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During my senior year in college, I did an independent research project in a lab that had several PhD students. This was my first personal immersion in graduate school culture. After that was five years of my own grad student career in a lab with several PhD students, four and a half years as a postdoc in a lab with several PhD students, and then a 37 year faculty career in which I mentored seven PhD theses, one masters, and served on committees of 38 PhD students. During this time, academic standards for training PhD students have evolved. In an email exchange with a colleague back in St. Louis, I wrote: "In our funding-driven culture, the luxury of having our students work out their own projects . . . is beyond the resources of most faculty. Faculty end up doing the concept and planning and use the students for execution. The result is that too many students are passive actors in their careers. A good fit for industry, but not for innovative start-ups or for academic PIs." ...

Here’s House Speaker Mike Johnson: “We want to take a blowtorch to the regulatory state. These agencies have been weaponized against the people. It’s crushing the free market; it’s like a boot on the neck of job creators and entrepreneurs and risk takers. And so health care is one of the sectors, and we need this across the board.”  This is one of those geriatric hobby horses Republicans love to ride. Kevin Drum is having none of it, and he brings the receipts: “I'm hardly in favor of regulation willy nilly, but all the evidence suggests that it hasn't hurt much of anything. Business applications in the US continue to rise. Our economic growth is the best among advanced countries. Construction spending has skyrocketed. The finance industry continues to make mountains of money. Innovation is strong. Business profits as a share of the economy have nearly doubled over the past two decades. “At the same time, air and water quality has improved tremendously over the past 50 years. I...

My wife and I are recently retired. We moved to New England to be close to our grandson and his parents. We’re living independently in a three-bedroom detached house. My parents were able to live independently into their early 80s, when my dad began to dement. My mom was much smaller than him, and wasn’t able to manage him physically, so they moved into a retirement community. The entry fee back then was $300,000, which they couldn’t afford, so one of my brothers and I funded that, and their retirement income could handle the monthly fees. “Most communities charge an entry fee. The average initial payment is about $402,000, but the fees can range widely, from $40,000 to more than $2 million, according to NIC, which tracks costs at some 1,100 CCRCs in 99 major U.S. markets. “Once residents move in, they pay monthly maintenance or service fees. Other continuing care communities operate on a rental model with no up-front fee. The average monthly charge across both types of communities in ...

Republicans have long objected to the ACA, and Trump tried several times to have it overturned; he’s claimed he’ll replace it with something better, but in eight years, he’s never come up with even a rudiment of a proposal. No, both sides aren’t equal: “Vice President Kamala Harris, who previously backed a universal healthcare plan, wants to expand and strengthen the health law, popularly known as Obamacare. She supports making permanent temporary enhanced subsidies that lower the cost of premiums. And she's expected to press Congress to extend Medicaid coverage to more people in the 10 states that have so far not expanded the program. “Trump, who repeatedly tried and failed to repeal the ACA, said in the September presidential debate that he has "concepts of a plan" to replace or change the legislation. Although that sound bite became a bit of a laugh line because Trump had promised an alternative health insurance plan many times during his administration and never deliv...

Kevin Drum over at jabberwocking.com watched the Trump spectacle over at Madison Square Garden so we didn’t have to. He zeros in on Elon Musk: “Elon used to be smart enough to do simple addition, but he thinks we can cut "at least" $2 trillion from federal spending—which amounted to $6.1 trillion  last year, not $6.5 trillion. The arithmetic here is simple. If you add up Social Security + Medicare + defense + veterans pensions + interest on the debt you get $3.9 trillion. There's only $2.2 trillion left.   “So Elon is claiming we should literally zero out the entire rest of the federal budget. Everything. The FBI, national parks, food stamps, Medicaid, education, NASA, the EPA, farm support, the NIH, all federal R&D grants, embassies worldwide, the FAA, the Department of Justice, the VA, the weather service, the border patrol, etc. etc. Everything.”   Note here that Trump promised not to cut Medicare and Social Security. He promised to increase defense spending. And i...

The plutocrats on the right want to dismantle the administrative state, so they say. Of course, their wealth derives directly from the fiction of private property and an administrative state is required to enforce that fiction. Their wealth is monetized in currency, which is another fiction that the administrative state holds a monopoly on.  The Bolsheviks destroyed the ruble through hyperinflation: they printed money at an unprecedented rate, causing the supply of paper money to grow exponentially, and they issued their own paper currencies called sovznaki, or Soviet tokens, to try to deny that they couldn't do away with money. The result was that the ruble's value was reduced to 1/20,000th of its 1917 value.  There’s a huge difference between the agrarian economy of 1917 Russia and 2024 America, but abolishing the Administrative state that underpins the American economy will cause extensive and lasting harm for the majority of Americans. Jeff Bezos, Elon Musk, Donald Tr...

Trump promises to round up the homeless and put them in government internment camps. Only if they seek treatment and counseling, they might then qualify to be moved to housing. Harris takes a “housing first” approach. Get a roof over their heads and some housing stability, then offer the treatments and counseling that can move them toward independence. The Trump approach sees homelessness as a problem for the housed, to be addressed by hiding them from view. The Harris approach sees homelessness as a problem for the unhoused, to be addressed by finding them housing. The Trump approach was tried during the Clinton Administration and largely failed: “Housing first grew out of experimentation that followed a realization those approaches weren’t working, said Watts. One  systematic review  of 26 studies comparing the two approaches found housing first programs decreased homelessness rates by 88 percent and improved housing stability by 41 percent, compared to treatment first model...

You might think universities would be immune to the financial pressures of the non-academic marketplace. You would be wrong. Brandeis University is struggling financially, and recently fired their resident string quartet, the Lydian String Quartet* after 40 years, to save $275,000. Other universities that, unlike Brandeis, have medical schools, are also struggling with their budgets. “More light has been shed on allegations of a toxic work environment at the University of Virginia School of Medicine and UVA Health.   “About a year ago, surgeons had raised concerns that they were pressured by leadership to upcode in an effort to bring in more money, according to  The Daily Progress.   “The news outlet obtained an audio recording from a meeting last November that was attended by surgeons, the department chair, and representatives for the health system's billing and coding team.   “"You're going to get in a lot of trouble if somebody tells [a surgeon] you need...

  Now I'm reading where *former* GOP Congressmen, *former* members of Trump's cabinet and now-retiring Mitch McConnell are only now--two weeks away from the election--admitting that Trump is an awful person. Look, I'm a member of the Church of the Second Chance, but Trump has been out of office for nearly four years, and he was awful for the four years he was in office. Why the delayed epiphany? "McConnell said Trump has “done a lot of damage to our party’s image and our ability to compete.” “Trump is appealing to people who haven’t been as successful as other people and providing an excuse for that, that these more successful people have somehow … cheated and you don’t deserve to think of yourself as less successful because things haven’t been fair,” McConnell said." Too little, too late, peeps. https://thehill.com/homenews/senate/4950971-mcconnell-criticizes-trump-maga-gop/

When I was growing up, I viewed being a physician as the zenith of achievement for someone interested in science. That changed when I got to college and became interested in research. I realized I didn’t have the temperament for a physician (OK, maybe a radiologist or a pathologist) and I became a lab rat. I did make a career as a professor in a medical school department and I taught thousands of 1 st  year medical students, but I really wasn’t interested in medical practice. When I started my faculty career, there was a lot of money sloshing around at the medical school. Back then, insurance companies paid a premium for patients seen at academic tertiary hospitals and clinics. But within a decade, managed care took over and medical schools across the nation were bleeding money. My university sold its hospital to Tenet while it was still profitable. That turned out to be problematic, so eventually the bought it back and sold it to SSM, which was better aligned with the Jesuit Catho...

  I keep seeing online navel-gazers complain that they don't know what Kamala Harris stands for. I jacked this from a discussion thread over at jabberwocking.com that answers that question pretty effectively: 1. She's against illegal immigration, and pro legal immigration. Can you say the same for Trump? Because he on multiple times has waffled between being pro or against legal immigration or whether or not he'll try to deport people legally in the US. 2. She is anti-discrimination of any kind. "Woke" is the right wing boogeyman that right wingers use to refer to anything they don't like. 4. She is in favor of fair taxing. Meaning taxing more those at the top, and taxing less those at the bottom. 5.She is pro-US economic and industrial interests. Trump keeps waffling between being anti-China and promoting Chinese interests, not to mention actually having all his trinket crap made in China. 6. She is pro-freedom of religion and freedom from religion. Unlike T...

I check 538 and Princeton Election Consortium many times a day. 538 has held to a 2+ percent advantage for Harris (which is within the margin of error) for weeks, while PEC took a deep dive for Trump and only recovered to a virtual tie in the past 36 hours.   Over at Talking Points Memo, Josh Marshall highlights the evidence that right-wing pollsters have been flooding the zone. While aggregators like 538 discount “house effects,” there may be a percent or two favoring Trump that can be explained by right-wing payola. Here’s the tl;dr: “Yes, zone flooding is real. Yes, it played a big roll in the false 2022 red wave. Yes, they’re doing it again now. But it’s probably have less impact on the quality polling averages than you might think.” Read the rest here: https://talkingpointsmemo.com/edblog/are-right-wing-pollsters-flooding-the-zone

Yesterday evening, we drove to Hopkinton MA to see a performance of “A Hatful of Rain.” The play is set in 1950s New York and is about the trauma of war and the impact of opioid addiction on a broken family. As you might expect, the characters are passionate: angry, resentful, accusatory, menacing. The depictions were realistic. While there was much shouting and characters talking over each other, I had no problem following the dialog.  Some of the language was a bit dated, but that was easy to overlook in this performance. The character of the pusher* was appropriately menacing, although his two enforcers were mostly played for laughs. Celia and Johnny Pope struggle with each other and the consequences of Johnny’s addiction. Johnny’s brother Polo is simultaneously compassionate and cynical. Their father is mostly in denial and looking for someone (besides himself) to blame for Johnny’s failure. Ever since we were in college, Linda and I have enjoyed theater. Since we moved East, w...

Housing is expensive here in East Providence. It’s even more expensive in Boston, an hour from here. Some folks live in Rhode Island and commute to Boston.  Over at jabberwocking.com, Kevin Drum argues that the “housing crisis” is really a housing crisis in California. He also takes on the argument that the big barrier to building new housing isn’t red tape: “Outside of California, the evidence doesn't support the idea of either a red tape crisis or a more general housing crisis. The post-COVID scene did have some weirdness to it that we might not have fully worked through yet, but you shouldn't get panicky over a couple of years of pandemic weirdness. Nor should you overreact to media accounts of housing in California or the very hottest cities. For 90% of you, the housing market is, at most, a little warmish, nothing more.” Drum posts graphs to support his argument. This is a bit above my pay grade, and I certainly haven’t surveyed housing markets in towns and medium sized ci...

I’m reading an article about Kamala Harris in the October 21 st  New Yorker. This paragraph caught my eye: “When Harris talks of the origins of her interest in government, she lingers on a moment from her time in Montreal: a friend from Westmount High, Wanda Kagan, was being physically and sexually abused at home, and Harris’s mother took her in. “A big part of the reason I wanted to be a prosecutor was to protect people like her,” Harris has said. In subtler ways, she was coming to see government as an arena where the powerful encounter the weak, bringing either aid or harm. She observed her mother—a small, watchful immigrant—grow nervous around people in uniform.” In a democratically elected government, the collectivized power and resources of the state can overcome the resources of private wealth to act on behalf of the interests of the majority. Government can also do great harm, as in the case of the Vietnam war and the US invasion and military occupation of Iraq. Hence, the C...

I’ll preface this post by repeating something I’ve said before: social security, Medicare, public schools, public libraries, immigration, reproductive choice, sensible gun control, racial tolerance and getting the state out of the marriage business are all bedrock conservative values that are also shared by liberals. I grew up on a blue island. Oak Ridge TN was a highly educated and tolerant community when I grew up there, in a state that was pretty right-wing. Later, I moved to the People’s Republic of Chapel Hill, a blue island in the state of Jesse Helms. From there, I moved to St. Louis, a blue island in a state where the Confederate flag of treason is displayed proudly. After 40 years, we finally moved to Rhode Island, a tiny blue state, but not a blue island, since it is surrounded by blue states. I don’t have a problem with political diversity. It’s just that we don’t really have it in America today. Because of our electoral system, there can only be two stable parties. Today, t...

  I was raised Roman Catholic, but I'm not a practicing Christian. That said, I'm not blind to the marketing of Christianity, especially evangelical Christianity, in the service of right-wing politics.    To the best of my knowledge, there is no place in the Gospels where Jesus stated an opinion on abortion, homosexuality or gay marriage. Happy to be educated here, but if Christians are followers of Christ's example and Jesus was silent, so should faithful Christians be silent (or at least not claim the mantle of Christianity on those topics). In re: immigrants, Jesus was not silent, however. "I was a stranger and you welcomed me" and "Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me". So xenophobia is obviously not Christian.   Jesus did say that he who is without sin should cast the first stone, and judge not, lest you be judged. So I won't judge those who claim to be evangelicals but ignore the Bible. I...

The popular right-wing grievance is that undocumented (“illegal”) immigrants are taking all the jobs. In particular, they’re stealing jobs from US citizens. What’s the evidence? If it were true that immigrants were stealing jobs from citizens, then if you plotted labor force participation by citizens and non-citizens over time, they would have a reciprocal relationship. As non-citizen participation rose, citizen participation would fall. Over at jabberwocking,com, Kevin Drum posts the graph, and it shows that both citizen and non-citizen participation move in tandem. I don’t see any evidence for job stealing there. One problem with the job-stealing hypothesis is that it is based on the lump-of-labor fallacy. In this model, there are only a finite number of jobs in America. But that’s not how it works. When a person works, they don't just light their paycheck on fire. They use their salary to pay for goods and services; IOW, they’re creating jobs. This is true regardless of citizens...

I had an email exchange a couple days ago with Josh Marshall over at Talking Points Memo about polls (which he’s written a lot about recently) and the election betting market (which he had never mentioned). Yesterday, he used our exchange as a jumping off point to explain why he doesn’t believe the betting market is reliable and certainly no improvement over polling. The money grafs: “First of all, as I said, bets are largely made on the basis of polls. But let’s go a bit beyond that. In theory at least in equity markets you have armies of industry analysts studying industries and providing insights into the future challenges and profitability of businesses. Same in commodities, currencies, bonds, etc. Investors make investments on the basis of this and other kinds of information. To the best of my knowledge there’s really nothing like this informing political betting markets. Again, it’s mainly polls and the “analysts” who you see in the media. If we’re talking about calling most race...

Donald Trump and JD Vance are campaigning on xenophobia. There’s no evidence that immigrants are any sort of threat to America, and the data show that immigrants commit crimes at *lower* rates than American citizens. Sadly, though, fear of the other seems to work in America: “Jeffrey Balogh, a resident of Erie, said at that event that he feels strongly about Trump’s proposals on immigration. He shared that he felt uncomfortable recently when he went to rent chairs from a business and five men who spoke a foreign language were standing outside waiting for a bus. “Not one spoke a lick of English,” he said. “You see a whole different environment.” Actually, Jeffrey doesn’t know whether these men do or don’t speak English. He only knows he didn’t hear it during the brief time he was in earshot. If he heard me speak, he probably wouldn't know that I can speak some French. Look, I’ve traveled to plenty of places where I don’t speak the language—Spain, Germany, Austria, Sweden, Greece, Ru...

The old model of a single doc running a practice is disappearing in America. Between the overhead and the reduced compensation, this model of health care delivery looks increasingly anachronistic. When I started as an assistant professor at a medical school in 1987, there was a lot of money sloshing around. Patients and their insurance companies would pay a premium to be seen by docs in an academic health care practice. Managed care put an end to that, and the medical school from which I recently retired is struggling to stay in the black after many years of deficits. At the other end of the food chain are private practice docs. As America ages, more and more of their patients are on Medicare (as am I). And the government is proposing to slash Medicare payments again. The only way to weather these cuts is through joining group practices, which can achieve an economy of scale. “Will his independent practice be able to survive another Medicare payment cut? That's what Terre Haute, In...

 I’ve posted here before about herd immunity. Prior to inoculation/vaccination, herd immunity was the result of enough people dying or surviving that the transmission of the disease (plague, smallpox, etc) was arrested in that population until the next generation of uninfected people grew up, whereupon the substrate for another round of death appeared. But lets be clear: the survivors weren’t necessarily healthy. Many polio survivors spent the rest of their lives in an iron lung. Others had a permanent limp or other neurological disability. With COVID, many survivors report neurological impairments like loss of taste, brain fog, anxiety or depression, as well as respiratory issues. Recent imaging studies of the brains of early COVID survivors have pinpointed the sites in the brain that are affected: “The 31 patients included in the study had all been hospitalized with COVID-19 towards the beginning of the pandemic, before  vaccines  were available. Like many patients admi...

While I was raised Roman Catholic, I had already rejected the RCC teaching on abortion by the time I started high school. It was not grounded in Biblical teaching nor was it grounded in biological science.   Most human conceptuses never make it to term, making God the greatest abortionist of all time. And mammalian stem cells have the potential to become a complete animal in every case where it’s been tested, so destroying a “potential” human life extends to the removal of human organs and amputations. But if you want to believe that human cellular life is sacred from the moment of conception, that’s on you. Just don’t try to impose your beliefs on others, particularly in cases of life-or-death medical decisions. “When Anna Nusslock showed up at her local hospital 15 weeks pregnant and in severe pain earlier this year, she said, a doctor delivered devastating news: The twins she and her husband had so desperately wanted were not viable. Further, her own health was in danger, and sh...

Vaccines are an unalloyed triumph of public health. That Donald Trump is attacking vaccines—any vaccines—is obscene. “ . . . on at least 17 occasions this year, Trump has promised to cut funding to schools that mandate vaccines. Campaign spokespeople have previously said that pledge would apply only to schools with COVID mandates. But speeches reviewed by  KFF Health News  included no such distinction -- raising the possibility Trump would also target vaccination rules for common, potentially lethal childhood diseases like polio and measles. “The Trump campaign did not respond to requests for comment on this article. Trump has presided over a landslide shift in his party's views on vaccines, reflected this campaign season in false claims by Republican candidates during the primaries and puzzling conspiracies from prominent conservative voices. Republicans increasingly express worry about the risks of vaccines. A September 2023 from  Politico  and Morning Co...

Last year, mRNA vaccines won the Nobel Prize in Physiology or Medicine. This morning found RNA once again the recipient of the Nobel Prize in Physiology or Medicine.  By the time I finished college, RNA was familiar to me as a family of biopolymers that together specified the manufacture of proteins in cells. Ribosomal RNA made up the platform and enzyme that performed the assembly of amino acids into proteins. Transfer RNAs were the small adapter molecules that brought each amino acid to the assembly plant. Messenger RNAs were the blueprint used to specify the order in which chains of amino acids were assembled into proteins. Importantly, the messenger RNAs in different cells dictated the properties of each cell, analogous to the combination of apps you’re running on your laptop dictates the tasks you can perform on it. During my scientific career, I witnessed the discovery of how messenger RNA from a single gene can be cut up and the pieces pasted together in different combinatio...

From Prof. Timothy Snyder's substack "Thinking about..." Shared with permission: "Think about the politicians Trump idolizes, Vladimir Putin in Russia and Viktor Orbán in Hungary. The first undid a democracy through fake emergencies, the second through persistent constitutional abuse. It is not hard to see why Trump likes them. "Now consider the Russian and Hungarian economies. Russia sits on hugely valuable natural resources, and yet is a poor country. The profits from its oil and gas are in the hands of a few oligarchs. Hungary sits in the middle of the European Union, the most successful trade project of all time. And yet Hungarians are poorer than their neighbors, in part because the Orbán regime corruptly channels EU resources to friendly oligarchs. "The lesson is clear. Democracy is a method of checking corrupt rulers. When there is no functioning democracy, corruption is unchecked. "And democracy is an element of a more fundamental guarantor of ...

High fructose corn syrup (HFCS) is everywhere—salad dressings, catsup, carbonated beverages. Fructose is sweeter, per unit mass, than cane sugar (sucrose), and apparently keeps better, so is a favored sweetener by the food industry. Unlike glucose, fructose in converted to free fatty acid in the liver and thus can contribute to hyperlipidemia, diabetes and heart disease. So stay away from fructose, right? Well, I’ve avoided high fructose corn syrup mostly because ever since I stopped eating desserts, my taste for sweet flavor has become more acute and I favor savory foods over sweet foods. But is my aversion to HFCS-containing foods also healthier? “. . . is HFCS  more  of a health risk than other sweeteners? Many of the sources that demonize HFCS list alternative sweeteners — cane sugar, honey, agave syrup, etc. — that they claim are healthier than HFCS, but those claims usually rest primarily on the fact that these alternatives to HFCS are “natural” rather than any actual da...

I was married by the time I started graduate school. I suspect that being in a committed relationship, and in particular with someone who was also a grad student, kept me centered during the stressful times. Perhaps these were different times, but a recent study shows that today’s PhD students are struggling with mental health issues: “The researchers compared the rate at which PhD students, people with master’s degrees and a sample of the general population accessed mental-health services. Before starting a PhD, students and people with master’s degrees used these services at similar rates. But use of psychiatric medicines, such as antidepressants and sedatives, increased among PhD students year-on-year during their studies. This peaked in the fourth and fifth years — the average length of a PhD programme in most countries — then fell in the sixth and seventh years. “Those at highest risk of being prescribed psychiatric medication during PhD studies were women and people who’d taken s...

The recurring bleat of vaccine denialists is that COVID should be addressed through “herd immunity.” Well, OK, a vaccinated population has herd immunity, but that’s not what they mean. They mean herd immunity in the sense of the Black Plague—the people who didn’t die were immune. Apart from all the deaths caused by COVID infections in unvaccinated people, there’s the issue of long COVID. While its etiology is poorly understood, its reality is certain. Vaccination not only keeps you out of the ED and the morgue, it also reduces your chances of long COVID. For victims of long COVID, there isn’t a cure, but there may be some relief: “In September 2021, Systrom was among the first clinicians in the nation to demonstrate a measurable change in the physiology of patients suffering from long COVID — and explain how those changes might account for the crushing fatigue that is among its most debilitating symptoms. The study helped establish long COVID as a legitimate condition and overcome the ...

I just finished reading “The Achilles Trap: Saddam Hussein, the C.I.A., and the Origins of America's Invasion of Iraq” by Steve Coll. By the onset of the US invasion and military occupation, I was convinced that (a) Iraq had no WMDs or active WMD programs, and (b) there was no collusion between Saddam and al Qaeda.  The idea that Osama bin Laden and Saddam Hussein were allies was facially absurd. Bin Laden was a religious zealot and Hussein was a secular dictator. They were enemies, not allies. And after years of searching, there was not an atom of evidence for Iraqi WMDs or WMD programs after the year 2000. Yet to the Clinton and Bush administrations, absence of evidence simply proved Saddam was hiding them. Coll confirms this, of course, and brings the receipts. So why did I read this book? Mostly to gain insight into Saddam Hussein and his behavior. To cut to the chase, Hussein was smart but paranoid and insular. After his failed invasion of Kuwait, he destroyed his WMD programs...

  The existential threat to humanity in this century is climate change. It is estimated that upwards of half a billion people will be displaced by flooding, fires and desertification due to global warming.  But such frightening predictions are based on climate modeling. How reliable are these models? It turns out, remarkably reliable: “Climate change doubters have a favorite target: climate models. They claim that computer simulations conducted decades ago didn’t accurately predict current warming, so the public should be wary of the predictive power of newer models. Now, the most sweeping evaluation of these older models—some half a century old—shows most of them were indeed accurate.”   *snip*   “The researchers compared annual average surface temperatures across the globe to the surface temperatures predicted in 17 forecasts. Those predictions were drawn from 14 separate computer models released between 1970 and 2001. In some cases, the studies and their computer ...