Tuesday: Hili dialogue

January 11, 2022 • 7:30 am

Welcome to the cruelest day, Tuesday, January 11, 2022: National Hot Toddy Day, and perfectly appropriate for Chicago’s current temperature of 8ºF (-13ºD). It’s also National Milk Day, National Shop for Travel Day (a good idea), Girl Hug Boy Day, Secret Pal Day, and National Human Trafficking Awareness Day.

News of the Day:

*Is the New York Times all that liberal and progressive? Not when it comes to their bottom line! As the Guardian reports, they’re opposing a union of their own employees:

The New York Times is one of America’s most vital totems of mainstream liberalism, right up there with expensive coffee and defensive explanations for sending your kids to private school. The New York Times is also, it turns out, one of America’s very best examples of how a boss is a boss. Because even as the paper pontificates about the dangers of inequality and gives sympathetic coverage to major union drives, the leaders of the company’s business side are busily trying to undermine their own unions.

Last April, 650 tech employees at the New York Times announced that they were unionizing. Rather than applauding them and proceeding to negotiate a contract, the company instead refused to voluntarily recognize the union. This is despite its own editorial board supporting a bill that would have made it legally binding for employers to voluntarily accept union requests when they are backed by a majority of the staff.

As the paper’s own editorial explained: “Under current law, an employer can reject the majority’s signatures and insist on a secret ballot. But in a disturbingly high number of cases, the employer uses the time before the vote to pressure employees to rethink their decision to unionize.” Now, this is what the New York Times company is accused of doing to its own employees.

. . .If you find this sort of anti-union behavior from the New York Times surprising, remember that another unit of unionized workers at the paper, those who worked for the product review section Wirecutter, had to go on strike during the busy Black Friday shopping weekend in order to secure a minimally fair contract. So while most of the editorial employees at the Times have been unionized for decades, the company is still exhibiting a chesty commitment to doing everything possible to keep any more of its workers from securing the same sort of benefits.

Bunch of hypocrites!

*You’re probably aware that there have been several interspecific heart transplants to humans from chimps (“xenotransplants”), and all failed within hours. We now have a better strategy: genetically modify an animal to minimize the probability of rejection and use animals hearts , like those from pigs, that are more similar to humans than those of chimps—and more readily available and modifiable. A xenotransplant was in fact done from a genetically modified pig to a human on Friday, and so far it’s working well, though we’re only four days in:

A 57-year-old man with life-threatening heart disease has received a heart from a genetically modified pig, a groundbreaking procedure that offers hope to hundreds of thousands of patients with failing organs.

It is the first successful transplant of a pig’s heart into a human being. The eight-hour operation took place in Baltimore on Friday, and the patient, David Bennett Sr. of Maryland, was doing well on Monday, according to surgeons at the University of Maryland Medical Center.

“It creates the pulse, it creates the pressure, it is his heart,” said Dr. Bartley Griffith, the director of the cardiac transplant program at the medical center, who performed the operation.

“It’s working and it looks normal. We are thrilled, but we don’t know what tomorrow will bring us. This has never been done before.”

. . . Pigs offer advantages over primates for organ procurements, because they are easier to raise and achieve adult human size in six months. Pig heart valves are routinely transplanted into humans, and some patients with diabetes have received porcine pancreas cells. Pig skin has also been used as a temporary graft for burn patients.

Well, you’re surely asking, “How was the pig genetically modified?” The answer is a stunner:

The pig had 10 genetic modifications. Four genes were knocked out, or inactivated, including one that encodes a molecule that causes an aggressive human rejection response.

A growth gene was also inactivated to prevent the pig’s heart from continuing to grow after it was implanted, said Dr. Mohiuddin,who, with Dr. Griffith, did much of the research leading up to the transplant.

In addition, six human genes were inserted into the genome of the donor pig — modifications designed to make the porcine organs more tolerable to the human immune system.

The team used a new experimental drug developed in part by Dr. Mohiuddin and made by Kiniksa Pharmaceuticals to suppress the immune system and prevent rejection. It also used a new machine perfusion device to keep the pig’s heart preserved until surgery.

If you’re not astonished by all that, you’ve lost your capacity for wonder.

*And another piece from the Guardian, this time even more disturbing. A new study from Canada indicates that, even after controlling for age, comorbidity, and the nature of the operation, women operated on by male surgeons die 32% more often than men operated on by male surgeons. That’s a big difference! A few quotes:

Women are 15% more liable to suffer a bad outcome, and 32% more likely to die, when a man rather than a woman carries out the surgery, according to a study of 1.3 million patients.

The findings have sparked a debate about the fact that surgery in the UK remains a hugely male-dominated area of medicine and claims that “implicit sex biases” among male surgeons may help explain why women are at such greater risk when they have an operation.[JAC: n.b., the study was among Canadian patients in Canada.]

“In our 1.3 million patient sample involving nearly 3,000 surgeons we found that female patients treated by male surgeons had 15% greater odds of worse outcomes than female patients treated by female surgeons,” said Dr Angela Jerath, an associate professor and clinical epidemiologist at the University of Toronto in Canada and a co-author of the findings.

. . . “Implicit sex biases”, in which surgeons “act on subconscious, deeply ingrained biases, stereotypes and attitudes”, may be one possible explanation, she said. Differences in men’s and women’s communication and interpersonal skills evident in surgeons’ discussions with patients before the operation takes place may also be a factor, she added. And “differences between male and female physician work style, decision-making and judgment”.

You’re probably thinking, “What about female surgeons? Do men do better with them, too?” The answer is no: the outcomes for male patients are about the same regardless of the sex of their surgeon.

Now remember, death after surgery isn’t that common, so a difference between 1% and 1.4% mortality is reported as an increase in 40%. Still, this finding disturbs me, because, according to the Guardian, the researchers seem to have controlled for everything but sex of the surgeon. If that makes a difference, it’s worrisome. After all, one unnecessary death is already one too many. You can find the paper, published in JAMA Surgery, here, and I hope some readers will go through it. I want an explanation!

*Every day I rethink my opinion about whether Russia will invade Ukraine. Most of the time I think they will, then I read something about “progress’ in the news and I think, “Well, maybe the Russians are bluffing.” And this ambivalence is exactly what Russia wants us to feel. But their demands are too far out of the U.S.-interest ball park, like withdrawing NATO lines back to decades ago, and our threatened “sanctions” are laughable.  Today, with progress very slow, I think Russia will invade. Ask me again tomorrow.

*Over at Medium, Peter Burns (who apparently has stolen my joke about pea color), has a good summary piece called “The Shameful Decline of Scientific American.”  There’s not much new here, though it does call attention to one of the most ludicrous papers in “studies” that pretends to be scientific, and you can read it here. It is a paradigmatic example of conflating science and “studies”, and I just remembered that I wrote about it here. If you want a good laugh, read the paper. (h/t Anna)

*Finally, today’s reported Covid-19 death toll in the U.S. is 837,911. an increase of 1,653 deaths over yesterday’s figure. The reported world death toll is now 5,514,603, an increase of about 6,900 over yesterday’s total.

Stuff that happened on January 11 includes:

  • 630 – Conquest of Mecca: The prophet Muhammad and his followers conquer the city, Quraysh surrender.
  • 1569 – First recorded lottery in England. Wikipedia has an interesting description:

the first recorded official lottery was chartered by Queen Elizabeth I, in the year 1566, and was drawn in 1569. The 400,000 tickets issued cost £0.50 each (roughly three weeks of wages for ordinary citizens), with the grand prize worth roughly £5,000. This lottery was designed to raise money for the “reparation of the havens and strength of the Realme, and towardes such other publique good workes”, including the rebuilding of ports and new ships for the royal fleet. Each ticket holder won a prize, and the total value of the prizes equalled the money raised. Prizes were in the form of both “ready money” and valuable commodities such as silver plate, tapestries, and fine linen cloth. Additionally, each participant was granted immunity from one arrest, “so long as the crime wasn’t piracy, murder, felonies, or treason.” The lottery was promoted by scrolls posted throughout the country showing sketches of the prizes

  • 1759 – The first American life insurance company, the Corporation for Relief of Poor and Distressed Presbyterian Ministers and of the Poor and Distressed Widows and Children of the Presbyterian Ministers (now part of Unum Group), is incorporated in Philadelphia, Pennsylvania.
  • 1879 – The Anglo-Zulu War begins.  Here’s a photograph of Cetshwayo kaMpande in 1875, who led the Zulus during the Ango-Zulu War. The Zulus lost.

  • 1908 – Grand Canyon National Monument is created.
  • 1922 – Leonard Thompson becomes the first person to be injected with insulin.

Thompson was 14 at the time and lived 12 more years, dying of pneumonia at 26. Here’s a photo:

Here’s the plane she used: her reliable Lockheed Vega, now residing in the Smithsonian’s Air and Space Museum in Northern Virginia:

Hoxha died in 1985, having been President for Life well, for life.  He did some good stuff, but was also an autocrat, reportedly killing 25,000 of his own people:

  • 1972 – East Pakistan renames itself Bangladesh.
  • 1973 – Major League Baseball owners vote in approval of the American League adopting the designated hitter position.

BAD DECISION. Everybody who plays should take their turn at bat!

Notables born on this day include:

  • 1755 – Alexander Hamilton, Nevisian-American general, economist and politician, 1st United States Secretary of the Treasury (d. 1804)

Hamilton is on the American tenner. He died in agony after he was shot in the lower abdomen by Aaron Burr during a duel (he lived 31 hours after he was shot):

  • 1842 – William James, American psychologist and philosopher (d. 1910)

Here he is. His brother was the author Henry James:

  • 1889 – Calvin Bridges, American geneticist and academic (d. 1938)

A student of T. H. Morgan, and therefore my distant academic cousin, Bridges was a terrific fly geneticist and also very handsome. I won’t recount his many exploits, including with women, but I recall he was once arrested for violating the Mann Act. Here he is inspecting dipterans:

You can see part of his story in the excellent movie Ford v. Ferrari, which came out a few years ago.  Here’s his most famous car, the Cobra (this model is the AC427:

  • 1946 – Naomi Judd, American singer-songwriter and actress

Those who cashed in their chips on January 11 include:

As the brewer of Canada’s most famous beer, Molson’s name will be immortal, eh? Here’s his funeral monument in Montreal:

Here’s a Canadian ad for Molson’s: “I am Canadian.” You can put the Molson’s into a Canadian, but you can’t take the Canadian out of a Canadian!

  • 1843 – Francis Scott Key, American lawyer, author, and songwriter (b. 1779)
  • 1882 – Theodor Schwann, German physiologist and biologist (b. 1810)

Here’s Schwann, famous for arguing, correctly, that animals as well as plants have cells:

  • 1928 – Thomas Hardy, English novelist and poet (b. 1840)

Here’s the cottage Hardy grew up in, followed by the graves of two of his cats (Snowdrop and Kitsy) in his larger and later home nearby (he carved the stones himself, and there are several other buried moggies), followed by the manuscript draft of his most famous novel. I photographed these while staying in Dorset in 2006. Hardy, to his credit, was a big-time cat lover.

 

  • 1941 – Emanuel Lasker, German mathematician, philosopher, and chess player (b. 1868)
  • 1966 – Alberto Giacometti, Swiss sculptor and painter (b. 1901)

Here’s Giacometti’s sculpture “Cat,” which is how every house cat would like to present itself at dinnertime:

  • 1988 – Isidor Isaac Rabi, Polish-American physicist and academic, Nobel Prize laureate (b. 1898)
  • 2008 – Edmund Hillary, New Zealand mountaineer and explorer (b. 1919)

Here’s Hillary’s ice axe with which he summited Mt. Everest; I photographed it in Wellington, NZ a few years ago:

  • 2015 – Anita Ekberg, Swedish-Italian model and actress (b. 1931)

Meanwhile in Dobrzyn: Hili is surprised and peeved:

Paulina: There is no meat.
Hili: What do you mean, there is no meat?
(Photo: Paulina R.)
In Polish:
Paulina: Nie ma mięsa.
Hili: Jak to nie ma mięsa?
(Zdjęcie: Paulina R.)
And a picture of little Kulka from Andrzej:

From Facebook:

Posted by Seth Andrews:

From Jesus of the Day:

Heartwarming: from the days when Jews and blacks used to be friends:

From John Cleese, who doesn’t listen to his doctors:

From Barry: a tweet showing state senator Scott Baldwin of Indiana, who later walked back his position (or rather, lack of a position). See him extricate his metatarsals from his mouth here.

From Ginger K. (I may have posted this before):

From reader Frank: a cowardly d*g tries to sneak into a cat’s bailiwick:

From reader Barry, who says “What is going on here?” I wrote my ant-biologist friend Phil Ward, who responded, ” These two ants are weaver ants (Oecophylla smaragdina), but I have no idea what they are doing with that plant structure and why. I guess they are treating it as a possible food item.”

Tweets from Matthew. This first one is really cool:

Here’s a video that purports to be a visualization of the nascent nebula, but surely part of it, if not all of it, is animated. Correct me if I’m wrong:

Cats!!!

53 thoughts on “Tuesday: Hili dialogue”

  1. Doesn’t sound like a profitable lottery…

    “Each ticket holder won a prize, and the total value of the prizes equalled the money raised.”

    Reply

    1. I interpreted “the money raised” to mean the state’s share. Which would mean half the money went to prizes while the other half went to the state.

      Three weeks wages for a get-out-of-prosecution free (once) card. Imagine the anarchy that would cause today.

      Reply

  2. Here’s piece from “The Federalist” website, which handily covers three pieces of updated information on Covid from CDC Director Walensky:

    -The vaccine doesn’t prevent transmission
    -“[T]he overwhelming number of deaths, over 75 percent, occurred in people who had at least four comorbidities”
    -Deaths from and with COVID aren’t the same thing

    (Apparently, WordPress doesn’t support the bulleted list in comments.) You can ignore the commentary and just watched the embedded clips of CDC Director Walensky.

    Reply

  3. On Djokovic and entering Australia:

    – Apparently, there was a bureaucratic error in the type of medical exemption visa he applied for (and was granted).
    – Many other medical exemptions were granted (dozens).
    – Djokovic has already had COVID-19, so he has a natural immunity now, and there’s no reason to think natural immunity is inferior to vaccine-generated immunity.
    – There are zero (AFAIK) incidents of professional athletes becoming seriously ill with COVID-19. (They are far out of the “target” demographic for serious illness.)

    He’s the defending Australian Open champion, the number 1 player in the world, and could well make history in Melbourne by taking his record 21st major tournament singles title (and extend his record count of Australian Open championships to 10 (next most are Emerson and Federer each with 6).

    His record last year was top of the world; and he came one match away from scoring the first calendar slam in men’s singles since Rod Laver in 1969 (he lost the US Open final to Daniil Medvedev).

    Why would they let a bureaucratic error prevent him from participating in the Australian Open? The courts made the right decision, in my opinion.

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    2. How deadly the virus may be or not to athletes is hardly the issue. Is it only athletes that other athletes come into close contact with? These guys live in a reality of “rules don’t apply to me”.

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      2. People seem to have forgotten what the efficacy measures were for the vaccines: They are judged effective at preventing hospitalization and death. Not illness. Not transmission. The jury is out on those for now; but it’s clear that many fully-vaccinated people are getting and transmitting COVID. (Not an argument for not getting vaccinated.)

        An amazing number of my fully vaccinated and boosted work colleagues and other people I know (dozens) are now testing positive for active COVID and have no symptoms or basically have “a cold”. I have no idea if I have it or have had it (fully vaxxed and boosted). I have not been in close contact with anyone who has it and I’ve had no symptoms, so I’ve not been tested. (I am working from home almost exclusively. These has been the heathiest two winters of my adult life.)

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    3. there’s no reason to think natural immunity is inferior to vaccine-generated immunity.

      Scientifically, there is every reason to think it’s inferior. The high points from the link: people with natural immunity but no vaccine, compared to vaccinated individuals, are more than 2x more likely to get reinfected and more than 5x more likely to end up in the hospital if they are.

      There are zero (AFAIK) incidents of professional athletes becoming seriously ill with COVID-19. (They are far out of the “target” demographic for serious illness.

      It’s not about whether he makes another competitor ill. It’s about whether he becomes a disease vector for the Australian populace.

      I’m agnostic whether they keep him in or out; I agree with the Aussie authority who said fame etc. shouldn’t matter, every entry application should be treated the same, meet the same health and safety standards. I don’t know whether he met those standards, but I hope the court in their finding applied them to him. I DO think the Aussie bureaucracy screwed up by not coordinating Tennis Australia’s communications about tournament entry requirements and the government’s country entry requirements. Everyone should be treated equally, yes, and that means nobody should be getting mixed signals from Australian organizations that causes them to buy a plane ticket, get on the plane, travel many hours to the country, book hotels, etc., and then be told when they arrive that they can’t enter the country. At an absolute minimum, Tennis Australia should have told all potential entries “our approval to compete isn’t the same as the government’s approval to enter the country. Once you receive our approval, you will have to contact the government and go through their process too.” The fact that they didn’t make this clear to foreign competitors is a pretty bad flub.

      Reply

      1. The high points from the link: people with natural immunity but no vaccine, compared to vaccinated individuals, are more than 2x more likely to get reinfected and more than 5x more likely to end up in the hospital if they are.

        That’s not what the link says. It is not comparing “had covid” with “had vaccine but not covid”.

        Rather, it is comparing “had covid and then had vaccine” with “had covid and then not had vaccine”. That’s very different.

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      2. “It’s not about whether he makes another competitor ill. It’s about whether he becomes a disease vector for the Australian populace.”

        And vaccination status says essentially nothing about that. It’s quite clear that fully vaccinated people are both getting and transmitting COVID-19. (They just aren’t getting seriously ill or dying — in anywhere near the numbers of the unvaccinated.)

        The efficacy measures for the vaccines do not include transmission. They are: Preventing hospitalization and death.

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    6. So, they released the court documents which laid out exactly what he did to comply with Aussie rules, prior to traveling there.
      After he recovered from Covid, in planning to play in Australia, he
      Received an Exemption Certificate provided by an Independent Expert Medical
      review panel commissioned by Tennis Australia.
      That certificate was reviewed and endorsed by the Medical Exemptions Review Panel of the Victorian State Government.
      And certified to comply with conditions established by the Australian Technical Advisory Group on Immunisation.
      So he was given a Visa, having met the conditions for a “quarantine free” arrival into Australia.

      When he arrived there, a person referred to in the case as the “delegate” decided to revoke his Visa. His request to contact the Tennis Australia medical officials, his lawyers, or his agent was denied, as was his request to get some rest before his initial hearing, since he had been in transit for 25 hours.
      They revoked his Visa, put him in a hotel, but seized his belongings, including his wallet and phone, even his clothing. His phone was returned after a few hours.
      He was not allowed to practice, or even change clothes.

      The The Australian government said that “Novak is not in captivity and can leave at any time.”, but did not mention that doing so would apparently make him ineligible for a future Visa for a period of three years.

      Importantly, the Judge at his recent hearing asked immigration officials “What more could this man have done?”, a question they did not have a satisfactory answer to.

      Reply

  4. The thing about the Times and unions does not surprise me. Talking a big ideal is a lot harder than practicing the deal. The doctor’s stats women v men also does not surprise me. It is similar to racism. The talk is much bigger than the reality. Read the story about how many congressmen in the past were owners of slaves. More than 1700 from 37 states. That is in the Washington Post. What is the most important issue in the pro Trump cult – racism and hate for liberals.

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  5. I was looking at the abstract of that surgery article (I no longer subscribe to JAMA so can’t see the full study). All I can say is, though it IS a large cohort, it’s in one province only, and though the size gives some weight to the findings, it IS retrospective and so the variables (which are probably numerous) are almost impossible to tease out. The odds intervals are not THAT striking, and I wish I could look at their statistical analysis to see how they did it (though I don’t doubt it was reasonably done). Still, this would at best be a hypothesis-generating study; people drawing conclusions about causes of the apparent effects are jumping several steps, but I suppose it makes it a better “news” story. We should remember the cohort studies that led to massive dietary and medical movements that were later shown not to be useful or more harmful that beneficial, like HRT for women, etc. It’s fascinating, of course, but a prospective, large cohort study like the WHI (though I don’t see anything LIKE that large being possible for this) would be more useful to see if there are real discrepancies. Also, do they happen outside of Ontario? Are they worse or better elsewhere? Does it even apply in GB proper or the US?

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    1. Agree. I have never seen a subgroup analysis (including this paper) which adequately adjusts for patients self selecting their hospital and/or doctor. Self selection is a well known variable that dramatically affects results and almost never gets accounted for (and as you said, there are plenty of other unmentioned variables).

      Without some balancing method like propensity score matching, I would wait for the follow up studies.

      Reply

      1. Tom, are you going on having read the full article and its statistical techniques or lack thereof?

        The beauty, if you will, of places like Ontario is that there is little opportunity for self-selection. In theory, the single payer places no restriction whatsoever on a patient’s choice of surgeon or any other doctor. In practice because of tight resource constraints in a publicly funded chaotic system rationed by queue, most patients take whoever’s available and has the shortest waiting list, or happens to be on call when they get hit by a car. If you are well connected, you might be able to inveigle yourself into the hands of your choice of surgeon. This doesn’t take money; sometimes it just means having an operating room nurse as a daughter-in-law. Being in the curling club with a member of the Board of your community hospital likely helps more but mum’s the word. The surgeon can’t charge more just because you had pull. It’s just a favour. Queue-jumping for free stuff is considered un-Canadian so if you do it everyone must pretend it never happened. It wouldn’t likely contribute self-selection bias of large magnitude.

        The authors of the Guardian story have more information from the 16-page article than is presented in the abstract. Knowing at least one of the stats guys well, I’m going to give them the benefit of the doubt that they controlled for everything possible to do in a retrospective study where all you have is what the treating doctors wrote down in the charts at the time. Propensity can sometimes be imputed from chart review, sometimes not. Remember, for example, in Canadian hospitals the patient’s race is never mentioned in administrative data and hardly ever in physician-entered clinical notes.

        Reply

        1. Yes, I am going on the full article, not the abstract (and I didn’t read the Guardian story).
          I am actually surprised sex discordance (female surgeon/male patient and male surgeon/female patient) is what the authors chose to focus on. What they presented showed better (or at least equal) outcomes for female surgeons across all patient categories. This held true for all types of surgery as well except for better male surgeon urology outcome (small numbers on the female surgeon side though) and equal surgeon outcomes for emergent surgery. The reason “Female Surgeons Have Better Outcomes” was not the headline makes no sense to me.

          However, there were some differences in patients. Male surgeons saw patients who were about 5 years older but comorbidity scores were comparable so may not have had any influence. Also, female patients represented 57% of the total (760k out of 1.3 million) but 65% of patients seen by female surgeons (93k female patients of 143k total seen by female surgeons). Again comorbidity scores were similar but female patients tend to have better outcomes so hard to say if seeing younger female patients influenced the results (which was why I mentioned propensity scores to help clarify). Subgroup analysis, regression models, and chi squared tests are what doctors are familiar with and so are typically requested (and any suggested variation aggressively resisted). But they can also be misleading.

          The other findings I thought should have been explored were surgeon characteristics. Female surgeons averaged 44 years old (males 49) and had been practicing 8-9 years (males 15-16). Surgery volumes were mostly in the 2, lower volume quartiles so for female surgeons vs male surgeons who were mostly in the 2, higher volume quartiles. This suggests to me the female surgeons are more currently trained on average (which is associated with improved surgery outcomes). Lower volume may afford them more time per patient which seems likely to improve outcomes as well.

          I certainly know (and work with) male surgeons who are misogynistic A-holes and I am not defending these types in any way. It would not hurt my feelings at all if female surgeons are better.
          But my point with self selection was that discrepancies don’t have to be a negative. Many female patients prefer having a female doctor. So for elective or semi-elective surgeries they may self select to a female surgeon (or at least her hospital), no queue jumping required. And patients who are less urgent tend to be less sick as well. There was no effort I could see to determine physiologic status so illness severity may or may not be relevant here. Just offering a scenario which gives disparate outcomes through a positive bias (healthier female patients preferring female surgeons and being able to get their choice).

          Reply

          1. Thanks for taking the trouble to review this. I can see how arbitrage — new female surgeons being referred lower-risk and female patients especially early in their careers, with established male colleagues at least temporarily taking on the more difficult patients of both sexes — could give lower complication rates to the female surgeons. Even if the patient has no opportunity to self-select, the referring GPs may well preferentially refer female patients to the new female surgeon with a short waiting list, and they generally do refer less complicated patients of both sexes to new surgeons who have not yet built up a local reputation. I had trouble getting my mind around why the effect should be strongest in male surgeon – female patient discordance when the surgical risks for women over-all are lower. But it seems that the effect is instead lower complications for female surgeons in all comparisons save urology — male surgeons better — and emergencies — both sexes the same.

            As a non-surgeon, I don’t worry too much about small differences in complication rates even drawn from large samples. If that was all that mattered, surgeons would operate only on low-risk patients and would be of not much use to patients with complex high-risk conditions. Avoiding one “unnecessary” death by not operating on a high-risk patient who could benefit would be a bad social bargain. True, the highly skilled surgeons we send our most challenging patients to do have low complication rates but perhaps not the very lowest in the country when taken to two decimal places.

            Propensity scores to get at patient-level risk more granularly would be good. Trouble is we don’t know much about what measurable variables predict outcomes and complications. There are a few well-known red flags but most patients don’t have any of them.

            I’m probably going to buy the article because there are tantalizing insights in the abstract.

          2. Thank you for your reply. I agree that non-surgeon referral patterns are another potential confounder, that is a good point I did not think about.
            The last study I was involved with using retrospective administrative data comparing pediatric trauma in teaching vs non-teaching hospitals illustrated your point on predictive variables (ie. lots of the know variables were not in the data base).

            And completely agree that small outcome differences in these type studies are not concerning. Figuring out who the good surgeons are in a given hospital has never proven all that difficult.

          3. I bought the article. Your insights made me do it. $40 well spent. Now I’m motivated to read it “for effect”.

  6. The Russians have got already an important unstated objective: They are talking to the US about Ukrain without Ukrain and without the EU (to the chagrin of both). The Russians have got recognition of status major power.
    I think it is unlikely the Russians will invade: what use would that be compared to threatening?

    Reply

    1. I haven’t (been able to make the time to) read every jot and tittle about the Ukraine situation in the NY Times (let alone in other media outlets), but, did the Russians say they wouldn’t meet with the U.S. if Ukraine tagged along? Did the U.S. go to bat for Ukraine participation in the meeting? (I know Ukraine is being “allowed” to meet with the big dogs the latter part of this week.) Or did the U.S. actively seek to keep Ukraine out of the meeting?

      Page A7 of the 1/11/2022 hard-copy NY Times states that “Tension between the nuclear adversaries has never been worse.”

      Really? The current situation is as bad as the Cuban Missile Crisis of October 1962? Where are the Russians currently defying The Monroe Doctrine? Or has the U.S. globally extended that doctrine? Are the Russians not worthy to have their own such doctrine?

      The dissolution of the USSR was apparently not good enough. By all means, lets strengthen global stability by extending NATO eastward as far as possible.

      Reply

  7. A quick comment about Molson’s Canadian, which is the “official” beer of the Toronto Maple Leafs. No Leaf fan that I know can stand the stuff–it has the same sort of acceptance that Heineken’s has, which is to say, none. Give me ANYTHING from Wellington or Sleeman!

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  8. I can’t go live in Thomas Hardy’s cottage forever, but I wish it was at least an air Bnb. What is it about those English cottages that make you want to go inside and light a fire and read a book?

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    1. Hope the book’s a good one – my experience of thatched roofiing is that the starlings nesting in it will keep you awake!

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    2. “What is it about those English cottages that make you want to go inside and light a fire…”.

      The rain and the lack of a heating system.

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  9. That real-time supernova is amazing! The big sun-like animation with stupid flames coming out of it is terrible CGI, but it looks to me like the slowly expanding colorful gas cloud video segments are real, and really wonderful. Though they probably used narrow-band color filters so the colors might not be what humans would see.

    I wonder why the makers felt it necessary to let the fake part dominate the video. If they had given a nice large view of the real thing it woul dhave been much better. I guess this is a “Get off my lawn” comment. Younger people need glitz?

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    1. Nothing in the video is real, it’s all “artist’s impressions” (other than the photos of the telescopes), which is why they didn’t highlight the real data. If you want to see the actual data, here is the paper click on “pdf” and look at Fig 2 (it’s a lot less impressive!),

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      1. How sad. Also, did you notice the ending of the paper?:

        “Research at Northwestern University and CIERA is conducted on the stolen land of the Council of Three Fires, the Ojibwe, Potawatomi, and Odawa people, as well as the Menominee, Miami and Ho-Chunk nations. Research at UC Berkeley is conducted on the territory of Huichin, the ancestral and unceded land of the Chochenyo speaking Ohlone people, the successors of the sovereign Verona Band of Alameda County. Keck I/II, ATLAS, and PS1 observations were conducted on the stolen land of the kānaka ‘ōiwi people. We stand in solidarity with the Pu’uhonua o Pu’uhuluhulu Maunakea in their effort to preserve these sacred spaces for native Hawai’ians. MMT observations were conducted on the stolen land of the Tohono O’odham and Hia-Ced O’odham nations; the Ak-Chin Indian Community, and Hohokam people. ZTF observations were conducted on the stolen land of the Pauma and Cupeño tribes; the Kumeyaay Nation and the Payómkawichum (Luiseño) people. Shane 3 m observations were conducted on the stolen land of the Ohlone (Costanoans), Tamyen, and Muwekma Ohlone tribes. VLA observations were conducted on the stolen land of the Chiricahua and Mescalero Apache tribes, and the Pueblo people.”

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        1. A useful definition of woke might be “good intention, but the means used to try to attain that goal are at best ineffective, at worst contraproductive, and, at least now, serve as a not-so-secret handshake which allows the woke to virtue-signal to one another”. If they really believe that stuff in the litany in the acknowledgements, then why do these people work for thieves? Difficult to find worse hypocrites anywhere. (Another point is whether the standard litany is correct and whether those stolen from had stolen the land from other peoples now forgotten,). If someone with such a paper applies for a job, the potential employer should say “I don’t hire people who benefit from theft; admitting that it is theft does not make it OK.”

          Needless to say, no-one stolen from is helped by such boilerplate waffle.

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  10. I also read the “surgical” paper’s long abstract but unfortunately couldn’t see the rest.
    The effect is real in the sense that it’s very unlikely to be a statistical fluke, but what the causality might be will be hard to tease out. AFAIK women generally fare worse after surgery (especially heart surgery where there’s lots of data), speculations for the reasons range from “they get operated in a later/worse stage of disease” to the (true) fact that it’s icy cold in ORs and women have higher risk of urinary tract infection in such situations (which must be among the complications they tested for here).
    Seeing that this study finds an operator-sex effect, one possibility would be that men’s hands are larger than women’s, and small hands might be better suited to operate on women’s smaller organs. A test of that hypothesis would be to look at data sets of children’s operations.
    There was another study not so long ago, I believe in one single ER, where it turned out that patients (I think of any sex) who happened to be on a female doctor’s shift fared better than the ones who were first seen by I man. Difficult to tease out all the factors here, too, but I remember thinking they did a pretty good job of controlling the confounders.

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  11. PS: The sex interaction effect should be easy to do controlled experiments on, they should also control some additional factors, like length of stay in the OR.

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    1. I think you underestimate how difficult it is to do any controlled therapeutic experiment with human subjects. Chart reviews are much, much easier, for all their limitations on validity.

      A randomized controlled trial to test the effect of sex of surgeon would be enormously difficult. First, patients needing surgery would have to consent to be randomized to receiving their surgery from the surgeon they were referred to, or to some other surgeon of opposite sex.* Then you would have to arrange that every practice location had at least one surgeon of each sex in every relevant discipline, available to operate (or put the patient on a waiting list) when the randomizer picked them. If the “other” surgeon had a longer waiting list or a poorer local reputation, the patient might withdraw from the study and demand her original surgeon. In the extreme, all patients might agree to continue only if they “drew” their original proposed surgeon. The study would then fail before it got started.

      Since emergency cases must be included in the study (as they were in the retrospective JAMA Surgery study) because they have higher risks, you would need to cover every discipline with two surgeons on call, not just one, in order to be able to provide the surgeon as randomized without delay. Surgeons’ families would not let them participate in such a study; they see little enough of them when only one surgeon has to be on call at a time. Because many locations (non-urban) and disciplines (neuro, ortho) have very few female surgeons, this would be a logistical impossibility.

      In an RCT you don’t control for outcome measures like length of stay in the OR because you don’t know what these will be when you start the study — they haven’t happened yet. If a sex-based difference in complications emerged from the trial, certainly you would want to look at all sorts of practice characteristics, including time taken to perform a particular operation, to explore possible mechanisms. But you don’t control for these things ahead of time.

      I do think there is an interesting signal trying to ring through the inevitable noise of this retrospective study. Why do women do (slightly, in absolute terms — relative risks are always misleading when numbers are small) worse when operated on by male surgeons compared to female surgeons, but men do not? Are there specific disciplines or operations where this effect is strongest? I may yet spend the $40 (in real US money) to read the full text of 16 pages.

      Anyway, the good news is there is no evidence that female surgeons in this study had worse outcomes over-all than their male colleagues. This wasn’t an aim of the study but it’s still gratifying to know.
      _______
      * A sort of natural experiment does occur in obstetrics, where women nowadays are delivered by whoever’s on call, not contractually their “own” obstetrician. If there are any male ob-gyns left, you could look for differences in outcomes between sexes.

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        1. It does. The 95% confidence intervals are stated in the abstract, both for the main result (the composite outcome) and one secondary result (death.) Lower bound of odds-ratio for death was 1.02. The over-all rate of the composite outcome was about 15% (any complication, death, and re-admission within 30 days) but neither death rate nor death numbers were mentioned in the abstract.

          So there is signal here. Lots to argue about at Surgical Grand Rounds for sure!

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  12. COVID numbers would be higher if Florida was being honest. They’ve been reporting daily deaths in low single digits. But go here. Click on any state from the list and you get charts of cases etc incl deaths. Look at FL after a surge in deaths that peaked in Sept. Compare with cases, which spiked back then and are now surging like they did in Sept. But deaths have flatlined. Then pick a few other states and try to find one like FL.

    Sure, treatment strategies/regimens have vastly improved since March 2020 as knowledge has been gained from various studies and better drugs have arrived on the scene, but if FL had really figured out how to bring daily mortality down to low single digits it ought to be all over the news.

    You don’t suppose that DeSantis (who now seems to be struggling with the aftermath of COVID himself) instituted something to sanitize the numbers in advance of spring break season?

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    1. If a state’s current active cases are mostly Delta, death rates will remain high, because deaths lag cases by many weeks or months of care in the ICU. If the cases are mostly Omicron, deaths will be low. Cases in U.S. hospitals are still a mixture of Delta from autumn with Omicron now making sudden inroads. If Florida had managed to clear off its Delta caseload (with deaths) before Omicron hit, it could expect to see very few further deaths for the rest of the pandemic.

      The UK has seen nearly zero impact on its ICUs as Omicron has swept the country with high hospitalization rates. This means they will see very few deaths from Omicron except for nursing home residents (who don’t get sent to hospital, much less get admitted to an ICU.)
      –This is from Our World in Data.

      You would expect a lot of deaths from Omicron only if your unvaccinated people are also unlikely to have been infected naturally — think Australia and Canada. If Florida has high herd immunity from months of unrestrained infection, low deaths rates could well be true. They paid for it with deaths earlier.

      I did read that Florida public health officials were said last year (or in 2020?) to have been under pressure to suppress death statistics. Whether this is still a thing I don’t know, but it would seem to be highly irregular to the point of unlikeliness for professional public health officials in a Western country to lie about this.

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  14. Re: the NYT and unionizing … Wokeness has always been a distraction from the real work that needs to be done on class inequality. All this agonizing about race in the most multicultural place on Earth, during the most tolerant time in all of history is purely about evading accountability for zero progress (arguably, regression) being made on class since the 1960s.

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    1. Wokeness often serves as a way for elite whites to hold onto their cultural and class privileges. The New York Times applauds itself for performative activism while helping maintain inequality and the ongoing anti-unionism of American oligarchies.

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  15. Insulin: My mother was 14 in 1922. Not long after Leonard Thompson, her friend Molly, across the street in southern Minnesota and diabetic, began to receive insulin injections and began to improve. Overjoyed parents? Nope! Xtian Scientists, they soon decided that this was counter to God’s Will and stopped the injections. Predictably, Molly died.

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  16. For “a laugh,” I went ahead and read this paper that you describe as an example of “studies.”

    https://www.journals.uchicago.edu/doi/full/10.1086/704991

    It is ludicrous, as you state, but I didn’t find myself laughing. I didn’t laugh because I was saddened at how poor the argumentation is. The article seems to me to be a word salad masquerading as scholarship. One example is how the author cites Einstein’s General Relativity as implying that the observances of Black women are just as valid as the observances of white men. (We obviously don’t need Special Relativity to recognize that statement as true.) What is pathetic about this claim is that Einstein’s General Relativity isn’t about which social group has the power to observe. It is about an entirely different subject—frames of inertial reference—that happens to employ the word “observer.” The author co-opted the word “observer” for her own purpose, either out of ignorance or to deliberately deceive.

    And that was just the beginning. I can’t even imagine someone taking the time to dismember this article point by point. Doing so would be such a monumental waste of time that I’m almost certain that this article will go unchallenged and become part of someone’s “truth.”

    I didn’t laugh because I couldn’t get past how much of a waste of time, talent, and resources the paper represents, and how misleading the conclusions are. How can The University of Chicago publish this kind of stuff under its imprimatur? I’m sad that there’s an industry that produces stuff like this.

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    1. Einstein’s relativity, Godel’s incompleteness, and Darwin’s evolution seem to be the scientific and mathematical discoveries that are most often misused this way. They seem to think that if one can draw an analogy between some well-respected principal and their argument-du-jour, that’s proof enough their argument is true.

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    2. Apparently the journal is somehow associated with the University of Chicago. At least in some fields, the U of C still has a good reputation, but Onion style stuff which, had Sokal written it, would have been criticized as too over-the-top to be good satire, does not bode well.

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  17. The video of the two ants seeming to balance an enormous flower bud is almost certainly upside-down. If it is faked, and I suspect it is, the flower(?) peduncle may have been spiked with sugar water or something so that the ants would hold on.

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    1. Or the flower bud is fixed to something above it, off-screen, from which it hangs supported, and the ants are just doing their usual ant things to whatever is dripping off the cut peduncle. The bud is motionless. Even with skilled ants strong enough to balance it, it should wobble just a little, as I do when standing motionless on my bicycle.

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  18. That bit about female patients not doing as well as males during surgery by males is intriguing. But moreso the suggestions for why, they seem plausible to me.

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  19. “Differences in men’s and women’s communication and interpersonal skills evident in surgeons’ discussions with patients before the operation takes place”

    The best surgeons I know do not have any apparent interpersonal skills.

    The Guardian article mentioned microaggressions, Implicit sex biases, and concluded with the statement “Having more female surgeons would improve all patients’ outcomes”. They did not claim that having higher standards for surgeon’s training, especially as it relates to patient’s sex, would improve outcomes.

    Actually, they made the opposite assertion. The stated that among the barriers to women’s entry into surgery is the lack of flexibility in schedules and rotations, and bias against less than full time training.
    The real barriers to entry are willingness to to devote yourself entirely to perfecting the skills required, and the ability to stand the stress and pressure involved. If you are the sort of person who cannot function when exposed to microaggressions, it is probably not the best fit for you. The same goes for people who want to learn surgery, but have other priorities in their lives, and want their surgical training to fit the gaps in their current busy schedule.

    In the military, there are some specialties where a big part of the experience is the instructors doing anything they can to get you to quit or wash out. The reason for that is because they don’t just want people who can competently learn the skills, they want people who are willing to make it their life’s goal to pass the course. If you have two applicants with apparently equal potential, the one who is fanatically obsessed with a need to get the “HOG” endorsement at Scout Sniper school is always better than the applicant who wants the endorsement so that it will look good for his next promotion.

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