The next 24 hours will test the boundaries of not speaking ill of the dead. So it goes…
The Northern Virginia doctor was born in D.C. and given a U.S. birth certificate. At 61, he learned his citizenship was granted by mistake.
I have been dealing with the Lovecraftian horror that goes by the name USCIS for 15 years now, and this is not surprising in the least. Not everyone gets to have their story told by the WaPo, so good for the doctor for making it happen — like a true American! Give the man his citizenship.
This is the perfect number of times a year to have cranberry sauce: one.
Nassim Taleb says it, and now James Fallows does to: predictions are worse than useless. Please pay attention to the worse than part.
Rejoice, our eight-month long nightmare is over. For now.
If you thought the state of American media was bad — and justifiably so — I can assure you that most of the world has it much worse. Every so often I get sent a link to a Serbian news site writing about cancer research, and it is always a disaster. Here is the most recent one, short enough to be quotted fully here (translation courtesy of Google):
A German company presented an anti-cancer drug: The tumor stopped growing in all patients
The German company Biontek (BioNTech) is currently raising hopes with its cancer vaccine CARVac.
The first research results show that tumors can be stopped from growing, and sometimes even reduced. The first successes occurred after two out of four vaccination doses.
Most study participants (59 percent) had their tumors shrink by at least 30 percent. In addition, the tumor stopped growing in almost all patients (95 percent) after vaccination. Like the covid 19 vaccine, the vaccine is based on mRNA technology.
This means that a certain protein is taken into the cell, allowing the body to repair it itself.
The new vaccine was developed by a team led by Biontek founder Ugur Sahin (58) and founder Ozlem Turecci (56).
So far, 44 patients have received it in four doses. Success was particularly high after two doses, after four doses the tumors were reduced by at least 30 percent in just under half (45 percent), and the cancer was stabilized in 74 percent of all patients.
Let me list the ways in which this is a terrible new story:
Where did the data come from? Was it a paper, an abstract, a press release, or a leak? A 2-second journey to DuckDuckGo shows that they were, in fact, presented at the 2023 ESMO Congress, which is the annual gathering of the European Society of Medical Oncology. The Serbian website does mention a Bosnian article as a “source” for there copy/paste job, but that article also doesn’t list where the data came from.
“The first research results…”, the article begins. Being the first is big news. But this aren’t the first results. Some were presented last year at the same congress, and even that was a follow-up of data presented earlier.
Vaccines make the news, so that’s what they highlight, but the trial is actually of a cell therapy with and without the vaccine. The 44 patients they mention are the ones who got the cell therapy with and without the vaccine, and there is no breakdown of how many of them got the actual vaccine. With cancer vaccine’s abysmal past record No, they are not now being “tried in cancer” after the success in Covid-19. They were, in fact, developed for cancer treatment, experienced failure after failure, and pivoted back to infectious diseases because of Covid-19; and what a good thing for all of us that they did! I highly doubt that the effect we saw was wholly due to the cells, not the vaccine (then again, I work at a cell therapy company). The paper which came out concomitantly with the abstract shows that about the same number of participants who got the vaccine progressed and responded (see Figure 2 for that).
“The tumor stopped growing in all patients”, the headline says. Well, loog at Figure 2 again, it’s what we call a waterfall plot, which is an aspirational name: if the bar goes up from baseline it means that the tumor grew, if it goes down it means that it shrank, so you want it to look like a waterfall. But in 8 of the 21 participants presented in the paper it grew! And in 5 more it barely came down — those count as “stable disease” because measuring tumors is not a precise science and a pixel here or there on the digital ruler can make all the difference. In only 8 of the participants did the tumor shrink, and in only one of those did it go away completely.
This is, I’m sad to say, about what you would expect for a Phase 1 trial of a cancer drug. Most patients who make it to such a trial have slow-growing tumors, and having a “stable disease” in that context — where you are allowed to have the tumor grow by 20% before calling it “progression” — is perfectly meaningless. Note that you will find terms like “disease control rate” or “clinical benefit rate” which combine participants whose tumors shrunk with those who had this “stable disease”. Those two metrics are also meaningless without a control group.
This became longer than I intended so I’ll stop here, but yes, it’s a sad state. It reminds me of dostarlimab, only much worse since in that case there was at least clear evidence that the drug was good, the only thing missing was context. Caveat lector!
So if not daily world news, what then? Well, Axios Local is a good option for DC, and has daily newsletter for more than two dozen other cities. StreetSense is a DC-only enterprise, and more relevant for me than whatever this is from The Washington Post. If the Council does start handing out vouchers to support local news, I know where mine will be going.
Here is an obvious analogy for you: the physical world — meatspace, if you will — as “meat” of an actual body, both skeletal (muscles, ligaments, tendons and such), and visceral (entrails, the liver, vital organs); the internet as nerve impulses connecting the various parts both sensorially (how are the navels of the world doing these days?) and in effect (from Facebook groups to GoFundMe pages bringing actual change).
You know how X and other social networks made everything feel connected to everything else? Well, there is an organic counterpart to this phenomenon, and it’s called a generalized tonic-clonic — or grand mal — seizure, manifesting, in the clonic phase, in widespread convulsions of the body.
The reason why our bodies are usually not convulsing is that the nerve impulse pathways are tightly controlled in space: there are separate nerves, differentiated brain areas for different roles, and let’s not forget the biggest separation of them all: two semi-independent brain hemispheres connected only by the corpus callosum which, imagine this, is sometimes cut completely for treatment of refractory seizures. There is also chemical separation: many of the pathways are inhibitory, and the most abundant neurotransmitter in the body is not dopamine, serotonin, acetylcholine or others you’ve heard of because they go haywire, but glycin, a modest amino acid which people don’t hear about because it is so good at its job of tamping down bad impulses.
The world’s ongoing convulsions started — after an initial tonic phase — right after we have all become interconnected: Hezbollah, Hamas, and your neighborhood association all hooked up to the same firehose. There is a feeling at the edge of my consciousness that the answer to solving them is in ourselves, and not in a new age self-fulfilment way but in pragmatic steps we can take to extrapolate from this most obvious analogy.
Nassim Taleb in Antifragile: The link points to an excerpt posted on the Farnam Street blog, which I stopped following years ago — too much noise in the form of wisdom nuggets — but still has its uses. You should really read the whole of Incerto
The more frequently you look at data, the more noise you are disproportionally likely to get (rather than the valuable part called the signal); hence the higher the noise to signal ratio. And there is a confusion, that is not psychological at all, but inherent in the data itself.
Now let’s add the psychological to this: we are not made to understand the point, so we overreact emotionally to noise. The best solution is to only look at very large changes in data or conditions, never small ones.
Alan Jacobs today:
If you’re reading the news several times a day, you’re not being informed, you’re being stimulated. Try giving yourself a break from it. Look at this stuff at wider intervals, and in between sessions, give yourself time to think and assess.
Always good to see convergence on important topics. I now get most of my news from books.