I am at ACR Convergence all weekend, but here are some quick shots:

• How it went
• Epistemic hygiene
• Maybe Bluesky has “won” (ᔥ*Dave Winer*)
• I hated Dubai until I learned about it

Here is a brief anecdote that may help contextualize some recent developments, in particular why anyone black, or brown, or uneducated, or poor may have preferred Trump over Harris.

Two apartments ago, a bit before Covid, we were living in a 2-bedroom apartment in Northwest DC that was absolutely gargantuan by European standards but must have seemed cramped for a family of five-plus-a-house-guest to our neighbors. One neighbor in particular, let’s call her Alice, seemed unusually interested in the goings on of our household: the foreign accents, the visiting grandparents, so many children. So she made a point to, whenever we bumped into each other in the hallway, gather as much information as possible, and give a few bits about herself in return.

Alice worked for a federal agency, you see, and as a hard-core democrat was trying to minimize the chaos that the orange man — this was during the first Trump administration — and his peons spewed on the people. Now the agency in question was healthcare-adjacent so my wife and I, both being physicians, knew that the problems ran deeper than the president and his appointees, but that is not the point of the story.

The point is this: with every interaction, Alice would highlight that we were not US citizens, then highlight some more that we had visiting family members who also were not citizens and who may or may not be in the country legally (they were all, of course, visiting on a tourist visa as they have been in more than a decade since we moved from Serbia), then apologize for what Trump was doing to the immigrants and aren’t we all lucky that DC is a town of welcoming democrats and can you please let her know if we needed any help with anything, at which point Alice would — unironically — wink.

It’s hard for me to say what felt more insulting, the sly and not so sly insinuations that we were there illegally, the entitlement that we must be best of friends because we were immigrants, or the expectation of gratitude to all the democrats for “fighting on our behalf” when there was no fighting to be had. And this is before we even had our green cards, staying on a combination of work and (this is my favorite name for a bureaucratic invention) Alien of extraordinary ability visas. I can only imagine how much worse the feeling would have been if we were citizens with the unfortunate property of having an unusual accent or unconventional (for upper-middle-class-non-hispanic-whites) housing arrangements.

To be clear, I have no idea what Alice’s intentions were. I am pretty sure she didn’t want to insult anyone, and that her thoughts and feelings were true. And it is often the case that someone can feel insulted for reasons completely within their control: a slight sense of shame that you weren’t living up to someone’s arbitrary standards, annoyance that you are spending hours on immigration paperwork when others don’t have to yet feel as welcome, outrage that anyone would give even a hint of a suggestion that you are a family of Anne Franks looking for an attic. All internal and within your own control, but not any less true. Humans being humans.

This was all before Covid-19. After March 2020 our hallway conversations turned into talks about masks, vaccines, and how everyone was grateful to have doctors in the building. About a year into the pandemic another neighbor ran out of their antipsychotic medications and started setting small fires and hitting random hallway doors with baseballs bats so we were soon out — the benefits of renting — but we stayed on good terms with Alice. Still, those first few impressions stuck, and majority of our interactions are only first impressions without the benefit of a pandemic to deepen a relationship.

One of the defining properties of America is, I’ve learned over the years, the tendency to go all-in. People don’t just go on a hike or two a year, they buy hiking gear, download hiking apps, plan out routes and become hikers. They don’t go out for a jog when the weather is nice and they feel like it, they train for a marathon. They don’t enjoy a night out at a restaurant, they rate and review and call themselves “foodies”. They don’t just like their work, they do it on evenings and weekends and holidays too. That is how you get to the highest GDP of any developed country, I guess, but there is also some subtlety lost and the democrats who were all-in on immigration have lost that subtlety and unintentionally — I hope — fanned the flames of indignation across the board. So not only were those pro-immigration efforts insufficient to overcome the feelings about the economy, they may have even hurt.

1. It won’t be close. Most pollsters are hacks who commit even greater statistics crimes than physicians so their 50/50 is most likely to mean a landslide either way.
2. That link above is to Nate Silver’s Substack post, but please remember that he is also a hack who builds prediction models from the polling garbage he describes above while knowing it is garbage. That is even worse than what the pollsters are doing because shouldn’t he know better?
3. Worse yet are economists who excuse the pollster behavior: they see crimes being committed and think yep, that’s how it should be. This is a University of Michigan professor of economics and a senior fellow of some pretty serious Think Tanks who doesn’t realize that fiddling with your results after you’ve collected them in order to better align with the aggregate of other people’s results is scientifically unsound. I’d send all of his papers to Retraction Watch for a close inspection.
4. From 538 to the NYT to Nate, every poll aggregator has for months been fed back its own bullshit. Little wonder then that they all converged to a 50/50: complete ignorance.
5. Prediction “markets” are no better than equity markets in reflecting reality. Which is to say, they reflect the reality of vibes and wishful thinking, not the ground truth. They are best ignored.
6. Sátántangó (2019) by the Hungarian director Béla Tarr is a 7-hour masterpiece shot in black and white; perfect for watching on a crisp autumn evening like tonight’s, no other screens allowed.

A Wall Street Journal article on physician work-life balance prompted lots of online chatter, including people remembering their parents' dedication to the calling. But times have changed. The choice now isn’t between spending time with family and patients, it’s between spending it with family and corporations. If practicing medicine were more meaningful, there would be less of a retreat to family life by people who self-selected for delayed gratification and frank masochism.

Lots of words spent in the New York Times on how Starbucks lost its magic and not one mention of the most straightforward way to bring that magic back: have it be a coffee shop again, and not a drive-through dessert stand.

No, I am not canceling my Washington Post subscription; the free one I had through my previous federal job expired and I never renewed it, so there was nothing left to cancel. My main source of local news has been Axios DC but The 51st popped up recently and is now getting amplified. It has fewer tips on where to get the best Cinco de Mayo margarita and more in-depth news, which is great. It also lists Old Town Alexandria as the number 1 spot for a fall walk around D.C. so they’re not perfect, but then no-one is. And of course, they are opportunistic about the recent local events (headline: D.C. Deserves Billionaire-Free Local News).

Andrew Gelman recently wrote about Columbia surgery professor’s research missconduct. I haven’t looked into the details but it seems like the retracted papers were all about lab research with no true clinical relevancy. In that context, this part of the post stuck out:

Can you imagine, you come to this guy with cancer of the spleen and he might be pushing some unproven treatment supported by faked evidence? Scary.

I can’t tell whether this was supposed to be a joke or if Gelman truly believes that faking mouse experiments directly leads to using unproven treatments, but in case it’s the latter I have to say that the logic is stretched. Yes, the kind of person who has no qualms about fake data is probably not all that rigorous about the evidence for surgical procedures, but for all we know he could be a master surgeon with excellent technique and great outcomes who also happens to have been a bad judge of character and trusted a bad actor. I suspect it’s the latter: the kind of multi-tasking surgery “superstar” that the professor in question seems to be tends to spend a lot more time in the the operating room (or, for another kind of a superstar, the board room), than the lab.

Now, if he were a medical oncologist or any other kind of doctor that gives cancer treatment then maybe things would have been more dubious — that kind of research tends to jump to clinic too quickly and without merit. But unless you’re transplanting pig’s hearts and working on other large animals, the lab is so far removed from the operating room that it is extremely unlikely any such evidence could be used to back up actual surgical treatment.

Incidentally, that last link is to Siddharta Mukherjee’s abomination of an article titled “The Improvisational Oncologist” (subtitle: “In an era of rapidly proliferating, precisely targeted treatments, every cancer case has to be played by ear.") from the May 2016 edition of The New York Times Magazine (it’s a gift link so feel free to read it; caveat lector) and it describes actual scientific and medical malpractice of bringing half-baked — though, admittedly, not faked — ideas from the lab into clinic. Gelman didn’t comment on his blog back then, but he did praise Mukherjee the following year for a New York Times opinion piece “A Failure to Heal” (another gift link there) that is about — wait for it — clinical trials that show the treatment that you thought would work doesn’t. ⊕ These kinds of trials tend to be called “negative” but there’s nothing negative about them! They bring positive value to the world. Maybe our improvisational oncologist learn something in those 18 months that separate the two texts?

To be clear, what Mukherjee artfully called “improvisational oncology” was (lab) bench to (hospital) bedside medicine, which is distinct from bench to bedside research: the concept of bringing laboratory findings to clinical practice quickly, but still with some semblance of a clinical trial that includes a pre-specified protocol, informed consent and regulatory oversight. You know, all the stuff that decreases the odds of laboratory malfeasance endangering patient care. I say decreases the odds and not prevents them completely because we do have a case of a bad actor completely destroying an entire field of clinical research (Alzheimer’s disease). Can you imagine the damage that kind of shenanigans would do if we didn’t have clinical trials standing between the lab and the commercial drug market?

COI statement: I am involved in a [course about clinical trials][6 and think they are the best thing that has happened to medicine since a cloth merchant wanted to take a closer look at some garments so there is some bias involved, but then again say what you’ll do and do as you say is both a major tenet of clinical trialists and good general practice.

Facts about The New York Times, from 2016

Historically, the Los Angeles Times, where I worked twice, for instance, was a reporter-driven, bottom-up newspaper. Most editors wanted to know, every day, before the first morning meeting: “What are you hearing? What have you got?”

It was a shock on arriving at the New York Times in 2004, as the paper’s movie editor, to realize that its editorial dynamic was essentially the reverse. By and large, talented reporters scrambled to match stories with what internally was often called “the narrative.” We were occasionally asked to map a narrative for our various beats a year in advance, square the plan with editors, then generate stories that fit the pre-designated line.

No wonder then that NYT crowded out all other newspapers: they brought a narrative gun to a journalistic knife fight. Story wins, reality be damned. (↬Mark Palko)

This morning on Axios DC:

Metro fixed its fare evasion problem on trains, and now they are focusing on the 70% of bus riders who don’t pay. That eye-popping rate is up from 17% pre-pandemic.

Yowza. There is more at WaPo. Kids and I take the metro bus to school from time to time and I can confirm that:

1. School children in general don’t use their free ride cards. It improves the flow of people and drivers don’t seem to care.
2. More than half of the adults just waltz in as well. That too improves the flow of traffic, and drivers don’t seem to care about that either.

A head-scratcher, that.

The Nobel Prize in physiology or medicine went to Victor Ambros and Gary Ruvkun, two American scientists for their discovery of micro RNA:

The pair began studying gene regulation while they were postdoctoral fellows at the Massachusetts Institute of Technology in the lab of H. Robert Horvitz, who won his own Nobel Prize in 2002.

And so the Nobel family tree grows.