Chinese towels

Another thought about Elizabeth Holmes and Theranos: Her billion-dollar medical-testing company based on secret and unproven technology in her twenties depended largely on a board of well-connected politicians and former politicians, notable for their lack of any relevant scientific expertise. But before she got to that point she needed to turn the heads of some scientists. According to the New Yorker, she caught the attention of dean of engineering Channing Robertson in her freshman year at Stanford:

One day, in her freshman year, Robertson said, she came to his office to ask if she could work in his lab with the Ph.D. students. He hesitated, but she persisted and he gave in. At the end of the spring term, she told him that she planned to spend the summer working at the Genome Institute, in Singapore. He warned her that prospective students had to speak Mandarin.

 “I’m fluent in Mandarin,” she said.

“I’m thinking, What’s next? She’s already coming into the research group meetings at the end of her freshman year with my Ph.D. students. I find myself listening to her more than to them about the next experiments to be done and the progress that’s been made. I realized she’s different.”

Clearly scientific acumen was exceptional. But what is the role of Mandarin? (This is the second story in the article about how she impressed people with her knowledge of the language.) I am reminded of the famous passage in The Hitchhiker’s Guide to the Galaxy:

A towel, it says, is about the most massively useful thing an interstellar hitchhiker can have. Partly it has great practical value… More importantly, a towel has immense psychological value. For some reason, if a strag (strag: non-hitchhiker) discovers that a hitchhiker has his towel with him, he will automatically assume that he is also in possession of a toothbrush, face flannel, soap, tin of biscuits, flask, compass, map, ball of string, gnat spray, wet weather gear, space suit etc., etc. Furthermore, the strag will then happily lend the hitchhiker any of these or a dozen other items that the hitchhiker might accidentally have ”lost”.

Is speaking Mandarin (assuming you’re not yourself Chinese) the intellectual equivalent of having your towel? Is that what he means by “What’s next?” He’s thinking, I’m dean of the engineering school at Stanford, and I don’t speak Mandarin. She’s only 18 and she’s managed to learn to speak fluent Mandarin. She must know all kinds of things that I have no inkling of.

Is that the reason why the chic private schools in the UK all seem to be teaching Mandarin?

How to do it: Medical testing edition

I was commenting just recently on the cult of big ideas, where people whose life experiences have given them hierarchical power are suckers for “ideas” that are mostly blather, lots of words about the irrelevant bits of the problem, distracting attention from the real difficulties. And now Theranos is in the news. I read about this company, started by the obviously charismatic Elizabeth Holmes, in The New Yorker about a year ago. My immediate reaction was, this must be a joke. It was very much in the spirit of Monty Python’s How to do it.

Theranos, a Silicon Valley company[…], is working to upend the lucrative business of blood testing. Blood analysis is integral to medicine. When your physician wants to check some aspect of your health, such as your cholesterol or glucose levels, or look for indications of kidney or liver problems, a blood test is often required. This typically involves a long needle and several blood-filled vials, which are sent to a lab for analysis… [Theranos] has developed blood tests that can help detect dozens of medical conditions, from high cholesterol to cancer, based on a drop or two of blood drawn with a pinprick from your finger. Holmes told the audience that blood testing can be done more quickly, conveniently, and inexpensively, and that lives can be saved as a consequence.

Sounds wonderful. Quick. Convenient. Inexpensive. Saving lives. How is she going to do all that? Well, she wears “a black suit and a black cotton turtleneck, reminiscent of Steve Jobs”. She dropped out of Stanford. She has a board of directors full of highly influential aged former politicians, but no scientists, so far as I can tell. She “is in advanced discussions with the Cleveland Clinic. It has also opened centers in forty-one Walgreens pharmacies, with plans to open thousands more. If you show the pharmacist your I.D., your insurance card, and a doctor’s note, you can have your blood drawn right there…. A typical lab test for cholesterol can cost fifty dollars or more; the Theranos test at Walgreens costs two dollars and ninety-nine cents.” Continue reading “How to do it: Medical testing edition”

The politics of impatience

What does it mean when someone who is himself significantly responsible for solving a problem expresses his “impatience” for a solution? I think of this because today’s Times has on page 2

George Osborne lost patience with the pensions industry yesterday, announcing action against insurers who blocked savers from accessing their cash.

And on page 4 we read of

news of a fresh delay of up to a year in publication of the Iraq inquiry, prompting Mr Cameron to say that he was “fast losing patience”.

Perhaps this outbreak of impatience is somehow related to the front-page story, which says

the very best they can expect is that it will take them time — but time is not on their side.

That one is about the pervasive decline in sperm quality due to plastics in packaging, sunscreens and cosmetics.

Every three minutes

From a Guardian article on a new theory about the aetiology of Alzheimer disease:

It is thought that this year one person every three minutes will develop dementia.

It’s hard to explain statistics in a way that they feel real to people, but is “one person every three minutes” really a useful way to think about a disease that develops gradually over many years, as opposed to, say, muggings? Perhaps they meant to say “one person every three minutes will be diagnosed with dementia”.

Do all babies look alike?

And if not, why don’t they have any privacy rights with regard to their photographs?

Here is the illustration provided by the BBC on its home page for a report on the decision to approve fertility procedures that take genetic material from three different people:

Not a three-parent baby, but they are expected to look similar to this one.
Not a three-person baby, but manufacturers promise they will look similar to this model.

One wonders what purpose this photograph serves. Are there readers who see the headline and think, “Wait, babies, I’ve heard of them. Can’t quite remember what they look like…” In what sense is this an illustration of the article? It’s not even a newborn infant. They might as well have shown a 90-year-old lady, because making three-person babies inevitably leads to the eventual creation of three-person 90-year-olds. It might be even more relevant to show an elderly person, because that’s the goal: the purpose of the procedure is to improve the health and longevity of the humans so conceived.

They could have used their stock photograph of weirdly lighted lab technicians pipetting something into a test tube instead.

I’m wondering, who is this baby who is standing in for a “three-person baby”? I’m used to seeing children have their features blurred out in news photos. But, of course, this one was presumably a “volunteer” model. One baby can stand in for all babies. (As long as it’s white, of course.)

What does an anti-vaccine activist want?

With the swelling of interest in the anti-vaccine movement, inspired by the recent California measles outbreak, I’ve seen a number of opinions published similar to this one from Ian Steadman in the New Statesman

Then there’s also this to think about: if somebody’s distrust of scientific and/or political authority is so great, for whatever reason – maybe they’ve been scared by sensationalist stories in the media, or maybe they sincerely believe the government has no moral right to dictate health choices to citizens – that they’re willing to significantly increase their child’s risk of catching a (possibly fatal) illness, then calling them names and telling them scientists and politicians disagree with them is probably futile. Arguing that “the science is settled” with someone whose stance is predicated on the belief that the standards of proof used by scientists are flawed is definitely futile.

The article is excellent, but I don’t entirely agree with this sentiment. Living in Berkeley and Oxford, I have encountered some vaccine refuseniks, and it’s not clear to me that they have anything as definable as a belief about “the standards of proof used by scientists”. Rather, I think that they have a desperate need to feel special, protected not by mass vaccination — and definitely not by anything as infra dig as “herd immunity” — but by their special virtue, which may be Christian purity or organic health-food purity. Continue reading “What does an anti-vaccine activist want?”

The value of diagnosis

What is diagnosis worth, if there is no treatment? This is a perennial question in medical ethics. I recall a passage in Roy Porter’s history of medicine, The Greatest Benefit to Mankind, referring to the sardonic praise heaped upon the clinic in Vienna (I think it was), where the magisterial diagnoses were always “swiftly confirmed at the autopsy”.

An article in Salon recounts the revelation from autopsy that comedian Robin Williams was suffering from Lewy body dementia at the time of his recent suicide. The article quotes the programming director of the Lewy Body Dementia Association, saying “Though his death is terribly sad, it’s a good opportunity to inform people about this disease and the importance of early diagnosis.” I know this is the sort of thing that someone in her position is required to say, but given that there is no cure, and very little by way of effective treatment, I wonder what “importance of early diagnosis” she is referring to, and what she takes the relevance of this event in particular to be. That early diagnosis allows you to know what’s happening while you’re still fit enough to take your own life?

Association by guilt

Guilt by association — you’re friends with a terrible person so you must also be one — is generally recognised as a pernicious logical fallacy. But what should we call this comment by Israeli Foreign Ministry spokesman Paul Hirschson, explaining why Norwegian trauma surgeon Mads Gilbert has been banned from returning to Gaza after he made critical remarks about the Israeli military activities this past summer? Dr Gilbert, he opined, is

not on the side of decency and peace and he’s got a horrible track record. I wouldn’t be surprised if his acquaintances are among the worst people in the world.

In other words, he’s a terrible person, so I’m sure his friends are too. Is this association by guilt?

False positives, false confidence, and ebola

Designing a screening test is hard. You have a large population, almost all of whom do not have whichever condition you’re searching for. Thus, even with a tiny probability of error, most of the cases you pick up will be incorrect — false positives, in the jargon. So you try to set the bar reasonably high; but set it too high and you’ll miss most of the real cases — false negatives.

On the other hand, if you have a suspicion of the condition in a particular case, it’s much easier. You can set the threshold much lower without being swamped by false positives. What would be really dumb is to use the same threshold from the screening test to judge a case where there are individual grounds for suspicion. But that’s apparently what doctors in Spain did with the nurse who was infected with Ebola. From the Daily Beast:

When Teresa Romero Ramos, the Spanish nurse now afflicted with the deadly Ebola virus first felt feverish on September 30, she reportedly called her family doctor and told him she had been working with Ebola patients just like Thomas Eric Duncan who died today in Dallas. Her fever was low-grade, just 38 degrees Celsius (100 degrees Fahrenheit), far enough below the 38.6-degree Ebola red alert temperature to not cause alarm. Her doctor told her to take two aspirin, keep an eye on her fever and keep in touch.

She was caring for Ebola patients, she developed a fever, but they decided not to treat it like a possible case of Ebola because her fever was 0.6 degrees below the screening threshold for Ebola.

A failure of elementary statistical understanding, and who knows how many lives it will cost.

Percents are hard

Some really bad science reporting from the BBC. They report on a new study finding the incidence of diagnosed coeliac disease increasing (and decreasing incidence of dermatitis herpetiformis, though this doesn’t rate a mention) in the UK. Diagnoses have gone up from 5.2 to 19.1 per 100,000 in about 20 years, which they attribute to increased awareness. Except, they don’t say what that is 100,000 of. You have to go back to the original article to see that it is person-years, and that they are talking about incidence, and not prevalence (in technical parlance); they use the word “rate”, which is pretty ambiguous, and commonly used — particularly in everyday speech — to refer to prevalence. If you read it casually — and, despite being a borderline expert in the subject, I misread it at first myself —  you might think they mean that 19 in 100,000 of the population of Britain suffers from coeliac; that would be about 12,000 people, hardly enough to explain the condition’s cultural prominence (and prominent placement on the BBC website). In fact, they estimate that about 150,000 have diagnosed CD in the UK.

As if aiming maximally to compound the confusion, they quote one of the authors saying

“This [increase] is a diagnostic phenomenon, not an incidence phenomenon. It is exactly what we had anticipated.”

In the article they (appropriately) refer to the rate of diagnosis as incidence, but here they say it’s not about “incidence”.

To make matters worse, they continue with this comment:

Previous studies have suggested around 1% of the population would test positive for the condition – but the data from this study suggests only 0.25% are diagnosed.

I think that normally, if you say “only x% are diagnosed” is meant relative to the number of cases; here it would mean 0.25% of the 1%. But, in fact, they mean to compare the 0.25% of the population who are diagnosed with the 1% who actually suffer from the disease.