Veep

Imagine that you are a presidential candidate and you need to choose a vice presidential candidate. Who would you choose?

• A man who will be a strong advocate for the positions that your party advocates.
• A man who is honorable and respected as a public official.
• A man who could step in if needed to take your place.
• A man who is vital and knowledgable, no matter what his age.

Now, imagine that the man is black. Does that change anything? No? Good.

Now, imagine that the man is a woman.

For democrats, they seem to have a problem with Sarah Palin. "How can she be a good mother and a public official?" more than one liberal woman asked me incredulously.

What a horrible position for liberals to take! Discounting a woman because she is a woman! One may not agree with her positions, but to take her to task for her ability to balance work and home in her own way is so...er...conservative.

Did McCain choose her because of the "W" card? To win Hillary votes? I doubt it, because liberal women are first and foremost liberals. If I know this, certainly he does, too. Perhaps it is because she was the best person for the job, the best person to win the conservative base and to balance the ticket. What a funny state of affairs: conservatives defending the choice of a woman and liberals attacking it! Just goes to show.

Show me the

Elsewhere in this blog, I have argued that life is like the wheel of fortune: anything can happen, but what does happen usually depends upon the law of probability. Statistically rare events can and do occur, but only rarely. In compiling statistics, knowledge is vital. The less accurate the knowledge, the less accurate will be the wheel of fortune. Items that are rare may occur frequently because the statistical model is faulty or incomplete.

Medicine is moving towards the wheel of fortune model, often called evidence-based medicine. Studies are done, controlling for as many variables as possible and then seeing what the short term and long term outcomes are. Studies are compared and contrasted with similar studies. Diagnostic and treatment pathways are then based upon these studies.

Most studies do not show an absolute perfection of any diagnostic or treatment pathway, only the greatest good for the greatest number. So, it is possible to go through an evidence-based diagnostic pathway only to have your condition misdiagnosed and to go through an evidence-based treatment pathway only to fail treatment and/or have adverse reactions to the treatment. Most people just define this simply as "S**t happens".

Medical professionals do not argue the truth of evidence-based pathways, but do argue the applicability of these pathways in places where they were not tested and in changing times. So a procedure that was found too dangerous in 1970 may now be the best thing we have, and a treatment that was found perfect for a 50 year old may be wrong for an 80 year old.

In health care, we have lots of people, so we can do a lot of experiments (of course, with their informed consent).

There are other arenas where there are lots of people, and yet, little evidence-based outcome directed research. Politics, economics, and education come to mind.

The research in these fields does not appear to choose proper outcomes, are not done prospectively, do not run long enough to see all the fallout, and generalize too broadly from the available data. This leaves these areas wide open to opinion, speculation, partially founded beliefs, and passions to "fix things" without knowing whether the "fix" is worse than the problem.

One example: A study showed that reducing payroll taxes for workers for one year increased hours worked during that year. The evidence-based conclusion was that lowering taxes increases work. This type of generalized conclusion would be blown out of the water by any 2nd year medical student and yet was (and is) widely accepted by many economists and politicos. It generalizes into the future something that is unknown. Could people get used to the lower taxes and regress back to their old work habits? Actually, evidence in other studies does indicate that people tend to regress to their mean. What per cent would regress? What per cent would continue to work longer hours? What per cent would work less hours? With longer hours on the job, what increase would there be in work related injuries and disabilities?

Those of you in economics, politics, education, and government, you got some splaining to do! For now, all of these areas are more like art forms than true sciences. Art is what you like, not what is true.

At my pay-grade

Two questions:
1. Is there evil?
2. Can we defeat evil?

First, the definitions:
Evil:
def 1. intentional cruel, injust and/or selfish acts
def 2. acts contrary to the teachings of a specific religion

Defeat:
def 1. Win a victory over; beat
def 2. Thwart; prevent the success of.

So, this answer actually has 4 parts.
Q1. Can we thwart cruel, unjust and/or selfish acts?
A1. Yes. All it takes is some bravery and courage. It is done all the time by average people, soldiers, police and firefighters, and others.

Q2. Can we win a permanent victory over all intentional cruel, injust and/or selfish acts?
A2. Since bad behavior is part of human nature, this may be more difficult. To do top down is to remove free will and thus to eliminate morality, which is the choice of doing good over evil. Even if we could do this top down, it is unlikely to lead to a better world. The main problem is that it leads to defining inequity as evil, with the haves being evil and the have-nots being victims, which is not always true and is frequently wrong. Bottom up, as people choose to live better lives, the world will truly become a better place.

Q3. Can we thwart acts contrary to the teachings of a specific religion?
A3. Only with extreme top-down Taliban/SS/"politicially correct" type of policies.

Q4. Can we win a permanent victory over those who would act contrary to the teachings of a specific religion?
A4. This actually falls into the provice of religion, as only G-d can stop all those who would act contrary to a specific religion. However, as above, mind-altering medications, indoctrinations, and "thinning of the herd" can go a long way to make this a reality.

So, when you hear arguments about defeating evil, remember that evil exists in all of us at one time or another. All we can do is thwart people committing evil acts as they happen and try to live as good lives as we each can do if we really try.

Bite me!

Sound Bites. This is how the news gets reported today, probably because we have such short attention spans. (are you still reading this? OK, just checking.) The attention span for a news story is less than 2 minutes.

Democrats, when asked about domestic drilling, drop these two bombs:

1. How can you say we need to drill? Did you know we are exporting record amounts of oil? Don't believe me? Look it up in the CIA handbook on the United States!

2. How can you say we need to free up land for the oil companies? They already have leases on 68 million acres that they are just sitting on. Don't believe me? Look it up in the Federal Record!

Both statements are true! But, as usual for democrats, only partial and misleading. What is amazing is that I can find out the rest of the story pretty easily on the net and yet you don't hear it in the media. No one rips into the democrats when they spout this partial and misleading tripe.

Here is a good explanation of the oil exchange between countries.

http://www.spokesmanreview.com/blogs/editors/archive.asp?postID=25015

Here is a good explanation of why the land the oil companies have leases on is really useless.

http://brokengovernment.wordpress.com/2008/07/16/68-million-acres-and-oil-companies-do-not-drill/


It is easy to find crap and spin it into sound bites. Partial truths, non-truths delivered sincerely and authoritatively, perhaps with a mockery of dismissal in your voice to let the other side know that you think they are just too stupid, too ignorant of the facts. Put them on the defensive. Make them have to explain things in more than 2 words.

DocBrain will give it a try.

How can you say Obama is different? He is deeply indebted to big oil! He has taken hundreds of thousands of dollars from them. Check this link:

http://www.factcheck.org/elections-2008/obamas_oil_spill.html

Dream on

Once upon a time there was the belief in the American Dream. The land of opportunity. Hope. Can do. If you build it, they will come. The shining city on the hill. Freedom. Blind justice. Land of the free, home of the brave. There was the belief that anyone could succeed. All you needed were the 3 R's; a good, hard work ethic; honesty (the best policy); a little pluck to take opportunity as it arises in your life; keeping your nose clean (ie, staying out of trouble); and family and friends to help you along the way. Perhaps, a little luck along the way, but always remembering that luck favors the prepared. When things didn't go just as you planned, you looked at yourself in the mirror, made new resolutions to be better the next time, picked yourself back up and got back in the race. There may be slings and arrows along the way. Injury, disease, death, and the disappointment when other people that you count let you down. But, you carry on, running, walking or crawling towards the dream. You do what you can to prevent bad from happening to yourself, your family, your friends, your neighbors, and your country.

The American Dream has never been disproven, and in fact there are numerous examples of its success. It is the main reason why people come to America. It is the main source of success, at least to the level of the upper middle class and I believe even beyond. And, it seems to DocBrain that most people who follow the American Dream are happy. By happy, I mean pleased with themselves; content in the belief that they have given life their best shot.


And then, there is the belief in the Gold Rule. No, the other one. He who has gold, rules. This is the belief that if you are not born with a golden spoon in your mouth, if you are not of proper birth, nothing much can be made of your life, so why even try? Just try to enjoy each day. Do whatever it takes to survive and succeed, as the American Dream is not for you. Cheat, steal, lie, skirt laws and ethics. Do whatever makes you happy. Drugs, alcohol, sex, music, driving fast and living hard. That is life. Walk away from challenges. Life sucks and then you die. Life gave you nothing so you owe no one anything in return. If you are to get anywhere in life, it will only be if others do the heavy lifting. Family running cover for you when you foul up. Entitlements from the government. Justice looking at you and cutting you a break because you didn't have that golden spoon.

Life under this Gold Rule is not a happy one. It may be filled with short term pleasures, perhaps even a feeling of pride at having survived, but no happiness. No feeling of having made it. A full life but an empty victory. In the end as in the beginning, you know that you were not one of the annointed ones. Life dealt you from the bottom of the deck.

DocBrain believe that the difference between the American Dream and the Gold Rule is in what you believe. Whatever one you believe is real to you. Simple as that. As politics begins to cater more to the believers in the Gold Rule, as the believers in the Gold Rule attempt to enslave the believers in the American Dream, what will the final outcome be? DocBrain believes that if the believers in the Gold Rule get the upper hand, America will become more a land of unhappiness and disillusionment. With no one to care, no one to turn to, the people will only be able to turn to the government. The government, with ultimate control over people, will truly become God, and its leaders will be the prophets and high priests.

FDA Factoids

A factoid sounds true, but may not be. The FDA has foisted factoids on us for years.

The FDA requires that drug trials compare the active drug against placebo not only for effectiveness, but also for adverse reactions. Any adverse reaction that occurs on the active drug to an extent greater than a predefined amount (usually 2%) or more often than placebo is required to be part of the package insert, needed to help the consumer make an informed consent to use the product.

Patients are randomized according to underlying demographics and disease status, making the primary outcome (effectiveness vs placebo) a true reflection of reality. However, the adverse reactions do not necessarily reflect reality as the patients are not randomized according to prior life experiences with pharmaceutical products.

For example, a person assigned to the active treatment group might have had dizziness in the past due to a long-forgotten inner ear problem or perhaps had dizziness in response to some other medication in the past. That person is now more likely to experience dizziness during the trial than a person with no prior experience of dizziness. Data is collected concerning hundreds of potential adverse reactions, making it quite likely that the population in the study, usually only a few hundred to a few thousand individuals, will not be completely randomized to past experience with each and every potential adverse reaction. This can lead to a data bias. If the difference between placebo and active drug is quite large, then it is more likely that the difference is real, but a tiny difference can clearly be due to lack of randomization according to the criteria being reported.

Any difference in adverse reactions between placebo and active drug in a study that is not overwhelming should be viewed with suspicion. Many patients on placebo develop adverse reactions, so called nocebo responses. The most common occurring on placebo are GI related (nausea, vomiting, abdominal discomfort, belching, constipation and diarrhea) and CNS related (dizziness, headache, blurred vision, lightheadedness, sleepiness, insomnia). Attribution of cause and effect in the absence of specific randomization to look for cause and effect is pseudo-science and falls into the realm of story-telling and not science. That pharma is required to disclose this information and prohibited from disclosing information concerning serendipitous additional unexpected benefits found with their product as compared to placebo shows the bias of the FDA and is not clearly in the best interest of patients.

Their your pictures!

The punchline of an old joke.

A man goes to a psychologist. The psychologist shows him Rorschach Inkblots (http://en.wikipedia.org/wiki/Rorschach_inkblot_test). The guy looks at the first picture and says "I see a naked woman". He says the same thing after each picture. Finally, the psychologist says, "Don't you think it is strange that you always see a naked woman?" The guy replies "Hey, their your pictures!"

DocBrain was just listening to a professor talking about racism in America. He sees racism everywhere, from the flood in New Orleans to the poverty of the inner city. No one can deny that some racism still exists, but so does some of every other bad thing. But it is not everywhere and not the root cause of every problem. As long as people continue to see racism as the core problem behind any problem that plagues the African-American community, striving for appropriate solutions will be hampered.

Racism is a head game. It is the straw dog used to justify being the underdog. It is used to justify not studying hard in school, not working hard, black on black crime as well as black on white crime, not winning when the opponent is not black, creating and listening to misogynist music, children without fathers, doing and dealing drugs, lack of politeness, and lack of patriotism. Since it is a justification, it must be invoked to explain behavior. It must be believed in order for it to have any real power over the individual.

The joke is that in order to see all the naked women, you gotta be crazy. Same goes for endemic racism.