NY Times Misinformation on Strokes

A NY Times article on strokes that was very misleading:

Until two months ago, Todd McGee, 34, was a healthy man in top physical condition — a builder, surfer and devoted father of a 15-month-old. The last person anyone would expect to have a stroke.

Yet a stroke has left him nearly unable to speak, with months, maybe years, of therapy ahead. Partly because of his age and partly because of the lack of a hospital with an M.R.I. machine where he lives, no one recognized the symptoms of a stroke until it was too late to administer a treatment that could have limited the damage and speeded his recovery.

This treatment, with a drug called t-PA (for tissue plasminogen activator), can help dissolve a brain-damaging clot in the 80 percent of victims who have strokes caused by them. But it must be administered within three hours of a stroke to be effective, and the sooner the better.

About only one stroke victim in five who could benefit from t-PA receives it, primarily because people don’t realize a stroke is happening and wait too long to get to the hospital.

* * *

Dr. Joseph Broderick, chairman of neurology at the University of Cincinnati Medical Center, said that in people under 50, trauma — often relatively minor trauma — to the carotid artery that feeds the brain is the main cause of stroke. Such trauma can occur as a result of a whiplash injury in a car accident, for example, or leaning back over the sink in the beauty salon or getting chiropractic manipulation of the neck, he said.

* * *

In reviewing Mr. McGee’s symptoms, it is easy to see why he, his partner and hospital personnel missed the cause of the problems. His first symptom was severe vomiting, which he thought was from the same “bug” that had afflicted his partner, Sue, and their daughter two days earlier. Then he got a headache, and not just any headache — “by far the very worst headache in my life,” he told Sue, who said he yelped at every bump in the road on the way to the hospital, where he was given an unrevealing CT scan and a potent painkiller and sent home.

Next, during a phone conversation, Mr. McGee began slurring his words, which he thought was a reaction to the medication. But soon after, the right side of his body went numb and he could not hold up his right arm. He went back to the hospital, where medical staff suggested that the numbness might be related to the headache, but considered it serious enough to transfer him to a major medical center.

Two days after the first signs of trouble, Mr. McGee’s problem was finally diagnosed as a major stroke, resulting from two clots caused by damage to the carotid artery, most likely from repeated trauma during surfing.

I sent the following letter to the NY Times in response:


To the Editor:

A recent article ("With Strokes, Knowledge is a Lifesaver," Dec. 12, 2006) claimed that people often fail to recognize the symptoms of a stroke, and thus fail to receive a certain clotbuster drug ("tissue plasminogen activator," or TPA) that potentially can break up blood clots in the brain if administered within a few hours of a stroke. In fact, TPA can be helpful in some circumstances, but in others it can be deadly.

For instance, the article's chief example of a stroke victim was a 34-year-old man who had an injury to the carotid artery. As it happens, I had the exact same type of stroke 3 years ago at age 29, but when I asked a stroke specialist (the late Hal Unwin) whether I should have received TPA, he emphatically said, "No. TPA is absolutely contraindicated in cases of dissection." This is because a dissection is an injury to an arterial wall, and there is a risk of hemorrhaging if the injury worsens. In the event of a hemorrhage, the last thing you want in your system is a drug that prevents blood clotting.

Sincerely,
Stuart Buck



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Sixth Circuit case

A Sixth Circuit decision came out yesterday -- on a very quick timeline -- reversing a district court decision to allow the University of Michigan, the Governor, and pro-affirmative action plaintiffs to stipulate to a federal court injunction blocking the enforcement of the Michigan constitutional ban on racial preferences. A nice line about the bizarre argument that the First Amendment somehow protects state entities from having to obey the state constitution:

The Universities mistake interests grounded in the First Amendment—including their interests in selecting student bodies—with First Amendment rights. It is not clear, for example, how the Universities, as subordinate organs of the State, have First Amendment rights against the State or its voters. See, e.g., Trustees of Dartmouth College v. Woodward, 17 U.S. 518, 629 (1819). One does not generally think of the First Amendment as protecting the State from the people but the other way around—of the Amendment protecting individuals from the State.

Also, I was very surprised to see that the federal district court had actually enjoined a state constitutional provision based solely on a stipulation, without even bothering to identify any federal issue in the case (let alone going through the usual 4-part analysis as to injunctive relief). Whatever you think of the merits of affirmative action, it is a very bad idea for plaintiffs to be able to "sue" a friendly politician, and then collude in a stipulation that allows a federal court to override state law based on nothing. As a lawyer, I cannot imagine a circumstance in which I would ask a federal court to do such a ridiculous thing.

Anonymous Sperm Donation

An interesting article: "My Father Was an Anonymous Sperm Donor:

I was angry at the idea that where donor conception is concerned, everyone focuses on the "parents" -- the adults who can make choices about their own lives. The recipient gets sympathy for wanting to have a child. The donor gets a guarantee of anonymity and absolution from any responsibility for the offspring of his "donation." As long as these adults are happy, then donor conception is a success, right?

Not so. The children born of these transactions are people, too. Those of us in the first documented generation of donor babies -- conceived in the late 1980s and early '90s, when sperm banks became more common and donor insemination began to flourish -- are coming of age, and we have something to say.

I'm here to tell you that emotionally, many of us are not keeping up. We didn't ask to be born into this situation, with its limitations and confusion. It's hypocritical of parents and medical professionals to assume that biological roots won't matter to the "products" of the cryobanks' service, when the longing for a biological relationship is what brings customers to the banks in the first place.

We offspring are recognizing the right that was stripped from us at birth -- the right to know who both our parents are.

And we're ready to reclaim it.

As Elizabeth Marquardt recently pointed out with regard to another donor sperm story:

Of course, the fact that all these half-siblings, and who knows how many more, were conceived in and mostly growing up in Colorado, and are now teenagers, and it’s completely up to their parents and the clinics whether to tell them the truth, and they will soon begin dating and might find that cute guy or girl who seems so *familiar* somehow really attractive . . . that fact alone — that we are intentionally setting up a generation of young people who could unknowingly sleep with a half-sibling — should be setting off alarm bells everywhere.

A good idea would be to require that all sperm donors: 1) consent to the release of their names and contact information; 2) keep their contact information updated at all times; and 3) agree to provide child support for any child conceived using their donated sperm. Of course, these requirements (particularly #3) would stop anonymous sperm donation dead in its tracks, which would be the point. Why should the law make it easy for men to conceive children (potentially with dozens of women) for whom they bear no responsibility?

Certain quotations in this NY Times article struck me as odd:

Historically, scientific journals have published only positive results — data showing one thing connected to another (like smoking to cancer). As a rule, they didn’t publish negative results (this drug didn’t cure that disease). Medical journals began publishing negative results a few years ago, but social science didn’t follow the trend. This is a problem. Not publishing negative results means that generations of researchers can waste time and money repeating the same studies and finding the same unpublishable results.

Then there’s publication bias. If, for example, a study found that welfare states have more terrorism than nonwelfare states, it would probably get published. If eight studies didn’t find a connection between welfare and terrorism, they probably wouldn’t make it into print, because technically, they didn’t find anything. So a survey of published literature might suggest that welfare and terrorism are linked, even though eight studies potentially proved otherwise. This could have serious implications.

“Social-science research results lead to huge, important decisions,” Lehrer says, about free trade, for example, or government spending on weapons. “That should require total transparency.” But since no one publishes negative results, Lehrer says, those important decisions are sometimes based on biased information. And there are data supporting his theory: early this year, a study found that the leading political-science journals are “misleading and inaccurate due to publication bias.”

“Everything we think we know may be wrong,” Lehrer says. “The correct results could be sitting in people’s file drawers because they can’t get them published.”

Why? J. David Singer, emeritus professor of world politics at the University of Michigan, says: “Folks in my generation are much too rigid, which means we can’t benefit from a nice piece of research that looks like it tells us nothing. These young social scientists are right to insist we start publishing negative results. Until we do, we’re just throwing away useful information."

No one publishes negative results? I don't think this is true. Take the example: Does welfare cause terrorism? If someone came out with a study purporting to show that welfare causes terrorism, I have no doubt that, far from suppressing the opposite result, there would be scores of social scientists and journals who would be highly motivated to publish studies showing that there is no relationship.

In the field of education, for example, there are all kinds of studies purporting to show that there is no relationship between school achievement and pretty much anything that you can name -- desegregation, charter schools, class size reductions, vouchers, No Child Left Behind, testing in general, academic tracking, bilingual education, school spending, neighborhood effects, teacher certification, and more. (I could cite studies for each of these points.) If someone came up with a solid study showing that there was no relationship between poverty and school achievement, that study would certainly be published, because it would be so provocative and interesting. It wouldn't be squelched on the theory that it was a mere "negative result."

The same seems to be true elsewhere. Social scientists are constantly coming out with studies purporting to show that there is no relationship between daycare and childhood aggression, or between divorce and adult wellbeing, or the rise of the welfare state and illegitimacy, or abstinence education and actual absinence, or the minimum wage and unemployment. Name any controverted subject in the social sciences, and you are almost guaranteed to find at least one study showing that there is no correlation between A and B.

All of that said, it is true that a lot of "negative results" wouldn't be published, but only because there's no reason to suspect a relationship in the first place. To return to education, it's interesting to find out that (according to some studies) funding may not have much effect on student achievement, precisely because the opposite is so often asserted. But no one would be interested in a study discussing any of the nearly infinite number of facts in the universe that never would have been expected have any relationship to school achievement in the first place (i.e., levels of sunspots; the presence of El Nino; number of frogs per capita in the community; etc., etc., etc.).

Similarly, in the hard sciences, I would imagine that medical journals are not interested in publishing 10,000 studies discussing all of the 10,000 substances that don't cure cancer (cayenne pepper, gravel, cranberry juice blended with apple juice, etc.). But they definitely are interested in studies showing, for example, that the combination of Plavix and aspirin often isn't effective in preventing heart attacks and strokes (as had previously been thought).

The interesting question is where to draw the line: Is a negative result worthwhile (because it disproves a relationship that was within the realm of suspectability), or not worthwhile (because it is too obvious)? Maybe there are various disciplines that draw that line too restrictively, but it's not true that "no one publishes negative results."

Supreme Court case`

As I predicted, the Supreme Court's "button in the courtroom" case was a quick-and-easy (and unanimous) reversal of a Judge Reinhardt opinion that had held that a defendant had been deprived of a fair trial due to the fact that the murder victim's brother wore a button with the victim's picture on it. In a brief 3.5 pages, Justice Thomas's majority opinion makes quick work of Reinhardt's conclusion that, by allowing the defendant's brother to wear the button, the state courts had violated clearly established federal constitutional law.

Apocalypto

It's rather rare that I get the chance to see a movie, but I just saw Apocalypto this afternoon. On the level of an action film, I'd rank it up there with Diehard as among the best that I've ever seen. Also, I share Daniel Larison's utter bafflement that so many reviewers are complaining about the "violence":

Unfortunately, all the critics have done Apocalypto a grave disservice in their emphasis on its supposedly overwhelming violence. This aspect of the film has been talked up so much that it almost convinced me, sight unseen, to not see it because the way people were describing it I came away with the impression that this was going to be something like the Chichen Itza Chainsaw Massacre. It was nothing like that, and not anywhere even close. In the last decade, we have been treated to a number of non-horror films (and undoubtedly piles of horror movies) that far exceed Apocalypto in brutality, gore and general bloodletting.

Exactly. If I had time, it would be interesting to look at the specific reviewers that have complained about the violence in this film, and look back to see if they were even more upset about the average horror film, or Pulp Fiction, or Natural Born Killers, or Audition, or any of probably a hundred other films one could name. (The scene where someone's heart is ripped out of his chest -- as part of ritual human sacrifice -- was actually less graphic than the scene in Dumb and Dumber, where Jim Carrey's character fantasizes about ripping out someone's heart to impress his would-be girlfriend. How many people complained about the violence in that movie?)

I suspect that complaints about "violence" are disingenuous. A lot of reviewers probably would really like to be able to say, "Mel Gibson is a bad person, and so you shouldn't see his movie." But that looks too much like blacklisting (supposedly not a good thing in Hollywood), and there are a lot of other good films that were made by people with personal demons. Another option is for the reviewer to say, "Don't see this, because it just isn't a well-done film." But that clearly isn't true. So the only thing left for the reviewer to say is, "Oh my, heavens to Betsy, I'm so shocked to see all of this violence."


On a deeper level, the theme of one of civilizational hubris: The good guys in the film are those who live in a simple village, minding their own business, spending their time with family and friends. The bad guys are from a large Mayan city that has laid waste to large areas around it, that sends out marauders to kill and capture people in other villages, and that seems to be ruled in part by a priest-figure who stirs up a false sense of patriotism by telling the crowds of people that their civilization is the highest achievement of man.

In fact, Gibson and his co-writer already mentioned the modern parallel to Time magazine earlier this year:

"The parallels between the environmental imbalance and corruption of values that doomed the Maya and what's happening to our own civilization are eerie," says Safinia. Gibson, who insists ideology matters less to him than stories of "penitential hardship" like his Oscar-winning Braveheart, puts it more bluntly: "The fearmongering we depict in this film reminds me a little of President Bush and his guys."

It will be interesting to see the reaction to this movie from all sides.

Go see it.

Blog Marketing

Marketing to bloggers is apparently popular -- but a bit dangerous as well. If you're going to market something to bloggers, it might be a good idea to have a clue as to what the blogger's interests are. For instance, the publishing marketer who asked me if I wanted a copy of Freakonomics a while back: genius.

The marketer who just sent me this email: Not so genius:

Hi,

I'm contacting you on behalf of Sears and M80 regarding Luke and Laura's 25th anniversary commemorative ring. I found your Steve Burton blog entry http://stuartbuck.blogspot.com/2006/08/healthcare-costs.html and think you might be of some help to me. Since you blogged about Steve Burton, I was hoping you might find the Luke and Laura 25th anniversary commemorative ring, or something related to it, blogworthy. I would be happy to send you some Luke & Laura merchandise as a thank you for your help or for you to blog about. I have a lot of different types of merch available, so we can discuss what works best for you.

If you’d like to help out, or would like more information, please let me know and I’ll be in touch soon!

Thanks!

I had no idea what this guy was talking about. So I did a search for "Luke and Laura 25th anniversary commemorative ring," and it turns out that it has something to do with the soap opera General Hospital.

Good plan there, fellas, sending spam to a blogger who cancelled his cable TV subscription urging him to use his blog to hawk kitschy items related to a soap opera.

Maybe they have some sort of automated harvesting program that scours blogs, and this program assumed that because I used the term "healthcare" I'd be interested in "General Hospital." Not true.

Supreme Court case

An odd question from Justice Breyer in the Kentucky school desegregation case:

Here we have a society, black and white, who elect school board members who together have voted to have this form of integration. Why, given that change in society, which is a good one, how can the Constitution be interpreted in a way that would require us, the judges, to go in and make them take the black children out of the school?

I don't see any sense in which anyone asked the Court to "make them take the black children out of the school." In fact, the petitioner's lawyer in the Kentucky case specifically noted that "[t]here were seats within the school. It wasn't at capacity. It wasn't near any one of the percentages or tipping percentages that the quota system in Jefferson County public schools applied. But she was not allowed in." Assuming that this is true, the white plaintiff could have been let into the school without displacing any black children whatsoever.

And as to the future, the school would not be "tak[ing]" any "black children out of the school," or white children, for that matter. It would presumably be able to keep the same student body, but as for future admittees, it would merely have to run a different admissions process without using race as a factor.

Also note that in the companion Seattle case, the record showed that not only white students, but also 89 non-white students were denied admission to their first-choice school on racial grounds. One could thus describe the school board's policy as keeping blacks "out of the school," i.e., out of their first-choice school.

The same could be said of Louisville's policy. Consider this recent news story:

Deborah Stallworth and her son, Austin Johnson, 15, stand in front of Central High School Monday, Nov. 27, 2006, in Louisville, Ky., where he's a sophomore. Stallworth was unhappy when her son was initially denied admittance to his neighborhood school and instead assigned to a school across Louisville that would have required "busing my baby halfway to Timbuktu," as she recalls it.

Again, it seems very odd to describe the plaintiffs as trying to "make them take the black children out of the school." The current policies already do that, to some extent. What the plaintiffs in both cases seek is a race-neutral policy -- and this would mean that more white and black children would get to attend their first-choice school. Whether that's a good thing depends on whether you think personal choice is more or less important than integration.

American Accents

I love American accents of all types. Absolutely love ‘em. Which is why I was delighted to find this website from George Mason University: the Speech Accent Archive. They have recorded a wide variety of Americans reading the same paragraph, so that you can get a flavor of different regional accents.

Some observations:

1. The guy from Connecticut sounds exactly like the sort of person who reads a personal essay on NPR.

2. The person from Beaumont, Texas sounds typical of a Texan. And I love the accent of the elderly woman from Arkansas; reminds me of my grandparents’ generation.

But some of the examples seem atypical, as if the person being recorded is trying to suppress an accent, or as if the person simply didn’t have a typical accent in the first place. Consider the samples from New Orleans, or Atlanta, or Alabama -- I’ve heard much stronger accents from all of those places.

If you want to hear a really strong Alabama country accent, check out the actor Lucas Black, who as a child starred in Sling Blade and the TV show American Gothic. (A great sample from Sling Blade is the 2.14 Mb clip available here.) At the same time, I’ve known upper middle class folks from Alabama who also had a heavy accent, but more genteel-sounding. I don’t really hear much of either accent in the website’s clip from Alabama.

As for Georgia, the researchers really need to get some clips from some of the country folk who grew up in farming towns in south Georgia -- I had a couple of friends in college who were from that background, and they had some of the thickest accents I have ever heard anywhere. (The thicker, the better, I say.)

The same is true of the website’s sample from North Carolina. The woman speaking in that clip has a very mild accent compared to some other North Carolinans. I’m thinking, for example, of one prominent North Carolinan, Judge David Sentelle of the D.C. Circuit. I distinctly recall one oral argument when Judge Sentelle asked a question of an attorney, but Sentelle’s North Carolina accent was so thick that the attorney obviously couldn’t understand what Sentelle had said. The poor attorney had to ask Sentelle to repeat the question, but still couldn’t understand, and so had to ask Sentelle to state his question a third time. In the meantime, Sentelle’s frustration became evident. It was slightly awkward. (I always loved hearing Sentelle ask questions at oral arguments, by the way; it’s not often you get to savor such a rich accent in a federal courtroom.)


UPDATE: One of the links on the website leads to this much more comprehensive resource: The International Dialects of English Archive, where you can listen to multiple samples from each state (some states have 10 or 20 examples of people of different ages and races, which is just perfect). It strikes me that older people often seem to have stronger and more distinct accents than younger people. For example, this white Arkansas female born in 1936 has a stronger accent than this white Arkansas female in her twenties. Similarly, this white Tennessee female born in 1934 has a wonderfully strong accent (I love it: “rare” is “ray-uh”) than this white Tennessee female born in 1979. I wonder what Americans will sound like in another 20 or 30 years.

The Sixth-Year Curse

Following on my earlier posts about this, Colleen Shogan -- a professor at George Mason -- emails to say that she has an article in Presidential Studies Quarterly about the fact that Presidents often face crisis or scandal in their sixth year in office. The article is here, and is well worth reading.