Monday, September 30, 2024

What happened to free speech?

Andy Kessler at the Wall Street Journal.

AK is on target.

History suggests that freedom is not the natural order. Are the ninnies of the world in the process of proving it? Are you?
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Sixty years ago this month, the Free Speech Movement was born at the University of California, Berkeley. How is that working out?

In mid-September 1964, Berkeley’s dean of students banned tables and political activity along the Bancroft strip, a 26-foot stretch of university-owned sidewalk near Telegraph Avenue down from Sproul Plaza. I walked around the area last week and found, almost paradoxically, a capitalist BMO Bank, a Marxist-glorifying César Chávez Student Center and a techno-optimist Open Computing Facility.

Berkeley’s 1964 students protested the table ban. On Sept. 30, five students were cited. More than 400 insisted that they were also responsible and should all be cited too. They then staged their first sit-in inside Sproul Hall, Berkeley’s administration building. The next day, tables were set up outside Sproul Hall. The police were called and arrested Jack Weinberg. Some 200 students surrounded the police car. Speeches began as thousands assembled. Mario Savio emerged as a Free Speech Movement leader.

With the cop car still surrounded by late afternoon on Oct. 2, 500 police officers were on hand at the university. A six-point agreement was reached with the university president, and the protests ended. As is typical of universities, committees were formed. A six-week ban on tables was instituted and Mario Savio and others were suspended. But by mid-November, the tables were back, and 3,000 students marched around campus.

On Nov. 23, 300 students staged another sit-in inside Sproul Hall. By Dec. 2, 1,000 students were inside the building. Sit-ins aren’t free speech—they are unlawful and can lead to violence. Mario Savio gave his famous “Put your bodies upon the gears” speech on the steps of Sproul Hall. Gov. Edmund Brown then sent 635 police officers, who arrested 814 students. More committees, a five-point proposal, and a convocation tried to calm things down. In January, and three months too late, an acting chancellor designated Sproul Hall’s steps an open-discussion area that allowed political tables.

Sadly, campus free speech has been lost since 1964. Savio’s speech has been an inspiration for civil disobedience, most recently at Columbia and elsewhere this spring. Even peaceful protests these days are now more about what you can’t say. What started as safe spaces and trigger warnings are now almost always one-way actions, cancellations and censorship of ideas progressives don’t like.

Especially at Berkeley. The Foundation for Individual Rights and Expression recently posted their 2025 College Free Speech Rankings of 251 colleges. The University of Virginia is ranked No. 1 for free speech. Berkeley is 225. New York University, Columbia and Harvard are last. Great company.

In 2017, Ann Coulter, Milo Yiannopoulos and David Horowitz had events canceled at Berkeley for “security concerns.” This February, a Berkeley pro-Israel event was postponed by protesters who broke into a building. Last week a member of Israel’s Knesset was harassed off stage at Berkeley by both left-wing Israeli and anti-Israel protesters. Some free-speech anniversary. Witness the naked hypocrisy: Free speech for me but not for thee.

Progressives love to censor. In 2019 Kamala Harris told CNN that Facebook and Twitter “are directly speaking to millions and millions of people without any level of oversight or regulation. And that has to stop.” In August former Labor Secretary Robert Reich, a Berkeley professor emeritus, wrote: “Regulators around the world should threaten [Elon] Musk with arrest if he doesn’t stop disseminating lies and hate on X.” State Department employees were urged not to use “gendered terms,” such as “manpower,” “you guys” and even “mother/father” and “husband/wife.” Gov. Tim Walz told MSNBC in 2022, “There’s no guarantee to free speech on misinformation or hate speech and especially around our democracy.” Uh, except for the First Amendment.

This has empowered Brazil to ban Twitter, triggering protests. Telegram founder Pavel Durov was arrested near Paris. The George Soros-funded, U.K.-based Global Disinformation Index is used to censor others. Hong Kong has arrested editors and publisher Jimmy Lai. The U.K. is arresting citizens over social-media posts. Madness! It’s time for the U.S., left and right, to protect free speech as an absolute, a modern Free Speech Movement, and set an example for the rest of the world.

Ironically, an “invisible sculpture” to free speech at Berkeley was proposed in 1989. Administrators agreed to it, so long as—you can’t make this stuff up—the Free Speech Movement wasn’t mentioned in the press release. It’s a patch of soil in Sproul Plaza surrounded by a granite circle inscribed: “This soil and the airspace extending above it shall not be a part of any nation and shall not be subject to any entity’s jurisdiction.” I stood inside the invisible cylinder and shouted the first subversive thing that came to mind: “master bedroom.” Not my proudest moment. But I wasn’t thunderstruck. No censorship there, unlike, it seems, everywhere else these days.

Wednesday, September 25, 2024

Perspective on AI and regulation

 From John Cochrane.

 

JC is on target.


Introduction

“AI poses a threat to democracy and society. It must be extensively regulated.”

Or words to that effect, are a common sentiment.

They must be kidding.

Have the chattering classes—us—speculating about the impact of new technology on economics, society, and politics, ever correctly envisioned the outcome? Over the centuries of innovation, from moveable type to Twitter (now X), from the steam engine to the airliner, from the farm to the factory to the office tower, from agriculture to manufacturing to services, from leeches and bleeding to cancer cures and birth control, from abacus to calculator to word processor to mainframe to internet to social media, nobody has ever foreseen the outcome, and especially the social and political consequences of new technology? Even with the benefit of long hindsight, do we have any historical consensus on how these and other past technological innovations affected the profound changes in society and government that we have seen in the last few centuries? Did the industrial revolution advance or hinder democracy?

Sure, in each case one can go back and find a few Cassandras who made a correct prediction—but then they got the next one wrong. Before anyone regulates anything, we need a scientifically valid and broad-based consensus.

Have people ever correctly forecast social and political changes, from any set of causes? Representative democracy and liberal society have, in their slow progress, waxed and waned, to put it mildly. Did our predecessors in 1910 see 70 years of communist dictatorship about to envelop Russia? Did they understand in 1925 the catastrophe waiting for Germany?

Society is transforming rapidly. Birth rates are plummeting around the globe. The U.S. political system seems to be coming apart at the seams with unprecedented polarization, a busting of norms, and the decline of our institutions. Does anyone really know why?

The history of millenarian apocalyptic speculation is littered with worries that each new development would destroy society and lead to tyranny, and with calls for massive coercive reaction. Most of it was spectacularly wrong. Thomas Malthus predicted, plausibly, that the technological innovations of the late 1700s would lead to widespread starvation. He was spectacularly wrong. Marx thought industrialization would necessarily lead to immiseration of the proletariat and communism. He was spectacularly wrong. Automobiles did not destroy American morals. Comic books and TV did not rot young minds.

Our more neurotic age began in the 1970s, with the widespread view that overpopulation and dwindling natural resources would lead to an economic and political hellscape, views put forth, for example, in the Club of Rome report and movies like Soylent Green. (2) They were spectacularly wrong. China acted on the “population bomb” with the sort of coercion our worriers cheer for, to its current great regret. Our new worry is global population collapse. Resource prices are lower than ever, the U.S. is an energy exporter, and people worry that the “climate crisis” from too much fossil fuel will end Western civilization, not “peak oil.” Yet demographics and natural resources are orders of magnitude more predictable than whatever AI will be and what dangers it poses to democracy and society.

“Millenarian” stems from those who worried that the world would end in the year 1000, and people had better get serious about repentance for our sins. They were wrong then, but much of the impulse to worry about the apocalypse, then to call for massive changes, usually with “us” taking charge, is alive today.

Yes, new technologies often have turbulent effects, dangers, and social or political implications. But that’s not the question. Is there a single example of a society that saw a new developing technology, understood ahead of time its economic effects, to say nothing of social and political effects, “regulated” its use constructively, prevented those ill effects from breaking out, but did not lose the benefits of the new technology?

There are plenty of counterexamples—societies that, in excessive fear of such effects of new technologies, banned or delayed them, at great cost. The Chinese Treasure fleet is a classic story. In the 1400s, China had a new technology: fleets of ships, far larger than anything Europeans would have for centuries, traveling as far as Africa. Then, the emperors, foreseeing social and political change, “threats to their power from merchants,” (what we might call steps toward democracy) “banned oceangoing voyages in 1430.” (3) The Europeans moved in.

Genetic modification was feared to produce “frankenfoods,” or uncontrollable biological problems. As a result of vague fears, Europe has essentially banned genetically modified foods, despite no scientific evidence of harm. GMO bans, including vitamin A-enhanced rice, which has saved the eyesight of millions, are tragically spreading to poorer countries. Most of Europe went on to ban hydraulic fracking. U.S. energy policy regulators didn’t have similar power to stop it, though they would have if they could. The U.S. led the world in carbon reduction, and Europe bought gas from Russia instead. Nuclear power was regulated to death in the 1970s over fears of small radiation exposures, greatly worsening today’s climate problem. The fear remains, and Germany has now turned off its nuclear power plants as well. In 2001, the Bush administration banned research on new embryonic stem cell lines. Who knows what we might have learned.

Climate change is, to many, the current threat to civilization, society, and democracy (the latter from worry about “climate justice” and waves of “climate refugee” immigrants). However much you believe the social and political impacts—much less certain than the meteorological ones—one thing is for sure: Trillion dollar subsidies for electric cars, made in the U.S., with U.S. materials, U.S. union labor, and page after page of restrictive rules, along with 100% tariffs against much cheaper Chinese electric cars, will not save the planet—especially once you realize that every drop of oil saved by a new electric car is freed up to be used by someone else, and at astronomical cost. Whether you’re Bjorn Lomborg or Greta Thunberg on climate change, the regulatory state is failing.

We also suffer from narrow-focus bias. Once we ask “what are the dangers of AI?” a pleasant debate ensues. If we ask instead “what are the dangers to our economy, society, and democracy?” surely a conventional or nuclear major-power war, civil unrest, the unraveling of U.S. political institutions and norms, a high death-rate pandemic, crashing populations, environmental collapse, or just the consequences of an end to growth will light up the scoreboard ahead of vague dangers of AI. We have almost certainly just experienced the first global pandemic due to a human-engineered virus. It turns out that gain-of-function research was the one needing regulating. Manipulated viruses, not GMO corn, were the biological danger.

I do not deny potential dangers of AI. The point is that the advocated tool, the machinery of the regulatory state, guided by people like us, has never been able to see social, economic, and political dangers of technical change, or to do anything constructive about them ahead of time, and is surely just as unable to do so now. The size of the problem does not justify deploying completely ineffective tools.

Preemptive regulation is even less likely to work. AI is said to be an existential threat, fancier versions of “the robots will take over,” needing preemptive “safety” regulation before we even know what AI can do, and before dangers reveal themselves.

Most regulation takes place as we gain experience with a technology and its side effects. Many new technologies, from industrial looms to automobiles to airplanes to nuclear power, have had dangerous side effects. They were addressed as they came out, and judging costs vs. benefits. There has always been time to learn, to improve, to mitigate, to correct, and where necessary to regulate, once a concrete understanding of the problems has emerged. Would a preemptive “safety” regulator looking at airplanes in 1910 have been able to produce that long experience-based improvement, writing the rule book governing the Boeing 737, without killing air travel in the process? AI will follow the same path.

I do not claim that all regulation is bad. The Clean Air and Clean Water Acts of the early 1970s were quite successful. But consider all the ways in which they are so different from AI regulation. The dangers of air pollution were known. The nature of the “market failure,” classic externalities, was well understood. The technologies available for abatement were well understood. The problem was local. The results were measurable. None of those conditions is remotely true for regulating AI, its “safety,” its economic impacts, or its impacts on society or democratic politics. Environmental regulation is also an example of successful ex post rather than preemptive regulation. Industrial society developed, we discovered safety and environmental problems, and the political system fixed those problems, at tolerable cost, without losing the great benefits. If our regulators had considered Watt’s steam engine or Benz’s automobile (about where we are with AI) to pass “effect on society and democracy” rules, we would still be riding horses and hand-plowing fields.

Who will regulate?

Calls for regulation usually come in the passive voice (“AI must be regulated”), leaving open the question of just who is going to do this regulating.

We are all taught in first-year economics classes a litany of “market failures” remediable by far-sighted, dispassionate, and perfectly informed “regulators.” That normative analysis is not logically incorrect. But it abjectly fails to explain the regulation we have now, or how our regulatory bodies behave, what they are capable of, and when they fail. The question for regulating AI is not what an author, appointing him or herself benevolent dictator for a day, would wish to see done. The question is what our legal, regulatory, or executive apparatus can even vaguely hope to deliver, buttressed by analysis of its successes and failures in the past. What can our regulatory institutions do? How have they performed in the past?

Scholars who study regulation abandoned the Econ 101 view a half-century ago. That pleasant normative view has almost no power to explain the laws and regulations that we observe. Public choice economics and history tell instead a story of limited information, unintended consequences, and capture. Planners never have the kind of information that prices convey. (4) Studying actual regulation in industries such as telephones, radios, airlines, and railroads, scholars such as Buchanan and Stigler found capture a much more explanatory narrative: industries use regulation to get protection from competition, and to stifle newcomers and innovators. (5) They offer political support and a revolving door in return. When telephones, airlines, radio and TV, and trucks were deregulated in the 1970s, we found that all the stories about consumer and social harm, safety, or “market failures” were wrong, but regulatory stifling of innovation and competition was very real. Already, Big Tech is using AI safety fear to try again to squash open source and startups, and defend profits accruing to their multibillion dollar investments in easily copiable software ideas. (6) Seventy-five years of copyright law to protect Mickey Mouse is not explainable by Econ 101 market failure.

Even successful regulation, such as the first wave of environmental regulation, is now routinely perverted for other ends. People bring environmental lawsuits to endlessly delay projects they dislike for other reasons.

The basic competence of regulatory agencies is now in doubt. On the heels of the massive failure of financial regulation in 2008 and again in 2021, (7) the obscene failures of public health in 2020–2022, do we really think this institutional machinery can artfully guide the development of one of the most uncertain and consequential technologies of the last century?

And all of my examples asked regulators only to address economic issues, or easily measured environmental issues. Is there any historical case in which the social and political implications of any technology were successfully guided by regulation?

It is AI regulation, not AI, that threatens democracy.

Large Language Models (LLMs) are currently the most visible face of AI. They are fundamentally a new technology for communication, for making one human being’s ideas discoverable and available to another. As such, they are the next step in a long line from clay tablets, papyrus, vellum, paper, libraries, moveable type, printing machines, pamphlets, newspapers, paperback books, radio, television, telephone, internet, search engines, social networks, and more. Each development occasioned worry that the new technology would spread “misinformation” and undermine society and government, and needed to be “regulated.”

The worriers often had a point. Gutenberg’s moveable type arguably led to the Protestant Reformation. Luther was the social influencer of his age, writing pamphlet after pamphlet of what the Catholic Church certainly regarded as “misinformation.” The church “regulated” with widespread censorship where it could. Would more censorship, or “regulating” the development of printing, have been good? The political and social consequences of the Reformation were profound, not least a century of disastrous warfare. But nobody at the time saw what they would be. They were more concerned with salvation. And moveable type also made the scientific journal and the Enlightenment possible, spreading a lot of good information along with “misinformation.” The printing press arguably was a crucial ingredient for democracy, by allowing the spread of those then-heretical ideas. The founding generation of the U.S. had libraries full of classical and enlightenment books that they would not have had without printing.

More recently, newspapers, movies, radio, and TV have been influential in the spread of social and political ideas, both good and bad. Starting in the 1930s, the U.S. had extensive regulation, amounting to censorship, of radio, movies, and TV. Content was regulated, licenses given under stringent rules. Would further empowering U.S. censors to worry about “social stability” have been helpful or harmful in the slow liberalization of American society? Was any of this successful in promoting democracy, or just in silencing the many oppressed voices of the era? They surely would have tried to stifle, not promote, the civil rights and anti-Vietnam War movements, as the FBI did.

Freer communication by and large is central to the spread of representative democracy and prosperity. And the contents of that communication are frequently wrong or disturbing, and usually profoundly offensive to the elites who run the regulatory state. It’s fun to play dictator for a day when writing academic articles about what “should be regulated.” But think about what happens when, inevitably, someone else is in charge.

“Regulating” communication means censorship. Censorship is inherently political, and almost always serves to undermine social change and freedom. Our aspiring AI regulators are fresh off the scandals revealed in Murthy v. Missouri, in which the government used the threat of regulatory harassment to censor Facebook and X. (8) Much of the “misinformation,” especially regarding COVID-19 policy, turned out to be right. It was precisely the kind of out-of-the-box thinking, reconsidering of the scientific evidence, speaking truth to power, that we want in a vibrant democracy and a functioning public health apparatus, though it challenged verities propounded by those in power and, in their minds, threatened social stability and democracy itself. Do we really think that more regulation of “misinformation” would have sped sensible COVID-19 policies? Yes, uncensored communication can also be used by bad actors to spread bad ideas, but individual access to information, whether from shortwave radio, samizdat publications, text messages, Facebook, Instagram, and now AI, has always been a tool benefiting freedom.

Yes, AI can lie and produce “deepfakes.” The brief era when a photograph or video provided by itself evidence that something happened, since photographs and videos were difficult to doctor, is over. Society and democracy will survive.

AI can certainly be tuned to favor one or the other political view. Look only at Google’s Gemini misadventure. (9) Try to get any of the currently available LLMs to report controversial views on hot-button issues, even medical advice. Do we really want a government agency imposing a single tuning, in a democracy in which the party you don’t support eventually might win an election? The answer is, as it always has been, competition. Knowing that AI can lie produces a demand for competition and certification. AI can detect misinformation, too. People want true information, and will demand technology that can certify if something is real. If an algorithm is feeding people misinformation, as TikTok is accused of feeding people Chinese censorship, (10) count on its competitors, if allowed to do so, to scream that from the rafters and attract people to a better product.

Regulation naturally bends to political ends. The Biden Executive Order on AI insists that “all workers need a seat at the table, including through collective bargaining,” and “AI development should be built on the views of workers, labor unions, educators, and employers.” (11) Writing in the Wall Street Journal, Ted Cruz and Phil Gramm report: “Mr. Biden’s separate AI Bill of Rights claims to advance ‘racial equity and support for underserved communities.’ AI must also be used to ‘improve environmental and social outcomes,’ to ‘mitigate climate change risk,’ and to facilitate ‘building an equitable clean energy economy.’” (12) All worthy goals, perhaps, but one must admit those are somewhat partisan goals not narrowly tailored to scientifically understood AI risks. And if you like these, imagine what the likely Trump executive order on AI will look like.

Regulation is, by definition, an act of the state, and thus used by those who control the state to limit what ideas people can hear. Aristocratic paternalism of ideas is the antithesis of democracy.

Economics

What about jobs? It is said that once AI comes along, we’ll all be out of work. And exactly this was said of just about every innovation for the last millennium. Technology does disrupt. Mechanized looms in the 1800s did lower wages for skilled weavers, while it provided a reprieve from the misery of farmwork for unskilled workers. The answer is a broad safety net that cushions all misfortunes, without unduly dulling incentives. Special regulations to help people displaced by AI, or China, or other newsworthy causes is counterproductive.

But after three centuries of labor-saving innovation, the unemployment rate is 4%. (13) In 1900, a third of Americans worked on farms. Then the tractor was invented. People went on to better jobs at higher wages. The automobile did not lead to massive unemployment of horse-drivers. In the 1970s and 1980s, women entered the workforce in large numbers. Just then, the word processor and Xerox machine slashed demand for secretaries. Female employment did not crash. ATM machines increased bank employment. Tellers were displaced, but bank branches became cheaper to operate, so banks opened more of them. AI is not qualitatively different in this regard.

One activity will be severely disrupted: Essays like this one. ChatGPT-5, please write 4,000 words on AI regulation, society, and democracy, in the voice of the Grumpy Economist…(I was tempted!). But the same economic principle applies: Reduction in cost will lead to a massive expansion in supply. Revenues can even go up if people want to read it, i.e., if demand is elastic enough. (14) And perhaps authors like me can spend more time on deeper contributions.

The big story of AI will be how it makes workers more productive. Imagine you’re an undertrained educator or nurse practitioner in a village in India or Africa. With an AI companion, you can perform at a much higher level. AI tools will likely raise the wages and productivity of less-skilled workers, by more easily spreading around the knowledge and analytical abilities of the best ones.

AI is one of the most promising technical innovations of recent decades. Since social media of the early 2000s, Silicon Valley has been trying to figure out what’s next. It wasn’t crypto. Now we know. AI promises to unlock tremendous advances. Consider only machine learning plus genetics and ponder the consequent huge advances coming in health. But nobody really knows yet what it can do, or how to apply it. It was a century from Franklin’s kite to the electric light bulb, and another century to the microprocessor and the electric car.

A broad controversy has erupted in economics: whether frontier growth is over or dramatically slowing down because we have run out of ideas. (15) AI is a great hope this is not true. Historically, ideas became harder to find in existing technologies. And then, as it seemed growth would peter out, something new came along. Steam engines plateaued after a century. Then diesel, electric, and airplanes came along. As birthrates continue to decline, the issue is not too few jobs, but too few people. Artificial “people” may be coming along just in time!

Conclusion

As a concrete example of the kind of thinking I argue against, Daron Acemoglu writes,

We must remember that existing social and economic relations are exceedingly complex. When they are disrupted, all kinds of unforeseen consequences can follow…

We urgently need to pay greater attention to how the next wave of disruptive innovation could affect our social, democratic, and civic institutions. Getting the most out of creative destruction requires a proper balance between pro-innovation public policies and democratic input. If we leave it to tech entrepreneurs to safeguard our institutions, we risk more destruction than we bargained for. (16)

The first paragraph is correct. But the logical implication is the converse—if relations are “complex” and consequences “unforeseen,” the machinery of our political and regulatory state is incapable of doing anything about it. The second paragraph epitomizes the fuzzy thinking of passive voice. Who is this “we”? How much more “attention” can AI get than the mass of speculation in which we (this time I mean literally we) are engaged? Who does this “getting”? Who is to determine “proper balance”? Balancing “pro-innovation public policies and democratic input” is Orwellianly autocratic. Our task was to save democracy, not to “balance” democracy against “public policies.” Is not the effect of most “public policy” precisely to slow down innovation in order to preserve the status quo? “We” not “leave[ing] it to tech entrepreneurs” means a radical appropriation of property rights and rule of law.

What’s the alternative? Of course AI is not perfectly safe. Of course it will lead to radical changes, most for the better but not all. Of course it will affect society and our political system, in complex, disruptive, and unforeseen ways. How will we adapt? How will we strengthen democracy, if we get around to wanting to strengthen democracy rather than the current project of tearing it apart?

The answer is straightforward: As we always have. Competition. The government must enforce rule of law, not the tyranny of the regulator. Trust democracy, not paternalistic aristocracy—rule by independent, unaccountable, self-styled technocrats, insulated from the democratic political process. Remain a government of rights, not of permissions. Trust and strengthen our institutions, including all of civil society, media, and academia, not just federal regulatory agencies, to detect and remedy problems as they occur. Relax. It’s going to be great.

Saturday, September 21, 2024

For coffee lovers

From the Journal of Clinical Endocrinology & Metabolism

Habitual Coffee, Tea, and Caffeine Consumption, Circulating Metabolites, and the Risk of Cardiometabolic Multimorbidity

Here is the link.

https://academic.oup.com/jcem/advance-article-abstract/doi/10.1210/clinem/dgae552/7754545?login=false

Here is the abstract.

Context

Cardiometabolic multimorbidity (CM) is an increasing public health concern. Previous observational studies have suggested inverse associations between coffee, tea, and caffeine intake and risks of individual cardiometabolic diseases; however, their associations with CM and related biological markers are unknown.

Methods

This prospective study involved 172 315 (for caffeine analysis) and 188 091 (tea and coffee analysis) participants free of any cardiometabolic diseases at baseline from the UK Biobank; 168 metabolites were measured among 88 204 and 96 393 participants. CM was defined as the coexistence of at least 2 of the following conditions: type 2 diabetes, coronary heart disease, and stroke.

Results

Nonlinear inverse associations of coffee, tea, and caffeine intake with the risk of new-onset CM were observed. Compared with nonconsumers or consumers of less than 100 mg caffeine per day, consumers of moderate amount of coffee (3 drinks/d) or caffeine (200-300 mg/d) had the lowest risk for new-onset CM, with respective hazard ratios (95% CIs) of 0.519 (0.417-0.647) and 0.593 (0.499-0.704). Multistate models revealed that moderate coffee or caffeine intake was inversely associated with risks of almost all developmental stages of CM, including transitions from a disease-free state to single cardiometabolic diseases and subsequently to CM. A total of 80 to 97 metabolites, such as lipid components within very low-density lipoprotein, histidine, and glycoprotein acetyls, were identified to be associated with both coffee, tea, or caffeine intake and incident CM.

Conclusion

Habitual coffee or caffeine intake, especially at a moderate level, was associated with a lower risk of new-onset CM and could play important roles in almost all transition phases of CM development. Future studies are warranted to validate the implicated metabolic biomarkers underlying the relation between coffee, tea, and caffeine intake and CM.

Violent crime soared under Biden-Harris

From the Crime Prevention Research Organization

Here is the link.

https://crimeresearch.org/2024/09/new-bureau-of-justice-statistics-crime-data-just-released-violent-crime-rape-robbery-and-aggravated-assault-soaring-under-biden/

Here is one of the charts.




The US does not have the most mass shootings in the world: A case of probable academic malpractice?

An informative video from John Stossel and John Lott.

Here is the link

Armed citizens save lives

From John Stossel and John Lott.

Here is the link

Monday, September 16, 2024

Destroying education – and kids

From Jonathan Turley.

JT is on target.

When production is in charge of quality control, there is no quality control.

Here is a link to JT’s blog entry.

Teaching Joy: L.A. School District Opts for “Educational Enjoyment” Over Standardized Tests

A new drug offers substantially reduced Lp(a) levels

 High levels of Lp(a) are a significant cardiovascular risk factor. There is not much available to lower it. Olpasiran, currently being tested, is a promising treatment.

 Here is a link to the paper “The Off-Treatment Effects of Olpasiran on Lipoprotein(a) Lowering: OCEAN(a)-DOSE Extension Period Results.”

 https://www.sciencedirect.com/science/article/pii/S073510972407671X?via%3Dihub

 Here is the abstract

 Abstract

 Background

 Olpasiran, a small interfering RNA (siRNA), blocks lipoprotein(a) (Lp(a)) production by preventing translation of apolipoprotein(a) mRNA. In phase 2, higher doses of olpasiran every 12 weeks (Q12W) reduced circulating Lp(a) by >95%.

 Objectives

 This study sought to assess the timing of return of Lp(a) to baseline after discontinuation of olpasiran, as well as longer-term safety.

 Methods

 OCEAN(a)-DOSE (Olpasiran Trials of Cardiovascular Events And LipoproteiN[a] Reduction–DOSE Finding Study) was a phase 2, dose-finding trial that enrolled 281 participants with atherosclerotic cardiovascular disease and Lp(a) >150 nmol/L to 1 of 4 active doses of olpasiran vs placebo (10 mg, 75 mg, 225 mg Q12W, or an exploratory dose of 225 mg Q24W given subcutaneously). The last dose of olpasiran was administered at week 36; after week 48, there was an extended off-treatment follow-up period for a minimum of 24 weeks.

 Results

 A total of 276 (98.2%) participants entered the off-treatment follow-up period. The median study exposure (treatment combined with off-treatment phases) was 86 weeks (Q1-Q3: 79-99 weeks). For the 75 mg Q12W dose, the off-treatment placebo-adjusted mean percent change from baseline in Lp(a) was −76.2%, −53.0%, −44.0%, and −27.9% at 60, 72, 84, and 96 weeks, respectively (all P < 0.001). The respective off-treatment changes in Lp(a) for the 225 mg Q12W dose were −84.4%, −61.6%, −52.2%, and −36.4% (all P < 0.001). During the extension follow-up phase, no new safety concerns were identified.

 Conclusions

 Olpasiran is a potent siRNA with prolonged effects on Lp(a) lowering. Participants receiving doses ≥75 mg Q12W sustained a 40% to 50% reduction in Lp(a) levels close to 1 year after the last dose. (Olpasiran Trials of Cardiovascular Events And LipoproteiN[a] Reduction–DOSE Finding Study [OCEAN(a)-DOSE]; NCT04270760

Sunday, September 15, 2024

Did IPCC get it all wrong about global warming?

By Nikolov and Zeller.

Roles of Earth’s Albedo Variations and Top-of-the-Atmosphere Energy Imbalance in Recent Warming: New Insights from Satellite and Surface Observations

Here is the link:

Nikolov and Zeller argue that:

Analogous to the famous “follow-the-money” approach often adopted by the social and political sciences to explain human behavior and social movements, this study can be described as a “follow-the-energy” journey to investigate the causes of recent climate warming.

The IPCC AR6 Working Group I (WG1) concluded that well-mixed greenhouse gases

were “very likely the main driver of tropospheric warming since 1979” [ 1 ]. However, Chapter 7 of the IPCC AR6 WG1 Contribution did not take into proper consideration the observed Geomatics 2024, 4 338 increase of solar radiation absorption by Earth in recent decades known as “global brightening” [ 2] (Section 7.2.2.3). The Report did not analyze the decrease of Earth’s shortwave reflectance evident in the CERES EBAF dataset over the past 20 years and its impact on GSAT. Published studies agree that the observed decrease of planetary albedo and the associated increase of solar-energy uptake by the planet must have had a significant impact on the global temperature. However, there has been no attempts thus far to quantify the actual effect of this solar forcing on GSAT. We tried to bridge this knowledge gap by developing a novel, non-statistical process model from First Principles that explicitly relates changes in TSI and albedo to global temperature anomalies. The model (Equation (16)) was derived from independent NASA planetary observations and basic rules of calculus without using Earth-specific data, greenhouse-gas radiative forcing, or positive (amplifying) feedbacks. Our goal was to verify the above IPCC AR6 conclusion by assessing the direct effect of measured changes in TSI and Earth’s sunlight absorption on the 21st-century global surface warming as documented by 6 temperature datasets.

Our analysis revealed that the solar forcing (i.e., TSI and albedo changes) measured by CERES explain 100% of the observed global warming trend and 83% of the interannual GSAT variability over the past 24 years (Figure 9), including the extreme 2023 heat anomaly (Figure 10). Albedo changes were found to be by far the dominant GSAT driver, while TSI variations only played a minor, modulating role (Figures 11 and 12). The sustained increase of sunlight absorption by the planet was also identified as the most likely driver of ocean warming in recent decades based on a high correlation (R2 = 0.8) between the shortwave radiation uptake and the mean annual temperature anomaly of the 0–100 m global oceanic layer (Figure 8). These results suggest a lack of physical reality to both the anthropogenic radiative forcing attributed to rising greenhouse gases and the positive (amplifying) feedbacks hypothesized by the greenhouse theory and simulated by climate models. This is because any real forcing (or amplifying feedback) outside of the increased planetary uptake of solar radiation would have produced additional warming above and beyond the amount explained by changes in the planetary albedo and TSI. However, no such extra warming is observed in the available temperature records. Hence, the anthropogenic radiative forcing and associated positive feedbacks are likely model artifacts rather than real phenomena. The empirical data and model calculations analyzed in our study also indicate that the Earth’s climate sensitivity to radiative forcing is only 0.29–0.30 K/(W m−2). Therefore, the greenhouse theory overestimates this parameter by 56–158%.

The lack of evidence for heat trapping by greenhouse gases in the climate system during the 21st Century raises an important question about the physical nature of the Earth’s Energy Imbalance (EEI). The latter is defined as the difference between the absorbed shortwave and outgoing LW flux at the TOA. EEI has been observed and calculated by various monitoring platforms for several decades. This index became a research focus in climate science during the past 15 years, because it has been perceived as evidence of anthropogenic heat accumulation (energy retention) in the Earth system that would commit the World to a prolonged future warming, even after human carbon emissions have reached a net-zero level. As a result of such a view, EEI is now called the “most fundamental indicator for climate change” [ 33 ]. However, our analysis of observed data, model calculations, and standard thermodynamic theory showed that EEI has been misinterpreted by the science community, since it arises from adiabatic dissipation of thermal energy in ascending air parcels in the troposphere due to a decreasing atmospheric pressure with height (see discussion in Section 4). Hence, integrating EEI over space and time in an effort to calculate some total “energy gain” by the Earth system, as done by researchers in recent years, is physically misleading, because EEI includes energy that was adiabatically lost to the system during the convective cooling process. Our analyses also showed that this energy imbalance results from a varying sunlight absorption by the planet and would only disappear if the Earth’s albedo stops changing and the uptake of shortwave radiation stabilizes, which is unlikely to ever occur. The reduction of human greenhouse-gas emissions cannot and will Geomatics 2024, 4 339 not affect EEI. Nevertheless, the Earth has gained a considerable amount of thermal energy over the past 45 years due to a sustained increase of shortwave-radiation uptake, which is a completely different mechanism from the theorized trapping of radiant heat by greenhouse gases, since it does not involve a hidden energy storage.

These findings call for a fundamental reconsideration of the current paradigm of understanding about climate change and related socio-economic initiatives aimed at drastic reductions of industrial carbon emissions at all costs. An important aspect of this paradigm shift should be the prioritized allocation of funds to support large-scale interdisciplinary research into the physical mechanisms controlling the Earth’s albedo and cloud physics, for these are the real drivers of climate on multidecadal time scales.

Australia Moves Toward Draconian Anti-Free Speech Law

From Jonathan Turley.

Here is the link.

https://jonathanturley.org/2024/09/14/australia-moves-toward-draconian-anti-free-speech-law/#more-223483

Wednesday, September 11, 2024

An Unconventional Case Study of Neoadjuvant Oncolytic Virotherapy for Recurrent Breast Cancer

Here is the link.

https://www.mdpi.com/2076-393X/12/9/958#

“Proving” safety and efficacy takes time. For a “better” treatment, the net impact of waiting is excess deaths. For a “worse” treatment, the net impact of waiting is saving lives.

But things are more complicated. Everything is probabilistic. It is better to think of the probability that the new drug will be net beneficial versus alternatives. Roughly, as testing goes on, this probability evolves. It tends to increase for good treatments and decline for bad treatments.

It makes sense to choose the new treatment once the probability reaches the appropriate level for the particular individual considering the new treatment. The appropriate probability varies across individuals and conditions.

The Government has a one-size-fits-all approach. Even worse, those who make the decisions focus more on avoiding any bad outcome because they know the resulting publicity can cost them their jobs. So, choices that should be made in favor of new treatments are routinely delayed beyond where lives are saved. The Government tends to wait too long before approving new treatments, hence tends to cause excess deaths.

Did crime rise under Trump and Fall under Biden? No, the Opposite is True

From the Crime Prevention Research Center.

For those who want the truth – here is the link.

https://crimeresearch.org/2024/08/did-crime-rise-under-trump-and-fall-under-biden/

Tuesday, September 10, 2024

Free speech – going, going, gone?

From Jonathan Turley.

Here is the link

https://jonathanturley.org/2024/09/08/the-blair-witch-project-former-prime-minister-calls-for-global-censorship-efforts/#more-223275

It is impressive how few people appreciate free speech and freedom in general. The society described in the book “1984” is on the way to be realized.

Sunday, September 08, 2024

Maybe Ms. Harris needs some economists

From Greg Mankiw’s blog.

Greg is Professor of Economics at Harvard University.

The response to the rollout of Kamala Harris's economic plan, especially the price gouging regulation, has not been good

When you lose the ever-reasonable Catherine Rampell, you should doubt whether you are positioning yourself to attract swing voters. Rampell writes, "It’s hard to exaggerate how bad this policy is. It is, in all but name, a sweeping set of government-enforced price controls across every industry, not only food. Supply and demand would no longer determine prices or profit levels. Some far-off Washington bureaucrats would....At best, this would lead to shortages, black market and hoarding, among other distortions seen previous times countries tried to limit price growth by fiat."

The centrist editorial page of the Washington Post titles their piece "The times demand serious economic ideas. Harris supplies gimmicks."

What is happening here? I have two hypotheses.

One is that the Harris campaign believes that the remaining persuadable swing voters are economically ignorant, so the campaign is offering them economically ignorant economic policies. Bryan Caplan's wonderful book The Myth of the Rational Voter documents a lot of mistaken beliefs among the general public, including an anti-market bias. Ms. Harris's political advisers may be steering her to pander to these mistaken beliefs,

A second hypothesis involves campaign personnel. The people I see mentioned as Harris economic advisers are Brian Deese, Gene Sperling, Mike Pyle, Deanne Millison, and Brian Nelson. All smart people, no doubt. But as far as I know, none of these people is trained as a PhD economist. They all seem to be lawyers. Maybe lawyers are more inclined to see a problem and think, "I know what new law will fix that." True economists are more respectful of the invisible hand and more worried about the unintended consequences of heavy-handed regulation.

Where is Jason Furman when you need him?

100x improvement in sight seen after gene therapy trial

From www.sciencedaily.com

Impressive.

Here is the link.

https://www.sciencedaily.com/releases/2024/09/240906141608.htm

Saturday, September 07, 2024

A Historical Comparison of the Collapse of Law Enforcement in US Cities. The Drop in Arrest Rates over the Last Few Years is Unprecedented

From John Lott at the Crime Prevention Research Center.

Eye opening.

Here is the link

Do Good Guys with Guns stop mass shootings?

From John Lott at the Crime Prevention Research Center.

JL’s statistics and analyses are among the best available.

Here is the link

Are AI Chatbots left-leaning?

From John Lott at the Crime Prevention Research Center.

JL is a top-notch researcher. I’ve taught statistics – JL’s is among the best on the topics he addresses.

Here is the link

Friday, September 06, 2024

Aquatic Lumberjacking

How a Precision Rifle doubles as a Chainsaw

By Will Dabbs, MD, at Guns magazine.

Hilarious

Here is the link

Thursday, September 05, 2024

Reasons for concealed carry: My interview with a psychopath

By Will Dabbs, MD at www.thearmorylife.com.

Crazy is a lyrically overused term these days. Psychiatrists institutionally despise that word. Labels are passe in today’s enlightened society. Such antiquated terminology invariably foments subconscious bias.

What most people mean when they use the word “crazy” is psychosis. Distilled to its essence, this just means disconnected from reality. People with schizophrenia, for example, typically hear voices or, more rarely, see things that are objectively not real. The age of onset is typically late teens or early twenties. The experience is uniformly horrifying for all involved, particularly the patient.

The overwhelming majority of folks who develop such maladies are utterly harmless. They might make you feel a little bit weird when first you meet. However, once you get to know them, in my experience they are people just like the rest of us. In fact, I’ve found that schizophrenics and folks with notable bipolar disorder are often a bit more artistic and creative than the rest of us. AntiSocial Personality Disorder (ASPD), by contrast, reflects an inability to empathize with the suffering of others.

One cute little blonde-headed kid I met in the hospital with ASPD looked perfectly normal. However, he came to us because he had spontaneously stabbed his foster mother in the thigh with a pencil. Thankfully, such extreme psychopathy is fairly rare. However, it is in those rare outliers where the real excitement can be found.

I met the subject of this article in the ER of a large metropolitan trauma center. Let’s call him “Frank.” He was 25 years old. At first impressions, Frank was incredibly imposing. I would guess he was maybe six feet one and weighed perhaps 210 pounds without a gram of extraneous body fat. This guy was built like Arnold Schwarzenegger circa 1984. He was a simply incredible specimen. I met the subject of this article in the ER of a large metropolitan trauma center. Let’s call him “Frank.” He was 25 years old. At first impressions, Frank was incredibly imposing. I would guess he was maybe six feet one and weighed perhaps 210 pounds without a gram of extraneous body fat. This guy was built like Arnold Schwarzenegger circa 1984. He was a simply incredible specimen.

Frank’s family had brought him to the ER because he was acting strangely at home. In the presence of a nurse, he proceeded to swallow a drywall screw along with a hypodermic needle he had retrieved from a sharps container. This bought him a ticket to the lockdown psych ward.

Frank was engaging and articulate, if a bit strange. I inquired regarding his story, and he was quite forthright. Frank ultimately taught me quite a lot. One of the things he taught me was that I should never leave the house without a gun. Let me explain.

When Frank was a teenager he developed an insatiable interest in the occult. He read rapaciously on the subject and subsequently began actively praying to Satan. When the time was right, he asked the Prince of Darkness to send him some company. Old Mephistopheles complied. At the time of our meeting, Frank said his head played home to three entities — Dagon, Demidagon, and Begorred. He said one of the three talked to him all the time.

Frank eventually took a job in a rough part of town. One day he was strolling past a group of four males just listening to his three pet demons having a confab. One of the three, I forget which, directed his attention to the four men. Let’s assume it was Dagon.

Dagon pointed out one man in particular for attention. He told Frank that he needed to “do something” about that guy. When Frank pushed back, Dagon explained that, if he failed to “do something,” then the man might hurt somebody. Frank explained that he didn’t care. Dagon said failure to intervene meant that this gentleman would actually hurt Frank.

My new friend then walked up to a total stranger and killed him because the voices in his head told him to do so.

Frank spent the next several years in prison. As near as I could tell, all he did for those years was lift weights. He had been released some 30 days before we met. He stopped taking his medications, and, before you know it, was snarfing hypodermic needles in the ER. As an aside, the needle and the screw passed of their own accord without further intervention. The human body is a simply breathtaking machine.

As he and I were alone in his room talking, I innocently inquired as to whether or not these three entities were speaking to him at that particular moment. He called one by name and said it was his turn to talk. I asked what he was saying. Frank turned his head slightly, looked me in the eye, and said, flatly and without emotion, “Kill, kill, kill, murder, murder, murder, kill, kill, kill, murder, murder, murder…” He kept saying that until I asked him to stop.

The following morning I returned to his room, this time at the head of a train of nursing students, PT students, and sundry straphangers. Of the nine of us who went into Frank’s room, I was, incongruously, the only physician and the sole male. We were arrayed in a line with me being farthest from the door. Frank was sitting up in bed shirtless with the sheet pulled up to his waist. As I mentioned, he was jacked like an absolute beast.

Once we filed in, Frank suddenly shouted at everybody to stop. To use a tired metaphor, time momentarily stood still. I didn’t know if he was about to kill and eat me, the girls, or some random sampling. He put his hands together in a strangely unnatural way and indexed to each of us one at a time, twirling his mitts rhythmically in our direction. Once he completed this exercise he smiled and pleasantly asked what he could do for us. I naturally asked him what exactly it was that he had just done.

Explaining as he might to a child, Frank said he knew we were coming to visit that morning. He elaborated that, the night before, he had moved all the furniture aside before drawing a big pentagram on the floor with soap. He said this was designed to keep us safe while we were with him in his room. When he realized that the soap pentagram was invisible, he made do with this weird individual counter-curse hand thing. I thanked him for both the explanation and the effort.

Inpatient facilities for the mentally ill are incredibly expensive. By contrast, anti-psychotic drugs are relatively cheap. In their defense, these medications do typically work quite well…if you take them as you should. In Frank’s case, he explained that the voices in his head would direct him to stop his medications from time to time when they needed him to “think clearly.” Just such a chain of events had brought him to the hospital that evening.

Frank was a nice kid with a really bad disease. The overwhelming majority of those similarly afflicted are quite incapable of the sorts of violence that bought Frank five years in the state pen. Fortunately, Frank remained peaceful and calm when we interacted with him. I fear what might have happened if he had not.

Those of us fortunate enough not to carry such a weighty burden should take great care not to stigmatize those who do. However, for that rare minority who do embrace the darkness, I pack a gun. Until and unless they do something that brings them into the light, these folks do indeed walk among us. I feel it’s simply sound policy for me to be prepared if I must face a deadly and unavoidable threat.

Wednesday, September 04, 2024

Harris Denounces Unfettered Free Speech

From Jonathan Turley.

JT is on target.

Too many people in this country do not sufficiently value freedom, which will eventually destroy it. We are on that road, and there is no sign that people will vote to preserve it.

Here is JT’s blog entry.

“That Has to Stop”: Harris Denounces Unfettered Free Speech in 2019 CNN Interview

I previously wrote how a Harris-Walz Administration would be a nightmare for free speech. Both candidates have shown pronounced anti-free speech values. Now, X owner Elon Musk and former independent presidential candidate Robert F. Kennedy Jr. have posted a Harris interview to show the depths of the hostility of Harris to unfettered free speech. I have long argued that Trump and the third-party candidates should make free speech a central issue in this campaign. That has not happened. Kennedy was the only candidate who was substantially and regularly talking about free speech in this election. Yet, Musk and Kennedy are still trying to raise the chilling potential of a Harris-Walz Administration.

In my book “The Indispensable Right: Free Speech in an Age of Rage,” I discuss how the Biden-Harris Administration has proven to be the most anti-free speech administration since John Adams. That includes a massive censorship system described by one federal judge as perfectly “Orwellian.”

In the CNN interview, Harris displays many of the anti-free speech inclinations discussed earlier. She strongly suggests that X should be shut down if it does not yield to demands for speech regulation.

What is most chilling is how censorship and closure are Harris’s default positions when faced with unfettered speech. She declares to CNN that such unregulated free speech “has to stop” and that there is a danger to the country when people are allowed to “directly speak to millions and millions of people without any level of oversight and regulation.”

Harris discussed her view that then-President Trump’s Twitter account should be shut down because the public had to be protected from harmful viewpoints.

“And when you’re talking about Donald Trump, he has 65 million Twitter followers, he has proven himself to be willing to obstruct justice – just ask Bob Mueller. You can look at the manifesto from the shooter in El Paso to know that what Donald Trump says on Twitter impacts peoples’ perceptions about what they should and should not do.”

Harris demanded that Trump’s account “should be taken down” and that there be uniformity in the censorship of American citizens:

“And the bottom line is that you can’t say that you have one rule for Facebook and you have a different rule for Twitter. The same rule has to apply, which is that there has to be a responsibility that is placed on these social media sites to understand their power… They are speaking to millions of people without any level of oversight or regulation. And that has to stop.”

In other words, free speech should be set to the lowest common denominator of speech regulation to protect citizens from dangerous viewpoints.

Harris’s views have been echoed by many Democratic leaders, including Hillary Clinton who (after Musk purchased Twitter) called upon European censors to force him to censor American citizens under the infamous Digital Services Act (DSA).

Other Democratic leaders have praised Brazil for banning X after Musk balked at censoring conservatives at the demand of the socialist government. Brazil is where this anti-free speech movement is clearly heading and could prove a critical testing ground for national bans on sites which refuse to engage in comprehensive censorship. As Harris clearly states in the CNN interview, there cannot be “one rule for Facebook and you have a different rule for Twitter.” Rather, everyone must censor or face imminent government shutdowns.

The “joy” being sold by Harris includes the promise of the removal of viewpoints that many on the left feel are intolerable or triggering on social media. Where Biden was viewed as an opportunist in embracing censorship, Harris is a true believer. Like Walz, she has long espoused a shockingly narrow view of free speech that is reflective of the wider anti-free speech movement in higher education.

Harris often speaks of free speech as if it is a privilege bestowed by the government like a license and that you can be taken off the road if you are viewed as a reckless driver.

Trump and the third party candidates are clearly not forcing Harris to address her record on free speech. Yet, polls show that the majority of Americans still oppose censorship and favor free speech.

In my book, I propose various steps to restore free speech in America, including a law that would bar federal funds for censorship, including grants and other funding that target individuals and sites over the content of their views. The government can still speak in its own voice and it can still prosecute those who commit crimes on the Internet or engage in criminal conspiracies. Harris should be asked if she would oppose such legislation.

For free speech advocates, the 2024 election is looking strikingly similar to the election of 1800. One of the greatest villains in our history discussed in my book was President John Adams, who used the Alien and Sedition Acts to arrest his political opponents – including journalists, members of Congress and others. Many of those prosecuted by the Adams administration were Jeffersonians. In the election of 1800, Thomas Jefferson ran on the issue and defeated Adams.

It was the only presidential election in our history where free speech was a central issue for voters. It should be again. While democracy is really not on the ballot this election, free speech is.

Jonathan Turley is the Shapiro Professor of Public Interest Law at George Washington University and the author of “The Indispensable Right: Free Speech in an Age of Rage.”

Behind the Brow That Furrows

Neha Aggarwal at jamanetwork.com

Growing up as the youngest child, I always sat in the back seat of the car. This was a position enabling infinite wonder. My gaze was unfettered and I could freely observe the world, as I was rarely turned to first for conversation. One sunny Georgia afternoon when I was 13 years old and had assumed my usual position in the back seat on the drive to our weekend outing, my gaze wandered. I saw the teeth of my older sister in the front seat as she vivaciously laughed while chatting with our mother. When the conversation mellowed into peaceful silence, my gaze shifted upward to the oval rearview mirror. I noticed a vertical line etched into the space between my mother’s eyebrows. Her brow was furrowed, and she did not seem to notice it.

I asked, “Mom, what is that line between your eyebrows?” She sighed, touching her brow in detached but slightly self-conscious frustration. She replied, “Do me a favor, and don’t stress about what you cannot control. Don’t inherit this from me.” This crease was a remnant of the stresses she has borne throughout her life. As I gazed solemnly at the line, I imagined what might have happened. Every time that she furrowed her brow, the skin pulled closer together, as if it were embracing itself to protect against the stressor. This continued until the skin could no longer risk being unshielded, choosing instead to remain connected at rest.

I did not fully comprehend her words at the time, so I exhaled my concern and hoped that my innocent question had not bothered her much. Yet I still wondered how raising my sister and me might have contributed to my mother’s stress lines, which she had accepted as a characteristic of her flesh. Would my sister’s laughter in the car have been possible without this mark on our mother’s forehead? Would my serenity in the back seat have been replaced by a different feeling altogether?

Eleven years later, I am a medical student in a maternal-fetal medicine clinic, and I meet you. You are a young single mother of 2 small children, but your presence at this clinic gives you an additional label: our patient. This label subjects you to our sensitive clinical eyes, which are perceptive not to make you feel exposed but so that we do not neglect to notice any detail that might impact your health. Embarking on the task of observation, I call upon my skills from afternoons in the back seat.

As we review the status of your pregnancy, I mentally check off the trimester-appropriate questions I am slated to ask you. I stay in my lane of medical questioning as a clerkship student on her obstetrics and gynecology rotation. However, in the midst of administering the formula-driven clinical questionnaire, I also bear witness to the linear indentations under your eyes. I turn away from the computer on which I was taking notes and angle my feet toward you. I discard the clinical questionnaire to ask what else has been impacting your pregnancy. The lines that were before just passengers on our conversation grow deeper, more consequential and consuming, with each new piece of your life you reveal to me.

I learn of your diagnosis of multiple sclerosis only 2 years ago. I imagine that the disease onset and eventual diagnosis felt utterly unjust. It injured your relationship with your body, which before implied a promise to never surprise you. You share with me how your body’s natural movements have changed, as has the way in which you interact with the world. The knowing look in your eyes testifies to this adjustment.

I see the pressure of motherhood you carry on your shoulders, your burning wish to bear life’s challenges before they can reach your children. I think about the line on my mother’s forehead, a small physical manifestation cluing an observer into her history of decades of struggle to ensure her family’s happiness. Bracing your children from these forces exhausts your energy, collapses the space between your shoulders, and pulls tension between your eyebrows until your skin can no longer stretch.

As you share your testimony of the challenges that multiple sclerosis has introduced to your everyday life, my observations deepen. Your multiple sclerosis establishes itself as the third person in the room, exerting a silent force over me as we interact. I see healing bruises on your legs from falls that came suddenly, irrationally—and, like a needled thread waiting to tighten, my legs tense from ankle to hip. I see laughter lines on your cheeks from watching your little ones growing up, and the corners of my mouth involuntarily rise. These pieces of you are not documented in our medical records, but they convey the silent stories that are woven into your flesh, subconscious but inexplicably alive.

Once I am educated on all this history with which you present, those tension lines never go away, and I see them more profoundly. They represent the challenges you have faced condensed into a small physical detail, easily overlooked if not further explored. The eyes that glimmered when we said hello to each other are now condensed by the skin underneath that bears the weight of the parts of your life to which your clinicians are uniquely privy. You trust us with your story, and we can only half-deliver for you. We cannot fix functional disability you have accumulated from prior relapses; we can only prevent future relapses with disease-modifying therapy. We cannot prescribe your disease-modifying therapy during pregnancy due to risks to the developing fetus. We know in the back of our minds that the smoldering disease course of multiple sclerosis over time exposes disability caused by old brain and spinal cord lesions. Our medicine lives in a world too entropic to capture its goals.

I bring in our attending physician, and we review the medical plan with you. We tell you to please let us know if the disability you notice from multiple sclerosis gets any worse during your current pregnancy or if you suspect a new flare is emerging. In the back of our minds, we consider the careful attention to fetal health involved in treating a flare during pregnancy. We veil our conversation with reassurances concluded from a qualitative estimate that pregnancy is an immunosuppressive state, which reduces the chance of a relapse happening while you are off your disease-modifying therapy. In the back of our minds, we hope the qualitative estimate will apply to you. We discuss routine care for the second trimester of pregnancy. In the back of our minds, we wonder how the guidebook to manage pregnancy would be different if it were tailored to patients with multiple sclerosis.

At the end of your visit, we say you are free to go. You stand and I observe your gait for the first time, as it is not part of routine examination in the obstetrics and gynecology clinic. As you begin to walk, you sway and immediately outstretch your arms, hoping to be steadied by the wall, or the computer, or anything nearby. I offer you my arm, and we walk down the hall together toward the clinic exit. I turn to you and say, “It was very nice to meet you, and please take care.” I try to listen to what you say in response, but all I can see are the lines under your eyes, and I feel my eyebrows furrowing.

Monday, September 02, 2024

Are climate models any good?

From Dr. John R. Christy, Distinguished Professor of Atmospheric and Earth Sciences at The University of Alabama

An informative video that puts climate models in perspective.

Watch it – the Q&A also is well worth listening to.

JRC makes a strong case that the climate models are not credible – bad statistics, bad science, and emphasizing agenda over the modelers’ own conclusions.

Here is the link.