Ethics

angech | August 30, 2017 at 2:33 am |

“There is a difference between MOVING PEOPLE
and SUBSIDIZING them to continue stupid behavior.”

“I will explain this slowly. I have no issue with people living in flood plains AS LONG AS they,not me, pay the FULL unsubsidized price of living there and fixing the problems associated with living there.

That means insurance reform which every right thinking libertarian understands. Dont make people in kansas subsidize the kooks to choose
to live on fault lines. You wanna live on a fault line? fine. pay a true unsubsidized insurance cost to do so. No federal bailouts.”

Blinkered ethical approach often seen in educated superior people who do not share other peoples problems.

People are not kooks because their great grandparents traveled to Kansas and settled there.
The choice they have, giving up family and friends and property and family ties to move some where else “Safe” is easy to spout when you do not live there.
If they have an earthquake, or people in Houston have a flood you can choose not to help and absolve yourself by saying it is all their own fault.
Impeccable line of heartless logic.

I will explain re smokers so you get it.
People did not choose to smoke.
Tobacco is addictive.
People made cigarettes and sold them society promoted it.
Now I know doctors who refuse to treat people who smoke and people who are overweight.
I repeat.
A blinkered ethical approach often seen in educated superior people who do not share other peoples problems.
Smokers are in my family and in your family.
Smokers are my friends [and enemies].
Smokers are part of the fabric [for richer or poorer] of our society.
Smokers and overweight people share a higher burden of disease.
A civilized doctor, a civilized society, picks up the pieces. We help them because they need help whether they caused their problems or not.
I do not expect you to change your attitude.
I have lots of friends who are vehemently anti-smoking and believe as you do. They are wrong as well.

The Mirror

Looking in the mirror.
” best to get ahead of the game than to be stuck losing an eyeballs game to intellectually inferiors– ie wuwt”
Games theory is an integral part of science. At least one, probably a lot more Nobel prizes, real ones, [not sorry for the snark].
Games have rules, even ones without rules, Climateball.

I was most interested in the part.
“A consensus is not manufactured, it emerges if all the various lines of evidence suggests a consistent picture. It is true that overturning a consensus can be very difficult, but this is often because doing so requires not only illustrating the strength of the evidence supporting the new position, but also why all the evidence supporting the original consensus is wrong, or has been misinterpreted. Overturning a consensus is not meant to be easy. ”

Turns out that consensus can be wrong?
Who could have guessed.
Perhaps the little line escapes the oversight.
“all the various lines of evidence suggests a consistent picture.”

Herein the problem for people like Steven, and others here, who see one bit of excellent proof, CO2 increase in atmosphere gives a warming atmosphere, while ignoring at least two other facts.
The earth is not a straight test tube with only air and CO2, there are confounding features.
Life is resilient and adaptable.

Ignoring the fact that not all the various lines of evidence support warming to the degree that the textbooks properly say should occur.

Strangely, from this side of the mirror, every argument used suffers from the same flaws in reverse.

“why all the evidence supporting the original consensus is wrong, or has been misinterpreted”

This is wrong. A lot of evidence there, most pointing in one direction.
Only hope for Skeptics is that it has been misinterpreted. History does give a couple of well known examples.

Origin of proto suns

angech says:
Your comment is awaiting moderation.
August 15, 2017 at 4:11 am

The answer to the first part of the problem seems to be that a natural cloud of space dust cannot and must not, by the laws of physics aggregate into a disc.
Caveats.
As always.
Natural would be a cloud of dust existing as it always has just drifting along in space stationary as Ragnar says.
Of course this is itself physically difficult [impossible to conceive].

The answer lies in two aspects.
One billions of years ago when the very large original and their second and third, tenth offspring exploded scattering the dust outwards not to return. Escape velocity.
Combined with an expanding universe? theoretically each particle would be most unlikely to congeal with other particles.
Gravity would however tend to draw some adjacent particles into files and rows of outward extending streaks so one can imagine over time streaks/streams of related matter traveling semi adjacent to each other.
Time is the factor here.
The universe was a lot smaller and these particles were impeded by the other stars and exploded star materials ending up in swirls around the other stars til they too exploded and clumping together with the other debris and interacting with the debris from the newer exploding stars.
These of course included heavy metal particles with more gravitational attraction.
It is not the gravitational attraction that causes the formation of discs and protostars. It is the left over differential movements of the particles that have come from different stars in different directions being forced into a mass that is assumed to all have the same angular momentum but doesn’t.
The bits that travel in opposite directions collide lose velocity and become subject to the effect of their gravity and start pulling everything in that was previously happily moving in unison with its own debris pattern [and not coming together]

The problem is somewhat similar to the discussions on Carbonate build up in the crust of the earth. On massive time scales we have a crust impregnated with billions of tons of inorganic matter that was once organic, now unrecognizable.
The universe is at least 4 1/2 times older than the earth with all that extra time to fashion the stars we see today.

Thanks for the interesting post. I hope my contribution is not perceived as token.

zeke temp adjustmnets 2014

Zeke (Comment #130058)

Mosh,

Actually, your explanation of adjusting distant past temperatures as a result of using reference stations is not correct. NCDC uses a common anomaly method, not RFM.

The reason why station values in the distant past end up getting adjusted is due to a choice by NCDC to assume that current values are the “true” values. Each month, as new station data come in, NCDC runs their pairwise homogenization algorithm which looks for non-climatic breakpoints by comparing each station to its surrounding stations. When these breakpoints are detected, they are removed. If a small step change is detected in a 100-year station record in the year 2006, for example, removing that step change will move all the values for that station prior to 2006 up or down by the amount of the breakpoint removed. As long as new data leads to new breakpoint detection, the past station temperatures will be raised or lowered by the size of the breakpoint.

An alternative approach would be to assume that the initial temperature reported by a station when it joins the network is “true”, and remove breakpoints relative to the start of the network rather than the end. It would have no effect at all on the trends over the period, of course, but it would lead to less complaining about distant past temperatures changing at the expense of more present temperatures changing.

CO2 and the atmosphere ATTP

Thank you for this post.
The effect of adding extra CO2 to the atmosphere is fundamental to explaining the temperature of the atmosphere and the earth.
While I disagree on the level of the feedbacks and other interactions the temperature increase due to CO2 increase causes it has an obvious effect*.

One of the problems I have is defining the surface of the planet as an effective entity.
Because of the atmosphere, which in a sense is part of the surface when it reflects light [That light bounced of earth] we do not have a real surface like a meteorite or the moon but a layer of surfaces depending on what depth the light penetrates too.
This leads to your concept of a radiating layer [then the layer from which the energy is radiated directly to space will move to a slightly higher altitude.], also known as a TOA,  which is an artificial designation of the effective surface layer of the earth.

“Essentially, the presence of greenhouse gases prevents energy from being radiated directly from the surface to space; instead it’s radiated from within the atmosphere. you can think of there being a layer in the atmosphere where the energy can be radiated directly to space.” Yes.

“However, the temperature of the atmosphere decreases with increasing altitude, and so moving the radiating layer to a higher altitude will reduce the outgoing energy flux.”

Not happy with this comment as the outgoing energy flux total must be higher. The real temperature at the artificial TOA is not the same thing as the construct of  “what temperature  the TOA needs to be to radiate this amount of energy into space. Two problems.

The amount of energy going out to space from a square meter at that extra height means there are more meters for the energy to go out from. Which means there is an increased outgoing [total] energy flux. Which makes sense as the earth is hotter.

Technically if the earth is warmer then the temperature at the higher altitude now being used would be warmer than what it was before. Practically as it is an artificial construct the air is warmer at lower heights than it used to be and probably does not change in temperature at all. Being very thin and not much GHG or energy absorbent molecules at 100 km.

“If we were in energy balance before adding the extra CO2, then we’ll now have more energy coming in than going out, and we’ll warm until we’re back in energy balance.”

Conceptually the energy coming in balances the energy going out. The instance you put the CO2 extra in it increases the heat of the atmosphere it is in*  by delaying the return of that heat as energy to space. This is a momentary and continuous delay the end effect is as you say, energy in equals energy out or energy balance..

Introduction

Thank you to Allan and U3A for asking me to give a talk on science in medicine today.  I wished to draw attention to the progress that has been made.  Scientific medicine has moved beyond  the standard of faith that it enjoyed with alternative forms of medicine but it has failed in important areas to bring people along with it.  I hope to  correct or clean up some of the doubtful areas and at the same time mention some of the new advances being made.  I will touch on the place of alternative medicine, diet and vitamins. I will address vaccines then issues with population health where medicine has moved away from treating the individual to treating the population.

Medicine is the art of healing concerned with the health of individuals. It consists of diagnosis and treatment of medical conditions, both of the body and the mind. It helps  the body and mind repair as much as is possible.

Healing is an innate function. The body has developed both repair and defensive mechanisms. As has the mind. Without a will to survive, to repair and recover the body alone is like a rudderless ship.

I hope you will find it informative.

PSA Screening

Prostate cancer and screening

PSA tests. The jury was out. Top specialists like Tony Costello at RMH actively push for early detection for early treatment. Other  groups like the USANZ preferred that screening not be done as the rewards of detection and the downside of the treatment outweigh, they felt,  any active management. How times change. Now the guidelines are to

  1. Offer evidence-based decisional support to men considering whether or not to have a PSA test, including the opportunity to discuss the benefits and harms of PSA testing before making the decision.
  2. For men at average risk of prostate cancer who have been informed of the benefits and harms of testing and who decide to undergo regular testing for prostate cancer, offer PSA testing every 2 years from age 50 to age 69, and offer further investigation if total PSA is greater than 3.0 ng/mL.

Compare and contrast the attitude here to that for women. Several factors weigh in the men are older, The cancer is internal rather than external so harder to get at. The operation has functional rather than cosmetic consequences..

I am an interventionist, I believe that the test itself is easy to do, compared to a mammogram and the results are easier to interpret. The follow up for a positive result is just as traumatic with the biopsy and examination being more difficult. I find it hard to square the idea of watching known cancer if presumed low risk and would prefer the idea of some treatment earlier rather than later.  Of great interest are 3 concepts. One that with a low PSA < 1.0 at 40 and at 60 YO ones risk of cancer is almost negligible [less tests one good outcome. Secondly that if the blood test is going up but there is no lump felt an MRI of the prostate can be done to give complete visualization of it and guide management better.

Choice of procedure Robotic surgery or radiation or both. With apologies to the surgeon who has done all the work Radiation would be a preferred option, just. The upside is that any local spread should get knocked off. secondly the side effects are broadly similar. Prostate cancer is particularly prevalent in the Shepparton area and perhaps a study should be done by our local hospital on the actual incidence.

Vaccination

Vaccination mentioned only to be discarded. A very contentious subject.

Vaccination is good for most people. and for the population as a whole.
It should be encouraged. Without the help of vaccinations many of us would not be here today. Vaccination is exposing the body to a less harmful form of a disease to let the body develop its immune response to the more serious disease when it comes along. The vaccine is a temporary measure and the body does all the work.
There are side effects to vaccination just as there are to all medical and alternative medical treatments.

A new problem is that we have overcome the most serious past illnesses but new vaccines are constantly being developed. There are now 15 different childhood vaccines. We have reached a grey area between protecting everybody from everything at great cost or accepting that we cannot and should not do so.
Anyone wanting to see the effects of non vaccination should visit an older graveyard and look at the number of young people with diphtheria as the cause.

Influenza is an interesting vaccine, Two A and B variations. A is the most prevalent and most current infections are variations of the swine flu from 2009. The older Hong Kong Flu is still mildly active and included. The controversy here is whether all children of all ages should have the flu shot.  Current guidelines is only for children at extra risk. The death rate from meningococcal disease is the same as that for the flu. Which double standard would you like to choose?

A shingles vaccine for older people is out to reduce the risk of shingles. It has a 3 year effectiveness and a 50%  reduction in risk. I think the benefit is very low for this  injection and it smacks  of  salesmanship.

Hep A recommended for all and Hep B if going to Asia or needing blood transfusions.

There is a common practice of subjecting terrified little people to an expensive unneeded vaccination for whooping cough. Yes I am talking about grandparents who are about to have a grandchild. It is a rite of passage that we all have to endure even though the stuff does not work very well. In the remote chance of the grandchild developing whooping cough you will be exonerated. Plus it comes combined with tetanus toxoid and diphteria toxoid so at least you get your 50 year old booster of tetanus toxoid.

extra heart stuff

This is where Skepticism should come into play.
We start as a single cell and live on average 70 years after being born.
Our death rate after the first year is quite low and usually due to bad luck.
Say 2 deaths per thousand per year.  At that rate we should live on average 250 years.
But little things get in the way as we age. Fourteen and the mind starts working and some people decide to leave of their own volition. This stays steady at 1 per thousand increasing the rate to  3. Car accidents and activity related problems kick in by 20, Things increase slowly till 55  at a rate of 7 with the consequences of lifestyle choices due to alcohol tobacco, drugs, sex, diabetes, diet, Blood pressure , atheroma and cancer. From then to 70 the rate increases to 20 a year at the turning point. 500 people have gone. But now the rate kicks up steeply until the majority of people  die in the next 14 years. the rate going up to 40 people a  year at 80.

Cardiovascular disease is the most important  cause of death  in people over 70 accounting for 50 percent of all deaths, half due to heart attacks, slightly less to strokes then other vessels. Cancer accounts for 30 percent. Infection and Kidney and lung disease a large amount of the rest along with infections often secondary to these preexisting conditions.

Basically we start off with good arteries and we are genetically primed to wear out  after 70. The arteries build up atheroma which is a combination of calcification and plaque in the vessel walls. We can hasten the process. Bad dental hygiene causing infection in the blood vessels, smoking, Excessive alcohol, Lack of exercise and obesity. Illness like diabetes and blood pressure.

We can actually measure the development of the atheroma with a High quality CCTA (64-slice and higher) is not only able to provide reliable information on coronary luminal changes, but also has the potential to visualize morphological changes of the coronary artery wall, characterize atherosclerotic plaques and identify non-stenotic plaques which may not be detected by invasive coronary angiography. This showed a significant age related increase in calcification
Of these patients with abnormal changes to the coronary arteries, the number of significant coronary stenosis was directly related to the age group, as less than 15% of patients under 56 years had significant coronary stenosis, but this was increased to 29% and 38% in the age groups of 56–65 years and over 66 years,

Cardiac CT for calcium scoring It has been assumed that measurement of risk factors causal for CAD (e.g. dyslipidaemia or hypertension) would be predictive of coronary events, but the relative hazard ratios of these risk factors are inadequate to accurately predict outcome. Seventy-five per cent of previously asymptomatic patients (men < 55 years, women < 65 years) developing their first MI, would have been ineligible for lipid-lowering therapy prior to the event if assessed with a global risk score.
In four major studies, more than 75% of all hard coronary events occurred in persons classified as low or intermediate risk, and the majority of persons classed as high risk had no coronary events. Risk score assessment alone is inadequate in predicting individual coronary risk.

In contrast, a measure of flow limiting obstruction (with ischaemia testing or CT coronary angiography) is not likely to predict risk.
Sixty-eight per cent of MIs occur in vessels with less than 50% obstruction prior to plaque rupture and thrombosis; and 86% occur in vessels with a less than 70% obstructive lesion (the degree of obstruction required to provoke a positive ischaemia test).Similarly, recurrent MIs are usually caused by a second ‘angiographically minor lesion’ commonly found in patients with a large plaque burden.

44% of individuals had a coronary score of zero. This cohort has such a low long-term risk (99.4% 12-year survival), that any further coronary testing is not required, and interventions like lipidlowering therapy are not likely to alter outcome.

A study of asymptomatic persons with a CAC score of greater than 1000 demonstrated they had a 25% risk of death or MI at one year,

William Osler Quotes

The good physician treats the disease; the great physician treats the patient who has the disease.
Medicine is a science of uncertainty and an art of probability.
We are here to add what we can to life, not to get what we can from life.
The first duties of the physician is to educate the masses not to take medicine.
The greater the ignorance the greater the dogmatism.In seeking absolute truth we aim at the unattainable and must be content with broken portions.
The young physician starts life with 20 drugs for each disease, and the old physician ends life with one drug for 20 diseases.
The teacher’s life should have three periods, study until twenty-five, investigation until forty, profession until sixty, at which age I would have him retired on a double allowance.
It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.
The future is today.
Variability is the law of life, and as no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease.
The philosophies of one age have become the absurdities of the next, and the foolishness of yesterday has become the wisdom of tomorrow.
The desire to take medicine is perhaps the greatest feature which distinguishes man from animals.
Look wise, say nothing, and grunt. Speech was given to conceal thought.