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July 31, 2020

On April 24th, in a virtual fundraiser, Joe Biden stepped out on a limb and made a prediction:

Mark my words: I think he [Trump] is gonna try to kick back the election somehow, come up with some rationale why it can’t be held.

Tim Murtaugh, then the Trump campaign’s communications director, reacted as if his candidate were someone for whom making an illegal and undemocratic move would be completely out of character:

Those are the incoherent, conspiracy theory ramblings of a lost candidate who is out of touch with reality.

A mere three months later, Trump tweets:

With Universal Mail-In Voting (not Absentee Voting, which is good), 2020 will be the most INACCURATE & FRAUDULENT Election in history. It will be a great embarrassment to the USA. Delay the Election until people can properly, securely and safely vote???

Randomization and abortion

July 30, 2020

Randomization is a proven technique for controlling bias in drug trials. Alas, it is something that is much harder to do with many of the other things we want to study about people. Ideally, to study the effects of drinking, we would take a group of people turning 21, and randomly assign them either to the subset that will be teetotalers or the subset that will drink, and follow them for the next ten years. Or fifty. There’s just no practical ways to do that. And it might seem as difficult to take a group of pregnant women wanting abortion, and randomly assign them to a subset that gets that and a subset denied that. Except there, some researchers realized they could come pretty close, by looking at women who were denied an abortion because they missed the cut-off date, and compare them to women who were under it. And the results — published in a book — are not surprising:

Women in the study who received the abortion they sought were more likely to be in a relationship they described as “very good.” (After two years, the figure was forty-seven per cent, vs. twenty-eight per cent for the women turned away.) If they had been involved with a physically abusive man at the time of the unwanted pregnancy, they were less likely to still be experiencing violence, for the simple reason that they were less likely to be in contact with him. (Several of the participants interviewed for the book talk about not wanting to be tethered to a terrible partner by having a child together.) Women who got the abortion were more likely to become pregnant intentionally in the next five years than women who did not. They were less likely to be on public assistance and to report that they did not have enough money to pay for food, housing, and transportation.

The obvious criticism is that what divided the two groups was not quite random. Those who made their cut-off date may have differed in some important regards from those who did not. Perhaps they were more conscientious. Or less bothered morally with their choice. And perhaps their extra dose of diligence and lesser tendency to dithering was what mattered to their future lives, rather than their having the abortion they wanted. There is a power to true randomness for revealing the nature of things that near-randomness doesn’t quite meet.

PBS has an article on the use of fetal tissue in medical research, including vaccine development.

Drug boosterism

July 29, 2020

Like everyone, I hope we find more drugs that are effective against Covid-19. Doctors and hospitals aren’t spurning hydroxychloroquine because they are raging leftists or hate Trump, but because it keeps failing in RCTs. They learn this by reading peer-reviewed research in medical journals. Josh Batts writes a good Facebook post explaining that history, with links to some of the relevant research.

Twenty years back, one had to go to a medical library to read those articles. When I lived in Austin, I often was quite grateful that the Texas Medical Association library there was so convenient. Now, all that research is online (though sometimes behind a paywall.) I hear many people complain they don’t like how the popular press reports on the research for drugs. Well, the research itself is just a click away.

Unless one is investing in some of the companies concerned, I have a difficult time understanding why someone would become a booster or opponent of any particular drug. Drug development isn’t football. There isn’t any exciting action to televise at a sports bar. There won’t be any tailgate parties. It makes a lousy spectator sport. I suspect one of the things historians will puzzle about this odd time in our nation is how so many Americans became such strong boosters of specific drugs, as if they were sports teams.

Update: Assistant Secretary for Health Brett Giroir makes the same point. Now, yes, maybe all the RCTs to date have the wrong protocol, and some other protocol works. What those proposing such need to do is organize an RCT showing that.

Fellowship and disease

July 28, 2020

We are social animals. And contagious diseases of wide variety propagate along our social connections. That provides an easy target for moralistic condemnation, damning as sinful or wrong some connection or some group, the proof being the disease they propagated. We should resist that kind of moralism, regardless of what direction it takes. When I read that Covid-19 spread at an Alabama Baptist meet-up, my first reaction is sympathy. Their religion is silly. Their longing for fellowship is not.

I am more critical that the disease tore through a party of anesthesiology residents at the University of Florida. They cannot be excused from ignorance of the underlying biology. And being young physicians, they should be more conscientious than average. But again, I don’t blame them for wanting to party. An epidemic forces each of us to walk a tightrope between the benefits of social interaction and the risk of infection. Each of our choices there is a trade-off. We should be careful of criticizing those who choose to travel to the left or the right of us, except when there is firmer ground for such criticism than merely that difference.

Historians studying hospital and infirmary records recently calculated that as many as one in five Londoners under 35 have syphilis. Ooops — had. This was in the late 18th century. Poor James Boswell may become more famous for having suffered the disease nineteen times, than for writing about his friend the lexicographer. (Cite.) Given the treatments then, and even a century later, I would not be surprised if some didn’t just jump into the Thames rather than face instruments and medicines as shown right. Especially for a second time.

Hanna’s long wet flow

July 27, 2020

The highest wind recorded yesterday in Corpus Christi was 54 mph. Not even hurricane force. But because Hanna came in south of the city, we experienced more storm surge than we had from recent hurricanes past. The walkway in the photo right normally has about four feet of seawall below it, there invisible under the waves. That surge did quite a bit of damage. The city marina’s fixed piers were flooded, as was some of its low land. Some sailors had to wait to check their boats, something I do not recall from storms past. Marina Del Sol fared worse, its breakwater not as high and its structures not so well made or maintained. One couple unwisely tried to ride out the storm there. The popular Bob Hall Pier was partly collapsed.

Harvey came in north of the city, with Port Aransas and Rockport bearing its brunt. We’re now seeing what the surge from even a small hurricane coming in south can do.

Eventually enough tree limbs broke in the neighborhood to take out our power in the wee hours of Sunday morning. After drinking coffee and before making pancakes, I rigged the Prius to power the house. (Note the disclaimer in that link: if you kill yourself or burn down your house trying to do this, your family should sue your high school physics teacher for failing to teach you how to think about current and how to safely make circuits.) Power was restored to part of the block late in the evening — they are working on the rest this morning.

I remain sensitive to how much we now depend on the cellular network during emergencies. I am in a few text chats with neighbors and friends regarding who needs what, and keeping those remote informed of the local state. If the storm had somehow destroyed some cell stations, those affected would be isolated and in more risk and nuisance because of that. Home internet provides some redundancy. It needs power for modem and router. Someone now will pop up to boast that POTS works independently of both power lines and radio signals. That indeed was one of the beautiful things about it. But signal lines, including internet, often share the same poles as power lines. And the 19th century is long gone. In the 21st, we rely on our personal, wireless communicator. Its hardware includes quite good radio capabilities. Because of its software, that works only in cohort with third-party infrastructure. Which seems careless to me. We should require cellphone providers to define a standard and to install software that supports peer-to-peer texting even in the absence of a cellular network, for the same reason that we require ferries to carry life-jackets. I hope there never is a large disaster that proves the need for it. Alas, the world is large and disasters come.

The calm

July 24, 2020

I spent some of the morning at the marina helping get boats ready. Then, a walk down by the bay, and still it looks like a normal July day. Then, floor exercises. We’re ready for the rains. Despite the dread “H” position, Hanna is forecast to be just a tropical storm.

Texas governor controls local epidemic policy

July 23, 2020

I often see or hear people saying that the mayor or county judges should take further steps to control the epidemic that now is raging here. They overlook that local officials here in Nueces County, as in Hidalgo County, are constrained by what Governor Abbott allows.

Turtle tussle

July 22, 2020

The Kemp’s ridley turtle is critically endangered. That might be because it nests in a fairly small geographic area, mostly in Tamaulipas, extending north to the barrier islands of south Texas. There is a bi-national program to protect it. Here in south Texas, that has resulted in the Padre Island National Seashore running daily patrols to locate nests, move eggs, incubate them, then release the hatchlings. Those releases have become popular attractions. More importantly, the national parks work to monitor the state of turtles along the Gulf of Mexico and Atlantic coast, track their migrations, estimate their populations, and try to understand variations in those. Donna Shaver has made turtle preservation and research her career work.

That costs money. Which funds have been reviewed. Perhaps putting some of the turtle work on the chopping block. Shaver has turned whistle blower, and has been placed under a gag order. According to Jeff Ruch of Public Employees for Environmental Responsibility:

The review would sharply curtail a program. It would confine rescue of sea turtles to park boundaries. It would cut back on research, and it would limit the public releases of hatchlings to just one week of the year, which doesn’t make any sense at all. It would cut back on the beach patrols and all of these recommendations violate, in some instances, the Endangered Species Act.

Which makes it less likely that my taller sister will get to see a hatchling release. Something she long has wanted to do.

The part that is a bit worrisome is limiting the Kemp egg retrieval to park boundaries. Those turtles don’t know where the national seashore ends, and where the county and state parks begin.

Watch and wait

July 21, 2020

If you walk into the health section of many grocery stores, you will find hundreds of supplements claiming to boost the immune system. Which claims are nothing but marketing bullshit. What actually does boost the immune system is a vaccine. So it is good that a few of the ones under development for Covid-19 are showing good, early results.

And we should hope that the positive result from Synairgen’s interferon treatment for Covid-19 proves out.

Don’t be surprised, though, when some of these drugs now touted later fail. Drug development is a risky path fraught with pitfalls and false hopes. I suspect many people, reading news about it only with regard to Covid-19, start to get disappointed, and some even paranoid. “First they say one thing. Then another. Put hope in one drug or vaccine, and then say it is no good.” That’s neither bad reporting nor the result of anything nefarious. It just is the nature of the beast.

That nebulized interferon trial was randomized against placebo and double blind. As are vaccine trials. Which gives them more legs than some of the Covid-19 studies much touted by some segments of the media that have not been. Those processes are not formalities — they are how researchers keep from fooling themselves. It was a small trial. And the results may differ in a larger trial, or unfortunate limitation or side effect show itself. As with the vaccines under development, we must watch and wait. Ideally, we will get multiple vaccines and therapies that are effective.

Salt and oysters

July 20, 2020

Because of the urban demands for the fresh water that feeds the Apalachicola river, heightened by recent drought, that beautiful bay has become a bit saltier. Which is less friendly to its famous oysters. Which has forced the state to close harvests for five years. Which might mark a permanent shift in both the local ecology and a local industry that depends on it.

Of course, I think about the proposed desalinization plant here in Corpus Christi when I read this. (Carolyn Vaughn wants to rethink that.) Increased salt is good for some species, bad for others. In the ideal world, no such project would get to first base without its proponents first funding an environmental impact study by a third-party chosen by some public process. For environmental protection, alas, the gulf coast states are pretty far from the ideal world. Industrial proponents would do better if, instead of pretending concern about the environment, they supported legal changes to protect it. Yes, that would cost investors money. On each and every project affecting the local waters. When you love something, it often costs money.