Should We Prevent Disease, or Slow Down Aging?

In previous posts I've talked a lot about mortality statistics and life expectancy, and gave a lot of reasons why the strategy of extending life by identifying, then curing or eliminating, one by one, the various known major causes of death (heart disease, cancer, diabetes, etc,) is probably a wrongheaded way to go. For example, I mentioned that total elimination of all forms of cancer would increase overall life expectancy by only three years. That's no reason to stop working on a cure for cancer, of course. We definitely should try to cure cancer, as a way to prevent needless suffering (but not as a way to obtain a major increase in life expectancy). To increase life expectancy in any kind of meaningful way, we have to do more than come up with newer/better cancer therapies.

Our basic task should be to figure out why and how cells and bodies age and die. This is our best hope at extending life expectancies. In other words, we should start from the hypothesis (well supported by observation) that organisms have a tendency to age and die no matter which diseases they get or don't get. If we can conquer or at least greatly slow the basic process(es) of senescence, maybe diseases like cancer won't be significant hazards until a person is, say, 150 or 200 years old, instead of 40, 50, 60, etc. years old. That should be the real goal. Get cancer at 150, not 50.

What do we know about senescence? Lots of bits and pieces. We know how to knock out various genes in fruit flies, for example, to make them live twice as long. But we still don't have a comprehensive theory of aging.

The major lines of research tend to focus on a just a handful of ideas. It's best not to think of these ideas as competing (mutually exclusive) theories. It's not like one of them will be declared "the winner" and the rest will be discredited. The major contenders are:

• The cross-linking/glycation theory
• The neuroendocrine theory
• The free-radical theory
• Telomere theory (replicative endpoint theory)
• The genome and protein maintenance theory

There's yet another theory, that organisms have death "programmed in," such that when a certain point is reached in old age, a well-ordered shutdown process is triggered. This apoptosis theory isn't really adequate to explain senescence (which is by nature gradual) and thus isn't really an aging theory per se, even though we know that apoptosis mechanisms do exist. Current thinking is that, at a cellular level at least, apoptosis is mainly a cleanup mechanism to stop defective cells (such as cancer cells) from reproducing.

Let's go through the major theories one by one.

Cross-Linking
Evidence for the cross-linking theory consists of the observation that over time, proteins (and certain other molecules) sometimes link to each other, covalently, either via sulfide bridges or through a process called glycosylation or glycation. Glucose molecules can stick to proteins, then transform into brownish molecules called advanced glycosylation endproducts, or AGEs. We know that cross-linking of collagen occurs in wrinkled skin, and it's possible cross-linking of proteins in the lens of the eye plays a role in cataract formation. It's been speculated that cross-linking plays a role in atherosclerosis and age-related decline in kidney function. Good evidence has emerged that AGEs play a role in pathogenesis of Alzheimer's disease as well as diabetes. In fact, work on AGEs and Alzheimer's disease has led to so many complementary findings that some researchers have begun referring to Alzheimer's Disease as "Type 3 diabetes."

Neuroendocrine Theory
The neuroendocrine theory of aging says that many aging processes start with the changes in hormone levels that come about late in life, triggered by processes deep within the brain. This theory almost died at one point, due to contradictory lines of evidence, but it has come back from the dead based on strong findings having to do with the insulin/IGF-1 hormonal pathway. IGF stands for insulin-like growth factor, a substance activated by growth hormone. In all laboratory organisms studied thus far (from fruit flies to worms to rodents), mutations that reduce the amount of circulating IGF extend life. Also, several varieties of dwarf mice lacking growth hormone (GH), prolactin (PRL), and/or thyroid-stimulating hormone (TSH), live much longer than their normal siblings and exhibit many symptoms of delayed aging. (See here and here.) 

Free Radicals
The free-radical hypothesis says that free radicals (whether originating endogenously via enzyme action, or through spontaneous chemical processes) are the source of most of the oxidative damage that tends to build up in tissues over long periods of time. Oxidative damage is associated with many disease processes, and in fact one of the weaknesses of the free-radical hypothesis is that free radicals are so prevalent, so toxic, and can cause so many kinds of damage to so many biological molecules and so many cellular systems, that there's hardly a disease that can't be explained away by a wave of the free-radical wand. It hasn't been a terribly helpful theory for making predictions. Health-food advocates have been saying for years that the best way to limit free-radical damage in your body is to eat antioxidants, but there's a difference between inhibiting redox reactions and scavenging free radicals, and the idea that any particular food can selectively target free radicals is a bit fanciful, to say the least. (A huge and largely contradictory literature exists on the subject; see this Wikipedia article and its 245 references.) None of this, of course, has kept food companies from trumpeting "Rich in Antixodants!" on food packaging. (They might just as well trumpet the use of preservatives. Most food preservatives are, in fact, antioxidants.)

Nonetheless, it's interesting that fruit flies raised in a 100% oxygen atmosphere tend to start dropping like (what else?) flies at very early ages. It's also interesting that some of the longest-lived humans in the world tend to live at high altitudes (where oxygen is in short supply). It turns out there's good evidence that mitochondria (organelles specifically concerned with respiration) are heavily involved in processes that affect aging, and as it happens, mitochondria are hotbeds of free-radical activity. In fact, at this point it could be said that the free-radical theory of aging has effectively transformed to the Mitochondrial Theory of Aging. For a somewhat technical look at the free-radical theory of aging, I recommend Ben Best's post on the subject. Mr. Best also has a fine discussion of antioxidants and aging here.

Telomere Theory
In contrast to most other theories of aging, telomere theory is elegant, easy to summarize, and well validated experimentally. In 1961, Leonard Hayflick and Paul Moorhead found that human fibroblasts tend to undergo a fixed number of doublings (typically 40) when grown in vitro; then they stop and die. The cells seem to remember their generation number and die when the number of ancestor generations reaches a certain limit, now known as the Hayflick Limit. The Hayflick limit was eventually explained in terms of how telomeres work. Basically, telomeres are like the little plastic tubes on the ends of shoelaces, without which the lace-ends fray, except telomeres occur at the ends of chromosomes. They're non-gene-encoding "starter regions" in the DNA, designed to help set up the machinery of replication. Due to the way DNA replication works, every new copy of DNA is very slightly shorter than the ancestor copy that preceded it. After many copies of copies of copies have been made, the end of the DNA is shortened so much that further copying will lead to (potentially disastrous) gene truncation, because there's not enough telomere DNA at the end to allow proper priming of the copying process. (See big tall graphic.) Therefore, to avoid disaster, cell division must stop after a certain number of chromosome replications, unless (of course) telomeres can somehow be replenished in the meantime. It turns out there's an enzyme just for that purpose, telomerase, which is indeed able to restore the "starter region" on the DNA (the plastic thingy on the end of the shoelace). When telomerase is allowed to replenish a chromosome's telomeres endlessly, the cell becomes immortal. In some cases, that means it becomes cancerous.

Needless to say, considerable research effort is being devoted now to telomeres and telomerase, to see how telomerase can be modulated in ways that might cure cancer and/or lengthen life expectancy of otherwise-healthy cells. We do know that human telomeres tend to shorten with age and that people with 'long life" in their families tend to have longer telomeres than most. You can get a feel for where things stand (and where they're headed) in telomere research by consulting the resources listed here.

Molecular Maintenance
Finally, there's the molecular maintenance theory of aging, which says that longevity of cellular machinery depends on keeping the basic macromolecules of life, namely proteins and DNA, in proper working order through continuous damage repair. As with the free radical theory, this is a complex topic, with many interesting aspects to it, and obviously space prohibits anything approaching a useful summary of recent findings here. Suffice it to say much of the relevant research centers around a special class of proteins called chaperones, which are specifically designed to prevent and/or correct protein misfolding. (There are chaperones for the proper folding of histone-DNA complexes as well. RNA chaperones are also known.) Most proteins auto-fold into their correct 3-D conformation at the time of synthesis, but some proteins require help for final "correct" folding. Chaperone proteins provide that help. Chaperones have another important function, which is to refold proteins that have partially denatured through heating. It turns out that with even a modest increase in termperature, many proteins begin to unravel, and once unraveled (even slightly), a protein doesn't automatically know how to refold itself back to the proper conformation. Chaperone systems come to the rescue of such proteins, making it possible for them to regain their proper (original) folding. Because chaperone proteins themselves are upregulated in times of heat stress, chaperone proteins have often been called heat shock proteins, and they have names like Hsp70 and Hsp90.

If you imagine a cell as a big origami factory, turning out intricately folded bits of paper (proteins) that have to be folded "just so" in order to serve their intended purpose, chaperones are the quality-control inspectors that spot a misfolded item and refold it back to its proper form ("just so") so it can once again function properly.

For a review of the possible role of chaperone proteins in fixing cell damage in aging cells, see J. Krøll's (2004) The molecular chaperones and the phenomena of cellular immortalization and apoptosis in vitro, Morley and Morimomo's "Regulation of Longevity in Caenorhabditis elegans by Heat Shock Factor and Molecular Chaperones," (Molecular Biology of the Cell
Vol. 15, 657–664, February 2004), Daniel Herschlag's "RNA Chaperones and the RNA Folding Problem" (September 8, 1995 The Journal of Biological Chemistry, 270, 20871-20874), plus "Aging and molecular chaperones," by Soti and Csermely, Exp Gerontol. 2003 Oct;38(10):1037-40.

With all of this as prelude, we can proceed to a discussion of one of the more fruitful lines of investigation involving anti-aging, something that has a long, well-established basis in scientific research, with clear implications for what you can do today, right now, to begin to increase your lifespan. We'll visit that topic tomorrow.

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Finance has always been more profitable

Evan Soltas recently turned heads with a claim that the finance sector takes home half of all business profits in the United States. It turns out that this is an overestimate; in fact, the number is somewhere around 30%. But the basic story is correct. Finance, which accounts for only about 8% of GDP, reaps about a third of all profits.

Here's a graph of finance's profit share, from The Big Picture:



Those numbers are from the NIPA accounts. Here's a more smoothed version of that time series, courtesy of The Baseline Scenario:



Now here, from Thomas Philippon, is a graph of the finance's GDP share:




As you can see, finance basically doubled both its GDP share and its profit share since the big deregulation of the early 1980s. And during the finance boom of the 00s, the sector reached truly dizzying heights.

BUT, take a look at those graphs, and you notice something else. Finance hasn't just captured an outsized share of profits since 1980; it has done so all the way back to World War 2.

In the 1940s and 50s, finance accounted for about 3% of GDP, and raked in about 8-15% of profits. In the 1960s and 70s, finance accounted for about 4% of GDP, and raked in about 10-17% of profits. In other words, finance has always been much more profitable than other sectors of the economy. We can blame financial deregulation (and other post-1980 factors like technology and globalization?) for the increase in finance's size, and some of the increase in its profitability, but not for all of the difference between the two.

Now, the question becomes: Why is finance so profitable? One possibility is socialization of risk: in other words, the government implictly guarantees that big banks won't fail, which allows banks to make profit in good times and shift losses onto the taxpayer when things go bad. This is not the same thing as explicit guarantees like the FDIC, which keep lending rates very low and hence squeeze bank profits. It's also not quite the same as Too Big to Fail (though TBTF is part of it); even if all banks were small, the government would bail out the system as a whole if a large enough percentage of the small banks started to fail.

Another possibility is that finance is a natural monopoly. This is weird, since finance has few network effects like Facebook or Google, and doesn't require exclusive local land access like a public utility. But in economics, any industry where economies of scale are large will gain monopoly power, and hence high profits. And banks may benefit a lot from economies of scale.

Why? My intuition says that it's part of the definition of what a bank is. A bank - or any financial institution that acts like a bank, which is most of them - makes its profits by borrowing short and lending long, and this makes it fundamentally vulnerable to a bank run (See the Diamond-Dybvig model for a formal economic model of this).

Now here's the question: All else equal, are bigger banks less vulnerable to runs? A run happens when a critical mass of a bank's creditors demand their money back at the same time. This requires some sort of coordination (which may be provided by a global game, an information cascade, a coordinating signal, some sort of sunspot equilibrium, etc.). The bigger a bank is, the more creditors (depositors, overnight lenders, etc.) it is likely to have. The more creditors a bank has, the harder it may be for a critical percentage of them to coordinate and cause a bank run.

So this might provide financial firms - which almost all act like banks - with significant economies of scale, and hence monopoly profits. But that's just my own conjecture; it may be completely wrong, and even if it's basically right, there may be other important reasons for finance's outsized profit share.

But the point is, finance has always been more profitable than other sectors, even under heavy pre-1980 regulation. This is a puzzle that needs solving.

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Gmail Ads: Harmful to Mental Health

Google's use of "interest-based ads" alongside Gmail's windows may seem annoying (and it is), but for a certain group of people it's more than annoying. It's actually harmful. 

Living with someone who has paranoid schizophrenia has taught me a lot about the condition. One thing I've learned is that schizophrenia's symptoms are complex and varied, and antipsychotic drugs do not ameliorate all symptoms equally. Hallucinations tend to respond better to the drugs than paranoia. That's Fact Number One.

This "interest based" ad has nothing whatsoever to do with my interests.

Fact Number Two is that paranoid schizophrenia is the most common type of schizophrenia. 

Fact Number Three is that even in paranoid schizophrenia patients who have made a good recovery, episodes of paranoia can still sometimes be triggered by certain external stimuli. This is where Gmail comes into play.

Every Gmail user, by now, has experienced the discomfiting deja vu that arises from seeing personalized ads next to an open e-mail. Two days ago, you may have written an e-mail to a friend in which you mentioned water pistols. Today, you write an e-mail to someone else and notice (along the right edge of the window) an ad with a blue headline: "Best prices on Glock semi-automatics." This is exactly the kind of thing that causes a person with paranoid schizophrenia to go into an ever-spiraling panic. Is Gmail reading my thoughts? Do Google engineers suspect me of murder? Am I being spied on by Homeland Security agents posing as Google employees? Did my friend that I wrote to two days ago betray me?

Am I being urged to commit suicide with a handgun?

By Google's own estimate, more than 425 million people worldwide use Gmail. It's likely that at least 3 million of them have schizophrenia. Many of those people have serious ongoing paranoia issues, even if they're responding well to medication. The last thing they need is to see paranoia-inducing sidebar links in their e-mail client every day.

By the way, the screenshot above is one I took this morning while viewing an e-mail to me that had nothing whatsoever to do with firearms. For whatever reason, Gmail decided to show me an "interest based ad" on firearms training. Why? I don't know. I don't own a gun, don't plan on owning a gun, don't have any interest whatsoever in firearms training. No ad could be less "interest based" than this one.

The problem here is that you can't turn sidebar ads off. "Web Clip" ads at the top of your e-mail window can be turned off (see this article to learn how), but the "interest based" ads cannot be turned off. At https://www.google.com/settings/u/0/ads/preferences/?hl=en you'll find: "Google tries to show you the most relevant ads, whether or not you're opted in to seeing personalized ads."

If Google wants to do the right thing, it needs to provide paranoia sufferers a way to turn off all personalized ads. The way things stand now, Google's spooky interest-based ads are merely an annoyance to most of us. But for some, they're a threat to mental health.

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Why liberals shouldn't turn against immigration

Dean Baker easily could have gone into academia, or sold out and gone on to make big bucks consulting in the private sector. Instead he did neither, choosing to work in the less prestigious, less-highly-paid world of liberal Washington think tanks. The reason is that he cared about the American working class, and wanted to dedicate his life to fighting on their behalf. This is extremely laudable.

However, that doesn't mean I always agree with Dean's ideas for helping the working class. In the last month, he has written a number of pieces with an anti-immigration slant. For example, on Feb. 2, he wrote this:

It's true that a declining population means that labor will be in shorter supply. That means that the least productive jobs will go unfilled. That is the way economies develop and the reason that half of our workforce is no longer employed in agriculture. In the U.S. this would mean that we might have fewer restaurants and the convenience stores won't be open all night. In Japan, perhaps they won't be able to find workers to shove people into the subway cars in Tokyo. What's the problem?... 

This is not to argue against immigration or immigration reform. The way we treat people who came to this country to work...is an outrage and is bad for the economy. However readers deserve a more serious discussion of the issues involved... 

Some immigration to the country undoubtedly provides economic benefits. However in nearly all cases there will be winners and losers. For example, a large flow of immigrants at the low-end of the labor force will hurt the people who have recently immigrated to the country. Some of us may not consider that a good thing.

On January 19, he wrote a piece saying that China's declining working-age population is good for wages (implying that the same would be true for us). And on February 26, he wrote an article for the Guardian, again calling for shrinking working-age populations:

There is no reason why the prospect of a stagnant or declining workforce should concern the vast majority of people... 

The people who hire help – the very same who also dominate economic policy debates – are terrified over the prospect that they will have to pay workers more in the future. 

But the rest of us can sit back and enjoy watching them sweat as ordinary workers may finally start to see their share of the gains of the economic growth of the last three decades.

The anti-immigration implications of this argument should be extremely clear. If shrinking labor forces lead to higher wages, then large-scale immigration will depress wages. Hence, we should consider immigration restrictions as a way to boost working-class wages. Some other liberal think-tankers, such as Jared Bernstein, have been writing pieces in the same vein. I call this view "labor protectionism".

There are four big, big reasons why I think that "labor protectionism" is a very bad idea, and should be dropped from the policy platform of American liberalism.

Reason 1: Agglomeration Economies

We are not living in an Econ 101 world, in which most people are employed as farmers, working the land. Instead, we live in a world with "increasing returns to scale", where economic activity gets a productivity boost from being concentrated. We also live in a world with transport costs, where companies want to put their offices and factories where the workers and customers are, and workers and customers want to live close to where they can get goods cheaply. These facts are summarized by Paul Krugman's theory of "New Economic Geography," for which he won the Nobel Prize.

But also, we live in a world in which knowledge economies are of extreme importance; when people cluster together in cities, their productivity goes up because of the accidental (and purposeful) exchange of knowledge and ideas.

For these reasons, the vast bulk of America's GDP is produced in extremely densely populated cities. Check out this infographic:



A casual glance shows that America's output is highly concentrated in big cities like New York and L.A. Studies confirm that living in a big city increases a worker's productivity by a substantial fraction.

If we were to kick a bunch of working-class people out of NYC, would NYC wages rise for the working-class people who were left, because of an artificial shortage of low-skilled labor? Maybe. But if we did this too much, NYC would start to lose its huge productivity advantage, and the tactic would backfire, reducing the wages of the working-class people who remained (to say nothing of the people who got kicked out).

Now realize that our modern world is very globalized. Much of our economy depends on trade (in fact, much more than the percent of GDP directly taken up by trade!). In the global economy, agglomeration economies mean that capital will flow to the country where the most productive workers and the densest, highest-purchasing-power markets reside. In other words, immigration helps us remain at the center of the global economy.

Reason 2: Politics

As you may have noticed, America's more liberal major party just won a historic electoral victory. This victory has many Republicans and conservatives fretting that liberalism has won in the U.S. But it's not the margin of Obama's victory that is producing this hand-wringing; rather, it's how Obama won. Specifically, Obama garnered 71% of the Latino-American vote and 73% of the Asian-American vote. These are the country's two fastest-growing demographics. If they continue to lean so strongly Democratic, the GOP is looking at a long, long time in the wilderness.

But why did Latinos and Asians abandon the GOP? The Republicans used to get a much larger share of both groups' votes. Many believe that the strongly anti-immigration views and policies of the Tea Party GOP in the last few years sent a clear message to Latinos and Asians that the GOP was a nativist party (the beginning of this was the grassroots conservative opposition to George W. Bush's immigration reform plan).

If, at this moment of triumph, liberals themselves were to turn anti-immigration, it would reverse the enormous gains and squander the historic opportunity that the GOP's nativist blunders have offered us. Think about whether the GOP or the Democrats would be better for America's working class. It's a no-brainer.

Reason 3: Offshoring

In today's globalized world, capital is highly mobile; multinational corporations can put their factories and offices wherever they want. If we did manage to push up wages here in America by restricting immigration, companies can partially offset this by relocating overseas. The offices and factories will go where the labor is. That is probably exactly what is happening with Japan, where population is declining and immigration is heavily restricted, but real wages have been flat or falling for many years.

In other words, offshoring cancels out much of the effect of immigration restrictions. Of course, we could try to block that effect by restricting offshoring and trying to trap capital here in the U.S. Labor protectionism would thus require actual, general protectionism in order to be effective. But actual, general protectionism would be bad for our economy, including our working class. We depend a lot on trade.

Reason 4: Social Security

The most enduringly popular liberal social program in the U.S. has been social insurance, a.k.a. Social Security. But as everyone knows, Social Security is put under extreme fiscal strain if the population starts shrinking. This would give political ammo to Republicans who want to destroy this cornerstone of the New Deal. Thus, immigrants - who are relatively young, and who almost all work - are key to preserving our system of social insurance in an age of low fertility among the native-born.

The Alternative: Focus on High-Skilled Immigration

There is a clear alternative to labor protectionism. Instead of focusing on decreasing the supply of working-class immigrants, let's focus on increasing the supply of high-skilled immigrants! Dean Baker, in fact, hits upon exactly this solution when he writes:

[A] large flow of very highly educated immigrants, such as doctors, can get the wages of these workers more in line with the wages of professionals in other wealthy countries and provide large savings in areas like health care.

This is absolutely right, but it receives only a small mention at the end of an otherwise distinctly anti-immigration post. Instead, support for more high-skilled immigration should be the centerpiece of liberals' approach to immigration.

Remember, even in Econ 101, what matters for wages is relative scarcity, not absolute scarcity. What that means is, for a given number of working-class population, every additional high-skilled immigrant raises working-class wages. So if we increase the absolute numbers of high-skilled immigrants, we will automatically raise working-class wages.

And if we shift our immigrant mix toward high-skilled immigrants, by allocating more visas based on skills and fewer based on family reunification, the effect on working-class wages will be even more dramatic. This is the upshot of the Atlantic article that Adam Ozimek and I wrote on high-skilled immigration in June 2012.

Brad DeLong once wrote:

I think the United States needs more immigrants--more people willing to take risks and work hard to seek a better life for themselves and their children, and illiterates from Chiapas seem to me as good as doctors from Calcutta.

I also like both varieties of immigrants. But if you care about the income distribution, the two are not equivalent. High-skilled immigrants are better for American working-class wages than low-skilled immigrants.

In conclusion: If liberals go the labor-protectionist route, the potential gains (in terms of working-class wages) are miniscule, or even negative, while the potential losses (in terms of political advantage for the Democrats) are absolutely enormous. But if people like Dean Banker drop the labor-protectionist angle and throw their political weight strongly behind a shift toward high-skilled immigration, the potential gains are very large and the potential losses miniscule.

The choice is clear.


Update: Dean Baker responds. I can't say I'm happy with what he writes ("As far as less-skilled immigration, I would want it sharply limited"), but hopefully the logic of my post will sink in over time...

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Why Life Expectancies Will Soon Go Down

Obesity rates began trending sharply higher in 1980.
Coincidentally, 1980 was the year of the first Dietary
Guidelines for Americans by the Department
of Health and Human Services.

Recently, I wrote about the fact that if we could eliminate all heart disease and all cancer overnight, human life expectancy would increase only slightly: just 6.7 years if heart disease is eliminated, 3.3 years if cancer is eradicated. (Those are CDC's numbers.) It seems clear that to extend life expectancies much beyond, say, 100 years will require more than merely eliminating the most common causes of death. It will require re-engineering the human body to be a good deal more robust in terms of its self-repair capabilities.

In my previous post, I hinted at the fact that today, it takes a much larger change in mortality rates to move the life-expectancy needle than it used to. The non-straightforward relationship of life-expectancy delta to mortality-rate delta is modeled in terms of something called Keyfitz Entropy, and the strange "diminishing returns" effect has been called Taeuber's Paradox (after public health researcher Conrad Taeuber). If you'd like more background on this, I suggest you start with the 2001 Science article by Olshansky et al. ("Prospects for Human Longevity") which shows that, because of Keyfitz/Taeuber effects, it's unlikely the U.S., at its current rate of mortality progress, will see 100-year life expectancies until the year 2485 (for women) or 2577 (for men).

Over the short term, I remain quite pessimistic. Dreamers like Ray Kurzweil are predicting immortality by 2040. My prediction is quite different. In the United States, we should expect to see life expectancies peaking right about now and start trending downward by 2020, based mostly on the sudden jump in obesity that began in 1980 (and the doubling of diabetes in the last 15 years).

Some 35.7% of adult Americans are obese and another 33% are overweight but not obese. The numbers for children are starting to approach those for adults. And we're continuing to trend sharply in the wrong direction. This will show up as an unwelcome drop in life expectancy when all the follow-on effects of epidemic obesity and diabetes begin to be realized.

It's important to note that overweight is a predictor of

• Type 2 diabetes
• hypertension
• stroke
• coronary artery disease
• pulmonary embolism
• asthma
• chronic back ailments
• osteoarthritis (and related hip and knee replacement)
• gallbladder disease
• obstructive sleep apnia
• colorectal cancer
• kidney cancer
• pancreatic cancer
• endometrial cancer
• ovarian cancer
• post-menopausal breast cancer

Those are just the possible somatic outcomes. Psychiatric comorbidity is also extremely common with obesity (and with chronic illness of any kind).

Smoking has been on the decline for decades but is starting to level off at around 15% of the U.S. population. Heart disease has decreased in parallel with the decades-long drop in tobacco consumption (although lung cancer rates, for some unknown reason, have merely leveled off and not gone down).

There are some important lessons to be learned here.

• Existing public policy efforts in combating obesity have been, and continue to be, an abject failure. Weight gain in the U.S. is out of control, across most demographics, including young children. A sharp increase in rate of weight gain started around 1980. The change in slope after 1980 doesn't correspond to a sharp increase in TV-watching, online gaming, or many of the other (entirely speculative) causal factors usually cited for obesity. There haven't been any sharp increases in causal factors other than calorie intake.
• Obesity is a proven risk factor for at least 16 serious illness types (not counting the adverse outcomes associated with diabetes). Because of the lead time required for these diseases to develop, we have not yet begun to see the full impact of the 1980 increase in the rate of weight gain.
• Much of the progress made against heart disease over the last 40 years has been driven by reduced cigaret smoking. But smoking rates are leveling off now (at around 15%) and aren't likely to go much lower, for a variety of reasons. Most of the low-hanging fruit, in heart-disease and cancer prevention, has already been picked. We shouldn't expect dramatic lowering of the mortality rates for heart disease or cancer (the No. 1 and No. 2 causes of death) going forward.
• When obesity knock-on effects (still in the pipeline) show up as increased mortality from diabetes, stroke, heart attack, cancer, etc., life expectancy in the U.S. will actually start going down.

It should be obvious that the single most important thing we can do right now to increase overall life expectancy in the U.S. is to get people to lose weight and teach their children to eat right. For a lot of reasons, I'm pessimistic on both of those. Corporations have no incentive to make children want to eat right; parents aren't doing the job; current public-health policies aren't doing the job; and it's politically unpopular in the U.S. right now to have the government step in with meaningful social programs.

In upcoming posts, I want to switch gears and start talking about the molecular biology of aging and the sorts of things we can do now (not 25 years from now) to extend life expectancy by 20%, 30%, or more. Stay tuned for details.

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Django Unchained: A white revenge fantasy

I don't intend to branch out into movie reviews, but Django Unchained struck me as a pretty politically important film, so I wanted to say a few words about it.

I loved the movie. Not for the cartoonish violence (which was OK, nothing special) or for Tarantino's trademark witty banter (which was a bit subdued). I loved Django for the politics.

First of all, I'm pretty sure that for all its elements of blaxploitation, Django's politics are all about white people. It's not a black revenge fantasy; it's a white revenge fantasy.

Anyone who grew up in the American South, as I did, knows how equivocal the region still feels toward its past. My history teachers went to great pains to emphasize that the Civil War wasn't fought over slavery, but because the North wanted to protect its economic interests (this is bullshit, by the way; of course it was about slavery, and everyone knows it). The "positive" impacts of slavery were mentioned - slaves were well-cared-for, many slavers had close relationships with their slaves, and yada yada. The fact that slavery was "more acceptable" in the world of the 1800s is always mentioned.

Having been defeated in battle, Southern whites made denial of their past atrocities a central pillar of their group pride - much the same way that Japanese right-wing nationalists defend Imperial Japan's occupation of Korea and brutalization of China, or Turkey denies the Armenian Genocide of Ottoman times.

In recent decades, though, as non-Southern America became more racially diverse, the South has become sort of the standard-bearer for Real White America. From New York to California, rural and working-class whites identify with the South. George Packer describes this process well:

[From the 70s onward], the Southern way of life began to be embraced around the country until, in a sense, it came to stand for the “real America”: country music and Lynyrd Skynyrd, barbecue and nascar, political conservatism, God and guns, the code of masculinity, militarization, hostility to unions, and suspicion of government authority, especially in Washington, D.C. (despite its largesse). In 1978, the Dallas Cowboys laid claim to the title of “America’s team”—something the San Francisco 49ers never would have attempted. In Palo Alto, of all places, the cool way to express rebellion in your high-school yearbook was with a Confederate flag. That same year, the tax revolt began, in California.

Racial homogeneity (ignoring those pesky Southern blacks, of course) is one of the South's selling points. The other is its fabled military prowess. Southerners are supposed to make the best soldiers. This is certainly the South's image of itself; the aforementioned history teachers wasted no time in describing all the battles that Robert E. Lee and Stonewall Jackson won before the North ground them down under the weight of superior numbers and superior industry. The idea of Southern men as a "warrior race" even gave birth to the "Southern race" mythology, in which some Southerners contended that they were descended from the chivalrous Norman warriors of old England, while the Northern whites were descended from cowardly, wimpy, Saxon shopkeepers.

But there is another white racial mythology, with even more power than the old Southern supremacy. This is pan-Nordicism, or the idea of the Germans/Nordics/Anglo-Saxons as the Real White People, which grew popular only in the late 1800s and remains fresher in our collective unconscious. If the Southerners are supposed to be good soldiers, they don't hold a candle to the fabled Prussians.

Which brings us to Django Unchained.

As some critics of the film have pointed out, the protagonist for the first two-thirds of the film is not Django himself, but his German mentor and benefactor, King Schultz:

This film follows a brave, cunning and fearless lead character whose name starts with a "D." Viewers of the film's trailer would think that character is Django, played by Jamie Foxx. In fact, his name is Dr. King Schultz, a German portrayed by Christoph Waltz, (spoiler alert) who sacrifices his life in the pursuit of freedom and justice for the black man. It is the white Dr. King, who after sharing a motivational tale about a man reaching a mountaintop, nobly gives his life for "black justice."

Schultz' attitude toward slavery is one of barely concealed disgust. He doesn't shoot slavers in cold blood, but obviously enjoys killing them when he has an excuse to do so. He dismisses slavery itself as "malarkey," waving his hand as if hundreds of years of history and atrocity were a passing annoyance. This is bound to annoy many black people, whose history is the one being trivialized. But Django is a movie about white people.

King Schultz, you see, is a German. Whatever claim Southerners have to be the Real White People, Schultz' claim is deeper and more credible. He's got Siegfried and Brunhilde. And slavery - the institution on which the South built its civilization - is beneath him. He is contemptuous of it and the degenerate human beings who practice it. He does not view slavery as "normal" for the 1800s. He does not shed a tear when he guns slavers down.

And gun them down he does - in droves. The supposedly mighty Southern warriors are no match for Schultz' Prussian gunnery. I see this as Tarantino giving a big fat middle finger to Southern pretensions of military manhood; one diminutive middle-aged German dude makes them look like amateurs. King Schultz, you see, is the Real Real White Guy, and one such man is worth a thousand of the chickenshit slavers who tried to usurp the mantle of the white race.

It almost seems as if Schultz' character came to the South just to serve this notice.

And here's the amazing part; it really, really worked. The theater where I saw Django was packed mostly with working-class-type white folks, more men than women. Exactly the kind of people who have felt such an affinity with the South in the last three decades. And every time Schultz gunned down another white Southern slaver, these people laughed and whooped and cheered. No moral equivalence was in evidence. There was no dismay at the easy defeat of Southern manhood.

Think about that. With a bit of cartoonish violence, Quentin Tarantino was able to do what a thousand reasonable op-eds and preachy biopics have been unable to do: reverse white people's affinity for the South. I see Django as a white revenge fantasy - whites, whose ancestors (like Tarantino's) had no part in the institution of slavery, saying "No. The South does not get to represent my racial group. If I was alive in the 1800s, I would have shot those assholes right in the head!"

Which, if you think about it, is probably exactly what they would have done. After all, the North did fight a very bloody war to end slavery, and many people in the North - for example, Ralph Waldo Emerson, and the folks who wrote "Battle Hymn of the Republic" - were quite clear that they thought violence was a perfectly legitimate way to cleanse the stain on their civilization. (Update: a commenter points out that German immigrants to the South in fact often bucked the local power structure and fought for the Union.)

Django is not black people's story of slavery, it's white people's. White Americans will never understand or share black Americans' historical experience of suffering and escaping from slavery, but they can remember, and be proud of, their own historical experience of fighting and defeating the slavers.

For almost forty years now, Americans have had to live with the creeping Southernization of our culture. The Confederate flags on the pickup trucks right next to the American flags. The country music playing at the car mechanic's shop. The pundits gushing about the folksy charm of Southern good-ole-boys like George W. Bush. The trumpeting of the South's superior economic model. The ambivalent portrayals of Confederate history. The notion that only a Southerner can win the Presidency. The very real domination of Congress by a heavily Southern Republican caucus. Etc. etc.

But in the last few years, a real pushback has begun. Obama's election is obviously part of it, but I think it's much more result than cause. The rest of white America is starting to realize (or to remember) that in many ways, the South don't really represent them that much. I see Django as part of that realization. And for that reason I love the film, despite its historical insensitivity and over-the-top blaxploitation.

Just like Turkey and Japan, the American South is going to have to realize that yes, they really were the bad guys back in The War. That doesn't mean they have to be the bad guys going forward. But admitting one's mistakes is the first step toward reform.

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Taeuber's Paradox and the Life Expectancy Brick Wall

A friend and I were talking the other day about mortality, morbidity, and other cheerful topics, and I happened to mention to him Keyfitz's classic 1977 paper on Taeuber's Paradox (for which there is, at the time of this writing, no Wikipedia page, mercifully), which in turn sprang from the somewhat counterintuitive finding that if cancer were eliminated as a cause of death, it would yield an increase in life expectancy of only a little more than 3 years. Maybe not everybody will find this result counterintuitive. It's by no means certain that Conrad Taeuber himself did. But Nathan Keyfitz did, and I did, and my friend Jeff did; and so, for purposes of this discussion, that's a quorum.

Cancer is not one disease, of course. Like "heart disease," it's a multiplicity of unspeakably terrible ailments. Nevertheless we count it as one disease in discussions of mortality in this country, so that we can point at it and say "Cancer is the Number Two cause of death in America," and then presidents can declare war on it, $10 billion a year in taxpayers' money can be set aside for research on it (approximately $500 billion in 2012 dollars spent since Nixon declared war), a $50-billion-a-year commercial industry of toxic therapies (some of which cost $10,000 a month) can be built around it, and meanwhile delusional goofballs like Ray Kurzweil can talk of achievable immortality (with arguments that don't even come close to passing the straight-face test) when there's no cancer cure in sight. (I don't consider transplanting my brain into silicon to be the same as achieving immortality, incidentally.)

It might do the Kurzweils of the world some good to spend a little time pondering the fact that roughly $20,000 in anti-cancer research money has been spent for every single person in the U.S. who has died of cancer in the last 40 years; and yet after 40 years, cancer is still the No. 2 cause of death in America; and after it's gone, after it's cured once and for all, this bane of human existence, this No. 2 Cause of Death, we will have extended human life a grand total of (drum roll, please) 3.3 years (loud cymbal-crash).

One reason eliminating such a significant cause of death has such a miniscule impact on life expectancy is that other causes of death rush in to fill the void. If you're 75 years old, suddenly eliminating cancer as a cause of death still leaves you with all the other killer diseases that make 75-year-olds go tits-up. It's more complicated than that, of course. One thing you have to consider is that eliminating a disease of later life has much less effect on life expectancy than eliminating an early-in-life disease. If you can prevent a fatal disease of childhood, the contribution to average life expectancy is much greater than if you can cure a disease that only befalls 90-year-olds. This is why life expectancies rose so sharply in the first years of the 20th century (and why we're not likely to see such a surge repeated any time soon). Starting in the early 1900s, killer diseases of early childhood (and early adulthood) began to abate one by one.

Bottom line, the calculation of Potential Gain in Life Expectancy (PGILE) is far from straightforward, because you need to know the mortality rate for the illness-in-question for every year of a person's life, and depending how that curve shapes out, you get a final PGILE number that's bigger or smaller than you might have guessed based on the illness's overall ranking in national causes of death.

Back in 1999 (but unfortunately not since then), the Centers for Disease Control, using 1990 Census data (and other data of the time), published information on the potential gain in life expectancy to be expected if various categories of death were eliminated. The numbers are shown in the table below.

CATEGORY OF DEATH	POTENTIAL GAIN IN LIFE EXPECTANCY (YEARS) IF ELIMINATED
CARDIOVASCULAR: All cardiovascular diseases	6.73
CANCER: Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues, AIDS, etc.	3.36
Diseases of the respiratory system	0.97
Accidents and "adverse effects" (health-care-induced deaths)	0.92
Diseases of the digestive system	0.46
Infectious and parasitic diseases	0.45
Firearm deaths	0.4
Certain conditions originating in the perinatal period	0.33
Suicide	0.3
Homicide and "legal intervention" (law-enforcement and penal-system-induced deaths)	0.29
Diabetes mellitus	0.27
Congenital anomalies	0.2
Alcohol-induced deaths	0.17
Drug-induced deaths (medicinal and recreational drug overdoses)	0.1
Sudden infant death syndrome	0.1
Nephritis, nephrotic syndrome, and nephrosis	0.1
Alzheimer’s disease	0.05
Urinary tract infection	0.04
Non-metastatic neoplasms, and "neoplasms of uncertain behavior and unspecified nature" (medical mysteries, basically)	0.04
Parkinson’s disease	0.03
Senile and presenile organic psychotic conditions	0.03
All others	1.96
TOTAL	17.3

Data taken from U.S. Decennial Life Tables for 1989-91, U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Volume 1, Number 4.

What the table says is (for example) if we could eliminate cardiovascular disease as a cause of death in America, average life expectancy would go up by 6.73 years. Again, it seems a trifle odd that if you eliminate the No. 1 cause of death in America, a disease category that kills roughly one in three people, life expectancy goes up only 8.6%. But (again), this is partly a reflection of the fact that cardiovascular ailments are (for the most part) not child-killers; they're diseases of middle age and old age. And if you don't die of heart disease, there are plenty of diseases of old age that will still kill you.

So in my own morbid way, I thought it might be a fun exercise if, utilizing CDC's data, we were to total up the potential-gain-in-life-expectancy numbers for all causes of death, to see where we stand in terms of life expectancy if we eliminate all causes of death. (Yes yes, I know I know, the numbers can't just be considered strictly additive, but this is a Gedankenexperiment, so cut me some Gedanken Laxheit.) It turns out the total possible gain in life expectancy from prevention of all causes of death is a rather modest 17.3 years, putting a theoretical limit on U.S. life expectancy of 78.2 + 17.3 == 95.5 years.

I don't for a moment hold this up as any kind of rigorous result. But I do think there is qualitative support here for the general notion that any quest for immortality that's based on mere elimination of current causes of death is fundamentally misguided. The individual PGILE numbers (as much as their sum) hint strongly at the idea that to extend human life significantly will mean doing far more than merely preventing the preventable causes of death (even if we consider the top 15 causes of death all "preventable" in one way or another, which of course many of them are not).

Exactly what that means, I'll leave as an exercise for the reader -- and will expound on in a separate blog. Assuming, of course, I live that long.

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The Comorbidity Crisis

The Comorbidity Crisis is not exactly a household word (yet), but I'm betting it will catch on. Multiple morbidity (presence of two or more medical conditions in a given patient at a given time) is increasingly common, and it's creating a kind of secondary health-care crisis of its own.

Approximately 75 million people in the U.S. have two or more chronic conditions, defined as "conditions that last a year or more and require ongoing medical attention and/or limit activities of daily living." [source] Some 65% of health care spending is directed at this 24% of the population. That's for the population as a whole. For the elderly, multiple morbidity is even more problematic. About 80% of Medicare spending goes to patients with four or more chronic conditions, with costs increasing exponentially as the number of chronic conditions increases. [source]

Multimorbidity is steadily getting worse over time, not just because the population is aging but because we're all getting sicker (or at least, showing up at the doctor's office with more complaints).

• A Dutch study found that while the prevalence of chronic diseases doubled between 1985 and 2005, the proportion of patients with four or more chronic diseases increased in this period by approximately 300%.
• The number of Americans receiving drugs for depression went from under 100,000 in 1955 to 13.3 million in 1996 to 27.0 million in 2005, and we now know that 68% of the mentally ill are comorbid for a physical ailment.
• From 1995 to 2010, the age-adjusted prevalence of diabetes increased by over 50% in 42 states and by more than 100% in 18 states. The median prevalence rose from 4.5% to 8.2% in the 1995-2010 time period (almost doubling in 15 years). [source]  Most adults with diabetes have at least one comorbid chronic disease, and as many as 40% have three or more. [source]
• In one study of 1122 diabetes patients, patients used an average of 13 medications to treat or prevent 8 different medical conditions. Typical diabetic comorbidities include obstructive sleep apnia, retinopathy (eye damage), neuropathy (deterioration of small nerves in extremities), nephropathy (kidney damage), cognitive deterioration (diabetic encephalopathy), and a wide variety of cardiovascular comorbidities.

The top and bottom quintiles of diabetes and obesity co-map.
From http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6145a4.htm

Less obvious is that comorbidity is spreading across various disease types that, in times gone by, wouldn't necessarily have been connected. Who knew, until recently, that gum disease had any connection to cardiovacular disease? Likewise, fifty years ago (when only 13% of the U.S. population was obese) there was no obvious link between being overweight and getting cancer. Today we know that there are statistically significant correlations between overweight (BMI greater than 25) and incidence of endometrial cancer, ovarian cancer, post-menopausal breast cancer, colorectal cancer, kidney cancer, and pancreatic cancer. [source] This is in addition to the well-known links between overweight and hypertension, stroke, coronary artery disease, pulmonary embolism, asthma, gallbladder disease, osteoarthritis, and chronic back pain.

Mental and physical morbidities lead from one to the other in subtle and not-so-subtle ways. Chronic physical ailments with a high "symptom burden" (e.g., chronic pain from arthritis) are often accompanied by depression. Depression, in turn, has been linked to altered immune function (including release of cytokines involved in inflammatory response), which opens the way to physical illness. If you're taking antidepressants, odds are high that you'll gain weight, putting you at greater risk of diabetes and the various cancers mentioned earlier. (One in six patients who take Zyprexa will gain more than 33 pounds in the first two years of use. [source] Moreover, all modern antipsychotics, according to Eli Lilly sales training literature, bring increased risk of diabetes.) It's a world of endless ripple effects.

One untoward outcome of multiple morbidities is polypharmacy, which leads to increased metabolic burden (toxic overload), drug compliance issues (forgetting to take pills), and adverse drug reactions (ADRs). One study found that the risk of ADRs was 2.65-fold higher in patients taking more than four drugs. But many patients take far more than four drugs. "If we apply the relevant CPGs to a 79-year-old woman with osteoporosis, osteoarthritis, type 2 diabetes, hypertension and chronic obstructive pulmonary disease, all of moderate severity," one researcher wrote, "the patient should be taking 12 different medications in 19 daily doses at 5 different times of the day" -- not counting any drugs to be taken "as needed."

The Morbidity Crisis is just getting underway. As DSM-V (due in May) expands the guidelines for mental illness, we're sure to see a continued sharp rise in mental/physical comorbidities; and as the population ages, we'll continue to see more people sick with multiple ailments, taking more drugs for more concurrent illnesses. The burden on the health care system will increase exponentially, and at some point, all of us will be poorer, not just in dollar terms but (very likely) in terms of basic health.

The winners in all this? Big pharma. You may want to buy some drug company stocks now. The really big profits are straight ahead.

			Revenues		Profits
Rank	Company	Fortune 500 rank	$ millions		$ millions
1	Johnson & Johnson	33	61,897.0		12,266.0
2	Pfizer	40	50,009.0		8,635.0
3	Abbott Laboratories	75	30,764.7		5,745.8
4	Merck	85	27,428.3		12,901.3
5	Eli Lilly	112	21,836.0		4,328.8
6	Bristol-Myers Squibb	114	21,634.0		10,612.0
7	Amgen	159	14,642.0		4,605.0
8	Gilead Sciences	324	7,011.4		2,635.8
9	Mylan	412	5,092.8		232.6
10	Genzyme	458	4,515.5		422.3
11	Allergan	459	4,503.6		621.3
12	Biogen Idec	471	4,377.3		970.1

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The Myth of the Medical Breakthrough

There's a popular myth afoot (maybe you've been spreading it?) that says that the roughly 50% increase in life expectancy that occurred in Western countries over the past 100 years can be traced directly to advances in medicine. The advent of antibiotics and vaccines, in particular, added years, perhaps decades, to people's lives. Didn't they?

Or did vaccines and antibiotics actually come along rather late in the game, after long-underway drops in infectious disease rates had already run their course?

Perhaps the reason we're not all dying from bubonic plague is that we no longer live with rats in our houses. Vaccines certainly had nothing to do with it.

What do you think? Are vaccines and antibiotics keeping us from returning to the Infectious Disease Age? Or did we emerge from the Infectious Disease Age for other reasons?

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Intelligence boosts for everyone!

One time a guy accused me of "wanting to always be the smartest guy in the room". I replied: "Apparently you haven't seen the rooms I hang out in." As a matter of fact, I've always enjoyed being the dumbest guy in the room, because I'd rather learn from smart people than have to explain stuff to people.

So I guess it's not surprising that I think we should offer intelligence-boosting technology to everyone. Given the option, I'd much rather live in a society where everyone was a super-genius, even if that would take away  my economic niche (Who would need a semi-smart finance professor in a world of super-geniuses?). But my desire to smart-ify everyone in America is not just for my own benefit; I think most people would benefit from 80 extra IQ points, on net. Sure, there are studies saying that smart people have emotional problems. But I suspect a lot of these are just due to growing up weird and different; if we smart-ified everybody, this wouldn't be a problem.

So how about the technology? Does it exist? Well, on the cyborg side of things, there are some experiments being done with artificial memory and augmented learning. And then on the genetic side of things, there is a big effort underway in China to find the genes that cause extremely high intelligence:

The roots of intelligence are a mystery. Studies show that at least half of the variation in intelligence quotient, or IQ, is inherited. But while scientists have identified some genes that can significantly lower IQ—in people afflicted with mental retardation, for example—truly important genes that affect normal IQ variation have yet to be pinned down. 

The Hong Kong researchers hope to crack the problem by comparing the genomes of super-high-IQ individuals with the genomes of people drawn from the general population. By studying the variation in the two groups, they hope to isolate some of the hereditary factors behind IQ... 

Scientist say that tens of thousands of regular people would have to be studied just to find the first useful IQ gene. 

That's where BGI's genomic deep dive comes in. The team will compare the genomes of 2,200 high-IQ individuals with the genomes of several thousand people drawn randomly from the general population. Because most of the supersmart participants being studied are the cognitive equivalent of people "who are 6-foot-9-inches tall," says Dr. Hsu, it should be much easier to identify many key IQ-related factors in their genomes. (Dr. Hsu is now vice president for research and graduate studies at Michigan State University.)

So we may soon know some genes for exceptional intelligence. This would probably allow us to create super-smart babies (through a "knock-in" technique), or maybe even to augment the intelligence of adults.

Now, people are going to be worried about this technology, for two main reasons. The first reason is that it has the obvious potential to create lots of social inequality. If the distribution of smart-ification technology is left to the private sector, rich people will start having much smarter kids than middle-class or poor people, and generational inequality will be the result. The solution to this is to socialize the technology. Make smart-ification technology available for everyone, via the government.

The second worry is that this smacks of academic racism and eugenics. And indeed, the American scientist who is the driving intellectual force behind the Chinese project is Steve Hsu, a Michigan State physicist who has written a fair amount of academic-racist and pro-eugenics stuff on the web defended the notion of "race" as a biological classification, raised questions about "group differences" in abilities between races, and argued vocally against affirmative action (and here is academic-racist blogger Razib Khan defending and praising Hsu). (Note: See update below.)

But I think this worry is clearly unfounded. Because smart-ification technology will be race-blind! The technology would work equally well on any person, black, white, Asian, etc. In fact, identifying specific genes for high intelligence would clearly indicate that race and intelligence are not fundamentally linked, thus essentially slaughtering the entire academic-racist culture.

So I say, best of luck to the folks at BGI. If they do find the smart genes, the U.S. government must make sure to hack their databases, steal the data, and - assuming it's safe - make smart-ification available free for the masses. Then maybe I can fulfill my fantasy of being the dumbest guy in any given room.

(Note: I don't think IQ is really the measure of intelligence, and in fact I doubt intelligence can be usefully described by a one-factor scalar model at all. But "IQ enhancement" is a shorthand for enhancement of all sorts of cognitive tasks - working memory, spatial visualization, learning speed, etc. etc.)


Update: Steve Hsu emails me, contending that he is not an "academic racist", writing:

I think you should rethink your incorrect characterization of me as an "academic-racist"...I don't know whether group differences in cognitive ability or behavior have any genetic basis. (In fact, this particular question is not one of my main interests -- I am much more interested in the genetic architecture of cognitive ability than in its distribution over ethnic groups.)

I'm certainly willing to give Steve the benefit of the doubt here. I define "academic-racism" by a focus on ethnicity as a determinant of abilities, not by a belief in genetic determinants of ability. So if Steve says he doesn't care about ethnicity, I'll take him at his word. But of course you can read Steve's "race and ability" blog post and decide for yourself.

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Warts and the Power of Suggestion

Not long ago I wrote a post (which got over 10,000 views) in which the controversial hypothesis was raised that perhaps the reason so many smokers are getting so much lung cancer, today (far more cases than can any longer be explained by science) is that we're all being programmed by the cancer warnings on cigaret boxes that tell us we are going to get cancer. In other words, maybe the power of suggestion is aggravating the problem.

Human papilloma virus.

I admit it seems ridiculous that merely planting the suggestion of cancer in someone's mind can make a person get cancer. (Still, read the evidence in my previous post.) But we know that the power of suggestion can, in fact, help rid a body of tumors; at least, tumors of a specific kind. The kind called warts.

Warts are, of course, benign papillomas, caused by a virus. And the strange thing about them is, it's been known for many years that patients can make their own warts go away by power of suggestion. This has been verified so many times in the literature that it needs no further argument. Some of the papers are listed below.

Well-known physician-author Lewis Thomas once wrote an engaging essay on this topic. According to Thomas:

There have been several meticulous studies by good clinical investigators, with proper controls. In one of these, fourteen patients with seemingly intractable generalized warts on both sides of the body were hypnotized, and the suggestion was made that all the warts on one side of the body would begin to go away. Within several weeks the results were indisputably positive; in nine patients, all or nearly all of the warts on the suggested side had vanished, while the control side had just as many as ever. It is interesting that most of the warts vanished precisely as they were instructed, but it is even more fascinating that mistakes were made. Just as you might expect in other affairs requiring a clear understanding of which is right and which the left side, one of the subjects got mixed up and destroyed the warts on the wrong side.

Experiments of this sort have not been tried on malignant tumors, for obvious ethical reasons. (You can't very well leave a control group of cancer patients untreated when treatment options exist.) Nevertheless, it makes one wonder. How much do we really know about the mind's control over vascular and immunologic processes?  Maybe there's more to this power-of-suggestion stuff than we might imagine?


References

Ewin, D.M. Hypnotherapy for warts (verruca vulgaris): 41 consecutive cases with 33 cures, Am J Clin Hypn. 1992 Jul;35(1):1-10. http://www.ncbi.nlm.nih.gov/pubmed/1442635

Sinclair-Gieben, A.H.C., Chalmers, D., Evaluation of Treatment of Warts by Hypnosis, Lancet 2: Oct 3 1959; 480-482. Cited and excerpted in media.noetic.org/uploads/files/chapter11.pdf

Smith, Arthur Preston, The Power of Thought to Heal: An Ontology of Personal Faith, Ph.D. Dissertation (1998) Claremont Graduate University, CA http://freehealing.org/dissert.html

Spanos, Nicholas R., Stenstrom, Robert J., Johnston, Joseph C.,  Hypnosis, Placebo, and Suggestion in the Treatment of Warts Psychosomatic Medicine 50:245-260 (1988) http://bscw.rediris.es/pub/bscw.cgi/d4465026/Spanos-Hypnosis_placebo_suggestion_warts.pdf

Tenzel, J.H.,Taylor, R.L., An evaluation of hypnosis and suggestion as treatment for warts. Psychosomatics 1969 Jul-Aug;10(4):252-7. http://www.ncbi.nlm.nih.gov/pubmed/5808618

Vollmer, Hermann, Treatment of Warts by Suggestion, Psychosomatic Medicine March 1, 1946 vol. 8 no. 2 138-142 http://www.psychosomaticmedicine.org/content/8/2/138.abstract

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Eli Lilly and its Zyprexa Go-to-Market B.S.

Eli Lilly Sales Organization backgrounder.

Weight gain and diabetes are among the small-print risks for all major atypical antipsychotic medications now. But not all atypicals are equal. What patients knew intuitively is now established scientifically: Lilly's Zyprexa produces the worst weight gain of all of the major atypicals. You don't have to dig through the medical literature to find out how bad the situation is. Just ask a friend. Or if you don't have any friends on Zyprexa, go online to the health forums, or to YouTube, where you won't have any trouble locating people who've gained 25% or more in body weight from taking Zyprexa.

Just for fun, you might want to hear how these drugs are sold to doctors. The  video below is by a guy who sold Zyprexa for a living. Have a listen. The spin job begins with Corporate, funnels down through Sales, reaches your doctor, and ends with (guess who?) you.

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New Atlantic column: Capitalism and the end of growth

New column up at the Atlantic, on whether or not capitalism requires infinite resource exploitation:

When we bump up against our planet's resource limits, the story goes, capitalism goes bye-bye. But is it true? Maybe, but I have my doubts... 

The simple Econ 101 theories that are used to justify free markets don't even have growth in them! In Econ 101, capitalism works because people gain from trade, not because they have more and more to trade over time. Efficiency, not growth, is the gold ring. In those simple toy economies, people just keep on cheerfully making their bargains of cattle and grain until the Sun explodes... 

But who cares about economic theories, right? What does history tell us?... 

[M]odern history doesn't seem to favor the "end of growth = end of capitalism" thesis. After all, middle-class incomes have been stagnating in rich countries on and off since the early 1970s. Energy and water - certainly the most important natural resources - have become scarcer and more expensive. In other words, we really have started hitting our resource limits. And yet in many ways, rich countries like the U.S., Europe, and Japan have become more capitalist since the 70s, with lower taxes, deregulation, widespread privatization, and a bigger role for financial markets (not that this has always worked out well, obviously!). Despite the increasing prices of oil and gasoline and water, people in the developed world have not clamored for capitalism's downfall... 

Looking at history, we see that the biggest challenges to capitalism actually came during times of rapid growth... 

Although it's less glamorous than the imagined utopias of the left or the right, the boring, pragmatic, plodding old "mixed economy" has proven to be the most robust, through times of growth and times of stagnation.

Read the whole thing here!

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A Few Thoughts about Semicolons

John Shuttleworth circa 1980.

Did you ever use too much dill in a recipe? Remember how it tasted? Semicolons are like that. Useful in a pinch, distasteful in excess. No one ever sits down to eat a bowl of them.

When I was a rewrite monkey at The Mother Earth News, many geological epochs ago (when men were monkeys), John Shuttleworth, founder of the magazine, chastised me mercilessly for using too many semicolons. How many semicolons was "too many"? Answer: any integer greater than zero.

Shuttleworth associated semicolons with academic writing and stuffy, pompous, pedantic writing in general. If periods were lag bolts and commas were pop rivets, semicolons were (to him) a kind of inferior duct tape, not to be trusted. He was unable to articulate his prejudices on the subject in a convincing fashion. Yet I think I know now what he meant.

I won't go so far as to say (as Shuttleworth did) that semicolons are evil. But I would agree with him that they're overused.

People typically use semicolons as an adhesive to join together two independent clauses. It's a stronger adhesive than a comma, but not as strong as a period. Example:

Deficit spending is an idea that no longer enjoys the kind of support it once did; it is one of many quaint Keynesianisms that have fallen into disfavor.

This is the kind of sentence Shuttleworth hated with the fire of a thousand suns. Why? It's two sentences pretending to be one. What's wrong with that? First, it makes a sentence twice as long, and long sentences suck. Also, semicolons put more work on the reader. A person encountering the semicolon in the above sentence, thinks "Okay, I'm being told to cache the meaning of the 16 words I just read so that I can see how the next statement relates to it." The trouble is, the reader may not want (or be able) to hold the preceding clause in memory, particularly if the followup clause is a long one. You're telling the reader to keep one ball up in the air while grabbing a new one. Why not just hand the reader Ball 1, then hand him Ball 2?

Deficit spending is an idea that no longer enjoys the kind of support it once did. It's one of many quaint Keynesianisms that have fallen into disfavor.

Was there ever any reason to combine these two sentences into one, using a semicolon? No. Not really. So why do it?

I agree with Shuttleworth that using a semicolon to join two independent clauses is a poor idea, seldom justifiable in terms of readability. It's the conventional ("accepted") way to use semicolons, yet it's also the worst possible use-case.

When should you use a semicolon? Here are the use-cases that work for me:

1. Use semicolons in any list in which the list items come with their own internal punctuation. Example: We made stops in London, England; Geneva, Switzerland; and Paris, France.

2. Use a semicolon to put a longer explanatory thought after a super-short statement that begs further explanation. Example: I don't like coffee; I'm jittery enough without it, and it keeps me awake at night. Shorter thought, then longer thought.

3.  Use a semicolon when you need to add a quick/short clarification or observation to the tail end of a much longer thought. For example: Only ten percent of patients had a full recovery after ten weeks of intensive treatment; a poor outcome by any measure. Longer thought followed by much shorter thought.

Also: When I see myself using more than one semicolon in a paragraph, or in a passage of less than, say, 300 words, I force myself to do a little rewriting to eliminate one or more semicolons. As a reader, I'm annoyed when I see semicolons cropping up everywhere in an otherwise-good piece of writing. I have to think there are others of my kind out there.

It's up to you. Use semicolons with abandon if you dare. But I think for most readers, semicolons are like dill weed. They nearly always spoil the recipe if used too freely.

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