Category: Medicine

My Conversation with Michelle Dawson

Here is the transcript and audio, I am very pleased (and honored) to have been able to do this.  She is an autism researcher, and so most of the discussion concerned autism, here is one excerpt:

COWEN: What would be the best understanding of autism, from your perspective?

DAWSON: The best understanding is seeing autism as atypical brain functioning, resulting in atypical processing of all information. So that’s information across domains — social, nonsocial; across modalities — visual, auditory; whatever its source, whether it’s information from your memory, information coming from the outside world, that is atypical. So that is very domain-general atypicality.

What autistic brains do with information is atypical. How it’s atypical, in my view, involves what I’ve called cognitive versatility and less mandatory hierarchies in how the brain works, such that, for example, an autistic brain will consider more possibilities, will nonstrategically combine information across levels and scales without losing large parts of it, and so on. And that applies to all information.

That is strictly my view. I’m not sure anyone would agree with me.

And:

COWEN: Now often, in popular discourse, you’ll hear autism or Asperger’s associated with a series of personality traits or features of personality psychology — a kind of introversion or people being nerdy in some regard. In your approach, do you see any connection between personality traits and autism at all?

DAWSON: There is a small literature that shows some connection. I think it’s very weak, and I say no, I don’t think autism is about personality. Autism is sort of orthogonal to personality. The two are not related. Whatever relation there is does not . . . arises from some third factor, let’s say. If there is one — and again, the evidence is, I think, very weak connecting autism to personality — so just say that maybe, if there’s something, let’s say that personality in autistics might be more high variance. That would be my totally wild guess, but I don’t think autism itself is about personality.

And here is Michelle again:

We don’t — I hope we don’t look at a blind person who is a successful lawyer and assume that he is only very mildly blind or barely blind at all, and then look at a blind person who has a very bad outcome and assume that they must be very severely blind.

We do make those kinds of judgments in autism, saying, “The more atypical the person is, the worse they must be in some sense.” That kind of bias has not only harmed a lot of autistic people, it really has impeded research.

Here is Michelle on Twitter.  We discuss and link to some of her research in the discussion.

Will the AIDS pandemic worsen again?

A 63-nation survey funded by WHO and the Bill & Melinda Gates Foundation found anywhere from 6 to 11 percent of new infections involved drug-resistant forms of HIV, and the trend was dire, with resistance increasing as high as 23 percent annually. Once individuals were put on their daily treatments, in 2017 failure rates due to drug resistance were as high as 90 percent in some countries, meaning new infections in those regions could no longer be controlled with the $75-a-year first-line therapies. The first such survey conducted in Cameroon, recently published, found that the majority of patients failing their primary treatments—up to 88 percent of them—were infected with resistant strains of HIV, and overall drug resistance rates in the West African nation in 2018 approach 18 percent.

Meanwhile, preventing HIV infection has fallen off the priority list, both in funding and individual action.

There is more of interest at the link, that is from Laurie Garrett, writing at Foreign Policy.

Facts about abortion history

1. In 1800, there were no formal laws against abortion in the United States, although common law suggested that the fetus had rights after a process of “quickening.”

2. Ten states passed anti-abortion laws in the 1821-1841 period.  De facto there were many exceptions and enforcement was loose.

3. Abortion became a fully commercialized business in the 1840s, and this led to more public discussion of the practice.  Abortion in fact became one of the first medical specialties in American history.  It is believed that abortion rates jumped over the 1840-1870 period, and mostly due to married women.

4. Drug companies started to supply their own abortion “remedies” in the 1840s on a much larger scale.

5. At this time there were few moral dilemmas, at least not publicly expressed, about the termination of pregnancies in the earlier stages.  That came later in the 20th century.

6. In 1878, a group of physicians in Illinois estimated the general abortion rate at 25%.  In any case during this time period abortion was affordable to many more Americans than just the wealthy.

7. Several states started to criminalize abortion during the 1850s.

8. 1857-1880 saw the beginning of a physicians’ crusade against abortion.  By 1880, abortion was illegal in most of the United States, and this occurred part and parcel with a rise in the professionalization of the medical profession.  These policies were later sustained and extended throughout the 1880s and also the early twentieth century.

9. Over the 1860-1880 period, doctors succeeded in turning American public opinion significantly against abortion.  The homeopaths supported them in this.

This is all from the very useful and readable book Abortion in America: The Origins and Evolution of National Policy, by James C. Mohr.

Talking to your doctor isn’t about medicine

On average, patients get about 11 seconds to explain the reasons for their visit before they are interrupted by their doctors. Also, only one in three doctors provides their patients with adequate opportunity to describe their situation…

In just over one third of the time (36 per cent), patients were able to put their agendas first. But patients who did get the chance to list their ailments were still interrupted seven out of every ten times, on average within 11 seconds of them starting to speak. In this study, patients who were not interrupted completed their opening statements within about six seconds.

Here is the story, here is the underlying research.  Via the excellent Charles Klingman.

Now solve for the telemedicine equilibrium.

Is NIH funding seeing diminishing returns?

Scientific output is not a linear function of amounts of federal grant support to individual investigators. As funding per investigator increases beyond a certain point, productivity decreases. This study reports that such diminishing marginal returns also apply for National Institutes of Health (NIH) research project grant funding to institutions. Analyses of data (2006-2015) for a representative cross-section of institutions, whose amounts of funding ranged from $3 million to $440 million per year, revealed robust inverse correlations between funding (per institution, per award, per investigator) and scientific output (publication productivity and citation impact productivity). Interestingly, prestigious institutions had on average 65% higher grant application success rates and 50% larger award sizes, whereas less-prestigious institutions produced 65% more publications and had a 35% higher citation impact per dollar of funding. These findings suggest that implicit biases and social prestige mechanisms (e.g., the Matthew effect) have a powerful impact on where NIH grant dollars go and the net return on taxpayers investments. They support evidence-based changes in funding policy geared towards a more equitable, more diverse and more productive distribution of federal support for scientific research. Success rate/productivity metrics developed for this study provide an impartial, empirically based mechanism to do so.

That is by Wayne P. Wals, via Michelle Dawson.

Simplifiers vs. constructors in science

Simplifiers give one a better overall picture of how the world works, whereas constructors are trying to build something.  The balance seems to be shifting, for instance in physics:

Within the Physics label…we find the simplifiers dominated three quarters of the Nobel Prizes from 1952 to 1981, but more recently constructors have edged the balance with more than half of those from 1982 to 2011.

There is also a shift toward constructors in chemistry, though it is less abrupt.  In the fields of physiology and medicine, however, simplifiers reign supreme and there has been no shift across time.  Three-quarters of the prizes are still going to simplifiers.

Does that mean we should be relatively bullish about progress in those areas, based on forthcoming fundamental breakthroughs?

All these points are from Jeremy J. Baumberg’s new and interesting The Secret Life of Science: How It Really Works and Why It Matters.

What should I ask Michael Pollan?

I will be doing a Conversation with Tyler with him, no associated public event.  Here is his home page, and the About section.  Here is Wikipedia on Pollan.  Here is a Sean Iling Vox interview with Pollan, on his recent work on LSD and other psychedelics, and his most recent book is How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence.  Pollan is perhaps best known for his books on food, cooking, and food supply chains. 

So what should I ask him?

The Ex-Post Dead Are Not Ex-Ante Hopeless

It’s well known that a large faction of medical spending occurs in the last 12 months of life but does this mean that the money spent was fruitless? Be careful as there is a big selection effect–we don’t see the people we spent money on who didn’t die. A new paper in Science by Einav, Finkelstein, Mullainathan and Obermeyer finds that most spending is not on people who are predicted to die within the next 12 months.

That one-quarter of Medicare spending in the United States occurs in the last year of life is commonly interpreted as waste. But this interpretation presumes knowledge of who will die and when. Here we analyze how spending is distributed by predicted mortality, based on a machine-learning model of annual mortality risk built using Medicare claims. Death is highly unpredictable. Less than 5% of spending is accounted for by individuals with predicted mortality above 50%. The simple fact that we spend more on the sick—both on those who recover and those who die—accounts for 30 to 50% of the concentration of spending on the dead. Our results suggest that spending on the ex post dead does not necessarily mean that we spend on the ex ante “hopeless.

…”Even if we zoom in further on the subsample of individuals who enter the hospital with metastatic cancer…we find that only 12% of decedents have an annual predicted mortality of more than 80%.

Thus, we aren’t spending on people for whom there is no hope but it doesn’t follow that it’s the spending that creates the hope. What we really want to know is who will live or die conditional on the spending. And to that issue this paper does not speak.

What should I ask Claire Lehmann?

I will be doing a Conversation with her (no associated public event), if you don’t already know here is Wikipedia on Claire:

Claire Lehmann is an Australian psychologist, writer, and the founding editor of Quillette.

Lehmann founded Quillette in October 2015, with the goal of publishing intellectually rigorous material that makes arguments or presents data not in keeping with the contemporary intellectual consensus.

Here is Claire on Twitter.  Here is her own home page and bio.  Here is the Quillette Patreon page.

So what should I ask her?

What if sleep was a commodity?

Dane emails me:

This is a speculative solve-for-the-equilibrium-type question that I’d love to get your thoughts on:

Imagine there was a technology that allowed essentially frictionless harvesting, selling, and buying of (non-perishable) human sleep. Essentially, anyone can strap in to a machine, be put to sleep, and their time/sleep would be harvested in a way that their time sleeping could be used by anyone else who would then get all the benefits of that sleep but instantaneously instead of sleeping themselves, maybe through a painless injection or a drink perhaps.

Imagine also that this technology was relatively non-capital-intensive, or at least, cheap enough that all humans were potential suppliers/buyers of sleep. Call them sleep-workers and sleep-consumers.

Additionally, there’s nothing “free” about the technology. Any sleep-worker’s or sleep-consumer’s lifespan would be unaffected in terms of calendar time. Instead, there would be a zero-sum transfer of waking hours between persons. Even an “around-the-clock” sleep-worker could only net 16 hours of saleable sleep per day. The other 8 hours would have to go to meeting their own sleep needs.

How would this market evolve? How would society evolve? What is the market price for an hour of sleep? How would norms around sleep-working and sleep-consuming evolve? How would the economic indicators evolve (GDP, productivity, inequality, etc)? Which jobs could or could not compete with non-consciousness? How would the welfare state then evolve? How much inter-temporal saving of sleep would there be? Should prisoners be allowed to sleep-harvest for their entire sentences? Would we allow them? Would it be ethical to farm never-conscious humans for the sole purpose of harvesting sleep? Etc…

What should I ask Michelle Dawson?

I will be having a Conversation with her, here is part of her Ordre de Montréal citation:

Michelle Dawson is an autism researcher who is passionately engaged in promoting the rights of autistic people. Her research has led to important advances in the understanding of autism and its legal status.

Ms. Dawson is autistic and has never attended university as a student. In the early 2000s, faced with the devastating effects of human rights violation based on her diagnosis, she started learning about autism science, ethics, and law.

Since 2004, she has been affiliated with the Université de Montréal’s autism research group. Despite her lack of formal education and the precariousness of her situation, she has collaborated widely with academics here at home and around the world, and made original contributions to autism research in scientific journals, encyclopedias, scholarly books, and conference presentations. She has also used social media to promote better standards in autism research.

Her work has contributed to the advancement of knowledge in several areas, including perception, cognition, learning, and intelligence in autism. She has documented the poverty of scientific and ethical standards in autism intervention research, and the resulting harm to autistic people. Contrary to long-entrenched views, she believes that autistics deserve the same basic rights as the rest of humanity. She also believes that in research, as elsewhere, autistic and non-autistic people should work together as equals.

She tweets at @autismcrisis, and here is her work at scholar.google.com.  I also have a co-authored paper with her, on Alan Turing.  Many of you also will know Michelle as a long time MR correspondent.

So what should I ask her?

Maybe British common law wasn’t so great for colonies after all

Legal Origins and Female HIV

Siwan Anderson

More than one-half of all people living with HIV are women, and 80 percent of all HIV-positive women in the world live in sub-Saharan Africa. This paper demonstrates that the legal origins of these formerly colonized countries significantly determine current-day female HIV rates. In particular, female HIV rates are significantly higher in common law sub-Saharan African countries compared to civil law ones. This paper explains this relationship by focusing on differences in female property rights under the two codes of law. In sub-Saharan Africa, common law is associated with weaker female marital property laws. As a result, women in these common law countries have lower bargaining power within the household and are less able to negotiate safe sex practices and are thus more vulnerable to HIV, compared to their civil law counterparts. Exploiting the fact that some ethnic groups in sub-Saharan Africa cross country borders with different legal systems, we are able to include ethnicity fixed effects into a regression discontinuity approach. This allows us to control for a large set of cultural, geographical, and environmental factors that could be confounding the estimates. The results of this paper are consistent with gender inequality (the “feminization” of AIDS), explaining much of its prevalence in sub-Saharan Africa.

That is from the latest American Economic Review.  Here is an earlier version and related material.

Why is there no lead-homicide connection in Eastern Europe?

Children growing up in former communist CEE countries during the 1980s were subjected to horrific amounts of industrial pollution, including extreme levels of prolonged lead exposure. Since lead is theorized to be a primary culprit in exacerbating violent crime, you would assume there would be a sizeable discrepancy in the homicide rate between, say, former East Germany and West Germany, or Western Europe and Eastern Europe as a whole. But the difference in the homicide/violent crime rate is negligible, with many former communist CEE countries having a lower homicide rate than Western Europe. I suspect the same is true when comparing the rate of mental disorders, which is another malady that is supposedly influenced by exposure to high levels of industrial pollution.

https://object.cato.org/sites/cato.org/files/serials/files/cato-journal/1992/11/cj12n2-2.pdf

That is from commentator Aurel at SSC.

Markets in everything

Meditation app Calm provides what it calls “bedtime stories for grown-ups” (an eclectic mix of lullabies, fairy tales, and short stories in audiobook form). But it’s now added highlights from the GDPR legislation to its roster, narrated aloud by former BBC radio announcer Peter Jefferson, who is famous in the UK for his readings of the Shipping Forecast — a nightly maritime weather report that’s cherished by non-maritime listeners for its repetitive and ritual qualities.

Jefferson doesn’t read the entire legislation (“which would take more than all night”), but he picks out more than half an hour of material, which is enough to send anyone to sleep. You can listen to an excerpt for yourself below, or download the app from Google Play or the App Store. Unfortunately, you have to pay to unlock the full GDPR reading (and a number of other Calm features), but you can test them all with a seven-day free trial.

Here is more, via the excellent Samir Varma.