbed Sissy that we ought cruise down Sunset for lunch, specifically to order some "healing burgers,"--my facetious reaction to having been cut off mid-sentence the prior evening after uttering the phrase "fruit juice" in the course of responding to a query concerning Sissy's daily diet. "Oh, no! No fruit juice!" "No sugar!" "No fat!" "No meat!"
 
The magical quality that "holistic" evangelists impute to various vitamins, herbs, and certain foods (the latter for both good and ill), frequently shouts down the more circumspect and common-sense notion of an adequate and balanced diet. In my mind I parry their personal anecdotes with the equally anecdotal evidence of the long and mostly healthy lives of the large extended family comprising my in-laws. Most of these rural northern Alabama farmers manage somehow to live into their 90's despite life-long daily breakfast doses of sausage and eggs with biscuits and gravy--along the rest of the typical meat-laden, putatively carcinogenic and arteriosclerotic farm fare that would make a brown rice zealot shrink in horror.

Most of these dietary-herbal and related recuperative obsessions ring resonant with the "bargaining" stage of Elizabeth Kubler-Ross's dying process model. Please, Lord, I'll change my indulgent, unhealthy ways, please-- just spare my life! See, I'm doing my herbal/ carrot juice/ seaweed/ colonic/ aromatic/ crystalite/ meditative/ mega-vitamin/ macrobiotic/ psycho-spritual penance; please, please spare my life!

Quantum quandaries
Given the stakes, productively traversing these vast and snarled thickets spanning credulous hearsay to incontrovertible fact has become an ongoing priority, and will so remain so long as need be. My lengthy academic and professional involvements with quantitative analytic disciplines, however, have proven both blessing and curse in helping Sissy deal with her struggle. While my fluency with empirical data and technical jargon helps me parse the literature and interact intelligently with the doctors, I am never certain of just how hard to lean on my scientific skepticism, given both what I know of the epistemological limits of "science" and the relentless barrage of sometimes intriguing alternative therapy assertions I encounter. While close study of biostatistical and epidemiological methodologies and critical works such as Peter Huber's Phantom Risk and Galileo's Revenge, Gross, Levitt, and Lewis's The Flight From Science and Reason, Carl Sagan's The Demon Haunted World: Science as a Candle in the Dark, and Kahneman and Tversky's Judgement Under Uncertainty: Heuristics and Biases tends to make one not suffer fools gladly, the predisposition can easily slip over into "narrow-minded arrogance."
 
It was, after all, a Santa Monica Chinese practitioner of acupuncture and herbal medicine, one Dr. Yi Pan, who first called Sissy's attention to a problem with her liver several years prior to her HCC diagnosis. She'd been referred to him by a girlfriend for attention to a menstrual problem. Dr. Pan had a diagnostic acumen requiring no x-rays, CT scans, or blood tests. Yet, the internet medical fraud site www.quackwatch.com dismisses traditional Chinese medicine as "ineffective," as do many other critics of alternative practices.

Tragically, Sissy summarily discounted his prescient admonition. I can only speculate wistfully on the implications of our having known three years earlier.
 
Renowned paleontologist Steven J. Gould eloquently cautions us in The Median Is Not The Message--wherein he recounts his triumph over the particularly frightful type of cancer known as mesothelioma--that indeed the individual is not a "statistic," that variation rather than expectation is the "hard" reality, and that in such recognition lies the potential for rational optimism. Yes, and probabilistic variation--with its seemingly paradoxical notion of order borne of randomness--is also fundamental to our dawning awareness of the broader implications of quantum theory. Unquestionably, we transcend our "data," changing that which we measure by the ineffable force of observation, and in such awareness may lie a key to healing, it is proclaimed.
 
But--is Deepak Chopra merely a cynical huckster, misrepresenting the ostensibly Hindu/Zen-like principles of sub-atomic wave/particle theory to sell books and tapes such as Quantum Healing to an apparently large and eager audience of scientific dilettantes mesmerized by the spurious conflation of the Ayurvedic and the sub-atomic? Is the deadly serious Chapter 14 of Scott Adam's otherwise hilariously flip best-seller The Dilbert Future mere dramatic counterpoint--a sophomoric and specious "self-help" interpretation of the principles of quantum mechanics so beautifully explicated in Gary Zukov's 1978 book The Dancing Wu Li Masters? Chopra, after all, has left himself a very big out by declaring that perhaps only 1% of those in dire medical need can lock onto the principles necessary to effect 'quantum' self-healing, a caveat akin to the "sold-as-a-dietary-supplement-only" and "not-intended-for-the-treatment-of-any-disease" disclaimers found on all herbal remedies. And, Scott Adams touts his empirical slovenliness almost as a virtue…

You see my Yellow Flags problem here?

I've not yet subjected the Jain et al paper to any formal "Argument Analysis and Evaluation" effort, wherein you ID and assess every premise-to-conclusion element and chain (pdf). Looks like it would entail maybe 50 hours to do so (we need an AI app for this). The paper contains 85 end-note references citations, many of which may contain actual empirical findings rather than being merely "metadata." Don't know yet. 

 

I've alerted the folks at Science-Based Medicine.

 

UPDATE

___

apropos OF THE TOPIC? FROM ANOTHER OF MY BLOGS, 2009

 

 

In the mid-late 1990s, while caring for my terminally ill daughter in Hollywood, I recall reading that there were more MRI machines deployed in the Los Angeles area than in the entire nation of Canada, the inference being that the American economics of hugely expensive sense-extending diagnostic imaging technologies such as MRI units, CAT scanners, cardiac dynamic stress test machines, etc tended toward the economically problematic. Every medical institution feels compelled to have them to be credible, competitive Players in the market, but everyone also needs to keep them all profitably humming, with viable billable payers at the end of the back office line. And, every additional install exacerbates the billable utilization problem. Damned if you do, damned if you don't.

Well consider a brief true story from several decades ago, written by surgeon and writer Dr. Richard Selzer:

On the bulletin board in the front hall of the hospital where I work, there appeared an announcement. “Yeshi Dhonden,” it read, “will make rounds at six o’clock on the morning of June 10.” The particulars were then given, followed by a notation: “Yeshi Dhonden is personal physician to the Dalai Lama.” I am not so leathery a skeptic that I would knowingly ignore an emissary from the gods. Not only might such sangfroid be inimical to one’s earthly well-being, it could take care of eternity as well. Thus, on the morning of June 10, I joined a clutch of whitecoats waiting in the small conference room adjacent to the ward selected for the rounds. The air in the room is heavy with ill concealed dubiety and suspicion of bamboozlement. At precisely 6 o’clock, he materializes, a short, golden, barrely man dressed in a sleeveless robe of saffron and maroon. His scalp is shaven, and the only visible hair is a scanty black line each hooded eye.

He bows in greeting while his young interpreter makes the introduction. Yeshi Dhonden, we are told will examine a patient selected by a member of the staff. The diagnosis is as unknown to Yeshi Dhonden as it is to us. The examination of the patient will take place in our presence, after which we will reconvene in the conference room where Yeshi Dhonden will discuss the case. We are further informed that for the past two hours Yeshi Dhonden has purified himself by bathing, fasting, and prayer. I, having breakfasted well, performed only the most desultory of ablutions, and given no thought at all to my soul, glanced furtively at my fellows. Suddenly, we seem a soiled, uncouth lot.

The patient had been awakened early and told that she was to be examined by a foreign doctor, and had been asked to produce a fresh specimen of urine, so when we enter her room, the woman shows no surprise. She has long ago taken on that mixture of compliance and resignation that is that the facies of chronic illness. This was to be but another in an endless series of tests and examinations. Yeshi Dhonden steps to the bedside while the rest stand apart, watching. For a long time he gazes at the woman, favoring no part of her body with his eyes, but seeming to fix his glance at a place just above her supine form. I, too, study her. No physical sign nor obvious symptom gives a clue to the nature of her disease.

At last he takes her hand, raising it in both of his own. Now he bends over the bed in a kind of crouching stance, his head drawn down into the collar of his robe. His eyes are closed as he feels for her pulse. In a moment he has found the spot, and for the next half hour he remains of us, suspended above the patient like some exotic golden bird with folded wings, holding the pulse of the woman beneath his fingers, cradling her hand in his. All the power of the man seems to have been drawn down into this one purpose. It is tell patient of the pulse raced to the state of ritual. From the foot of the bed, where I stand, it is as though he and the patient had entered a special place of isolation, of apartness, about which a vacancy hovers, and across which no violation is possible. After a moment the woman rests back upon her pillow. From time to time she raises her head to look at the strange figure above her, then sinks back once more. I cannot see their hands joined in a correspondence that is exclusive, intimate, his fingertips receiving the voice of her sick body through the rhythm and throb she offers at her wrist. All at once I am envious -- not of him, not of Yeshi Dhonden for his gift of beauty in holiness, but of her. I want to be held like that, touched so, received. And I know that I, who have palpated 100,000 pulses, have not felt a single one.

At last Yeshi Dhonden straightens, gently places the woman’s hand upon the bed, and steps back. The interpreter produces a small wooden bowl into sticks. Yeshi Dhonden pours a portion of the urine specimen into the bowl, and proceeds to whip the liquid with the two sticks. This he does for several minutes until a foam is raised. Then, bowing above the bowl, he inhales the older three times. He sets down the bowl, and turns to leave. All this while, he has not uttered a single word. As he nears the door, the woman raises her head and calls out to him in a voice at once urgent and serene. “Thank you, doctor,” she says, and touches with her other hand the place he had held on her wrists, as though to recapture something that had visited their. Yeshi Dhonden turns back for a moment to gaze at her, then steps into the corridor. Rounds are at an end.

We are seated once more in the conference room. Yeshi Dhonden speaks now for the first time, in soft Tibetan sounds that I’ve never heard before. He has barely begun when the young interpreter begins to translate, the two voices continuing in tandem – a bilingual fugue, the one chasing the other. It is like the chanting of monks. He speaks of winds coursing through the body of the woman, currents that break against barriers, eddying. These vortices are in her blood, he says. The last spendings of an imperfect heart. Between the chambers of her heart, long, long before she was born, a wind had come and blown open a deep gate that must never be opened. Through it charged the full waters of her river, as the mountain stream cascades in the springtime, battering, knocking loose the land, and flooding her breath. Thus he speaks, and is silent.

“May we now have the diagnosis?” A professor asks.

The host of these rounds, the man who knows, answers. “Congenital heart disease,” he says. “Interventricular septal defect, with resultant heart failure.”

A gateway in the heart, I think. That must not be opened. Through it charge the full waters that flood her breath. So! Here then is the doctor listening to the sounds of the body to which the rest of us are deaf. He is more than doctor. He is Priest.

I know, I know, the doctor to the gods is pure knowledge you’re healing. The doctor to man stumbles, most often wound; his patient must die, as must he.

Now and then it happens, as I make my own rounds, but I hear the sounds of his voice, like an ancient Buddhist prayer, its meaning long since forgotten, only the music remaining. Then the jubilation possesses me, and I feel myself touched by something divine.

[1976: Richard Selzer, MD, Mortal Lessons: Notes on the art of surgery]

'eh?

 

Woo? Or astute "clinical" cognition emanating from a vastly different culture? A human MRI able to accurately probe the patient's "biofield?"

UPDATE

"Biofield Science" author Shamini Jain:

_________

We now return you to your regularly scheduled #Covid19 pandemic

 

We're likely gonna hit ~800,000 US deaths by year's end. I'm seein' packed sports stadiums, concerts, theater re-openings, schools back in sessions (with endless #FreeDumb fights over mask requirements)... have to have concerns.
 

Get your vaxx.

 

ERRATA

 Sad.

 

Starting to see these news items every day. In my uncharitable moments, I call this "U.S. Covid19 Herd Immunity Threshold Denominator Reduction."

FROM NEW ISSUE, SCIENTIFIC AMERICAN

In the senior community where my mom lives, death is a frequent visitor. When we talk about a recent loss, the story is often the same: her neighbor fell, and things got worse from there. Falls are the seventh-leading cause of death for adults aged 65 and older in the U.S., and their prevalence has jumped more than 30 percent in recent years, according to a 2018 report from the U.S. Centers for Disease Control and Prevention. Even when a spill doesn't cause serious injuries, it can be the beginning of the end for elderly adults, explains Patricia Dykes, who studies fall prevention at Brigham and Women's Hospital in Boston. “They become afraid to move. They'll think, ‘Maybe I shouldn't walk so much.’ Then they get weaker, and their balance gets poorer.” This starts a spiral of more falls, increased injuries and worsening health. 

 

“Fear of falling prevents older people from doing the things that would prevent falls,” she says. 
There are likely many reasons for the rise in fall-related deaths. For one thing, more people are surviving heart disease, cancer and strokes and living into their 80s and 90s with impairments and chronic conditions that make them unsteady, says epidemiologist Elizabeth Burns of the CDC, who co-authored the 2018 report. “We also know that Americans use more medications than they used to,” she says. Polypharmacy—taking four or more medications—increases the chance of falling. So does taking a drug that impacts the central nervous system, such as an opioid or antidepressant. Age-related changes in eyesight, cognition, muscle strength and balance also raise risk.


But experts insist that falling is not inevitable. Targeted exercises, modified drug regimens and fixing vision problems can reduce the risk. New technology may help, including smartphone apps that analyze gait, as well as AI tools that alert busy health-care providers to fall risks among their patients…

Yeah. I have to remind myself that I am a "senior" now pushing 76. Addled with Parkinson's, and increasingly wobbly. "Elderly." An admitted fall risk (I've had several). 19 months of Covid19 restrictions have not helped. After my 2018 SAVR px in California, I'd made it all the way back to the basketball court by late 2019. 5-6 hours a week of 5-on-5 pickup. Check Ball.

 

On March 13th, 2020, they had to shut down our basketball gym. It remains closed.

 

My new Baltimore cardiologist had razzed me in December 2019: "Y'know what the number one cause of death is for guys like you? Falling."

 

Gee, thanks, Doc.

BOOKS ON DECK

Stay tuned.

 

MORE FROM SCIENTIFIC AMERICAN

POLICY
Scientists: When Talking to the Public, Please Speak Plainly
Jargon is appropriate when you’re speaking with colleagues, but it’s a turnoff for the rest of us
By Naomi Oreskes | Scientific American October 2021 Issue

With the persistence of vaccine denial, as well as many Americans still reluctant to face the facts of climate change even in the face of devastating floods and record-breaking heat, social media has been suffused with theories about why people don't trust science. In my own work, I have talked about how 40 years of partisan attacks on government have led to distrust of government science and then of science generally.

But this past year another issue has been bugging me. It's the way scientists talk. This is not a new concern. Many years ago science writer Susan Hassol and atmospheric scientist Richard Somerville wrote a humorous but serious piece about how the terms that climate scientists use mean one thing to them but often something very different to others. In the climate system, for example, “positive feedback” refers to amplifying feedback loops, such as the ice-albedo feedback. (“Albedo,” itself a bit of jargon, basically means “reflectivity.”) The loop in question develops when global warming causes Arctic ice to melt, exposing water that is darker and reflects less of the sun's warming rays, which leads to more warming, which leads to more melting ... and so on. In the climate system, this positive feedback is a bad thing. But for most, it conjures reassuring images, such as receiving praise from your boss…

Examples of confusing and misleading scientific terms abound. When astronomers say “metals,” they mean any element heavier than helium, which includes oxygen and nitrogen, a usage that is massively confusing not just to laypeople but also to chemists. The Big Dipper isn't a constellation to them; it is an “asterism.” Computational scientists declare a model “validated” when they mean that it has been tested against a data set—not necessarily that it is valid. In AI, there is machine “intelligence,” which isn't intelligence at all but something more like “machine capability.” In ecology, there are “ecosystem services,” which you might reasonably think refers to companies that clean up oil spills, but it is ecological jargon for all the good things that the natural world does for us. And then there's my favorite, which is especially relevant here: the theory of “communication accommodation,” which means speaking so that the listener can understand.

Studies show that alien terms are, in fact, alienating; they confuse people and make them feel excluded. One study showed that even when participants were given definitions for the terms being used, jargon-laden materials made them less likely to identify with the scientific community and decreased their overall interest in the subject. In plain words: jargon turns people off…

Indeed. Dr. Oreskes rocks. See also my #SciComm posts.

ERRATUM

"Bioflield Science?"

 

COVID-19 CODA: SUSAN B. GLASSER IN THE NEW YORKER

…Consider the news this week that now one in five hundred Americans has died in the pandemic; total deaths in the country approach seven hundred thousand. What’s worse, covid deaths—the vast majority of them preventable, avoidable deaths, now that science and the federal government have provided us with free vaccines—are continuing to rise across large swaths of vaccine-resistant Trump country. This is not a tragic mistake but a calculated choice by many Republicans who have made vaccine resistance synonymous with resistance to Biden and the Democrats. The current average of more than nineteen hundred dead a day means that a 9/11’s worth of Americans are perishing from covid roughly every thirty-eight hours. To my mind, this is the biggest news of the Biden Presidency so far, and it has nothing to do with Afghanistan, or the fate of the budget-reconciliation bill, or Bob Woodward’s new book.

America spent twenty years fighting wars in Afghanistan and the Middle East because of 9/11. The 2001 attacks reordered American foreign-policy and national-security thinking for a generation. Does anyone believe that something comparable will happen as a result of the pandemic’s catastrophic death toll, which is far vaster than that of any other crisis in the modern era? It’s hard to imagine, especially because the continuing loss of life is a result of G.O.P. political strategies that intentionally undermine the success of Biden’s policies. How can this President, or any President, reset from that?…

_________

 

September 11th, 2001

 

Highly recommend the Netflix documentary series (5 hours total). I watched all of it yesterday. Squares totally with everything I've already learned.

 

20 YEARS ON: "THE WILL TO FIGHT."

As the Taliban rapidly crushed US-backed Afghan forces, many politicians, pundits, and military leaders expressed surprise at having overestimated an ally’s will to fight and underestimated the enemy’s... That attitude reflects political and military leaders’ continual discounting of research, supported and known by many of those leaders, on the importance of sacred values and spiritual strength to the will to fight. It may remain “imponderable”—and attendant security challenges seemingly intractable—so long as it continues to be viewed through a narrow lens of instrumental, utilitarian rationality.

Throughout history, revolutionaries willing to sustain extreme conflict have been “Devoted Actors” fused together by faith in defending or advancing non-negotiable “sacred values,” whether religious or secular, like God or country. Insurgents willing to sacrifice for their cause have often prevailed with far less firepower and manpower than opposing state forces that mainly relied on material incentives such as pay and punishment... 

Research indicates that the Taliban and their supporters believe it’s worth dying for establishment of an Islamic Emirate—not global jihad—involving territorial sovereignty under Sharia law. Motivation and strength can be found on both sides of conflict. Research found that US Air Force Academy cadets’ perception of spiritual strength, tied to group loyalty, was more strongly associated with willingness to fight than was physical formidability. Yet, however strong the esprit du corps of American fighters, no amount of arms or training could ensure its transference to other forces and cultures...

 

By failing to recognize limits on the ability to impose on other cultures values that have taken many years to attain gradually in its own culture, the United States and its partners will continue the unsound habit of approaching problems by building up the wrong kinds of allies and armies—weakly modeled in America’s image but devoid of the spirit that can only arise from one’s own values and cultures. To honor Western democratic values by example, advancing them through financial, media, and moral alliances, and using force only to defend rather than dispense, is a surer way forward.

 

—AAAS Editorial

BEING GOOD (Simon Blackburn)

“…toleration is often a good, and we do well to put many imperialistic certainties behind us. When in Rome do as the Romans do-but what if the Romans go in for some rather nasty doings? We do not have to lift the lid very far to find societies whose norms allow the systematic mistreatment of many groups. There are slave-owning societies and caste societies, societies that tolerate widow-burning, or enforce female genital mutilation, or systematically deny education and other rights to women. There are societies where there is no freedom of political expression, or whose treatment of criminals cannot be thought of without a shudder, or where distinctions of religion or language bring with them distinctions of legal and civil status.

Here we have a clash. On the one hand there is the relativist thought that `If they do it that way, it's OK for them and in any event none of my business: On the other there is the strong feeling most of us have that these things just should not happen, and we should not stand idly by while they do. We have only perverted or failed solutions to the problems of which standards to implement, if the standards end up like that.

Here it is natural to look to the language of justice and of `rights: There are human rights, which these practices flout and deny. But the denial of rights is everybody's concern. If young children are denied education but exploited for labour, or if, as in some North African countries, young girls are terrifyingly and painfully mutilated lated so that thereafter they cannot enjoy natural and pleasurable human sexuality, that is not OK, anywhere or any time. If they do it, then we have to be against them.”

GEORGE PACKER:

“September 11 wasn’t a sui generis event coming out of a clear blue sky. It was the first warning that the 21st century would not bring boundless peace and prosperity. Al‑Qaeda was less a primitive throwback to the Middle Ages than an augury of the anti-liberal politics and virulent nationalism that would soon reach around the world, even to America, where the hijackers once aimed their blows.”

CODA

 

You can't do better than this author for your coming to fully understand our failure in Afghanistan.

Sarah Chayes's remarkable trajectory has led her from reporting from Paris for National Public Radio and covering the fall of the Taliban in Afghanistan to running a soap factory in downtown Kandahar in the midst of a reigniting insurgency. She went on to advise the topmost levels of the U.S. military, serving as special adviser to two commanders of the international forces in Kabul and then Chairman of the Joint Chiefs of Staff Mike Mullen. She left the Pentagon for a five-year stint at the Carnegie Endowment for International Peace, where she extracted the broadly relevant core from those experiences...

TWO MORE...

 

I've cited these previously as well. See also my SIGAR post.

_________

Ivermectin®

 

Covid-19 herd immunity threshold #MAGA denominator reduction Rx.

 

UPDATE

 

Your doc or hospital refuse to give you Ivermectin (or any other bozo #MAGA meds)? No problem: get a court order.

_________