Last week I suggested that it could very well be that a second Brexit referendum would stumble into Arrow’s paradox, with Remain preferred to soft Brexit, soft Brexit preferred to no deal, and No Deal preferred to Remain. I wasn’t expecting rapid confirmation, but here it is, from a poll of about 1000 British adults:
“…but it reduces the chance of taxes”.
New heart treatment is biggest breakthrough since statins, scientists say
I just came across this breathless headline published in the Guardian from last year. On the one hand, this is just one study, the effect was barely statistically significant, and experience suggests a fairly high likelihood that this will ultimately have no effect on general medical practice or on human health and mortality rates. I understand the exigencies of the daily newspaper publishing model, but it’s problematic that the “new research study” has been defined as the event on which to hang a headline. The only people who need that level of up-to-the-minute detail are those professionally involved in winnowing out the new ideas and turning them into clinical practice. We would all be better served if newspapers instead reported on what new treatments have actually had an effect over the last five years. That would be just as novel to the general readership, and far less erratic.
On the other hand, I want to comment on one point of what I see as exaggerated skepticism: The paragraph that summarises the study results says
For patients who received the canakinumab injections the team reported a 15% reduction in the risk of a cardiovascular event, including fatal and non-fatal heart attacks and strokes. Also, the need for expensive interventional procedures, such as bypass surgery and inserting stents, was cut by more than 30%. There was no overall difference in death rates between patients on canakinumab and those given placebo injections, and the drug did not change cholesterol levels.
There is then a quote:
Prof Martin Bennett, a cardiologist from Cambridge who was not involved in the study, said the trial results were an important advance in understanding why heart attacks happen. But, he said, he had concerns about the side effects, the high cost of the drug and the fact that death rates were not better in those given the drug.
In principle, I think this is a good thing. There are far too many studies that show a treatment scraping out a barely significant reduction in mortality due to one cause, which is highlighted, but a countervailing mortality increase due to other causes, netting out to essentially no improvement. Then you have to say, we really should be aiming to reduce mortality, not to reduce a cause of mortality. (I remember many years ago, a few years after the US started raising the age for purchasing alcohol to 21, reading of a study that was heralded as showing the success of this approach, having found that the number of traffic fatalities attributed to alcohol had decreased substantially. Unfortunately, the number of fatalities not attributed to alcohol had increased by a similar amount, suggesting that some amount of recategorisation was going on.) Sometimes researchers will try to distract attention from a null result for mortality by pointing to a secondary endpoint — improved results on a blood test linked to mortality, for instance — which needs to be viewed with some suspicion.
In this case, though, I think the skepticism is unwarranted. There is no doubt that before the study the researchers would have predicted reduction in mortality from cardiovascular causes, no reduction due to any other cause, and likely an increase due to infection. The worry would be that the increase due to infection — or to some unanticipated side effect — would outweigh the benefits.
The results confirmed the best-case predictions. Cardiovascular mortality was reduced — possibly a lot, possibly only slightly. Deaths due to infections increased significantly in percentage terms, but the numbers were small relative to the cardiovascular improvements. The one big surprise was a very substantial reduction in cancer mortality. The researchers are open about not having predicted this, and not having a clear explanation. In such a case, it would be wrong to put much weight on the statistical “significance”, because it is impossible to quantify the class of hypotheses that are implicitly being ignored. The proper thing is to highlight this observation for further research, as they have properly done.
When you deduct these three groups of causes — cardiovascular, infections, cancer — you are left with approximately equal mortality rates in the placebo and treatment groups, as expected. So there is no reason to be “concerned” that overall mortality was not improved in those receiving the drug. First of all, overall mortality was better in the treatment group. It’s just that the improvement in CV mortality — as predicted — while large enough to be clearly not random when compared with the overall number of CV deaths, it was not large compared with the much larger total number of deaths. This is no more “concerning” than it would be, when reviewing a programme for improving airline safety, to discover that it did not appreciably change the total number of transportation-related fatalities.
On moving to the UK almost a dozen years ago I quickly noticed that the one thing that unites the political establishment, left and right, is that they don’t like foreigners. Or rather, maybe better phrased, they may personally like and even admire some foreigners, but they recognise that such exotic tastes are not for everyone, and that disliking foreigners is a valuable national pastime, deserving of their official support.
And so, after claiming through the Brexit campaign that it was all about national sovereignty and repatriating billions of pounds for the NHS, and having spent the better part of two years diplomatically digging a grave for the national future, the Tories strike on bedrock: We have betrayed national sovereignty and destroyed the national economy, but it’s all worth it because we still get to kick out the foreigners. Or, in the prime minister’s words:
“Getting back full control of our borders is an issue of great importance to the British people,” she will say, adding that EU citizens will no longer be able to “jump the queue ahead of engineers from Sydney or software developers from Delhi”.
I’m willing to go out on a limb here and suggest that the subset of British — or, given their current fragile mental state, I should perhaps call them Brittle — voters who voted Leave with the thought uppermost in their minds of improving the prospects for Indians to migrate to the UK was… less than a majority. But even more striking, EU citizens who moved to the UK over the past 40 years, following the same agreements that allowed Brittle people to seek work and better lives anywhere on the Continent, are retrospectively branded as “queue jumpers”, the most rebarbative class in the English moral order. Theresa May is summoning her countrymen and -women to defend a fantasy queue.
In the 1990s the German media teemed with entreaties to tear down the Mauer im Kopf, the “mental wall” (a phrase of the author Peter Schneider that actually long preceded the fall of the physical wall in Berlin), as a necessary prelude to a stable national identity, and a democratic and prosperous future. Maybe the Brittles need to dissolve their fantasy queues, to break up the Schlange im Kopf, before they can start building a new nation on the rubble they are making of their past.
One of the weirdest phenomena engendered by the tawdry incentive structure of academic publishing is the academic spam that we all get, such as this invitation that I just found in my inbox:
Dear Prof./Dr. D. Steinsaltz:
As Co-Editor-in-Chief of the International Journal of Statistics in Medical Research. I am pleased to invite you to join our editorial board member team or reviewer board team.
Esteemed researchers are invited to join the editorial boards of excellent journals, and it is a mark of prestige that they put on their CVs, etc. This is vaguely formulated like such an invitation, but then goes on with
If you are interested to be the part of the journal as member in editorial or reviewer board then please send your CV along with photograph.
making it clear that they have no idea who I am, and they’re just spraying out these invitations to all and sundry. It’s part of the fungal growth of journals needed to meet the needs for publications to fill other people’s CVs for their academic hiring and promotion. The best part was that this flattering invitation was closed off with a dutiful unsubscribe notice “If you wish not tor receive any such communication in future.” (Which also gave a taste of the standard of writing and editing expected for this journal.)
It reminded me of this line from Tom Lehrer’s outro to the song “Alma” (on the album That Was the Year that Was):
Not long ago I received a letter which said: “Darling, I love you, and I cannot live without you. Marry me, or I will kill myself.” Well, I was a little disturbed at that until I took another look at the envelope, and saw that it was addressed to Occupant.
Senator Lindsey Graham has lamented the chaotic way that old accusations of sexual abuse are resurfacing to derail men’s careers.
“If this is enough – 35 years in the past, no specifics about location and time, no corroboration – God help the next batch of nominees that come forward,” he told reporters. “It’s going to be hard to recruit good people if you go down based on allegations that are old and unverified.”
I think we can all agree that the current haphazard approach to reporting, investigating, and punishing sexual violence from the distant past, with mores changing and memories fraying, is not ideal, not for the victims, not for justice.
Ultimately, I think what we need is a Sexual Truth and Reconciliation Commission (STaR Commission). As in post-Apartheid South Africa, the Commission would be empowered to offer amnesty to offenders in exchange for confession of all sexual offenses, and full and frank accounts of the facts from the period of the War on Women.
Of course, before we can have the Truth and Reconciliation, we need first to overthrow the old regime of gender-apartheid and hold free and fair gender-neutral elections. That will be some time yet. By that time, we can hope that computer technology will have progressed to the point that it will be possible to store and distribute the complete record of the crimes.
I was in high school when the Hitler diaries flashed across the media firmament, and I was fascinated by the eagerness with which so many responsible people accepted as plausible what were quickly unmasked as transparent frauds. An important selling point was the observation that the diaries never mentioned the extermination of the Jews, and I remember very specifically an article in Time magazine that teased the possibility that Hitler himself may not have known of the extent of the Holocaust, with speculation by historians that underlings may have acted on their own. I had an insight then about what would motivate people to seek out evidence that someone they “know” — even if knowing them only by their reputation as a famous monster — was innocent of an important crime. Just by learning about a historical figure we inevitably develop some psychological identification with him, he becomes one of our acquaintances, and then to mitigate the cognitive dissonance we are attracted to exculpatory evidence, even better if it is such as tends to diffuse responsibility rather than creating other specific monsters.
The writer Richard Marius once told me that after he had written his biography of Thomas More, where he had to come to some resolution on the purported crimes of Richard III, and decided that Richard was guilty of everything, he got harassed by people calling themselves Ricardians. They insisted that the criminals were Henry VII, or Edward Tyrell, or some anonymous unknowable others. Again, Richard III is a famous villain, but since he is famous, people identify him, and want to believe him not such a villain.
The French aphorism tout comprendre c’est tout pardonner goes deep. Bare familiarity is enough to create a motivation to pardon everything.
I see a connection to the way conservatives jumped at the theory that Christine Blasey Ford had indeed been sexually assaulted, but that she had mis-identified Brett Kavanaugh as the perpetrator. This doesn’t change anything about the number of evil people in the world, but it renders them anonymous. (Ed Whelan crossed a line when he went full Ricardian and accused a specific classmate of Kavanaugh’s. In principle, this serves all relevant purposes of the free-floating accusation, but by libelling a specific private citizen it created too many other complications and even, dare I suggest, moral qualms.) Continue reading “Kavanaugh’s evil twin and the Hitler diaries”
Whatever one thinks of the burden of proof on sexual assault, the new reports on Brett Kavanaugh’s youthful leisure activities show that he anticipated the modern GOP in putting party ahead of principle.
Isaac Asimov, in a side-remark in his Treasury of Humor, mentioned a conversation in which a participant expressed outrage at a politician blathering about “American goals”. “His specialty is jails, not goals,” and then seeming to expect some laughter. It was only on reflection that Asimov realised that the speaker, who was British, had spelled it gaols in his mind.
I was reminded of this by this Guardian headline:
Labour has shifted focus from bingo to quinoa, say swing voters
The words bingo and quinoa look vaguely similar on the page, but they’re not pronounced anything alike. Unlike Asimov’s example, this wordplay is in writing, so spelling is important. My feeling is that wordplay has to be fundamentally sound-based, so this just doesn’t work for me. Maybe the Guardian editors believe in visual wordplay.
Alternatively, maybe they don’t know how quinoa is pronounced.
There’s an interesting article in the NY Times about a young legal scholar, Lina Khan, who is gaining attention for a novel and detailed argument that antitrust enforcement in the US has come to be inappropriately fixated on price as the sole anticompetitive harm, and so giving a free pass to Amazon. I have no original thoughts about the argument, but I am intrigued by the dismissive language of the critics cited in the article. One (antitrust lawyer Konstantin Medvedovsky) called her approach “hipster antitrust”. And then there’s this:
Herbert Hovenkamp, an antitrust expert at the University of Pennsylvania Law School, wrote that if companies like Amazon are targeted simply because their low prices hurt competitors, we might “quickly drive the economy back into the Stone Age, imposing hysterical costs on everyone.”
Is “hysterical costs” a real thing? Or was he just reaching for a word that would impugn the rationality of a female opponent, and came up with the classic wandering womb?