Adoption Paradox

Wading through all the bureaucracy around adoption for the THIRD time....( Hoping the third time is the charm.)...it occurs to me that international adoption has created a paradoxical situation. We have only increased child trafficking by trying to prevent it.

The supposed intentions of those who have increased regulations on adoption to the point where it takes $40,000 just to have a chance was to cut down on trafficking. More and more roadblocks were put into place. Something had to stop the international parade of third world exploitation. Adoptions used to be a moving cycle. Western parents to be heard of a place where it was easily possible, and all ran there creating  lots of demand. The demand then pushed up the supply of children as middlemen did everything including stealing children to sell them to orphanages. Poor people in various third world countries had discovered roles along the cycle like running an orphanage could be highly profitable. Eventually things got completely out of hand, and a country would have to be shut down to international adoption.

The idea that more bureaucrats checking every step of the process would cure this mess was naive. What I feel it has actually created is institutionalized corruption as well as entirely new levels of straight up corruption. I'm sick of a system I feel was built only to shake me down...where the safety of children is not even a primary concern....

My Israel, My Israelis

After quite a process (OK, let's be honest a never ending vikuach...) I am going for an interview with a Zionist organization tomorrow for the purposes of my Aliya (Jewish immigration to Israel).

I am quite aware of all the politics around Israel, but all I can think of is my friends. How much I miss them. The Israel I love is not a totally individualistic society like the USA. We are a collective society to some extent. If you live this every day it's hard to see, but we bring a new meaning to the word nation. I miss my friends so much...Argoye, Dani, Michelle, Eyal, Miki, Yoni, Sandra, Leem, Adele, Tamir and even you angry Ori and many more... for me you are Israel. And I hope soon my paperwork gets the final stamps, and I will be finally officially Israel too.

It's hard for Americans to imagine the togetherness of Israelis. Even Americans in Israel question me about why I don't just want to make more $$ in the US. I was actually offered a nice position in a hospital here...but I turned it down. There is always the question with any decision of what you are giving up. I would never give up you, haverim Israelim. It's also hard for Israelis to understand the level of love I feel for Israel from the green and blue of the Galilee/Ha Galil to the skyscrapers of Tel Aviv to the deserts  to the Hot beaches of Eilat. Paradoxically sometimes for people not born in Israel our nation and land are even more important to us. It sounds crazy, but I think I'm going to be one of those olim who drops and kisses the ground. But even more important to me than the land are my friends. I can't wait to see all of you. I may email my flight info....I'm not sure I'll be going on a typical Aliya flight or what. I sort of imagine myself getting off the plane either coming in a group being surrounded by all that flag waving and being weirded out or if I come alone feeling isolated. But one thing is for sure, I want to see you soon!

If anyone happens to have the time to meet me....Yalla! Give me 5 seconds to kiss the ground, and then we can dance because I'm coming home!

Race Together

Starbucks tried to start a campaign called Race Together or #RaceTogether. I'm a highly critical and cynical person, but I actually think their corporate heart was in the right place. If ever there has been a time to discuss race and racism everywhere it is now. After decades of progress, we suddenly seem to be backsliding. After the fall of Apartheid in South Africa, it seemed the world had finally kissed a race discrimination based system goodbye. Hundreds of years of struggle including people as famous as Sojourner Truth to people as as inconsequential as myself was coming to an end. Or so we thought...but consider what has happened in just the last few months all over the "civilized" world.

In the USA: Ferguson, MO in 2015 has become metanymic of  the American legal system that devalues black bodies while simultaneously using them for profit through endless fines over pointless minor infractions

In France: the targeting of Jews for terrorist attacks

In Israel: Race baiting used by Bibi Netanyahu against Arab-Israeli citizens for of all things VOTING

Racism is a given phenomenon in many places in the world, but in our modern world we have not succeeded in erasing it. Indeed we have in some cases amplified even the most violent and dehumanizing consequences of racism due to our tremendous efficiency and technological capabilities.

Perhaps it is a bit racist of me to say this, but I don't think most white Americans realize the extent to which racism colors the lives of nonwhites. Most live in a bubble where issues of race are pure abstractions. If statistics are to be believed most white people in the USA don't even have a nonwhite friend...in a country where nonwhites make up about 40% of the total population...it doesn't take a sociologist to look at those numbers and realize we have some race issues. It might take a sociologist or historian to explain the totality of racism's meaning for certain groups like Native Americans or African Americans...Nonetheless, I think any effort, no matter how simplistic and naive, to move us forward must be applauded. Because what are really the alternative in the US? Moving closer and closer to an all out race war? Staying stuck in a system most of us know is deeply unjust if we are presented with the facts about it? Very few of us want that...I hope.

Feminist Fantasy World: Abortion Rights

I am extremely uncomfortable with the ever increasing enshrinement into the law in otherwise progressive countries, European ones, of abortion as a right. Perhaps abortion should be a right in some moral schemas...but the logic around such an idea is questionable.

We, women already have a legal right to say no to sex even to our husbands. I believe this right to say no is essential to our well being. But in my mind saying we have a right to abortion in all cases on someone else's bill is sort of like saying we have a right to liposuction but worse. Just like when you eat ice cream with every meal you risk getting fat, if you have full on penis in the the vagina sex you risk getting pregnant. And it isn't as if this kind of sex just unexpectedly happens so quickly you don't know what hit you. Unless you live in a nudist camp, you have to at least decide to get your clothes off which takes a few seconds. When you decide to use contraception you know full well that there is a risk of contraception failure...

The only real argument I see made for this supposed right to abortion is gender equality...but gender equality is some abstract goal no one would understand anyways. We are born biologically different. Men don't have a right to breastfeed or easily experience multiple orgasms...

There are at least a few ideologically dangerous ideas that come with the 'right to an abortion.' One is that it is normal for a woman to be so weak and unempowered in her relations to men that she can't say no to sex...so she needs abortions to manage her life. If this is the case for women, we need a revolution, not just abortion clinics. Another idea tied up in abortions is that a woman can schedule the pregnancies in her life with ease, which is leading to more and more abuse of women in the workplace...for further commentary check out the soon to be published book White Coats, Black Lies.

Everyone is an editor...NOT!

I never edit this blog....it's just my personal rambling...

I have worked as an academic editor, and it usually takes me about an hour to finish three pages. I am meticulous when I am getting paid. I also add additional references and ideas. I have two degrees, and I use them...

As I have been dealing with different editors for my book, I am reminded of the time years ago I paid good money to have my resume translated to Hebrew. I got the resume back, and found errors in it. I confronted the translator, and she admitted I was right about the errors. She changed them immediately. She had taken over a week to produce something I could have made myself with Google translate. I was angry, extremely angry.

As I deal with editors I am finding they don't know basics, and can't follow instructions. I'm talking BASICS, like italicize or put quotations around a book title...put a page of a book all in the same font and size....These people often claim to have degrees, but I couldn't have passed high school if I edited my own writing this badly. OK, OK...so I went to one of the top high schools in the country, but still...WTF! Money seems to be no good barometer of quality...because everyone I have paid, regardless of the amount, totally sucks.

I found out about one good editor from a friend...but she is too busy to do any work this month...what I really want to know is whether these bad editors know they are scammers. Do they actually think they are worth anything. Is this how Americans all operate, imagining that they are brilliant when they can't even fix spelling mistakes?

For the sake of anyone looking for an editor I want to include some reviews of lousy editors I have dealt with...but I can't even do that without fear of getting into a lawsuit. I feel that every last thing in America besides expensive yogurt and lettuce is a scam in one form or another. I'm going to go into a cave and edit my own work...

Angry at the World's Science Reporters

For not understanding evidence based medicine.

I recently got into an online debate with some anti-vaxxers. What makes me so angry is not which side of the argument people take, but their total noncomprehension of biostatistics. People have no idea what it means to prove something scientifically. I'm going to put in an excerpt from Chapter 3 of my book. May a science journalist please read it and stop publishing nonsense....

A touch of statistical thinking is all you need to know to see through the nonsense of many articles that incorrectly misuse statistics and research. A real statistician might find my hints about statistics criminal in oversimplification. But the truth is plenty of doctors can barely do statistics. If you train at a top tier medical school there will be a heavy emphasis on research. Lower tier medical schools tend to work as if they were going to create clinicians only. I think this pattern is wrong on many levels. I do not think a medical doctor should have to add research to their career beyond training; however you really only learn to understand by doing in many cases. When I left Penn I went to Technion because of its emphasis on research. The amount of new material in medicine grows exponentially. There are now always over a hundred new studies in any given field coming out. Any good doctor who stays good past medical school has a few specific characteristics. One is the ability to comprehend and weigh new research. In the American system new research cannot change the way you practice medicine. In the US every doctor dreads being hauled into court. At that point you are going to prey whatever you did was in line with the guidelines for your specialty. But what about those of us who want to do more, to give our patients the very, very best medicine has to offer. When you have exhausted everything within the guidelines, the treatments that might work are experimental. But knowing what works and what is oh so much pharm company deception is a matter or understanding statistics.

  Let’s start with the big picture. What is science? Science is the best method humanity has developed to understand reality. Science is a process, not a group of static facts. Science as a field is a sort of competition to see who can get the truth about any given reality. The referee in the competition is always statistics. Statistical analysis is central to the process of all sciences. The process of science can be distilled to a sequence. Here it is: the science six step:

1. Observe stuff
2. Make some ideas about why things work the way they do
3. Refine these ideas into stuff you can actually test (hypotheses)
4. Examine the existing evidence for your hypotheses
5. If there is not enough evidence to draw firm conclusions, do some experiments
6. Evaluate the data already existing and possibly data from your experiments 

 So there you have it. It doesn’t really matter that much whether we are talking about something as esoteric as quantum mechanics or something as banal as biology. Science is the same. The process is universal. Ultimately it’s hard to know what reality is, but you can very easily figure out what it isn’t. If you understand the mistakes people make in the statistical analyses of studies, you can see through a lot of nonsense. People, and even a lot of scientists, usually trip on step number six in my schema of science. To evaluate data you need statistical analysis. But a really good scientist is using statistical knowledge from at least step four forward.

Not everyone needs to or should work as a scientist. The world could probably get along without us easier than it could get along without farmers. Our lives are enhanced by the millions of people who are not scientists. Artists, cake bakers, well diggers and so on are all contributing a lot to society. The problem is that all these people, and even their leadership frequently misunderstand science. Those we have trusted to interpret science for them, often journalists with limited training in science, often misrepresent it and its results. I think none of this is going to stop anytime soon due to the poor state of education in the USA. Fortunately with a little training even a well digger can see through the nonsense that flies into print. Many science articles are full of mistakes.  

The three most useful to understand mistakes in scientific studies in my opinion are selection bias, recall bias and what I call underpowering. If you can understand these three concepts, the next time someone points out something to like the fact that her grandmother and mother both conceived past forty as proof that you have nothing to worry about at 35, you will be able to cut them down to size and tell them about reality.

A recent example of bad research I saw was an article a friend posted to Facebook. The article claimed proof that nonvaccinated children were healthier than vaccinated ones. All participants were children of parents in a parenting group dedicated to not vaccinating their children. If you have training in statistics at all you can see what a scientific train wreck the article was already, and you may want to skip the explanation in the next paragraph.

The article is a perfect example of a lot of problems. Selection bias: is a group of parents in an anti-vaccine group representative of the general population? What is half of them got thereafter kid number one got an illness they linked in their mind to vaccination? Recall bias: In recording disease and health people don’t recall things exactly the way they were. The classic example is the mothers of deformed babies. They remember themselves as having taken medicines during pregnancy, and wonder if they made the wrong choice. The truth is most women take some medicine during pregnancy. Most women who get normal kids tend to forget they took something. The woman with the formed baby will sit there and guilt trip herself out over every time she even looked at acetaminophen. We see what we want to see, or sometimes don’t want to see, when we look back. The parents in the study my friend posted to facebook recorded their children’s diseases. If they had a preconceived notion that their unvaccinated kid was always healthy, they may have forgotten a few illnesses. Finally the article was weak because it was not powered to prove anything to begin with. Power, in terms of a study, could be thought of as the ability to proclaim the conclusions of the study scientifically true. Power is, to be precise, the probability that the study will correctly lead to the rejection of the false null hypothesis. The null hypothesis is that the conclusion asserted was not true. A study gets more power based on the sample size. The size of an effect also effects power, but for a study like this one on vaccines the main power issue was sample size. The next time someone tells you about one case of something happening as proof, think of it as a study of one single subject. How much power does a study of one single subject have? Very, very little; essentially none. The next time someone makes a scientific assertion about a whole population to you based on one single case rest assured that it proves not much except that whoever told it to you doesn’t understand science.

I am passionate about science. But we don’t need scientific studies to tell us everything. Many things are obvious. For example , we don’t need a scientific study to tell us that women between 60 and 70 don’t get pregnant naturally. It’s obvious. Nonetheless many bad scientists try to sneak claims nearly as outrageous into the literature.  I feel we would all be better off if we all learned biostatistics; but realistically it won’t happen. To help dispel any future myths produced in the future by bad scientists and uninformed science writers I am including a checklist to evaluate supposedly scientific claims on fertility.

1.       What are the author’s scientific credentials? Circle one: an MD or DO; a PhD; an MPH or MS in biostatistics; this author has no known scientific credentials

Anyone can write something that is correct, but if the author is not trained in biostatistics it is highly likely he or she might unknowingly misrepresent the situation. On the other hand plenty of PhDs make science mistakes. Just having a degree behind your name does not prove much.

2.       Is the author’s claim in line with what we see in reality?

Extraordinary claims require extraordinary evidence. The more outlandish a claim is the more proof it should require. If someone claims most women can give birth after menopause if they simply take vitamins, you would want to see the highest levels of scientific proof for such a claim. In this case the highest level of proof would be several studies including a blinded randomized controlled trial on many subjects.

3.       If there is a study cited, does the study have enough subjects?

Single case reports, or case series prove very little. Any one person can be an anomalie. Generally speaking reliable trials include hundreds of subjects. If someone tells you about a study with 5 people, it could be interesting; but it couldn’t be powered to prove much almost by definition.

4.       Was the study published in a reputable journal?

There are plenty of nonsense journals which will publish anything. And with the advent of the internet anything is publishable. The peer review process is not perfect, but like democracy, it’s basically the best system we have come up with until this point. If the study was published in a very disreputable journal, beware!

5.       Are the studies author’s funded in such a way that they have a financial interest in proving a certain point?

It is possible that an author does a great study and just happens to prove whatever point the pharm company paying him wants proven because it is true. On the other hand it happens too often to be a chance occurance. Dr. Ben Goldacre has written about such phenomenon extensively. For lots of good highly readable information about the pitfalls of bad science he can’t be beat.

 And there...please read me all you idiot science writers who write articles like "Study of Three Infants PROVES vaccines cause measles"!