Getting doctors to be doctors again

kw: book reviews, medicine, doctors, advice

There is a strong parallel between medicine and religion. Even more, the contrast between "doctoring" and genuine medical practice is like that between religion and faith. My favorite proverb about religion is

The core of religion is a checklist. You can hang it on the wall. A robot could perform the checklist perfectly. You cannot.

This is why I say that my faith is not a religion. Faith is a divine relationship; religion is a specified practice. What about doctoring? Doctors today make explicit use of checklists, which they often call "pathways", to "work up" a patient who comes to them with a particular "chief complaint". A wry joke going around is, to get seen quickly in an emergency room, when you tell the receptionist why you are there, make sure that you mention your chest hurts. Of course, that means you'll be there at least 24 hours and spend an extra $10,000.

If you actually try this, you will find yourself on the "Chest Pain Pathway", which involves a series of tests, including a CT scan, and an overnight stay for "observation". If you don't actually have any chest pain, you will still have a hell of a time getting off the pathway. There are hundreds (thousands?) of such "pathways".

The modern doctor will listen to you only for a few seconds, until you say something that triggers one of the pathways. If 10-15 seconds pass and no pathway is yet identified, the doctor will interrupt you with a series of questions, always of the yes/no variety. Once you mention the "right words" that trigger a pathway, even in passing, more yes/no questions follow, and pretty soon the doctor will stand and say "we'll do a couple of tests" while heading for the door. Less than a minute will have passed. If you happen to be a rambling storyteller, particularly if you are under great stress and confusion, you may not yet have talked about the real reason you are there! But now you are on a pathway, and you may never get off it (because you may die, or be sent home with "no finding").

It is estimated that at least 100,000 people die in U.S. hospitals due to "misdiagnosis". In most cases, it would be more accurate to say they died without a diagnosis, because they were killed by the hunt for one.

To literally save your life, you first have to do everything you can to stay off one of these pathways, because here's the dirty secret. A pathway is designed to minimize the chances you will sue the doctor, or at least make it very unlikely that you could win a malpractice lawsuit. They are NOT designed to lead to a diagnosis. But, it is becoming apparent that pathways themselves are a kind of malpractice.

Drs. Leana Wen and Joshua Kosowsky call this "cookbook medicine". I call it "robot medicine". A robot can do it; you don't need a doctor for that (look up "Symptom checker" and try the one at WebMD, for example). Robot medicine is a practice of "ruling out", and you'll hear a doctor say, "This may be a heart attack," (you mentioned chest pain) or, "We have to rule out a cranial hemorrhage" (you used the words "worst headache"). Drs. Wen and Kosowsky have written When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests to help you and me learn to stay off such pathways and drive a doctor to diagnosis.

Another proverb you probably know: To a man with a hammer, everything looks like a nail. The very availability of CT scanners, and the readiness of insurance companies to pay for CT scans, means that scanners are massively overused. Ditto for MRI and PET and other scanners, and for increasingly specific (and costly) blood tests. Excess CT scans are particularly worrisome, because even the most modern, low-dose scan exposes you to 500-1,000 times the radiation of an old-fashioned X-ray. ER's ought to have a chart on the wall:

• Got chest pain? Prepare for an overnight stay, 3-4 blood draws and a CT scan. Equivalent radiation dose (ERD): 400 chest X-rays.
• Terrible headache? 2 blood draws and a CT scan of the head. ERD 500 dental X-rays.
• Abdominal pain with diarrhea? Prepare to spend the night, plus 3 blood draws, a sigmoidoscopy [actually a good idea!] and an abdominal CT scan. ERD 600 X-rays.

And so forth. Just for grins, if the radiologist has any trouble reading the CT scan, or notices any anomaly, you'll get a second CT scan (or if you are lucky an MRI scan: there is no radiation), with a different IV of contrast "stuff". Many folks are allergic to the contrast injection, such as my wife, who is allergic to both media that are used for kidney X-rays. Meaning she can never have another X-ray looking for kidney problems.

Properly used, CT scans save lives. But they come with a known risk: a 1-2% increase in the chance of getting cancer after 20 years or so. If, as some contend, 98-99% of CT scans are unnecessary, then it is a wash, a life lost to cancer for every life saved.

In the past it was not so. An early chapter of the book traces medical history over the past 20 centuries. Of the four stages of medical practice, the third may have been the best. From the time of Pasteur and Koch, and into the early era of antibiotics, doctors were very diligent to get a good "history" from a patient, plus they had a growing number of effective remedies, both medicines and surgical techniques. Prior to the 1960's, diagnosis was king. The most effective doctors had a quality known as Augenblick (German for "eye blink"). My uncle's father was one such. He could diagnose many, many conditions at a glance, yet he always took time to hear what the patient said (or the person who brought the patient in, if the patient was unconscious). The history might modify the eyeblink diagnosis. He took nothing for granted, but also had enormous common sense. If a patient arrived at the hospital with a note from him, the doctors there knew the diagnosis was a good one.

Diagnosis is still king, but the king is in hiding. Doctors practice defensive medicine, particularly in the ER. This consists not in driving to a diagnosis, but in "ruling out" rare conditions that could lead to a lawsuit if they are missed. The way a good entry interview ought to go is simple. You tell your story and the doctor listens to all of it. If you aren't a good storyteller (some doctors use the disparaging term "poor historian", but such doctors ought to go be plumbers or something), the doctor will ask questions to move the story along; preferably, questions not of the yes/no variety. At some point, the doctor will have a short list of possible diagnoses. The questions that follow are designed to distinguish among these competing diagnoses. This is called differential diagnosis. At some point, one idea is the most likely, and this is the working diagnosis (sometimes there will still be two, and that may be the actual case, that you have two things wrong at once). A good doctor won't just do all this in his head, but will discuss the possibilities with you, and will tell you the working diagnosis, or perhaps the last two possible diagnoses, with suggestions for making a final distinction. Only then can effective treatment begin.

It helps to learn to be a better storyteller. Consider chest pain. It is sure to trigger a "chest pain pathway", unless you first mention that you helped your cousin move yesterday, and carried one end of her piano. If you can also press a finger to one spot, saying, "It hurts the most right there", you have a chance of knocking your doctor off the pathway, and getting appropriate help for a pulled muscle in your chest. If not, you could be swept along with the momentum of the pathway, and go home a day or two later, with a CT scan or two under your belt and at least 3 fresh needle sticks. And, nothing for your pulled muscle.

The word "doctor" means "teacher". Prior to "modern medicine", a doctor taught all her patients how to recognize what symptoms meant, and what to do about it. Doctors didn't ask yes/no questions until late in the process, to distinguish provisional diagnoses from one another. During the history-taking phrase, the questions were open-ended, intended to get every scrap of information you could deliver.

To help your doctor arrive at the right diagnosis, and thus to treat you for the right condition, these days you have to help out, a lot! To this end, Drs. Wen and Kosowsky spend half the book training us to use their "8 Pillars to Better Diagnosis":

1. Tell your whole story. This means making sure the doctor gets it all, particularly that which worries you the most (don't let embarrassment hold you back; tell it all). And don't answer yes or no to yes/no questions; use them as a springboard to tell more of your story. When the doctor interrupts, interrupt right back (as nicely as you can).
2. Assert yourself into the doctor's thought process. I'd have used the word "insert", but the authors are emphasizing that you have to be assertive, almost pushy, to keep the doctor collaborating with you.
3. Participate in the physical exam. Of course, show the doctor "where it hurts", so to speak, but also ask what he is thinking. Ask for jargon words to be explained.
4. Make the differential diagnosis together. Ask for the doctor's list of ideas. If none make sense, say so and ask, "What else could this be?" The initial net needs to be broad, but seek a balance. 100 vague possibilities are not a differential diagnosis.
5. Partner for the decision making process. Continue to ask how this or that possibility can be most simply eliminated, or how any one could be confirmed.
6. Apply tests rationally. Don't agree to "ruling out" tests for low-probability conditions unless your doctor can make a good case why every symptom you have described fits that condition, and none of them in themselves make it less likely. Be sure you understand what every test is meant to distinguish or determine.
7. Use common sense to confirm a working diagnosis. The visit is not over without a working diagnosis. But it has to make sense.
8. Integrate the diagnosis into the healing process. The doctor must tell you what to expect from the treatment she prescribes or recommends, and how it relates to the diagnosis. The working diagnosis may not have been the right one, so knowing what to expect can clue you in that something isn't quite right.

Nobody will remember these points during an ER visit, or even an office visit, so one third of the book consists of exercises and practices to help you get very familiar with the process. No longer can you and I afford to passively "let the doctor do the doctoring", because we will almost always find ourselves being pushed toward one of the "pathways". These pathways are not helpful to you, but to the doctor's malpractice insurance carrier. Throughout, the authors stress that we must be respectful with the doctor, not confrontational, because, after all, we went to him for his help, and such help will be harder to elicit if we offend him. If your doctor is thin-skinned and arrogant, do everything you can to change doctors.

My most important take-away from this book is a question that I need to ask: "Doctor, what will this test determine? What is the diagnosis you wish it to confirm?" If the doctor intends to "rule out" something, don't agree to it. Demand (nicely) a differential diagnosis, and ask where the test fits into that.

I am in the process of getting a new doctor. A couple weeks ago my wife made an appointment for me (shoulder strain) with my primary care physician. John is a good doctor, one who listens much better than most, and we've developed a good working relationship. But a week later, his office called to say that he had retired, there is now a new doctor taking over the practice, and did I still want the appointment? Well, what choice do I have? Now that I am on Medicare, it is hard to find a doctor who will take a new patient. I accepted the appointment. Now I have a new doctor to train. I'll make copies of the relevant parts of WDDL and study up, so when I see him a couple days from now, I can start off on a good footing and gain an appropriate collaborative relationship.

The hand that rocks the cradle…

kw: book reviews, nonfiction, sociology

Y'know that T-shirt that says:

If Mama Ain't Happy
Ain't Nobody Happy!

I wish it were truer than it really is. A colleague of mine (now deceased) once said, in his best Bill Cosby voice (though I don't know if the Coz ever said it), "A woman's power lies in saying, 'If you don't, then I won't!'." There's just one trouble with this. Powerful men seldom love any woman enough to care what she may think. Worldwide, all the really powerful men are either adulterous (often rampantly so), or have a harem, in societies that expect that sort of thing from sultans and princes.

I just finished reading The Athena Doctrine: How Women (and the Men Who Think Like Them) Will Rule the Future, by John Gerzema and Michael D'Antonio. In their Introduction, they present ten virtues that women have (or seem to have) in greater measure than men, and state that these virtues comprise the Athena Doctrine, a wiser way to run governments, businesses and families. They illustrate these virtues and combinations of them with stories from ten countries or groups of similar countries. They close by promoting a balance between traditionally male and traditionally female approaches to problem solving and management.

I agree with their thesis. In fact, I'd state their subtitle thus: …How Women Must Prevail if We Are to Have a Future. But I have to say that the book needs to be redone, probably by a married couple of long standing (and, sad to say, in today's America I need to specify that I mean a man and a woman, long married to one another, with equal responsibility in producing the book). The stories are potentially fascinating (each chapter has from about 4 to about 10), but the writing is dull and couldn't hold my attention. There is just a little bit of a fawning note, as if the authors were "women wannabees". I wish it were a better book. Its message is much needed.

You don't have to hate statistics

kw: book reviews, nonfiction, mathematics, statistics, popular treatments

Measure something. Say, take a yardstick and measure the width of the kitchen counter. In my kitchen, I get 24 inches. That is an observation. Guess what? You can't do statistics using one observation. Not because you are somehow incompetent, but because of the way statistics is defined. A common definition is:

Statistics is the practice or science of collecting and analyzing numerical data in large quantities.

Note the final qualifier: "in large quantities". It is possible to do a certain amount of statistical inference using just a few items—and we'll do some momentarily—but you typically need lots of data to produce a robust inference. However, a few principles can be seen by analyzing just a few observations. I measured my counter in five more locations. Here are all my observations:

24
24 1/8
23 7/8
23 7/8
23 3/4 (= 23 6/8)
23 5/8

We can do a few things with these six numbers. First, comparing the largest with the smallest, we see that the range is 3/8 (just under 1cm). I can take the average, which comes to 23 7/8. Hmm; if the building plans specified a 24 inch counter top, this one averages an eighth inch too narrow. Then there is a trend. These are in order, from one end of the counter to the other. The largest measurement is the second one, the smallest is the last, and the rest of the measurements follow a decreasing trend. In angular terms, a "tilt" of 3/8" in about 10 feet is only a sixth of a degree, but I'd expect a builder to do better than have "nearly a half inch" of variation over ten feet. Oh, well. One of my projects for later this year is to replace the counter tops anyway. I hope quality control has improved since these were installed in the 1970s!

Now for just a little terminology. The "average" I figured is known at the "mean". It is not the only way to determine "central tendency". Another is the "median", which means, the one in the middle (or the average of the central two if the sample has an even number of observations).  For example, if I sort these six numbers (in this case, just move the 24 1/8 above the 24), it happens that there are three that are 23 7/8 or larger, and three that are 23 7/8 or smaller. So the median is 23 7/8. This is not always the case, and perhaps it is not even usually the case. For example, if I have the seven numbers 1, 2, 3, 5, 8, 14, 30, the mean is 9 but the median is 5. Note that only 2 of these numbers are greater than 9.

Another such measure is the "mode", which means the most likely value. Mode is really not too meaningful when there are only six observations, but for these data, the mode is also 23 7/8. Suppose instead that I had measured that fourth width as 23 3/4. This would have very little difference on the mean (23 6.8/8) or the median (23 13/16 or 23 6.5/8), but the mode would now be 23 3/4, because that number arose the most frequently (twice).

This illustration shows how these are related (Image from The Daily Dongle). A frequency plot of a very regular set of measurements such as shown in (a) will have mean, median and mode that are equal or nearly equal. Sometimes we make measurements that have more than one "hump" (their distribution is called bimodal) as in (b). But (c) and (d) show two ways that a series of measurements may reveal a skewness, in which case the three measures will be quite different.

Each has its uses. Average height of Euro-American males is best described as the mean, the numerical average of all measurements. We might also surmise that the median and mode will be very similar to the mean. But if you include Euro-American women, the bimodality may not be too evident, but it is there. At the very least a frequency plot will be flatter on top and have a wider total range. If the average male is 70" tall and the average woman is 64" tall (for Euro-A's, anyway), the grand average will be 67", but that single number tells you less than the two numbers, segregated by sex.

What about yearly income, or prices of homes in a city or county, or the whole country? When you hear a Real Estate report on the radio, you will hear, for example, "Median home price has risen by $5,000 in the past month". Why not use the mean? Because the distribution is skewed. There might be a few homes with very small values, and a few with very high values, but where do you put the "middle"?

Example: Broken Arrow, OK (I know someone there). The least expensive houses on the market, as I find from Realtor.com, are in the $25,000-$50,000 range. The most expensive, in the range between $1.2 million and $1.4 million. Do you think it likely that home prices are evenly distributed between these limits, producing a "middle" value of about $700,000? Not likely! In this market, this moment, 684 homes are for sale. Houses # 341 and 342 on the sorted list the web site provides are both priced at $170,000. That is our median for this market (today). Quite a bit different from 700k, isn't it? Half the houses' owners are asking $170,000 or less, and the other half are asking more. If you can afford a $200,000 house, at the most, you have a lot to choose from. Wherever the larger values in a distribution are a big multiple of the smaller values, the median is usually the best measure of "average".

This is my simple attempt to explain a few statistical principles. Charles Wheelan does a superb job of explaining these and a goodly number of others in Naked Statistics: Stripping the Dread From the Data. In the middle of the book, for example, he dwells quite a bit on the Central Limit Theorem. This has to do with sampling.

Above, I took six measurements of my kitchen counter. I could have taken a lot more, perhaps spaced every inch, or even closer. Suppose I sent my wife into the kitchen with a yardstick and asked her to make six measurements, with the same yardstick, in locations of her choosing. Then perhaps we could grab some of our neighbors and have them repeat the experiment. Now I will have several sets of numbers, and each set will have its own average. Do you think any of the averages will be close to, say 22, or 27? Not unless there are some BIG wiggles in the counter's shape, that I avoided with my measurements. If I could get a lot of my neighbors to make sets of measurements, the Central Limit Theorem (CLT) predicts that they will be distributed a lot like section (a) of the illustration above, clustering about some average value that is close to the "real" mean for all possible measurements of my counter.

As the author goes on to show, with marvelous examples, this is the source of the power of polling. Not only can a poll yield very useful results about all 180 million American adults by polling 1,000 or 2,000 people (properly chosen!), marketers (who pay the most for such data) can predict some of our preferences based on what we have already bought or even searched for (Google sells its search results, don'tcha know). My wife and I have "loyalty cards" from a few local grocers and other stores. We get discounts on certain items for scanning the card when checking out. In a sense, the store is paying us for the right to keep track of our purchases. Something else we get during checkout is a series of spot-printed coupons (the more we buy the more coupons they print). Some coupons are for more of the things we often buy. Others are for similar items of competing brands (the brands' owners are in on this also). And there will usually be a few "wild card" coupons that show up over time, for things we might not usually buy. Why? Because other people whose purchasing habits are similar to ours buy those things, and the store is betting that we are more likely to try those items if we get a coupon to prod us, compared to giving the same coupon to random shoppers. They have also figured out that we are "on the edge of elderly", so some of the coupons are for things like Ensure (an energy drink for old folks) or Depends (adult diapers).

Think about it. A typical supermarket has tens of thousands of customers that visit regularly. If 25% have the store card, they can slice and dice that population a dozen or a hundred ways, to target their coupon campaign. And, since coupons cost almost nothing to print, they can throw in 30%-50% off-the-wall coupons so we don't realize how precisely we have been targeted!

If you get nothing else out of this book, read it carefully for the author's explanation of the CLT and his stories of how it is used (such as how Target "helped" a father learn that his teen daughter was pregnant). He reveals all sorts of tricks of the trade, such as the numerical way to handle binary differences such as male/female. I am a math junkie, so of course I love a book like this. But I think the math-averse will also find it very entertaining and informative.

Bigger goes along with better

kw: book reviews, nonfiction, history, economics, sociology

I remember my father telling me, when I was a pre-teen or early teen, his theory of "why kids are getting bigger" and in particular, why new Olympic records were still being set, after generations of competition. "Better food and better medicine. When kids don't get sick as much, they can get bigger and stronger and faster and smarter."

Another memory. Valley Forge, maybe five years later. A park guide said, "General Washington was like Goliath to the British. The average 'redcoat' was about 5-foot-2, and Washington was 6-4. He rode the biggest horse he could find, and it scared the crap out of the British." He exaggerated a little—Washington was 6'-2" (187 cm), and as the chart below shows, British recruits just prior to 1800 were about 5'-6" (167 cm)—but the point is accurate. He was the tallest man most of them had ever seen. Of course, most of his own men were similar in stature to the British, and he scared the crap out of them also.

This chart illustrates a "Waaler Surface". It is from page 60 of The Changing Body: Health, Nutrition, and Human Development in the Western World Since 1700 by Drs. Roderick Floud, Robert W. Fogel, Bernard Harris, and Sok Chul Hong. The chart is rather complex, so take a moment to peruse it, and then I'll explain.

For Americans, refer to these tables:

Height
160 cm = 63.0" ≈ 5'-3"
170 cm = 66.9" ≈ 5'-7"
180 cm = 70.9" = 5'-11"
190 cm = 74.8" = 6'-3"
(to convert cm to inches, divide by 2.54)

Weight
40 kg = 88 lbs
60 kg = 132
80 kg = 176 lbs
100 kg = 220 lbs
(to convert kg to lbs, multiply by 2.2046)

The Iso-BMI curves—the dashed lines—set a foundation. The heavy curve shows minimum risk of dying in the next ten years. To the left is underweight, and to the right is overweight. Now, the iso-mortality-risk curves—the thin solid lines—show relative risk of dying within ten years, gleaned from a study of middle and late middle aged Norwegian men, and correlated with the sketchier records of the past 300 years throughout Europe. The curve labeled 1.0 passes through the minimum-risk curve at 1.675m (66") height. At that point, the healthiest weight is 72 kg (168 lbs). But a person taller than 1.84m (72.4"), weighing about 80 kg (176 lbs) has a 30% lower mortality risk!

Hmm. I am 6'-0" and 207 lbs (1.83m and 94 kg). That puts my relative mortality risk at 0.9. That is 15-20% worse than the optimum for my height. More properly, among a group of men just my size, 20% more of them are likely to die in the next ten years, compared to those at optimum weight/BMI. That is according to this Waaler surface.

But the little circled × and + signs mark the important historical message of this chart. Throughout most of the past 300 years, the French were shorter than the British, and less healthy. However, the trend through time has brought the two populations to near parity, with average heights of about 1.77m (just under 5'-10"), and though the British tend to be heavier, their mortality risk is the same (they are on the same iso-mortality-risk curve).

A little further along in the book, Table 2.5 on page 67 lists the average height for men in six European countries, as it has changed since 1750. I converted the data into this chart:

A quarter-century marked 18-IV, for example, refers to the years 1875-1899. That is the range of dates during which men in a particular cohort reached physical maturity.

I am not sure what happened in Denmark since 1975, but for three of the other five countries the height scoops up toward the 1.8m range, then slows down approaching the year 2000. The last data point is missing for Hungary, and we see that France is apparently a little behind England and the Scandinavian countries, perhaps lagging by 25 years (It is tempting to speculate that the different lines will converge on some optimal average height, but only time will tell).

This is something the authors remark upon, that in the richer western countries the trend of increasing height seems to be slowing down. Perhaps there is a genetically-determined maximum height for each family, and as barriers are removed, through better nutrition, better medical care and less need for very heavy labor, that maximum is being reached by a larger and larger number in each generation.

The book is a textbook for a socio-economics course. Thus it is very dense with figures and tables and discussions of the sources and assumptions and calculations needed to reach the authors' conclusions. In a way, the plethora of illustrative material shortens the reading substantially. Reading a text-only book of this density, of 374 pages, would have taken somewhat longer than the 12 days it took me! I can swallow up a page-size table quicker than I can read a page of scientific text. I would say that the first 80% of the book is devoted to "confidence building": presentation of the facts and sources and so forth, so that the later conclusions will be more readily accepted. If the authors choose to write a more popularized version, I'd expect something quite a bit more brief.

But this book is quite valuable as it is, for those willing to slog through it. All that data on size and weight and purported health are fine, but what has caused it? And are we really healthier? Not all agree that we are. Much of the work discussed, work done by the authors and many colleagues, and by others, including those who may draw different conclusions, is intended to tease out mortality and morbidity as they have progressed through time. Prior to about 1930, when the first effective antibiotics were developed, we see that average size and health were already increasing. The "Third World" is presently living an 18^th-Century life, nutritionally and medically, and it shows; average adult male heights for most groups are near 1.65m, plus or minus 5 cm or so.

However, the discussions do not dwell only on averages. One large section deals with distributions of caloric intake, compared to the basal metabolic requirement plus "maintenance", which is necessary to stave off long-term starvation. Throughout the 1700s and into the early 1800s, 15-30% of the poorest didn't have enough to eat, and were starving. Even those just a little better off had little energy to work. Did you ever wonder why the beggars in poor countries (and poor areas of richer ones) do little more than sit around begging? I am not talking about panhandlers on American city streets, but the truly destitute. It is because they eat so little they have no energy left for any kind of work.

For example, if a man of a certain size could sleep all day, his basal metabolism might require 1,600 calories (AKA kcal). Yet he needs to awake from time to time to, at least, eat and eliminate. Also, his body uses some energy replacing worn out tissues. These maintenance activities bring his caloric requirement to 2,030 (an added 27%, or 430 kcal). Just walking around takes about 3 times as much energy as sitting still (2x for the walking and 1x for basal). This factor of 3 is a Physical Activity Ratio, or PAR; a 24-hour walk would require 4,800 kcal (the exercise plus the basic) plus 430 (maintenance) for a total of 5,230. Of course, a full-time panhandler won't walk 24 hours, but may walk a few hours a day. If we assume 4, the total caloric requirement is 2,030 plus about 530, or 2,560 kcal. If this person does anything else except lie around quietly, more calories are needed.

At the high end of the scale, assuming a farmer can eat all he needs to, the PAL for most farm labor is about 5. Farmers work long days; 10 hours or more is quite common, 7 days per week. Then many around-the home activities have a PAL around 2. A farmer's energy budget may resemble this:

• sleep 8 hr: 530
• labor 10 hr: 3,330
• family interaction 3 hr: 400
• read, talk, etc. 3 hr: 300
• body maintenance: 430

That all adds up to 4,990 kcal that he needs to eat. The next time you are at a café that farmers or farm hands frequent, don't be surprised by their enormous breakfasts! However, for those without such ready access to abundant food, such as the lower classes in 18^th Century Europe, undernourishment was the norm. Dad was underfed and couldn't work hard enough to earn much, Mom was underfed and so had undersized babies; she had a scant milk supply and after being weaned the youngsters frequently went hungry. They grew up short and scrawny. Then, being undernourished made them all less able to fight off disease, which also takes energy. Their lives were short and hard, and other charts in the book show how size correlates with social class. Simply put, the aristocrats were taller because they could afford sufficient food, and being better nourished means they were less often ill.

The epigenetic effects of such a history can't be shrugged off in a single generation. The 300-year chart above shows how gradual the change was. Increasing food supplies came first, and it took a few generations for size changes to follow. 300 years represents 12-15 generations.

Now we can consider life expectancy. At this point, data for women was also available. This chart, from page 148, shows the increase just through the 20^th Century. The bars represent average remaining life expectancy. Thus, for 65-year-olds, only a dozen or so years remain, meaning that on average they can expect to live to age 80 (men) or 85 (women; for the 2000-2002 figures).

From the bottom, note that at age 0 compared to age 1, there is quite a difference in 1900, but very little in 2000, though for both there are great increases from 1900 to 2000. Infant mortality was so great in 1900, that a 1-year-old, who had already survived a few "childhood diseases", could expect on average 5-6 years more life than a newborn.

As an aside, two years ago we visited a cemetery in Missouri, where some of my ancestors are buried. I was sobered by the large number of tiny gravestones for infants and children under 5, who had died between about 1830 and 1930. The gravestones for those who survived to ages in the range 70 and up were very few. I think my great-grandfather was the only 90-year-old buried there. When he was 65, in 1935, his average life expectation was to live to about 77. He beat that, but most didn't. My father, who was 88 when we went there, had given me a list of men to look for, in the nearby town, men he had known as a child. I reported later that I found them all—in the cemetery. Dad is the last survivor of his generation from that town.

Today, it is considered unusually tragic to have a child die. Prior to 1900 it was tragically common. So perhaps the age-15 figures tell the best story. At age 15, in 1900 a young man might expect to live another 48 years, to 63. By 1950, it was 53 or 54, to almost 70, but by 2000, a 15-year-old has an average remaining expected lifetime of 62 years, to age 77. For young women, add 3-4 years to all these figures.

Now we come to the last figure I wish to show, Figure 6.8 from page 341:

The squares on the dotted lines are for Union soldiers who'd survived the American Civil War, measured and weighed at ages 40-59, and their dates of death from military pension records. The circles on solid lines are from modern non-Hispanic Americans, measured and weighed at ages 40-59 in the 1980s (61,000 of them). In both data sets, the relative mortality risk is for the succeeding decade. The simple message is clear. Being shorter is riskier, and being too skinny is also riskier. The "sweet spot" for the Civil War veterans is about 1.9m tall and BMI near 24 (87 kg: 6'-3" and 192 lbs). For the recent cohort, it is about the same height, but optimum BMI is nearer 26 (94 kg or 207 lbs).

Both BMI charts show that risk rises gradually upwards of 26, and picks up faster after 30, the criterion for "obese". However, a Waaler chart such as the one above is needed to ferret out whether being short and heavy is better or worse than being tall and heavy. Look at the Waaler surface above: at any BMI between 19 and 31 or 32, being over 1.8m tall is better than being 1.6m tall at any weight!

But this introduces a new and sobering realization. In the west we have gone from being undernourished to overnourished. In America 30-40% are now obese, and the European nations are following closely behind. Mortality and morbidity (chronic debilitation from illness) are increasing again. The number of morbidly obese (BMI more than 40) is the most rapidly increasing segment of American society. I'd be morbidly obese at 295 lbs, or 134 kg. These days I know lots of folks over 300 lbs, and a few in the 400-plus category.

As the authors of Changing Body show, there has been an amazing run of three centuries, with improving nutrition, public health, medical care, that have led to taller and heavier and stronger and even smarter people throughout the west. But we are going over the top. Now we spend about as much for weight loss programs and products as we do for food. How long will it be, until, if nothing else, those who most easily grow exceedingly obese are culled from the gene pool?

Tree of beauty, tree of healing

kw: book reviews, nonfiction, trees, natural history

The Ginkgo is not only one of the most beautiful trees, it is distinctive. Once you have seen one, you will likely recognize one at a distance. Here in the U.S., few have seen really big ginkgo trees. The oldest one in the country is probably one in Georgia that is said to be 222 years old, planted to commemorate a visit by George Washington in 1791. The largest is probably one in Connecticut, planted in 1860, and 33m (110ft) tall. Several American ginkgoes have a girth of about 5m (16ft), or a diameter in the range of 1.6m (5ft). Compare those with one in Yongmunsa, Korea, that may be as old as 1,100 years, with a height of 62m (203ft), a girth of 14m (46ft) and thus a diameter near 4.5m (15ft). One tree in China has a diameter over 5.8m (19ft). However, most of the "street tree" ginkgoes in the West are less than 100 years old, perhaps 20m (65ft) tall and half a meter (20in) in diameter. I see a row of ginkgo trees of about that size when I visit the Hagley Museum near Wilmington, Delaware.

The Chinese, Japanese and Koreans seem to have found a medicinal use for almost everything. While the American FDA has about 800 approved drug substances (and more than 100,000 formulations), an apothecary shop in Asia is likely to have 10,000 or more ingredients and an uncounted number of ways of compounding mixtures. Extracts and other preparations of ginkgo leaves, seeds and bark are used to treat many bodily ailments. In the West, we seem to limit ourselves to a leaf extract that is mildly effective for memory problems and perhaps for some forms of dementia. My mother used it once she began to suffer dementia (my father remembered for her, when to take it).

A very comprehensive and readable account of ginkgo natural history is found in Ginkgo by Peter Crane, former Director of the Royal Botanical Gardens of Kew, England. I knew the genus Ginkgo is ancient but I didn't realize just how ancient. Though the species Ginkgo biloba as described by Linné is a few millions or tens of millions of years old, numerous fossil ginkgo species date back as far as 300 million years or more. The ginkgo line survived the great Permian mega-extinction event. However, they almost didn't survive the Pleistocene!

A few million years ago, a small number of different ginkgo species had worldwide distribution. The ice ages that began about 5.5 million years ago, and ramped up in earnest some 2.5 million, nearly did them in. By about 5,000 years ago, as well as botanists and paleontologists can determine, only a few small groves of ginkgo trees survived in remote parts of China. However, humanity, the agent of the current mega-extinction, in this case saved the ginkgo, partly because the Chinese liked the edible nuts, and perhaps also because of their beauty (I suspect if poison ivy were in danger of extinction, most people would gladly let it go!).

In seven sections and 37 compact chapters, Dr. Crane introduces us to the natural history of the tree, its ebb and flow through time, and how ginkgoes and humans have interacted for at least a couple of thousand years. Most folks are impressed by things like record size, but these are neither the largest of trees, nor the longest-lived. They have other unique features.

As I mentioned above, the tree's outline is distinctive, though certain old pine trees can look very similar. But the leaf! There is nothing like it. The species was named for its bilobed leaf. Not all ginkgo leaves have the central cleft, and on older trees, few do. But with or without it, the fan-shaped leaf is unique. It is said that the Chinese love the ginkgo because its leaves resemble their paper fans. I suspect the leaf inspired the paper fan!

Also, in contrast to all the common "hardwood" trees, the ginkgo is not a flowering plant. It is more closely related to "seed ferns". The male tree bears small pollen cones, and the female tree bears somewhat larger ovule cones. They are wind pollinated. Few trees are dioecious (that is, having separation of sexes), but some familiar trees are, such as red maple and yew. But ginkgo pollen is absolutely unique. The sperm swims to the ovum, once released from the pollen grain upon contact with the ovule. Finally, ginkgo leaves turn yellow, seemingly all on the same day, in early fall. Where they have been naturalized into a forest, an aerial view of the forest in early October (in the North, anyway!) will have a polka-dot appearance. By the time their yellow leaves fall, the reds of maples and other such trees will dominate.

Because of quirks of human nature, ginkgoes have been preserved. Without, they might have gone extinct hundreds of years ago. Can we muster up a sufficiently widespread love of other trees that are now endangered, to preserve them as effectively?

Ethics predates us

kw: book reviews, nonfiction, primatology, morality, atheism, theism

An experimenter enters an enclosure containing an ape, and sets down two small boxes. If the ape puts one on top of the other, it is rewarded with a carrot. It soon learns to stack boxes, happily eating the carrots. Then the experimenter leaves and goes into an enclosure nearby containing another ape, which has been able to see this whole procedure. The ape soon sets one box upon another, and happily receives a carrot to eat. After a few repetitions, the experimenter returns to the first enclosure, presenting the same two boxes. This time, when the ape stacks them, it receives a grape. Several repetitions yield several grapes. Now the experimenter returns to the second ape. This one immediately stacks the boxes, so the experimenter presents a carrot. Angrily, the ape rejects the carrot. Clearly, it wants a grape.

The sense of "fair play" is not unique to humans.

Observations of apes and other primates "in the wild" confirm not only the sense of fair versus unfair treatment, but also social morals. In one instance, two families of baboons came upon a small fruiting bush. There was not enough fruit for both families. Rather than fight or even confront each other, both families ran off in opposite directions. This is but one of many, many indications that the Hobbesian notion of "nature red in tooth and claw" is quite wrong-headed.

Even further. You may have seen the Disney movie in which Akela, the alpha wolf, misses a kill, and the troop turns against him. This doesn't actually happen, among either wolves or apes. Even when a "beta" displaces an "alpha", the deposed leader is not exiled. In fact, when an animal has become ill or disabled, its fellows help it. For example, an ape dying of infection is comforted by other apes, who groom it more than usual and bring food. And the internet is full of pictures and videos of cross-species animal adoptions and "friendships", between dog and cat, sow and puppies, and the gorilla Koko with her pet kitten All Ball. The Tarzan stories, in which an ape adopts a human infant, would not resonate with anyone if adoption were not a common occurrence.
Most human adoptive parents do a good job raising the totally unrelated child. So do most cross-species adoptive "parents".
Social consciousness and altruism are not unique to humans.

Primatologist Frans de Waal has studied chimpanzees and bonobos, and the striking differences between them, for decades. While bonobos (formerly "pygmy chimpanzees") are more peaceable, both species of ape display ethical and moral behavior. Of course, moral lapses result is fierce chastisement, in both species, but, then so do moral lapses among humans. Think how you were raised. Maybe your parents spanked you, and maybe not, but "time out" and other forms of correction still train the conscience, and it is well known that parents who eschew all forms of "punishment" raise spoiled brats.

In his book The Bonobo and the Atheist: In Search of Humanism Among the Primates, de Waal demonstrates that the conscience is not only a human attribute: all social mammals (and perhaps all mammals) show evidence of having a conscience to be trained. Don't we speak of a psychopath as someone lacking a conscience? In spite of parental training and other social sanctions, a psychopath behaves amorally. Whatever mental "organ" it is that makes most of us into rule-keepers (at least most of the time!), is absent in a psychopath. If we had no innate tendency to "goodness", however defined, no training method could make us capable of goodness.

The author's thesis is that morality predates religion. As an atheist, he distances himself from "neo-atheists", or "evangelical atheists" (who are actually anti-theists). He recognizes that nearly all of us have the "God-shaped hole" (a paraphrase of Pascal), such that, as Voltaire said, "If there were no God, we would have to invent him." Of course, many evangelical Christians claim that the God-shaped hole is universal, but to my careful observation over many years, I would have to say, not entirely. There are some quite contented nontheists (a word I prefer to "atheist").

The impetus to write the book arose from responses to a blog posting by the author, "Morals without God?" He realized he would have to explain himself further. Many folks did get his point, but some, particularly neo-atheists, missed it. He does not desire to drive God or religion out of society. Indeed, he spends half a chapter outlining the three Twentieth Century attempts to do so, by Joseph Stalin, Pol Pot, and Mao Zedong. Stalin's effort resulted in at least 15 million killed; Pol Pot's attempt killed 3 million; and Mao topped them all, killing more than 100 million Chinese. The anti-religious effort he doesn't mention is that of Hitler, who attempted to exterminate one particular religion. In doing so, not only 6 million Jews were killed, but so were nearly 6 million Christians, plus tens of thousands of homosexuals and other "undesirables" (in Hitler's view). Yeah, it is true that misapplication of religion has led to many killings, but the greatest evils arose from trying to eliminate religion. This exposes the mis-aiming of the anti-theists. They clearly hate religion, and any one of them could become another Pol Pot or Mao as a result.

de Waal posits that small pre-agricultural bands of humans didn't need religion, that religions arose along with the need to manage large populations. Since I sharply distinguish between faith and religion, I mostly agree: faith is all about how the individual relates to God or gods, while religion is all about organization of the faith-full. The larger the number, the more organization is needed, which is why I prefer smaller churches. The trouble is, religion also provides hierarchy, rites and rituals, all human-created structures in which the faith-less can fake it, to the point that many churches are simply social clubs with barely a nod toward a mostly absent deity.

The book is full of fascinating research findings, that illustrate how other animals, not just us humans, display compassion, fairness and altruism. Dogs know when they are treated fairly, or not; elephants try to help a fallen comrade, whether a relative or not; and one story tells of a camel that was beaten savagely, frequently and unfairly, that meekly bided its time, and when alone with the drover, bit the top off his head! Self-defense is a moral value also.

de Waal picked bonobos to compare with us, because physically they more closely resemble early human ancestors such as Ardipithecus. Bonobos are more slender than chimpanzees, have longer legs and can more nearly walk upright. Whether "Ardi" also had the peaceable nature of bonobos is unknown. We need to constantly recall that, not only do we have millions and billions of years of evolution leading up to us, but so do bonobos, and chimps, and parakeets and oak trees. The hominin family tree branched from other apes around 7 million years ago, while bonobos and chimps probably branched from one another 4-5 million years ago (the moist forests in which both live are notoriously bad for fossil preservation). Which ape diverged most from that extinct ape species of 7 million years ago that gave rise to all three of us? The human, the bonobo, or the chimpanzee? I think it is more like the 3-legged stool. We all diverged about equally, in different directions.

We can say that our behavior is some mixture of both bonobo and chimp behaviors, plus some additions (not many). But a chimp scholar might make the same claim, that chimp behavior is some mixture of human and bonobo, with some additions! And so forth. The singular added factor for humans is our ability to function in larger and larger groups. de Waal makes a good case that religion has facilitated that ability. He hopes that morality can gradually be disentangled from religion, because he has also shown that we are moral, or at least have moral ideals, whether or not we are religious. He does not propose a different organizing principle. His book gives us all much to ponder.

She is not only ape about apes.

kw: book reviews, nonfiction, plants, memoirs, polemics

Jane Goodall is known for her lyrical writing, and her new book—which hardly mentions chimpanzees!—is, if anything, even more lyrical. With the help of Gail Hudson, she has written Seeds of Hope: Wisdom and Wonder From the World of Plants. At first, a reader may wonder why a primatologist would write about plants. As she tells us in the opening chapter, her first love was a tree, a beech (named Beech) in which she sat and read or drew or wrote for many a childhood hour. That is not all.

By the second half of the book, her hortatory purpose emerges in full. She has seen a good deal more of the world than most of us ever will. Everywhere, among the wonder and beauty, there is damage and tragedy. Of course, her beloved chimps are in danger, but their greatest peril is the shrinking forest. Where 50 years ago the tiny Gombe reserve was surrounded by forest and a piece with it, now it is an isolated enclave, with bare ground, or monoculture farm fields, right up to the boundary. If we save and restore the forest, we will also save the apes…if not, not.

This is happening everywhere. At one time, the First World exemplified the "taming of the wilderness" in favor of agriculture and agribusiness. For example, nearly every acre of the United States that is arable is devoted to that purpose. While this comes to just under half the total land area, and cities and roads and other pavements take up only about 5%, much of the rest is logged or otherwise exploited, including an increasing proportion of our national parks and monuments. And this is the "new world"! Now the Third World is going full steam ahead, building, plowing and planting, polluting, and generally straining to outdo all our worst sins.

The first half of the book is descriptive, of the author's life and of a systematic trek through the plant world, from the various aspects of the plants themselves to the uses made of them by animals and humans. Starting in chapter 11, things turn dark. Its title is "Plants that can harm". Why do plants make so many chemical substances? Many, many of them are insecticides, bitterants (to discourage browsing mammals) or downright poisons. Some of these substances can be used as medicines (the subject of Chapter 10); indeed, nearly every medicine is either extracted from a plant or chemically derived from a plant chemical. But so are many poisons and "recreational" drugs. All the ways a plant can heal or harm are a product of human redirection of chemicals the plants make for self defense.

But even "good" crops are not without their dark side. In the West, we may have outlawed slavery, which was largely agricultural, but agriculture, particularly the picking of fruits and vegetables, is still an area rampant with abuses, of workers, of the land, and of domestic animals. And in "developing" countries the abuses are the worst, including continued slavery. Think about that the next time you buy cotton underwear without checking whether it was both organically and ethically grown.

The last five chapters describe suggestions for taming agriculture itself. It has become the master and we the slaves. This can be turned around, and the featured initiatives, including Roots & Shoots, which Ms Goodall and a group of teens started in Tanzania 22 years ago, show at least part of the way. Crops such as coffee and cacao (chocolate) grow poorly in monoculture, compared to polyculture with appropriate plant companions. With more time and research, we are likely to find that many crops share this characteristic. This in not new: read Malabar Farm by Louis Bromfield; the farm has been in operation since 1939. One tidbit: corn grows better when it shares the field with alfalfa. Other innovative ways of growing crops, some of them thousands of years older than agribusiness, just might feed more people than the current "big business" way we have fallen into in the West.

Even at her most polemical, Jane Goodall writes lyrically, and manages to avoid being too "preachy". But we need out preachers. She is one of the best.

Reading this book could be hazardous to your health…or not

kw: book reviews, nonfiction, humor, warnings

You know you're in trouble when it makes you laugh and you don't know why. Encyclopedia Paranoiaca by Henry Beard and Christopher Cerf (with others) struck me that way at times. Consisting of a few hundred very short articles, from less than a half page to a page or so, it presents all the things you need to avoid to be healthy and safe…or so they claim.

In keeping with the Encyclopedia image, there are nearly a thousand sources referred to. Nearly all are web articles or blog posts, undoubtedly dredged up by "the staff of the Cassandra Institute". At first I found the titles of some articles puzzling. Then I realized the meta-joke of the book. They were selected to put two or more opposing phobias one after another. For example, "sun exposure" is followed by "sun exposure, insufficient" and then by "sunscreens". The last article warns of the dangers caused by slathering on the SPF 50 stuff, though the primary risk is overconfidence: people not wearing any sun protection are likely to be cautious, while those who think they are "protected" may stay out in the sun so long they burn anyway.

Another juxtapositional joke is "escalator handrails", about the horrible germs that coat them, followed by "escalators", in which we are cautioned that these devices are so risky we absolutely must cling tightly to the handrail for the entire ride. And then the dangers of "hand sanitizers, alcohol based" weigh in on one side, while "hand washing" discusses the dangers thereof, and advises that hand sanitizers ought to be used instead. And when it comes to sleeping positions, after four articles one might conclude it is best not to sleep at all (and, sadly, there isn't an article about the genuine dangers of extended sleeplessness).

Of course, Beard and Cerf have more tricks up their sleeve than these. The "experts" they reference include one fellow who calls U.S. treasury bonds "worthless confetti", and prefers to invest in things "Bernanke can't destroy", such as bottled water and flashlight batteries. A few are more credible, but only a few.

Some worthwhile advice is to be found hidden among the jokes. For example, it actually is a good idea to carry a few clean plastic bags on a trip; one can be used to hold the TV remote in the hotel room because the maids never clean them, and they are devilishly hard to clean anyway (dunking in soapy water will degrade their performance). I am sure a sufficiently paranoid person can find other uses for plastic bags when in a hotel room or other public places.

A lot of the "dangers", such as burning candles at dinner time, are played straight from the source, which has overstated the case all by itself. Sure, burning candle wax emits some benzene and toluene. In large amounts these are toxic and cause all kinds of distressing symptoms, including death (like if you drink some). But the editors conveniently leave out any indication that you'd have to burn hundreds of candles to breathe a measurably toxic dose of toluene, and then you are more likely to burn your place down, or simply pass out from heat stroke.

For most of us, the book is a fun read. The genuine fear I have is that someone truly paranoid will read this book and think it is serious.

A science book? Hardly

kw: book reviews, nonfiction, art, science

Give an artist an inch and he'll take an easel. In this case, an artist named Hancock was commissioned to illustrate a very short article (~300 words) titled "Where does Earth's water come from?" It appears he did read the article, but the very first fact is mis-stated (see upper left). The Earth is not 3/4 water; water cover's 3/4 of the planet's surface. By mass, water is less than 1/4,000 of Earth, and by volume, less than 1/1,000.

At least Mr. Hancock has read the item, which appears on page 42 of The Where, the Why and the How: 75 Artists Illustrate Wondrous Mysteries of Science, edited by Jenny Volvovski, Julia Rothman and Matt Lamothe. Many of the artists seem to have read no more than the article's title, and taken off from there, and neither the article's author nor the editors checked them for anything approaching factual accuracy.

All but a very few of the "illustrations" are impressionistic interpretations, and illustrate nothing. This makes the image above quite a bit better than most. Of course, the articles themselves are too short to do more than skate the surface of a subject and list a few semi-relevant items; none is longer than 400 words, about the size of the abstract for a scientific monograph. Of course, they make better reading than monographs!

In a few cases, the artist did a much better job, possibly because he or she actually knew some science. The title of the article on page 40 is "Are earthquakes predictable?" and this image by Isaac Tobin accompanies it on page 41. While also a bit impressionistic, it shows the principle of a fault, or fracture, in the rock layers underground. The locations of faults is the single most important factor in predicting earthquake locations, if not their timing.

Of course, the article dwells more on our failure to determine the timing of earthquakes, as it ought to. But an illustration showing the seismometers and other equipment used to attempt such predictions would make poor visual fare. So I like this image.

In one case, the artist seems to have done a better job than the scientist.  On page 70 we find, "What explains latitudinal patterns in species diversity?" The writer, Professor Joanna E. Lambert of UT San Antonio, presents a "maybe this, maybe that" approach that doesn't really answer the question.

This image neatly illustrates the question, and leads a viewer to the conclusion, "Well, DUH, life is harder near the poles!". Dr. Lambert did hit on this issue late in the article. Deserts and mountaintops at low latitudes have lower species diversity also, because life is harder there. The reduction of diversity with latitude is only part of a larger picture, that wherever life is better served by energy balance, plus sufficient water and nutrients, there will be richer diversity. Fewer plants and animals can make a living where these are in short supply. The illustration is by Lotta Nieminen, and is one of the best in the book.

There are two cases of total scientific blunder. In the article on page 28, "What happens to time as you approach the speed of light?", the premise is flawed. The question implies a fixed reference frame, and Einstein showed that there is no such thing. An object may be moving at some high velocity relative to our solar system, but from the viewpoint of someone in or on that object, it is the solar system that is moving fast. Because of the false premise, the author states that an observer in a fast-moving spaceship would see a clock on Earth "moving so fast that you would not be able to see the hands." Totally false. The Earth observer would indeed see the spaceship's clock moving more slowly, but the spaceship observer would see a clock on Earth moving equally slowly! That is the prediction of Special Relativity. It is called the time dilation paradox, and Special Relativity cannot resolve it.

So why did a clock put on a satellite that circled the Earth really fast come back showing less time had elapsed, than on Earth? General Relativity provides the answer. Acceleration and Gravity, which are equivalent in their effect on time, perform their magic on the clocks. In addition, Lorentz contraction makes the "traveler" experience a shorter trip. Thus, to the spaceship observer, a trip of a light year is shortened to something much less, while the ship clock seems to run at normal speed. In a sense, you could say that the contraction of space and the dilation of time balance out, while the acceleration required to get the spaceship "out there" and back, makes the system unbalanced, so that the clock that speeds up, turns around and slows again upon return is the one found to be slowed during its trip. Now my digression is longer than the article that triggered it! And I have given only a portion of the answer.

However, I must go on to another blunder. The illustration on page 31, for the article "How are stars born, and how do they die?" is a howler. It shows a nursery full of bassinets containing glowing clouds. They are labeled, "baby main sequence star", "baby supergiant star"—so far so good—, and then "baby red giant star", "baby neutron star", "baby red dwarf star" and "baby white dwarf star". Yeegads! A red giant is an aging star, while a white dwarf and a neutron star are two kinds of very elderly star. You can't have a "baby neutron star"!!! Also, a red dwarf is just one kind of main sequence star. The article's author, or at least the editors, really ought to have caught this. A better illustration would have shown a couple of bassinets, but shown the other kinds of stars with canes and hearing aids, or in rocking chairs. At least there was no "baby supernova". OMG: I just looked again…there is a "baby black hole"! That may have been possible a few microseconds after the Big Bang, but not any time since. A black hole is one kind of dead star, or if you will, a zombie star that can eat other stars. Hmm, put that into your illustration. P.S. The artist is one of the book's editors.

Efforts to bring together the arts and the sciences are commendable. Illustrators of scientific books and articles have always known that art can often illuminate science (and so have the scientists who hire them!), which is why they stay in business. A good illustration can show you something no photo can properly capture. However, while an illustrator is an artist, not all artists can be illustrators, as this book amply demonstrates.

New or old, some ways are good and some are not

kw: book reviews, nonfiction, sociology, social anthropology, syntheses

In his new book The World Until Yesterday: What Can We Learn From Traditional Societies?, we learn that Jared Diamond has spent 3-4 weeks every year, for some 50 years, in New Guinea. He wasn't there to study the people, but the birds. But he had to learn a number of the languages—or at least know the names of common birds in the more common languages used there—, interact with the people, and live among them. You could say that cultural anthropology came along for the ride. He is a synthesist (AKA a systems analyst), as amply shown by his books Collapse and Guns, Germs and Steel. In this book he seeks to answer the question embedded in its title, by finding what is different, and what is the same, between large-scale, modern, "state government" societies, and smaller-scale traditional societies.

As he does, let us first classify societies according to scale:

• A Band consists of "a few dozen" individuals, typically one or a few extended families.
• A Tribe can contain hundreds, with the characteristic that everyone knows every one. Dunbar's Limit, canonically 150, but in the range 100-230, is the number of relationships a person can sustain.
• A Chiefdom, which can only arise where agriculture is practiced, consists of a few thousand or several thousand persons.
• A State ranges in size up to a population of a billion or so.

Scale alone explains some of the differences. Politically, a band or tribe will have a loose dominance hierarchy, of the type we call a pecking order. Chiefdoms require hierarchy, a separation between decision makers and everyone else, while states require much more governmental organization and specialized trades, otherwise the result is not actually anarchy, but instead a quick return to many chiefdoms and bands. As we can see in most modern nations, governing a million to a billion persons requires several levels of organization. France, for example, has 27 Régions, 101 Départements, 342 Arrondissements, 4,032 Cantons and 36,781 Communes, at last count. That is a total of six governmental levels. In the U.S. we have four levels of government, but below the national and state levels, the names vary: counties and parishes are at the same level, just in different states; and for that matter, Pennsylvania is formally a Commonwealth.

There is a bigger, day-to-day consequence of having centralized government. One of the first things a state government will do is assume a monopoly on violence. Vengeance for wrongs done is disallowed by government. Among bands or tribes we find frequent conflict. The book's third chapter is about a "tiny war" that occurred in 1961 in New Guinea among rival tribes of the Dani, an upland people in New Guinea. Two tribal alliances totaling 10,000 people fought a series of skirmishes and pitched battles between February and September. One massacre killed 125, while all other dead numbered 11. 136 dead in 8 months seems tiny to us, but it amounts to about 1.4% of the populace. The number who died in the American Civil War a century earlier was about 625,000 out of a total population of about 34 million. The death toll was thus 1.8%, on the same relative scale as the war among the Dani. Yet it took 4 years, not just 8 months.

The "war between the states" was America's bloodiest war. It was one of only three very bloody wars in 230+ years. But the Dani in New Guinea were at constant war, and some still are. The 1961 war was just one of many. It is exceptional only in that it was well observed and recorded by Western observers. The war I remember growing up was the Vietnam War, during which 58,000 Americans died over a 20-year span. As horrendous as it seemed to us in the 1960s and 1970s, that was the actual "tiny war" (Of course, the number of Vietnamese dead was much greater, from a much smaller population. It isn't tiny to them by any measure!). American dead in all the wars since has yet to rise above 10,000.

To my point: every level of government has its own appointed killers (AKA peace-keepers): police, sheriffs, national guard and the five national armies (Army, Navy, Air Force, Marines and Coast Guard). They and they alone are permitted to use legal violence. It may seem unfair. However, the risk of dying in armed conflict in a modern state is between 1/10 and 1/100th the risk experienced in a traditional society.

As Diamond sees it, agriculture brought new risks and actually led to a lower standard of living for most, that is for everybody except a small number of state-supported elites. Raising that standard of living by government-led distribution of food and goods, by division of labor, and then by public health measures, has been a 9,000-year learning experience. Yet this is only "yesterday", which is the author's thesis. Humans had about 100,000 years to learn to live in bands and tribes. We are just beginning to learn to live properly in larger societies.

The learning experience is ongoing. So far, "The West" has achieved many benefits: doubling of life span, very low infant and maternal mortality, near-elimination of starvation among them. Yet the universal distribution of abundant food, for example, has risks of its own. People in traditional societies (several hundred exist today) typically die before the age of 50 of an infection or by violence. People in WEIRD (Western, Educated, Industrialized, Rich, Democratic) societies typically die in their 70s or later of heart disease, diabetes or cancer.

This particular difference shows that natural selection is ongoing. The rate of morbid "late onset" diabetes (AKA Type 2) among Europeans and Euro-Americans is about 6% (ranging from 2% to 10%), while it is in the 30% to 50% range among people recently Westernized. Living in a feast-and-famine environment selects for "thrifty" food storage. But that thriftiness leads to obesity once food is always abundant. Life in a WEIRD society gradually results in premature death for the most thrifty, and selects for those able to maintain healthier weight and healthier blood pressure. Basically, in about half a millennium, the Euro-world has made a head start in doing so. Natural selection in action! It is fascinating.

So, doctors can say all they want to us about eating better and getting more exercise. A few will, but most won't. We are lazy by nature. I suspect there is a genetic influence on how well we listen to our doctors, or at least on how well we actually take care of ourselves. In another 500-1,000 years, if humanity survives, I suspect people will be better adjusted to a world of abundance…unless that has collapsed. Who knows, the world may return to a much smaller human population living in bands and tribes again. Natural selection would then switch course again.

Jared Diamond has a great ability to put together a big picture. I have just skated the surface of a few issues that caught my interest as I read. This book joins a small collection of those to which I periodically return. I don't spend all my time reading only new books.

A lot of pain, a little hope

kw: book reviews, nonfiction, food poisoning, lawsuits

According to a CDC report from a year ago, summarized here, about 5,000 people die each year in the U.S. from food poisoning. Some 1,800 deaths are from Salmonella, Listeria and Toxoplasma, leaving 3,200 to "all other agents". About 90 of those "other" cases are from E. coli, usually the strain known as O157:H7. This strain of "coliform" bacteria is unusually scary. A victim doesn't get sick the same day, as is the case with Salmonella; it takes about 3 days. That is when the pain and bloody diarrhea begin. By then, the load of bacterial toxin in the body is ramping up massively. At that point, antibiotics cannot be used; they are simply deadly, because the bacteria release even more toxins as they die, and the patient is almost certain to die as a result. While the immune system fights the bacteria, organ after organ will fail or flounder. The official term is HUS, or hemolytic-uremic syndrome, which means that blood cells are shredded and the kidneys shut down.

O157:H7 killed four children in California and Washington state in 1993, all due to contaminated ground beef at some Jack in the Box restaurants. Another 600 were sickened, and many of them are suffering continued debilities. The restaurant chain settled a series of lawsuits for record amounts (for the time), but the most significant effect was a major change, not only in the way ground beef is cooked in restaurants, but in the ways cattle are slaughtered and processed, transported and distributed.

Looking back to those scary days, Jeff Benedict researched and interviewed and studied and has written Poisoned: The True Story of the Deadly E. Coli Outbreak That Changed the Way Americans Eat. The book is part documentary narrative, part docudrama. I found it remarkable that so many of the principals figures freely shared with Benedict as he worked through the great amount of material from newspaper accounts and court records, and also gave many hours to interviews. In an America for which the word "corporate" is most commonly associated with "greed", the company executives (particularly the JitB CEO Bob Nugent) and key lawyers acted in amazingly ethical fashion.

A quirk of the writing finally clued me in that Bill Marler was the "hero" of the book, with strong secondary "performances" by Roni Austin and Suzanne Kiner. Roni's daughter Lauren Rudolph was the first to die, and Suzanne's daughter Brianne nearly died, but recovered after weeks in a coma. The quirk? The trio are nearly always called by their first names, like single-name rock stars. Every other person mentioned in the book is nearly always called by last name. It irked me at first until I understood the author's purpose.

Mr. Benedict takes us blow-by-blow through an unflinching narrative of the tragedies and the legal and political wrangling that led to large damage awards for the hundreds of families of victims, and the record-setting awards to the Kiner family and those whose children died or were most severely affected with HUS, which often led to lifelong dialysis or kidney transplants. Even the more, he shows us the steps taken under the leadership of Dave Theno which have revamped the production and processing of ground beef, and are affecting the processing of other meats.

The legal cases made the career of Bill Marler and his associate Bruce Clark (you can find them here). I don't mind giving that plug, because if the book's portrayal is accurate, we have here a couple of lawyers who are quite different from the sharks one typically thinks of.

It is a shame that it takes a tragedy to motivate significant change. The top five hamburger chains, McDonald's, Burger King, Wendy's, Sonic, and Jack in the Box, procure and prepare beef patties differently than they did 20 years ago. Still, when I see that E. coli, of the O157:H7 strain and several similar ones, still kills 90 Americans yearly, I feel we have a ways to go.

The essentially American push for more, better, faster, cheaper (especially cheaper) is largely to blame. Cattle, whether prime beef or hamburger quality, are mostly raised in feed lots, where they eat corn rather than grass, and are kept crowded in dung-filled pens in which they must be heavily dosed with antibiotics to keep them from dying where they stand. The ideal way to raise cattle is on grass. I have had grass-fed beef, and it is significantly different (and better tasting!). The trouble is, that takes a lot more room, and we probably don't have enough room. Are we willing for our hamburger "fix" to be "treated" with a $15 burger (and that's just the one off the dollar menu)? Until we are, food poisoning can't be conquered.

Getting familiar with familiar birds

kw: book reviews, nonfiction, natural history, birds, paintings, drawings

A week ago we found the first blue, cast-off robin egg shell in the middle of the back yard. Robins carry empty shells away from the nest, to mislead predators, but I knew the nest was within 50-100 feet. A few days later, I saw the male (so I assume because his colors are so distinct) following me as I cut the lawn. He didn't follow closely, keeping a dozen yards back, but I could see that he was having good success picking out worms, which he carried to our apple tree—to be sure, about 100 feet from where we found the egg shell. I can think of two reasons for his behavior. Of course, the newly cut grass is shorter, and robins hunt for worms by sight. Earthworms frequently push out a little processed dirt, and sometimes their end sticks out of the ground briefly. But also, many worms come out of the ground when it is "thumped". This seems to be a mole-avoidance maneuver. It is the basis of "worm thumpers", sundry devices for thumping against the ground (some are wind driven), used by anglers to get bait. I reckon my power mower was doing plenty of thumping! The robin somehow learned to take advantage of it.

I wonder who else might have observed this behavior by a robin? A likely candidate is Julie Zickefoose. In her recent book, The Bluebird Effect: Uncommon Bonds with Common Birds, Ms Zickefoose writes of 25 bird species with which she has had an uncommon level of contact, although her chapter on the Ivory-Billed Woodpecker is based on others' stories. She is a licensed rehabilitator for songbirds, a job few take on because an infant bluebird or phoebe needs at least one feeding per hour, for ten days or more!

As Yogi Berra said, "You can observe a lot just by looking." Looking is what birdwatchers do best. Fortunately for us, Ms Z is not just a looker but a painter and sketcher. She draws and paints from life, or from very recent memory. She laments that she is no cartoonist, able to draw a made-up scene, even if its elements are remembered and not imagined. To me, that is no loss. An artist's eye and hand are better than a camera, making clear to the viewer details that she subtly enhances in a way no automatic device can capture.

This painting forms the book's frontispiece, and is on its cover. It has instantly become my favorite picture of a bluebird.

The essays in Bluebird Effect brought together for me a trend I had observed without taking particular note. Baby birds in open nests fledge quicker than those in cavities (or bird boxes). One of the fastest is the mourning dove; the babies are ready to fly in 10-12 days after hatching. A typical cavity nester, the tree swallow, takes about twice as long. The reason is simple, once it was pointed out to me. An open nest is harder to defend, so the young need to spend as short a time there as possible. During several years I checked bird boxes on a box trail set up by my company (I'd still be doing it, but I retired). Our most frequent "guests" were tree swallows. I recall it was typically about three weeks from hatching to an empty box. There are also barn swallows that nest atop a porch column at a place I frequent. The mud nest tucked under the roof is well protected, and those young stay on the nest about three weeks also.

Even in a bird box, species differ. House wren and chickadee babies leave the nest within about 2 weeks. I also remember chickadees as very aggressive. They are scrappy little critters! I think of them as avian Napoleons. However, the "bird lady" at a museum where I volunteer told me that a house wren will typically drive off a chickadee, though it is even smaller. Nature is not all sweetness and light.

Ms Zickefoose has a special love for phoebes, and named her daughter Phoebe. This young phoebe is just 9 days old. Its feather coat is full, but the wing pinions are only half grown. A few more days will take care of that. One of the author's specialties is drawing young birds daily as they develop. This is what she calls a "drawing". The book is filled with the author's art. It is also a tad oversize (8¼ x 8¼, or 21x21 cm), making it a mini-coffee-table book. The art is worthy of a full-size coffee-table book, but I know the market for those is tiny. This size is just right. I love it.

I remember being told not to handle baby birds; that my smell would make the parents abandon them. This is a convenient bit of fiction to keep kids from hurting baby birds. I have since learned that it is quite OK to return a fallen youngster to the nest. The parents are smart enough to continue caring for their baby. Not only so, they will probably attack you while you are doing your kindness for their chick. A bluejay peck hurts, even through a ball cap!

The author has come to feel that the turkey vulture is her totem, or a special sign to her. Seeing them makes her happy. This sketch shows feeding behavior. Many of the sketches and drawings in the book are right out of her field notes, complete with her comments.

She is one of the lucky ones to have seen an albino vulture. It was not totally white, having a few black pinions, including three primaries on the right. After she reported her sighting to others, the bird was seen by others at both ends of its migratory route. No need for a leg band on that bird!

I too like seeing these big buzzards, as they are also called. When I was a teen, we lived near Cleveland, Ohio, and would go to a place called Whipps Ledges near Hinckley to see them returning from South America. We would sing a parody of "Swallows come back to Capistrano" about the buzzards returning to Hinckley.

A turkey vulture is big enough to support plenty of brain, and these birds are curious and comical. My wife took the picture below last October, when a pair of vultures came into our yard, devoured a roadkill squirrel they'd carried in, then swept up to the neighbor's roof, where one looked in his window.

This picture, like the others my wife took that day, was shot through a window. No way was she going to go outside, with the birds nearly as tall as she was! Besides, they'd just have flown away.

Whether it is the gentleness of a dove, or the cussing ability of a titmouse, the essays in this book amuse, delight and inform. I learned that the call "peter-peter-peter" I have been hearing is a tufted titmouse in full territorial defense mode. They are small gray birds that I have a hard time distinguishing from a mockingbird (I usually don't carry binoculars; Ms Z has at least one pair in every room with a window, and wouldn't be caught outside without). I have a suggestion. This book has four parts, with essays pertinent to each season. She would to well to produce an entire book about each season, supplementing the lovely seasonal set by Edwin Way Teale.

A Bible lost and only partly found

kw: book reviews, nonfiction, history, bible, manuscripts

Interested in translating the Hebrew Bible for yourself? Step 1: learn the Hebrew of the Sixth Century BCE. Then get access to a critical edition of the Hebrew Bible, preferably the Leningrad Codex. This clip is from Exodus. Links to biblical texts are found at this Brandeis University page. That is step 2. Step 3 is to begin translating.

What is a critical edition? It is one that contains the most accurate compilation from all earlier manuscripts (see an example below), plus apparatuses that help a translator. For Biblical Hebrew, these include headnotes, footnotes and indications of the frequency of special words, and most importantly the diacritical marks above and below the letters, which indicate pronunciation and even the stress or emphasis to use while reading aloud. This helps a translating scholar determine the precise meaning of a word.

Think of the English "word" display. It is actually three words. As a noun or a verb, it is stressed dis-PLAY, but as an adjective most people say DIS-play. Then there is dove; to refer to a lovely, cooing bird, we say duvv, but the past tense of dive is pronounced dohv.

This situation is tougher in Hebrew, which has only one explicit vowel (aleph) and one semivowel (yod). SPPS NGLSH WR WRTTN THAT WY? (and without the question mark, either…nor any spaces between words!) How could you tell the difference between meet, met, mite, meat, and mete?

The self-chosen task of the Masoretes was to gather a compilation from the best manuscripts such as the Second Century CE one shown here, to produce an edition such as the Eleventh Century Leningrad Codex shown above. It is not known whether the original books were written this way, or whether there were word separations and punctuation, at least. All surviving early manuscripts look like this one. But the Masoretes had centuries of oral tradition and scholarship regarding how every word was to be pronounced during public reading, knowledge of which words were unique or used but twice (even if a certain string of consonants did not appear unique; its vowel sounds did differ).

They also developed methods to ensure faithful copying. A sheet of parchment was prepared by scoring with a grid. Each grid cell was to contain one letter. Every page of the entire Bible was gridded and thus would be identical to that in every other Masoretic copy.

The Leningrad Codex, dated about 1008, is the earliest complete Hebrew Bible, and the best. There was once a chance to make it second best, as we read in The Aleppo Codex: A True Story of Obsession, Faith, and the Pursuit of an Ancient Bible by Matti Friedman. The 500-leaf (1,000 page) manuscript that became known as the Aleppo Codex (more here) was produced in the same generation as the Leningrad Codex, but in Tiberias, on the Sea of Galilee, rather than in Cairo. It was the work of a single scribe, supervised by the chief scholar of his generation, and double-checked by the scholar and other skilled copyists to ensure that every letter, every vowel point, every item was perfect.

Mr. Friendman is currently based in Jerusalem, where the surviving portions of the Aleppo Codex are housed. By his account, during several years he crisscrossed the world to track down the manuscript's story. The book is part historical chronicle, part whodunit, but the "who" remains obscure, right to the end. It is hard to interview sources when most of them are dead.

The Aleppo Codex looks a lot like the Leningrad. This portion, from the end of Deuteronomy, shows purple stains at the page corners that have been touted as burn marks, but are actually fungus.

The manuscript was intended to guide scholars and copyists. It was used by Moses Maimonides, who was its custodian in the late 1100s. Sadly, he was the last scholar to use the book for its intended purpose. During later upheavals, it was taken first to one place, then to another, and eventually to Aleppo, in Syria, to the oldest Jewish community in the area (the Jews of Aleppo were there before the Syrians). It was kept safely in Aleppo for 600 years, until the day the UN voted to divide Palestine, setting up the state of Israel for the Jews after nearly 1,900 years as a stateless people.

In the rioting that followed the announcement, in late 1947 (just three weeks after I was born), the Great Synagogue of Aleppo was burned, and all the manuscripts scattered, including those in a doubly locked box. What happened next is a great mystery, one Friedman has largely solved, but not entirely. For months it was thought that the manuscript, called the Crown of Aleppo, had been burned. But it was not. That was a cover story. It was taken first to Turkey and then to Jerusalem.

At some point, about 40% of the leaves went missing, including nearly all the Torah, and the portion at the end that contains much of the Prophets. The remaining portions have been photographed (finally!) and images may be found at the link above.

The pages have a rather distinctive look, as this image shows. While all Masoretic texts are identical in layout, including where each letter is on each page, the handwriting is distinctive. The entire Aleppo Codex was crafted by a single scribe. Many others are in the hand of more than one scribe. Experts can recognize the handwriting. Even I can see that this scribe wrote more regularly and precisely than the scribe who wrote the Leningrad fragment shown above. It is the nearest thing to a machine-printed page produced in manuscript history.

Author Friedman set himself to peel back the layers of a very deep onion, to determine the true story of this manuscript's travels, and if possible to determine what became of the missing portions. He had the very great help of at least one or two of the principal players who were still living. He was also able to obtain documents that had been kept hidden for half a century, and it is likely that his narrative is accurate. His first objective was thus achieved. But not the second. When did the missing parts go missing, and who is responsible? Suspicion falls on a certain person, but much documentary evidence that could corroborate the suspicions of the remaining players has been lost, destroyed, or was never produced. A 4-year trial in the 1950s led to more obscurity, requiring much detective work to pick out the story from misdirection on nearly everyone's part.

We could have had a perfect Bible, in Friedman's opinion. The opportunity was squandered.

Making zombies possible

kw: book reviews, horror, fiction, post-apocalyptic fiction

After finishing the prior book, I spent a couple of hours with Deadline by Mira Grant. That was about all I could take. The book is based on an "explanation" for people becoming brain-eating Zombies because of a virus infection. The other theme is that with everyone staying indoors (or else!), more media entertainment is needed, so zombie fighters wear all sorts of cameras to go out and kill them by the dozens.

I had my fill of gore by about page 20, so I flitted about, reading portions of another several pages, and the conclusion. This being the middle book of a trilogy, it was not surprising that the book ends with a hint that the virus may be one day overcome. I mean, if you aren't going to at least try to "solve the problem", why raise it? Downers don't sell.

Anyway, good writing skills, but the author isn't someone I'd want to hang out with.

Oh, by the way, there is a preview of the third book in the end papers. Somebody gets cloned. I wonder how the clone gets the memories of the original? Not enough that I'd want to read it.