What I'm Reading (July 23)

By Chuck Dinerstein, MD, MBA — Jul 23, 2020
What exactly do we mean, scientifically, when we talk about individuals? ... Can a model of surgical care costing a small fraction of care in the U.S. teach us anything? ... Nassim Taleb writes about the use of masks. Some habits are hard to break, especially when we see them as the norm and not a habit at all.
Image courtesy of klimkin on Pixabay

I have long been fascinated by how we tell “us” from “other,” the primary job, it seems, of our immune system. But in science, the categories we have chosen as our descriptors are now being questioned. Gender is fluid, race is a social construct, and age is a chronotropic representation of aging. 

“The task of distinguishing individuals can be difficult …Even on Earth today, it’s clear that nature has a sloppy disregard for boundaries: Viruses rely on host cells to make copies of themselves. Bacteria share and swap genes, while higher-order species hybridize. …Even humans contain at least as many bacterial cells as “self” cells, the microbes in our gut inextricably linked with our development, physiology and survival.

These organisms are “so intimately connected sometimes that it’s unclear whether you should talk about one or two or many,” … And yet, the notion of what it means to be an individual often gets glossed over. “So far we have a concept of ‘individual’ that’s very much like the concept of ‘pile,’” said Maxwell Ramstead, a postdoctoral researcher at McGill University. “If there’s a pile of sand, you intuitively know this is a pile of sand. But a pile is not a precisely defined thing. It’s not like after 13 grains, it moves from a collection to a pile.””

Quanta explores the question of what constitutes an individual, What Is an Individual? Biology Seeks Clues in Information Theory.

“In 10 years, India will become the first country in the world to dissociate health from affluence. India will prove that the wealth of the nation has nothing to do with the quality of health care its citizens can enjoy.”

The developing world cannot afford the prices paid for medical care or equipment here in the US, and manufacturers have developed low-cost alternatives. Some of those inexpensive alternatives have returned home to us. For example, ultrasound machines, once costing $150K, can now be purchased for a quarter of the price and work as well, if not better. Here is a look at a model of surgical care from India. It would be far too disruptive to our healthcare “ecology,” but there are many lessons to be learned. Not the least of the lessons is that no matter how inexpensive the care, the government always wants it for less. (Unless you’re a defense contractor) From Bloomberg, via the Pocket, The World’s Cheapest Hospital Has to Get Even Cheaper

“There is no evidence that masks work,” I kept hearing repeated to me by the usual idiots calling themselves “evidence-based” scientists. The point is that there is no evidence that locking the door tonight will prevent me from being burglarized. But everything that may block transmission could help. Unlike school, real life is not about certainties. When in doubt, use what protection you can.”

Let me be honest. I like what Nassim Taleb writes about, a least one of my fellow writers, not so much. Among the many hats that he wears is statistician specializing in situations of low probability but high risk. In this piece, found in Medium, he takes on the fallacies in our thinking about masks in the time of COVID. Incompetence and Errors in Reasoning Around Face Covering

“The social habits we tend to see as either the fabric of society or unintended corollaries of social life—gathering at high-density, shaking hands as a greeting, traveling, and interacting when infectious—have become established as social norms. Path-dependence tells us that far more energy needs to be invested in campaigns to eliminate these habits than is required to perpetuate the habits.”

What can complexity science tell us about COVID-19 and society in general? From Nautil.us, The Damage We’re Not Attending To

 

Chuck Dinerstein, MD, MBA

Director of Medicine

Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.

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