Group items tagged

The living, breathing source of the data and images we juggle, meanwhile, is in the bed and left wondering: Where is everyone? What are they doing? Hello! It’s my body, you know

Our $3.4 trillion health care system is responsible for more than a quarter of a million deaths per year because of medical error, the rough equivalent of, say, a jumbo jet’s crashing every day.

I can get cash and account details all over America and beyond. Yet I can’t reliably get a patient record from across town, let alone from a hospital in the same state, even if both places use the same brand of E.H.R

the leading E.H.R.s were never built with any understanding of the rituals of care or the user experience of physicians or nurses. A clinician will make roughly 4,000 keyboard clicks during a busy 10-hour emergency-room shift

In the process, our daily progress notes have become bloated cut-and-paste monsters that are inaccurate and hard to wade through. A half-page, handwritten progress note of the paper era might in a few lines tell you what a physician really thought

so much of the E.H.R., but particularly the physical exam it encodes, is a marvel of fiction, because we humans don’t want to leave a check box empty or leave gaps in a template.

For a study, my colleagues and I at Stanford solicited anecdotes from physicians nationwide about patients for whom an oversight in the exam (a “miss”) had resulted in real consequences, like diagnostic delay, radiation exposure, therapeutic or surgical misadventure, even death. They were the sorts of things that would leave no trace in the E.H.R. because the recorded exam always seems complete — and yet the omission would be glaring and memorable to other physicians involved in the subsequent care. We got more than 200 such anecdotes.

The reason for these errors? Most of them resulted from exams that simply weren’t done as claimed. “Food poisoning” was diagnosed because the strangulated hernia in the groin was overlooked, or patients were sent to the catheterization lab for chest pain because no one saw the shingles rash on the left chest.

I worry that such mistakes come because we’ve gotten trapped in the bunker of machine medicine. It is a preventable kind of failure

How we salivated at the idea of searchable records, of being able to graph fever trends, or white blood counts, or share records at a keystroke with another institution — “interoperability”

The seriously ill patient has entered another kingdom, an alternate universe, a place and a process that is frightening, infantilizing; that patient’s greatest need is both scientific state-of-the-art knowledge and genuine caring from another human being. Caring is expressed in listening, in the time-honored ritual of the skilled bedside exam — reading the body — in touching and looking at where it hurts and ultimately in localizing the disease for patients not on a screen, not on an image, not on a biopsy report, but on their bodies.

What if the computer gave the nurse the big picture of who he was both medically and as a person?

a professor at M.I.T. whose current interest in biomedical engineering is “bedside informatics,” marvels at the fact that in an I.C.U., a blizzard of monitors from disparate manufacturers display EKG, heart rate, respiratory rate, oxygen saturation, blood pressure, temperature and more, and yet none of this is pulled together, summarized and synthesized anywhere for the clinical staff to use

What these monitors do exceedingly well is sound alarms, an average of one alarm every eight minutes, or more than 180 per patient per day. What is our most common response to an alarm? We look for the button to silence the nuisance because, unlike those in a Boeing cockpit, say, our alarms are rarely diagnosing genuine danger.

By some estimates, more than 50 percent of physicians in the United States have at least one symptom of burnout, defined as a syndrome of emotional exhaustion, cynicism and decreased efficacy at work

It is on the increase, up by 9 percent from 2011 to 2014 in one national study. This is clearly not an individual problem but a systemic one, a 4,000-key-clicks-a-day problem.

The E.H.R. is only part of the issue: Other factors include rapid patient turnover, decreased autonomy, merging hospital systems, an aging population, the increasing medical complexity of patients. Even if the E.H.R. is not the sole cause of what ails us, believe me, it has become the symbol of burnou

burnout is one of the largest predictors of physician attrition from the work force. The total cost of recruiting a physician can be nearly $90,000, but the lost revenue per physician who leaves is between $500,000 and $1 million, even more in high-paying specialties.

I hold out hope that artificial intelligence and machine-learning algorithms will transform our experience, particularly if natural-language processing and video technology allow us to capture what is actually said and done in the exam room.

as with any lab test, what A.I. will provide is at best a recommendation that a physician using clinical judgment must decide how to apply.

True clinical judgment is more than addressing the avalanche of blood work, imaging and lab tests; it is about using human skills to understand where the patient is in the trajectory of a life and the disease, what the nature of the patient’s family and social circumstances is and how much they want done.

Much of that is a result of poorly coordinated care, poor communication, patients falling through the cracks, knowledge not being transferred and so on, but some part of it is surely from failing to listen to the story and diminishing skill in reading the body as a text.

As he was nearing death, Avedis Donabedian, a guru of health care metrics, was asked by an interviewer about the commercialization of health care. “The secret of quality,” he replied, “is love.”/•/

Is this enough? Or is it rather a capitulation to relativism, a manifesto for political quietism, a worldview that treats injustice as something to be abhorred but not constantly fought against? This might be seen as the core progressive objection to the way of Montaigne. Or is his sensibility in an age of religious terror and violence and fanaticism the only ultimate solution we have?

here’s what we do know. We are fallible beings; we have nothing but provisional knowledge; and we will die. And this is enough. This does not mean we should give up inquiring or seeking to understand. Skepticism is not nihilism. It doesn’t posit that there is no truth; it merely notes that if truth exists, it is inherently beyond our ultimate grasp. And accepting those limits is the first step toward sanity, toward getting on with life. This is what I mean by conservatism.

you can find in philosophy any number of clues about how to live; you can even construct them into an ideology that explains all of human life and society – like Marxism or free market fundamentalism or a Nietzschean will to power. But as each totalist system broke down upon my further inspection, I found myself returning to Montaigne and the tradition of skepticism he represents

If I were to single out one theme of Montaigne’s work that has stuck with me, it would be this staring of death in the face, early and often, and never flinching. It is what our culture refuses to do much of the time, thereby disempowering us in the face of our human challenges.

But these latest shifts challenge key infection control assumptions that go back a century, putting a lot of what went wrong last year in context

They may also signal one of the most important advancements in public health during this pandemic.

If the importance of aerosol transmission had been accepted early, we would have been told from the beginning that it was much safer outdoors, where these small particles disperse more easily, as long as you avoid close, prolonged contact with others.

We would have tried to make sure indoor spaces were well ventilated, with air filtered as necessary.

Instead of blanket rules on gatherings, we would have targeted conditions that can produce superspreading events: people in poorly ventilated indoor spaces, especially if engaged over time in activities that increase aerosol production, like shouting and singing

We would have started using masks more quickly, and we would have paid more attention to their fit, too. And we would have been less obsessed with cleaning surfaces.

The implications of this were illustrated when I visited New York City in late April — my first trip there in more than a year.

A giant digital billboard greeted me at Times Square, with the message “Protecting yourself and others from Covid-19. Guidance from the World Health Organization.”

That billboard neglected the clearest epidemiological pattern of this pandemic: The vast majority of transmission has been indoors, sometimes beyond a range of three or even six feet. The superspreading events that play a major role in driving the pandemic occur overwhelmingly, if not exclusively, indoors.

The billboard had not a word about ventilation, nothing about opening windows or moving activities outdoors, where transmission has been rare and usually only during prolonged and close contact. (Ireland recently reported 0.1 percent of Covid-19 cases were traced to outdoor transmission.)

Mary-Louise McLaws, an epidemiologist at the University of New South Wales in Sydney, Australia, and a member of the W.H.O. committees that craft infection prevention and control guidance, wanted all this examined but knew the stakes made it harder to overcome the resistance. She told The Times last year, “If we started revisiting airflow, we would have to be prepared to change a lot of what we do.” She said it was a very good idea, but she added, “It will cause an enormous shudder through the infection control society.”

In contrast, if the aerosols had been considered a major form of transmission, in addition to distancing and masks, advice would have centered on ventilation and airflow, as well as time spent indoors. Small particles can accumulate in enclosed spaces, since they can remain suspended in the air and travel along air currents. This means that indoors, three or even six feet, while helpful, is not completely protective, especially over time.

To see this misunderstanding in action, look at what’s still happening throughout the world. In India, where hospitals have run out of supplemental oxygen and people are dying in the streets, money is being spent on fleets of drones to spray anti-coronavirus disinfectant in outdoor spaces. Parks, beaches and outdoor areas keep getting closed around the world. This year and last, organizers canceled outdoor events for the National Cherry Blossom Festival in Washington, D.C. Cambodian customs officials advised spraying disinfectant outside vehicles imported from India. The examples are many.

Meanwhile, many countries allowed their indoor workplaces to open but with inadequate aerosol protections. There was no attention to ventilation, installing air filters as necessary or even opening windows when possible, more to having people just distancing three or six feet, sometimes not requiring masks beyond that distance, or spending money on hard plastic barriers, which may be useless at best

clear evidence doesn’t easily overturn tradition or overcome entrenched feelings and egos. John Snow, often credited as the first scientific epidemiologist, showed that a contaminated well was responsible for a 1854 London cholera epidemic by removing the suspected pump’s handle and documenting how the cases plummeted afterward. Many other scientists and officials wouldn’t believe him for 12 years, when the link to a water source showed up again and became harder to deny.

Along the way to modern public health shaped largely by the fight over germs, a theory of transmission promoted by the influential public health figure Charles Chapin took hold

Dr. Chapin asserted in the early 1900s that respiratory diseases were most likely spread at close range by people touching bodily fluids or ejecting respiratory droplets, and did not allow for the possibility that such close-range infection could occur by inhaling small floating particles others emitted

He was also concerned that belief in airborne transmission, which he associated with miasma theories, would make people feel helpless and drop their guard against contact transmission. This was a mistake that would haunt infection control for the next century and more.

It was in this context in early 2020 that the W.H.O. and the C.D.C. asserted that SARS-CoV-2 was transmitted primarily via these heavier, short-range droplets, and provided guidance accordingly

Amid the growing evidence, in July, hundreds of scientists signed an open letter urging the public health agencies, especially the W.H.O., to address airborne transmission of the coronavirus.

Last October, the C.D.C. published updated guidance acknowledging airborne transmission, but as a secondary route under some circumstances, until it acknowledged airborne transmission as crucial on Friday. And the W.H.O. kept inching forward in its public statements, most recently a week ago.

Linsey Marr, a professor of engineering at Virginia Tech who made important contributions to our understanding of airborne virus transmission before the pandemic, pointed to two key scientific errors — rooted in a lot of history — that explain the resistance, and also opened a fascinating sociological window into how science can get it wrong and why.

Dr. Marr said that if you inhale a particle from the air, it’s an aerosol.

biomechanically, she said, nasal transmission faces obstacles, since nostrils point downward and the physics of particles that large makes it difficult for them to move up the nose. And in lab measurements, people emit far more of the easier-to-inhale aerosols than the droplets, she said, and even the smallest particles can be virus laden, sometimes more so than the larger ones, seemingly because of how and where they are produced in the respiratory tract.

Second, she said, proximity is conducive to transmission of aerosols as well because aerosols are more concentrated near the person emitting them. In a twist of history, modern scientists have been acting like those who equated stinky air with disease, by equating close contact, a measure of distance, only with the larger droplets, a mechanism of transmission, without examination.

Since aerosols also infect at close range, measures to prevent droplet transmission — masks and distancing — can help dampen transmission for airborne diseases as well. However, this oversight led medical people to circularly assume that if such measures worked at all, droplets must have played a big role in their transmission.

Another dynamic we’ve seen is something that is not unheard-of in the history of science: setting a higher standard of proof for theories that challenge conventional wisdom than for those that support it.

Another key problem is that, understandably, we find it harder to walk things back. It is easier to keep adding exceptions and justifications to a belief than to admit that a challenger has a better explanation.

The ancients believed that all celestial objects revolved around the earth in circular orbits. When it became clear that the observed behavior of the celestial objects did not fit this assumption, those astronomers produced ever-more-complex charts by adding epicycles — intersecting arcs and circles — to fit the heavens to their beliefs.

In a contemporary example of this attitude, the initial public health report on the Mount Vernon choir case said that it may have been caused by people “sitting close to one another, sharing snacks and stacking chairs at the end of the practice,” even though almost 90 percent of the people there developed symptoms of Covid-19

So much of what we have done throughout the pandemic — the excessive hygiene theater and the failure to integrate ventilation and filters into our basic advice — has greatly hampered our response.

Some of it, like the way we underused or even shut down outdoor space, isn’t that different from the 19th-century Londoners who flushed the source of their foul air into the Thames and made the cholera epidemic worse.

Righting this ship cannot be a quiet process — updating a web page here, saying the right thing there. The proclamations that we now know are wrong were so persistent and so loud for so long.

the progress we’ve made might lead to an overhaul in our understanding of many other transmissible respiratory diseases that take a terrible toll around the world each year and could easily cause other pandemics.

So big proclamations require probably even bigger proclamations to correct, or the information void, unnecessary fears and misinformation will persist, damaging the W.H.O. now and in the future.

I’ve seen our paper used in India to try to reason through aerosol transmission and the necessary mitigations. I’ve heard of people in India closing their windows after hearing that the virus is airborne, likely because they were not being told how to respond

The W.H.O. needs to address these fears and concerns, treating it as a matter of profound change, so other public health agencies and governments, as well as ordinary people, can better adjust.

It needs to begin a campaign proportional to the importance of all this, announcing, “We’ve learned more, and here’s what’s changed, and here’s how we can make sure everyone understands how important this is.” That’s what credible leadership looks like. Otherwise, if a web page is updated in the forest without the requisite fanfare, how will it matter?

They all had to be the same species.

was not surprising to find that Neanderthals and modern humans interbred, a clear expectation of the biological species concept.

I wonder when the penny will drop: when we have five pieces of a 5,000-piece jigsaw puzzle, every new bit that we add is likely to change the picture.

e identity of the fourth player remains unknown but it was an ancient lineage that had been separate for probably over a million years. H. erectus seems a likely candidate. Whatever the name we choose to give this mystery lineage, what these results show is that gene flow was possible not just among contemporaries but also between ancient and more modern lineages.

cientists succeeded in extracting the most ancient mitochondrial DNA so far, from the Sima de los Huesos site in Atapuerca, Spain.

We have built a picture of our evolution based on the morphology of fossils and it was wrong.

when we know how plastic - or easily changeable - skull shape is in humans. And our paradigms must also change.

e must abandon, once and for all, views of modern human superiority over archaic (ancient) humans. The terms "archaic" and "modern" lose all meaning as do concepts of modern human replacement of all other lineages.

he deep-rooted shackles that have sought to link human evolution with stone tool-making technological stages - the Stone Ages - even when we have known that these have overlapped with each other for half-a-million years in some instances.

e world of our biological and cultural evolution was far too fluid for us to constrain it into a few stages linked by transitions.

We have to flesh out the genetic information and this is where archaeology comes into the picture.

Rather than focus on differences between modern humans and Neanderthals, what the examples show is the range of possibilities open to humans (Neanderthals included) in different circumstances.

research using new technology on old archaeological sites, as at La Chapelle; and

Most A.I. researchers agree that models trained using R.L.H.F. are better behaved than models without it. But some argue that fine-tuning a language model this way doesn’t actually make the underlying model less weird and inscrutable. In their view, it’s just a flimsy, friendly mask that obscures the mysterious beast underneath.

In a nutshell, the joke was that in order to prevent A.I. language models from behaving in scary and dangerous ways, A.I. companies have had to train them to act polite and harmless. One popular way to do this is called “reinforcement learning from human feedback,” or R.L.H.F., a process that involves asking humans to score chatbot responses, and feeding those scores back into the A.I. model.

Shoggoths are fictional creatures, introduced by the science fiction author H.P. Lovecraft in his 1936 novella “At the Mountains of Madness.” In Lovecraft’s telling, Shoggoths were massive, blob-like monsters made out of iridescent black goo, covered in tentacles and eyes.

@TetraspaceWest said, wasn’t necessarily implying that it was evil or sentient, just that its true nature might be unknowable.

And it reinforces the notion that what’s happening in A.I. today feels, to some of its participants, more like an act of summoning than a software development process. They are creating the blobby, alien Shoggoths, making them bigger and more powerful, and hoping that there are enough smiley faces to cover the scary parts.

“I was also thinking about how Lovecraft’s most powerful entities are dangerous — not because they don’t like humans, but because they’re indifferent and their priorities are totally alien to us and don’t involve humans, which is what I think will be true about possible future powerful A.I.”

when Bing’s chatbot became unhinged and tried to break up my marriage, an A.I. researcher I know congratulated me on “glimpsing the Shoggoth.” A fellow A.I. journalist joked that when it came to fine-tuning Bing, Microsoft had forgotten to put on its smiley-face mask.

@TetraspaceWest, the meme’s creator, told me in a Twitter message that the Shoggoth “represents something that thinks in a way that humans don’t understand and that’s totally different from the way that humans think.”

In any case, the Shoggoth is a potent metaphor that encapsulates one of the most bizarre facts about the A.I. world, which is that many of the people working on this technology are somewhat mystified by their own creations. They don’t fully understand the inner workings of A.I. language models, how they acquire new capabilities or why they behave unpredictably at times. They aren’t totally sure if A.I. is going to be net-good or net-bad for the world.

That some A.I. insiders refer to their creations as Lovecraftian horrors, even as a joke, is unusual by historical standards. (Put it this way: Fifteen years ago, Mark Zuckerberg wasn’t going around comparing Facebook to Cthulhu.)

If it’s an A.I. safety researcher talking about the Shoggoth, maybe that person is passionate about preventing A.I. systems from displaying their true, Shoggoth-like nature.

A great many people are dismissive of suggestions that any of these systems are “really” thinking, because they’re “just” doing something banal (like making statistical predictions about the next word in a sentence). What they fail to appreciate is that there is every reason to suspect that human cognition is “just” doing those exact same things. It matters not that birds flap their wings but airliners don’t. Both fly. And these machines think. And, just as airliners fly faster and higher and farther than birds while carrying far more weight, these machines are already outthinking the majority of humans at the majority of tasks. Further, that machines aren’t perfect thinkers is about as relevant as the fact that air travel isn’t instantaneous. Now consider: we’re well past the Wright flyer level of thinking machine, past the early biplanes, somewhere about the first commercial airline level. Not quite the DC-10, I think. Can you imagine what the AI equivalent of a 777 will be like? Fasten your seatbelts.

@thomas h. You make my point perfectly. You’re observing that the way a plane flies — by using a turbine to generate thrust from combusting kerosene, for example — is nothing like the way that a bird flies, which is by using the energy from eating plant seeds to contract the muscles in its wings to make them flap. You are absolutely correct in that observation, but it’s also almost utterly irrelevant. And it ignores that, to a first approximation, there’s no difference in the physics you would use to describe a hawk riding a thermal and an airliner gliding (essentially) unpowered in its final descent to the runway. Further, you do yourself a grave disservice in being dismissive of the abilities of thinking machines, in exactly the same way that early skeptics have been dismissive of every new technology in all of human history. Writing would make people dumb; automobiles lacked the intelligence of horses; no computer could possibly beat a chess grandmaster because it can’t comprehend strategy; and on and on and on. Humans aren’t nearly as special as we fool ourselves into believing. If you want to have any hope of acting responsibly in the age of intelligent machines, you’ll have to accept that, like it or not, and whether or not it fits with your preconceived notions of what thinking is and how it is or should be done … machines can and do think, many of them better than you in a great many ways. b&

@BLA. You are incorrect. Everything has nature. Its nature is manifested in making humans react. Sure, no humans, no nature, but here we are. The writer and various sources are not attributing nature to AI so much as admitting that they don’t know what this nature might be, and there are reasons to be scared of it. More concerning to me is the idea that this field is resorting to geek culture reference points to explain and comprehend itself. It’s not so much the algorithm has no soul, but that the souls of the humans making it possible are stupendously and tragically underdeveloped.

When even tech companies are saying AI is moving too fast, and the articles land on page 1 of the NYT (there's an old reference), I think the greedy will not think twice about exploiting this technology, with no ethical considerations, at all.

@nome sane? The problem is it isn't data as we understand it. We know what the datasets are -- they were used to train the AI's. But once trained, the AI is thinking for itself, with results that have surprised everybody.

The unique feature of a shoggoth is it can become whatever is needed for a particular job. There's no actual shape so it's not a bad metaphor, if an imperfect image. Shoghoths also turned upon and destroyed their creators, so the cautionary metaphor is in there, too. A shame more Asimov wasn't baked into AI. But then the conflict about how to handle AI in relation to people was key to those stories, too.

said it was capable of miniaturizing its nuclear weapons and attaching them to rockets, meaning it would feasibly be able to blast them at all its imperialist pig-dog enemies in the USA—but obviously, these claims haven't yet been verified.

features of the skull, it is thought to have been a male with large cheek bones, teeth, and jaws, but a small brain

newly described skull also expands the morphological variability of the specimens found at the Dmanisi site—some of which appear less primitive. Despite this variability, Zollikofer believes all the specimens are members of the same species. That would be “the most parsimonious explanation,”

He suggested that other hominin fossils previously classified as separate species—such as H. habilis, H. rudolfensis, and H. erectus—should be re-examined.

urge for a change in perspective, because what has happened in the last ten years is that people tried to divide—they tried to show species diversity—and what we try to show now is diversity, but within one single evolving species,” Zollikofer said.

The history of science is replete with examples of simpler (“more elegant,” if you are aesthetically inclined) hypotheses that had to yield to more clumsy and complicated ones.

This is both why there is no such thing as a “crucial” experiment in science (you always need to repeat them under a variety of conditions), and why naive Popperian falsificationism is wrong (you can never falsify a hypothesis directly, only the H&A complex can be falsified).

The Duhem thesis explains why Sober is right, I think, in maintaining that the razor works (when it does) given certain background assumptions that are bound to be discipline- and problem-specific.

So, Ockham’s razor is a sharp but not universal tool, and needs to be wielded with the proper care due to the specific circumstances.

There is no shortcut for a serious investigation of the world, including the spelling out of our auxiliary, and often unexplored, hypotheses and assumptions.

Dr. Arthur Beaudet, a professor at the Baylor College of Medicine and the chairman of its department of molecular and human genetics, applaud the effort. He believes that the acts committed by men like Mr. Lanza and the gunmen in other rampages in recent years — at Columbine High School and in Aurora, Colo., in Norway, in Tucson and at Virginia Tech — are so far off the charts of normal behavior that there must be genetic changes driving them.

Everything known about mental illness, these skeptics say, argues that there are likely to be hundreds of genes involved in extreme violent behavior, not to mention a variety of environmental influences, and that all of these factors can interact in complex and unpredictable ways.

The National Institutes of Health was embroiled in controversy about 20 years ago simply for proposing to study the biological underpinnings of violence. Critics accused researchers of racism and singling out minorities, especially black men.

Studies of people at the far end of a bell curve can be especially informative, because the genetic roots of their conditions can be stark and easy to spot, noted J. H. Pate Skene, a Duke University neurobiologist. “I think doing research on outliers, people at an end of a spectrum on something of concern like violent behavior, is certainly a good idea,” he said, but he advised tempering expectations.

“If we know someone has a 2 percent chance or a 10 percent chance or a 20 percent chance of violent behavior, what would you do with that person?” Dr. Skene said. “They have not been convicted of anything — have not done anything wrong.”

Ultimately, understanding the genetics of violence might enable researchers to find ways to intervene before a person commits a horrific crime. But that goal would be difficult to achieve, and the pursuit of it risks jeopardizing personal liberties.

No one should seek to die or give in to a disease they can legitimately fight. God knows how many pills I take a day to keep the virus – and all its and their side-effects at bay. But I get to live healthily and meaningfully. The way some elaborate and cutting edge treatments all but kill the patient in order to save her troubles me. It’s a loss of perspective as well as immensely expensive for the entire system.

our culture’s gradual alienation from the fact of our deaths – our distancing ourselves even from the old and infirm in ways previous cultures didn’t and couldn’t – is not, in my view a healthy thing.

these sophisticated treatments are taking healthcare money away from the young, taking up more and more of our collective healthcare resources, and extending lives only be perpetuating continuous agony and nausea and pain for the patient and devastating consequences for families and friends.

We will all die. We should not seek it. But we should not flee from it for ever.

at some point what seems to me to matter more is not the length of our lives but the content of them and the manner of our deaths.

At some point, medicine is a function of a social disease of modernity: the flight from our own mortality. But fleeing it does not defuse it. Only facing it does.

it makes no sense to compare the federal budget to a family budget, which is what the Consumer Price Index is based on. One needs to use a broader index, like the gross domestic product deflator, which measures price changes throughout the entire economy.

For large numbers, the percentage of the gross domestic product is both the easiest to find and best to use.

Since the “burden” of the debt basically falls on the entire economy, the debt-to-G.D.P. ratio is generally considered the best measure of that burden. It also facilitates international comparisons without having to worry about exchange-rate adjustments.

international price comparisons can be especially tricky because current market exchange rates may not accurately reflect relative values or standards of living. Economists generally prefer to use something called “purchasing power parity,” but such data is not always easy to come by

There is much more to say on this topic. I recommend an essay on the Measuring Worth website that discusses different measures of value over time and how they materially affect our perceptions. There are also new statistical measures coming online that may provide even better data, like the Billion Prices Project from M.I.T., which gathers price data in real time directly from store price scanners.

This is an area where trial and error is the best strategy. The important thing is to make an effort to provide proper context where it appears necessary and not to simply ignore the problem.

the cost-benefit analysis of “breaking bad” when the alternative is imminently “dying alone” is rigged in favor of the very short term, i.e. zero-sum evil. If Walt had had to weigh a long, unpredictable lifetime of unending fear and constant danger for his family and himself, he would have stopped cooking meth.

was he happy? Yes, but in a way that never really reflects any inner peace. He is happy in a way that all millionaires and tyrants are happy.

Machiavelli differs from later realists like Hobbes—and more contemporary “neorealists” like the late Kenneth Waltz—in recognizing that human agency matters as much as the structural fact of international anarchy in determining both foreign policy behavior and ultimate outcomes in world politics.

It should be taught because it really does convey the egoist appeal of evil, of acting ruthlessly in the world

The benefits only work if your life is nasty, brutish and short. The costs are seen in the exhausted, broken eyes of Skyler, the betrayal of an only painfully faithful son, the murder of a brother-in-law, the grisly massacre of dozens, the endless nervous need to be on the alert, to run and hide and lie and lie and lie again, until life itself becomes merely a means to achieve temporary security.

Breaking Bad should be taught alongside Machiavelli – as a riveting companion piece.

a leader’s choices can have a pivotal impact on politics, both domestic and international.

Though fortune be capricious and history contingent, the able leader may shape his fate and that of his state through the exercise of virtu. This is not to be mistaken for “virtue”, as defined by Christian moral teaching (implying integrity, charity, humility, and the like). Rather, it denotes the human qualities prized in classical antiquity, including knowledge, courage, cunning, pride, and strength.

Dr. Krogan and his colleagues set about finding proteins in our cells that the coronavirus uses to grow. Normally, such a project might take two years. But the working group, which includes 22 laboratories, completed it in a few weeks.

In 2011, Dr. Krogan and his colleagues developed a way to find all the human proteins that viruses use to manipulate our cells — a “map,” as Dr. Krogan calls it. They created their first map for H.I.V.

That virus has 18 genes, each of which encodes a protein. The scientists eventually found that H.I.V. interacts, in one way or another, with 435 proteins in a human cell.

In February, the research group synthesized genes from the coronavirus and injected them into cells. They uncovered over 400 human proteins that the virus seems to rely on.

The flulike symptoms observed in infected people are the result of the coronavirus attacking cells in the respiratory tract.

The new map shows that the virus’s proteins travel throughout the human cell, engaging even with proteins that do not seem to have anything to do with making new viruses.

Kevan Shokat, a chemist at U.C.S.F., is poring through 20,000 drugs approved by the Food and Drug Administration for signs that they may interact with the proteins on the map created by Dr. Krogan’s lab.

If promising drugs are found, investigators plan to try them in an animal infected with the coronavirus — perhaps ferrets, because they’re known to get SARS, an illness closely related to Covid-19.

Even if some of these drugs are effective treatments, scientists will still need to make sure they are safe for treating Covid-19. It may turn out, for example, that the dose needed to clear the virus from the body might also lead to dangerous side effects.

In past studies on animals, remdesivir blocked a number of viruses. The drug works by preventing viruses from building new genes.

In February, a team of researchers found that remdesivir could eliminate the coronavirus from infected cells. Since then, five clinical trials have begun to see if the drug will be safe and effective against Covid-19 in people.

Other researchers have taken startling new approaches. On Saturday, Stanford University researchers reported using the gene-editing technology Crispr to destroy coronavirus genes in infected cells.