Merry Christmas to all who celebrate!
Image by Midjourney v6. The prompt was my own.
I am not a fan of “wellness” visits, those yearly exams that your insurance insists you should do even if you don’t have any medical problems. Evidence from randomized controlled trials suggests they don’t make any difference to people’s health, but they (obviously) contribute to the primary care physicians' workload.
Having said that, I recently reached a nice round number of years, so it was time to get my cholesterol checked and finally get a flu shot. I enjoyed the banter, but I could also see how and why there may be no health benefit. If annual exams are good for anything, it is to find chronic asymptomatic conditions that have long-term consequences — high blood pressure, high cholesterol and high glucose are the big ones at my age. Testing for them has the highest yield in a generally low-yield visit, so whoever is seeing you should get at least those three right.
After this morning I suspect most places are not doing it right. The person checking my blood pressure did not care at all about the correct technique: whether I still had my sleeves on when they placed the cuff, whether my feet were on the ground or hanging over the raised exam table, whether my legs were crossed, or whether I was talking while measurement was being taken. Worse yet, no one asked or cared whether I had anything to eat or drink before getting my blood drawn for the labs. I could have downed a sugar-and-cream-laden coffee with a Boston cream chaser minutes before the visit and no one would have known. This is the complete opposite of Serbia, where they drill into you at an early age that you must have nothing to eat or drink — water excepted — before getting your blood drawn for anything; which is an extreme of its own kind but one that at least doesn’t result in lab results that you can’t interpret.
At best the loose approach to testing leads to more labs having to be drawn if and when something comes back out of range and the doctor wonders why. At worst it leads to misdiagnosis (“Your cholesterol is through the roof, you’d better be on a statin!") or missed diagnosis (“Your cholesterol is a bit too high but you ate before the labs were drawn so it’s probably just from the food.") — neither is good.
Even when properly done, I don’t think the annual exams are worth it. There are plenty of reasons to see the physician for other things, and sneaking in a blood pressure check and some labs on top of those is easy enough without overburdening the system. For those fortunate enough to be without ailments, a visit every 5–10 years to make sure all the screenings are up to date sounds about right. The paradigm of treating your body as a car to be taken to the shop for scheduled maintenance is wrong: our bodies aren’t intelligently designed mechanisms with replaceable parts that wear out at a predictable rate, and we can’t be taken apart and put back together at a whim. The trend of renaming the annual exam to something else recognizes this reality.
The replacement term, wellness visit, is not much better. In theory it should make the doctor (or nurse practitioner) enhance the lives of people they are seeing by taking a more holistic approach: “You are not a patient, you are a person.” In practice, it turns doctors into box-checkers: are you suicidal (yes/no), do you drink alcohol (yes/no), do you use illicit drugs (yes/no). It takes time away from things doctors were trained for — to treat disease that can be treated, provide council about the diseases that can’t, and know the difference between the two — and makes them do things that are as important, maybe more so, but not in their area of expertise.
The problem isn’t unique to medicine. It’s good to have the police around to deal with murder and theft, not so much when there is a domestic dispute or an acute psychotic episode, now (holistically?) called “a mental health crisis”. They used to be matters for the extended family or neighbors to deal with, not an outside force. Wherever the two were lost, public and private services picked up some of the responsibilities; the doctors seem to have gotten the role of the friendly ear, listening to the issues that used to be mulled over a cup of tea, or — sure, I’ll go there — in the bowling alley. This is a job they were not trained to do and for which they receive no compensation, so in that sense it is fair: the (American) society got what it paid for.
The perks of being born in late December, after the (Gregorian) Christmas but before the New Year:
📚 Writing with Style: The Economist Guide may not be the most important style guide to come out, but it has to be the funniest. Between the self-references and the dry wit lie many lessons: that even professional writers do some things a certain way because the alternative would “look weird”; that I use too many commas, the Oxford comma being one of them; and that if my name were ever to be mentioned in The Economist it would lose its diacritics — unless I insisted they stay. It earned its place on the shelf above the screen.
Merry Christmas to all who celebrate!
Image by Midjourney v6. The prompt was my own.
I tend to add “to all who celebrate” because the Serbian Orthodox Church is still on the Julian calendar, which is off by 13 days. Most orthodox churches are aligned with the Gregorian calendar and have been so for the last 100 years thanks to a revision proposed by — drumroll please — the Serbian Orthodox Church. Having a good idea and not following through because Russia isn’t on board is a typical Serbian thing to do, so points for consistency I guess.
While I admire Craig Mod’s extensive introduction to Walking and Talking, the European part of me — which is 100% to the nearest decimal — is rolling his eyes and thinking, “Really, Craig?”
This is America at its best and worst: optimize, plan, extract every ounce of utility from what is supposed to be a leisure activity. I’d rather go flaneuring.
It was a good year for television! Or for my clearing the backlog, as some of these came out years ago:
Last year’s list is here.
Today’s Washington Post has a good write-up on how genetic engineering of the near-extinct American chestnut tree to make it more resistant to infection went wrong:
After he enlisted the help of Ek Han Tan, a geneticist at the University of Maine, to analyze the chestnut’s genome, they made their discovery this fall: The plants they were working on were, in fact, not Darling 58 trees.
Instead, they found they were working with a different chestnut line — called the Darling 54 — where the gene was inserted in another chromosome entirely, potentially corrupting one of the tree’s existing genes.
…
In a phone interview, Newhouse, the SUNY ESF director, acknowledged the mix-up but said he wasn’t sure what transpired.
“As far as exactly how it happened, we don’t know,” he said. “It must have been a label swap between these two trees that we were working with at the same time” in or around 2016.
The brilliant minds who think engineering mosquitos is a good idea can’t foresee that even a seemingly innocuous clerical error can lead to disaster, never mind the second-order effects to nature if your project succeeds. Whoever’s read Taleb’s Incerto (or some of his tweets) knows better.
My podcast diet has become stale. I work from home more, commute less, and have decided not to wear AirPods when others are around, With a family of five this means no more than 30–45 minutes in the early morning before anyone else is up. And those minutes are filled with the usual suspects, which continue to be fine, but they are also two elderly economists with similar views. Where’s the variety?
So, here is an aspirational list of things I will try out in 2024. Be warned: a few years ago I put Lex Friedman’s podcast on a similar list, and apologized profusely after realizing it was a good cure for insomnia and not much else. As always, caveat lector.
If the links above were not explicit enough, here are my actual regulars: ATP, EconTalk, Conversations with Tyler, with a sprinkling of The Talk Show and Dithering. They all feature prominently in years past: 2022 — 2021 — 2020 — 2019 — 2018 — The one where I took a break from podcasts — The very first one.
🍿 Klaus (2019) flew under the radar for us when it first came out, so kudos to the Netflix recommendation algorithm for resurfacing it for the holidays. It is a classically — and beautifully — animated family movie that’s not trying to be hip or edgy, and is all the better for it.
This time last year, Netflix scrapped the director’s follow-up project. Here’s hoping that Ember will find a new home.