Wednesday, March 29, 2023

The Little Black Bag: Medical Care as a Faustian Bargain

“Every doctor tells me something different,” I said.

The doctor replied, “That’s why we call them opinions.”


We benefited from a daylong conference about multiple myeloma hosted by the HealthTree Foundation of Lehi, Utah, and held at the Thompson Conference Center on the UT Austin  campus. Four oncologists presented guidelines, recommendations, and recent findings in both morning and afternoon sessions. At lunch, two of them joined us at our table. Overall, I am looking forward to a longer timeline in a better situational context. Most encouraging was that my new goal of ten years will likely include alternative options and improved treatments. In fact, for the oncologist one of the challenges is the long list of approved drugs already available. For the patient, each one comes with an array of annoying or debilitating side effects from diarrhea to blindness and coronary arrest. That being as it may, the conference started out with a strong positive statement about the ongoing research: “It is a story of hope.”

 

It is also important to consider whatever else might ail you. “Try to avoid the chronic health issues of a fulltime patient” such as diabetes and high blood pressure. That speaks to the sociology of oncology. Treatments are not so readily available for those lacking social capital. Of the fifty or so attendees, every one looked like us: middle class people with health insurance. Nonetheless, I am in a support group that meets (virtually) once a month and of the ten or twelve of us, we have ten or twelve different stories. My catchphrase is: “Predictions are statistical; outcomes are individual.”

 

When the Plague struck, I mixed every concoction I could think of and half of my patients died by my hand and the ones who survived called me their savior. -- Faust

 

Hier war die Arzeney, die Patienten starben,

Und niemand fragte: wer genas?

So haben wir, mit höllischen Latwergen,

In diesen Thälern, diesen Bergen,

Weit schlimmer als die Pest getobt.

Ich habe selbst den Gift an Tausende gegeben,

Sie welkten hin, ich muß erleben

Daß man die frechen Mörder lobt.

Faust, Erster Teil, Vor dem Thor.

 

This was our medicine; the patients died,

“Who were restored?” none cared to ask.

With our infernal mixture thus, ere long,

These hills and peaceful vales among,

We rag'd more fiercely than the pest;

Myself the deadly poison did to thousands give;

They pined away, I yet must live,

To hear the reckless murderers blest.

Faust, Part I. Before the City Gate.

Translated by Bayard Taylor 

 

Having moved 25 km south of Austin, I decided to find a cardiologist closer to home. The first one spent so little time with me–not 120 full seconds—that when I got down to my car, I stopped, turned around and went back in to insist on a consultation. I asked specifically about the side effects of oncology treatments and he was surprised. So, he set an appointment with another specialist. 

 

I told that specialist that I have no knowledge of my own anatomy. Speaking to each other at the same time, I asked if I have a mitral valve prolapse—“Do you have a mitral valve prolapse?”—or a bicuspid aorta—“Do you have a bicuspid aorta?”—and how does the murmur sound—“Do you have a murmer?” He stopped. “You are asking me while I am asking you.” 

Yes. I had an echo cardiogram the other day. Everyone listens to my heart. What can you tell me? 

“We will know more when you have a CT scan.”

 

On the way home, I remembered “The Little Black Bag” by Cyril M. Kornbluth. 

 

I forget things and that concerns me. So, I scheduled an Alzheimer’s assessment with a neurologist. I passed. She said that I have only (mild) age-related cognitive impairment. “It’s normal,” she said. “I don’t believe that it is normal,” I replied. “People like you never do,” she said. 

 

PREVIOUSLY ON NECESSARY FACTS

How Do You Make God Laugh? 

Welcome to the Future 

Bob Swanson and Genentech 

Misconduct in Science and Research 

Friday, March 17, 2023

What Color is the Orion Nebula?

On the Cloudy Nights discussion board, the question of the nominally “true” color of Messier 42 as well as many other nebulae and stars has been tossed up for discussion. One frequent contributor to the board insisted that he could see pink in the Orion Nebula and, moreover, that anyone who could not suffered from defective vision. Another stalwart relied on standards that he derived from measurements made during daylight photography of other objects and from those defended his interpretive photographic processing. These are examples of confirmation bias: the operator is first pleased by an image and then finds objective reasons supporting the choice. 

At the same time, chatrooms across the internet, apparently starting at Reddit and soon including Gizmodo and Ars Technica, were abuzz about Samsung’s claim that its artificial intelligence learning algorithm enhanced a photograph of the Moon taken with a Galaxy S21 Ultra. In fact, the software recognized the object as the Moon and added details from other images. This was not an isolated example of artificial enhancement. 

When photography became available for astronomy, subjective experience was supposed to have been removed. Perhaps the best case was the Orion Nebula, first photographed by Henry Draper and Mary Ann Palmer Draper on 30 September 1880. (See “The Drapers’ First Photograph of Messier 42” here: https://aas.org/posts/news/2022/10/month-astronomical-history-september-2022 By that time, the Orion Nebula had been rendered in drawings for almost 200 years. One consequence of all the attention was that the representations tended to converge to a common understanding: they started to look alike. Now they do not.

 

https://phys.org/news/2013-03-astrophoto-beautiful-orion-nebula.html


To me, the most important fact is that astronomers explore and record Messier 42 and the rest of the universe in different wavelengths and we can only reproduce the very narrow visible band: x-rays, ultraviolet, infrared, and radio waves must be transduced into some false color presentation. The 3500 stars otherwise hidden by the dust and gas in the Orion Nebula were only revealed with infrared imaging. (See The Orion Nebula: Where Stars are Born by C. Robert O’Dell, Harvard University Press, 2003.) The nebula itself is a complex space of emissions and reflections. Therefore, many valid transductions are possible.

 

A more informative discussion would start with which species is doing the viewing. 

“In comparison, butterflies and mantis shrimp have a dozen classes
[of sensory cells] to cover a broader range of the spectrum
(from deep ultraviolet to far red light), which gives them hyperspectral vision.” 


Geographers call it "ground truth." When you have a photograph that shows yellow, is that reflection, subtraction, filtering, or emission? You do not know until you go there for yourself. I completed my master's degree in 2010 with two classes in geographic information systems. One of our projects was to present our university stadium. Our school colors were green and white. The concrete was painted green. So were the wooden seats. The field was artificial turf, also green. Surrounding the field were real living green plants, from grass and shrubs to trees. The assignment was to sort out the wavelengths of imaging and deliver an informative presentation.

 

PREVIOUSLY ON NECESSARY FACTS

Why Evidence is not Enough 

Galileo and Saturn: Epistemology not Optics 

Visualizing Complex Data 

Knowledge Maps

 

 

Friday, March 3, 2023

Fake Americans

As a contractor in information technology, I usually work for placement and consulting firms. It is easier for me to be a W-2 employee though for my most recent project I was direct on a 1099. Very many placement firms headquartered in India have US addresses and through VOIP and other tools their recruiters have US phone numbers. I accept it all as a benefit of our global marketplace. Moreover, working in sales myself, I have been encouraged to take a less ethnic name for working on the phone, being "Michael Martin" as needed. So, I understand: If your name is Ramakrishna Suryadevara, you can be Kris Devara or Randy Devara or whaever. But there's a limit.


It was not that he called himself "Paul Miller" but that he flew the flag.
Many people are surprised to learn that non-citizens can serve in the American military. We are a nation of immigrants. Military service is one way to prove that you deserve to be a citizen. I had uncles born on the other side of the ocean who served in World War II (in our army, of course). We had a family narrative from the distaff side about a friend who voted illegally and when arrested showed his battle scars (from World War I) to the judge insisting that they gave him the right to vote. Somehow the authorities cleared up the paperwork for him. Anyway, people who serve in the military pick up American slang and drop many of their foreign habits. In fact, that story is the narrative behind the "Go for Broke" stamps of the US Postal Service that celebrate ethnic Japanese who fought in the American armed forces during World War II. It so happened that the Hawaiians did not understand that their buddies from the mainland had come from concentration camps ("relocation centers") until they were given a tour. There's a lot of lessons out there.

PREVIOUSLY ON NECESSARY FACTS