Curmudge and Jaded Julie Talk About Cause and Effect

Receding glaciers, melting snow on Mt. Kilimanjaro, and reduced polar bear habitat were purported to prove that global warming was occurring.  Actually, the temperature at the summit of Mt. Kilimanjaro never rises above the melting point of ice.

Reprinted from Curmudgeon’s Wastebasket Originally Posted January 27, 2010

“Jaded Julie, I’m concerned that many people don’t understand basic science.”

“If basic science means physical chemistry and thermodynamics, I would be concerned that you are concerned. In fact, Curmudge, I would consider you to be an unrealistic zealot.”

“No, Julie. I mean really basic grade-school stuff. Let’s write a play to illustrate a very simple lesson. The time is almost 400 years ago, and the setting is the city of Florence in northern Italy. My character is called Cattivo Uomo, and you will be Spossate Infermiera.”

“Which are, of course, Nasty Man and Jaded Nurse in Italian (actually, the adjective should follow the noun, i.e., uomo cattivo).”

“The curtain has gone up, and you and I are up early watching the sun rise.”

“What a beautiful sunrise, Cattivo.”

“It happens every morning, Spossate, just like clockwork.”

“We would be in big trouble if the sun didn’t go around the earth so regularly. It must come closer in the summer when it gets so warm here. Then the glaciers in the Alps melt back. Thankfully, it gets cooler at night when the sun is around on the other side.”

“Can you think of any other explanation for our days and nights, Spossate?”

“It seems pretty obvious to me that the sun goes around the earth. Everyone sees it rise and set, and that’s what they believe.”

“I’ve heard about another explanation…that the sun stands at the center of our universe, and that the earth rotates once every 24 hours.”

“Outrageous! Who said that, Cattivo?”

“It was our neighbor, Mr. Galilei. His ideas are going to get him into a lot of trouble.”

“Our play’s over, Julie. Curtain down. Did it teach you a lesson?”

“I’m shocked that 400 years ago virtually everyone thought that the sun moved around the earth every day, but that was the easiest explanation.”

“We know now that the accepted explanation was false. So what is the lesson that our story teaches?”

“I’ve got it, Curmudge. No matter how evident the effect, it does not prove the cause.”

“By the way, Julie, in the play Cattivo Uomo, and Spossate Infermiera were up early watching the sun rise.  My daughter wondered what an old man and a young woman were doing together at that hour of the morning.”

“And I’ll bet, Curmudge, that you evaded the question.”

Kaizen Curmudgeon 

Link to posting from blog archives: The Curmudgeon Shadows Jaded Julie 7/26/2007

http://kaizencurmudgeon.blogspot.com/2007/07/curmudgeon-shadows-jaded-julie.html

Curmudgeon and Jaded Julie Read the Newspaper

Reprinted from Curmudgeon’s Wastebasket Originally Posted January 22, 2010

This alludes to the alarmist publicity given to the early speculation regarding impending global warming.

“Curmudge, I see that you are reading the editorial and opinion pages of the newspaper.”

“It takes less time, Jaded Julie. The regular news pages contain a lot of useless stuff like the latest indiscretions of professional athletes and entertainers, and they often omit information that is truly important. In addition, the ‘news’ sometimes contains ‘spin’ that is hard to detect.”

“Okay, so what’s wrong with spin in the news?”

“If you see the ‘spun’ information again and again, you might eventually believe it. Ultimately, it may become an urban legend (the Brits call it an urban myth) in which you acquire unquestioning faith.”

“That doesn’t sound good, Curmudge, especially if the info is wrong or at least uncertain. So why should this subject be of interest to people working in health care?”

“Virtually no one that I know in health care has time to read the news critically. Perhaps we can provide some guidance to help them avoid getting hoodwinked by what they read. We’ll also give a refresher on the ethics of ‘speaking with data.’ "

“How can we do that, Old Guy?”

“In our next few conversations we’ll suggest some cautionary signals that will alert the reader to possible spin. Things like confusion over cause-and-effect and the possible impact of vested interest in reported information. We’ll also mention some less familiar, but in-the-news, topics like mathematical models and peer-reviewed research publications. One story will be an allegory, and another will be a play starring you as a tired-out Italian nurse, Spossate Infermiera.”

“Wow! I can hardly wait. But I’ll bet there are some people out there who are so set in their beliefs that they will consider your ideas to be just the ranting of an old man.”

“That’s okay, Julie. My age is my license to rant.”

“I presume that every one of our conversations will have a lesson. Can we add a short lesson to end your tirade for today?”

“Sure, Jaded Julie. Here it is: When a writer quotes a politician who is talking about science, put on your skeptic’s hat.”

Kaizen Curmudgeon

Link to posting from blog archives: Jaded Julie Learns about “Gemba”  6/19/07

A Look Ahead on Kaizen Curmudgeon

A Look Ahead on Kaizen Curmudgeon

“Hey, Curmudge, you seem to have become rather critical of conventional wisdom lately.”

“That’s for sure, Julie.  If it becomes fallacious dogma, like the LNT hypothesis applied to low-level radiation, I’m unforgiving.  However I’m eager to study unresolved topics like anthropogenic (man-made) global warming that have become dogma only to some people.”

“A curmudgeon with an open mind?  How unusual!  I guess that explains why our next few discussions will be on global warming.  I hope that your old, leaky brain recalls that we talked about that subject rather indirectly back in January and February of 2010.”

“I do, Julie.  That was in our personal blog, Curmudgeon‘s Wastebasket, in which we posted controversial items not allowed by our corporate sponsor.  Let’s reprint some of these old Wastebasket postings in our current blog to remind our readers about the hot topics in global warming back in 2009-2010.  Here are the rather subtle lessons that we attempted to teach: (a) watch for ‘spin’ in the news, (b) cause and effect confused the locals, but not Galileo, (c) mathematical models and vested interests, (d) peer-reviewed publications (alluding to “climategate”), (e) wizardry, climate prognostication, and draconian solutions.”

“Then what next, Old Guy?”

“I’ve spent the past couple of weeks bringing myself up to date on climate issues.  Most of the literature is still highly polarized.  What I was seeking was an article that was comprehensive, unbiased, and current.  And I found one.  Here’s the link.  It was written by a Norwegian, Emil A. Røyrvik of SINTEF Technology and Society.  Because the paper is 82 pages long, I suggest that you start reading it ASAP.”

“Thanks a lot, Curmudge.  And I was hoping for a summer vacation.  So are we going to base our postings on that article alone?”

“Not quite, Julie.  We’ll try to give an overview of what is being said today on both sides of the debate.  Nevertheless, concerned readers will need to do some studying on their own.  Remember that a blog is too short to really teach a subject.  We can only tell a reader where to find information so he can teach himself.”

“Tell me, Curmudge, do you really think that we can discuss a controversial topic without favoring one side or the other?”

“Not since our blog became independent.  If I had to be totally unbiased, I could no longer be a curmudgeon; and we’d have to change our names to Snow White and Grumpy.” 

   

Kaizen Curmudgeon

Link to posting from blog archives: Curmudgeon and Jaded Julie Talk about Names, 5/23/07

     

Kaizen Curmudgeon for Seniors

A little history:  The Kaizen Curmudgeon blog was founded in May 2007.  Its original focus was on Lean (a management culture used by Affinity and ThedaCare), leadership, and health care.  Until January 2012 the blog was sponsored by the Performance Excellence Team at Affinity Health System.  Kaizen Curmudgeon is presently independent and authored by Dwight Easty in Ridgeview Highlands, apartment 1643.  He is advised by a three-person editorial board that includes one physician.

Although the blog’s original mission has not been abandoned, its focus is shifting toward health care and topics of interest to senior citizens.  Regrettably, new readers of Kaizen Curmudgeon will have missed many of the early years’ postings that would have been of value.  To help them “catch up,” there will be a link to a pertinent archived posting at the end of each new posting.

In every posting’s right margin is a paragraph titled About Me; it is actually about the blog’s fictional protagonists as well as the author.  (It neglects to mention that the fictional Kaizen Curmudgeon is the author’s alter ego.)  Also in the margin is the blog archive showing dates but not titles and a blank where one can subscribe (free) to the blog by entering his/her email address.  And to further aid new readers, attached below is a partial table of contents showing titles and posting dates of articles of potential interest to senior citizens.  Some—but not all—of the dates are hyperlinks to the original posting.

“So, Jaded Julie, what do you think of that idea?”

“It’s great, Curmudge.  Your fellow residents of the old folks’ home should find the postings interesting, possibly more so than the blog’s original readers.”

“Julie!  It’s not an ‘old folks home.’  It’s a senior citizen apartment community.  My building has a heated underground garage, it is nonsmoking, and it is never noisy.  For me, it is the perfect place to live.  Residents may be as young as 55, go to work every day, and of course are more active than I am.”

“Thank goodness.  If they weren’t they would be dead.”

“Julie, you are incorrigible!”

“I try, but the old geezer who writes this stuff has the last word.  Every few years you have a good idea.  The last one was six years ago when you conjured up my name.  Keep up the good work.”

“Thanks for the reassurance, Jaded Julie.  What would I do without you?”

Kaizen Curmudgeon—Contents of Interest to Seniors

Kaizen Curmudgeon Blog Title—Date Posted

The Curmudgeon and Jaded Julie Talk About Names—5/23/07

Nursing—The Curmudgeon Shadows Jaded Julie—7/26/07

Stan’s Story—10/30/08

Patient Safety—All postings between 11/06/08 and 3/12/09 except 12/18/08

Patient Safety—Infections 2—2/05/09

Patient Safety—Human Factors—2/19/09

Patient-Centered Communications—6/11/09

Communicate—Think—Diagnose—Communicate—6/18/09

Physicians and Lean—6/25/09

Primary Care in 1940—(Doc on call 24/7.)—8/20/09

More About Primary Care in 1940—8/27/09

Mistakes—mnemonics, sleep deprivation—4/01/10

Mistakes 2—standard work, checklists, ‘Isabel’—4/08/10

Mistakes 3—necessary fallibility--7/22/10, see also 2/19/09

Amazing Devices—AutoAnalyzer, pulse oximeter—8/05/10

Amazing Devices 2—Library resources, PDA Road Map—8/12/10 (already out of date)

Amazing Devices 4—ultrasound, electronic stethoscope—9/09/10

A Day in a Hospital in Prague—4/23/09

Brand and Generic Drug Names—5/14/09

Volunteering: the Seniors’ Raison D’être--1/07/10

Lean Lessons from Long Ago--2/25/10

A Culture of Elegance--3/25/10

Hey patients, checklists are okay.--4/29/10

Twice Blessed--5/13/10

Judgment--6/18/10

AIDET for Physicians—10/01/09

AIDET Redux--7/01/10

Docs on a Treadmill--7/15/10

Evidence-Based Medicine—The Patient’s Perspective--9/23/10

Evidence-Based Medicine 2—review articles, clinical trials--9/30/10

Evidence-Based Medicine 3—evaluating the literature--10/14/10

Evidence-Based Medicine 4—“Will it help my patient?--10/14/10

Evidence-Based Medicine 5—getting a second opinion--10/21/10

The Robot--11/03/10

Superbugs--11/04/10

Stan’s Story Redux—12/29/10

The Middle Years—2/09/11

Way to go!—The value of an advance directive.--2/17/11

Way to go! 2—The end is near,--2/24/11

The Old Men’s Table—4/18/11

The Crystal Ball 4—5/12/11

The Crystal Ball 5—5/19/11

The Crystal Ball 6—5/31/11

The Crystal Ball 7—6/03/11

The Crystal Ball 8—6/13/11

Conventional Wisdom—8/08/11

Sepsis—introduction, pathogenesis--8/26/11

Sepsis 2—diagnosis, management—9/07/11

Sepsis 3—resuscitation bundles—9/15/11

The Bad, Good Medication (prednisone)—9/23/11

Flow—1/13/12

Standardized Clinical Processes—2/16/12

Explanation—3/01/12

Doc Talks—Introduction—4/02/12

The Teamwork-Artistry Spectrum—4/08/12

Docs and Teamwork—4/15/12

Specialists—Introduction—4/22/12

Why Physicians Choose Specialties—4/28/12

A Puzzlement—7/08/12

Complex Systems (e.g., health care)—7/15/12

Health Care Elsewhere—7/29/12

Health Care Elsewhere 2—8/05/12

Health Care Here.  How might it change?—8/12/12

Health Care Here.  Further thoughts on changes.—8/19/12

Emotional Intelligence—Introduction—11/27/12

Emotional Intelligence 2—12/06/12

Risks and Fears—Introduction—1/03/13

Risks and Fears—Examples—1/13//13

Risks and Fears 3—(The Old Risks and Benefits File)—1/20/13

Bloggers—Affiliated or Independent—1/27/13

The Ordeal 1 (cancer chemotherapy)—2/04/13

The Ordeal 2—2/10/13

The Ordeal 3—Summary—2/16/13

Unconventional Wisdom 1—2/28/13
Unconventional Wisdom 2—Mice in the Laboratory—3/07/13

Unconventional Wisdom 3—Epidemiology—3/20/13
Unconventional Wisdom 4—Radiation Background—4/01/13

Unconventional Wisdom 5—How much?  How does it work?—4/15/13

Unconventional Wisdom 6—Policy Issues—4/24/13

Happy Sixth Birthday

“Happy sixth birthday, Curmudge.  Who would have expected that our blogging adventure that began in May 2007 would continue for 250 postings?  When we reached 100 postings in 2009, I thought the old man who writes our words would have a literary lobotomy.”

“You mean run out of ideas, Jaded Julie?  Obviously it didn’t happen.  But we’ll have to admit that it helped for us to lose our corporate sponsors and with them our constraint against discussing controversial topics.”

“Now I understand that the old man will try to expand blog readership among his senior-citizen neighbors.  I hope he realizes that might change his image in the neighborhood.  When he first moved in and went to work every morning at his (volunteer) job, he may have appeared to be a button-down corporate type.  Then when we lost our sponsor and he worked full time in the apartment, he was likely viewed as sort of a hermit.”

“Please note, Julie, that a hermit-curmudgeon is an oxymoron.  One can’t be argumentative and bad-tempered all alone.  The old man’s revealing himself as our author will symbolize that the real curmudgeon is coming out of the closet.”

“To appeal to new readers, our discussions will speak more about health care and other topics of interest to seniors.  We’ll even post a partial table of contents of blog archives from which many Lean and leadership postings have been removed.  I suspect, Curmudge, that our long-term readers won’t miss them.”

“Fortunately, Julie, if our senior-citizen friends can find the right pair of glasses (like the old man who puts words in our mouths), they should have time to read our postings.  We’ll see.  Buon compleanno (happy birthday [in Italian])!"

  

Kaizen Curmudgeon

Unconventional Wisdom 6

Policy Issues

“Hey, Curmudge, how did we get into this mess, anyway?”

“Actually Julie, I think there are two messes—the policies themselves and their unintended consequences.  Let’s start with Mess #1, the official recognition of the linear no-threshold (LNT) hypothesis in the U. S. and other countries (but not France).  This is discussed at length in several of the papers in Dose-Response Vol. 10, No. 2 and 4 (2012).  The big problem is that one can’t rigorously prove a small increase or small decrease in cancer deaths at very low doses of ionizing radiation when 20% of the human population die of cancer from any number of causes.  It’s the classical problem of trying to discern a small signal amid a lot of noise.  So the government takes the easy way out and assumes that the LNT hypothesis is valid.”

“Because of that policy, people have acquired an unshakable belief that ionizing radiation at all levels will cause cancer.  Gosh, Old Guy, just imagine the political power derived from that fear by anti-nuclear power activists and the promise of big payments to corporations that move ‘contaminated’ soil from one place to another.  It’s even the raison d’être for the town’s basement tester and radon exterminator.  And this happens because people choose to ignore, or (more likely) are totally unaware of the weight of evidence showing radiation hormesis or at least a threshold.”

“You’ve got it Julie, as usual.  Now let’s consider Mess #2, the consequences of the LNT.  The nuclear accidents at Chernobyl and Fukushima provide examples of decisions made by governments that were overly protective against radiation but that caused great harm to the populace emotionally, financially, and socially (1).  In the Chernobyl area 200,000 people were forcibly resettled where the natural background plus the Chernobyl contribution exceeded 500 mrem per year; recall that the natural background in Denver is 600 mrem per year. ‘Following the Chernobyl accident in 1986, an estimated 100,000- 200,000 Chernobyl-related induced abortions were performed in Western Europe.  Perceptions of radiation risks affected personal choices about continuing pregnancies.’ (2)”

“Curmudge, that’s horrible!  And then there was the Fukushima disaster in March 2011.  Ninety thousand people were evacuated from an area that had an estimated first-year dose of 2 rem to as high as 22 rem (3).  There are locations in Brazil and Iran with higher background than that.  Actual losses in the disaster were 15,000 deaths due to the tsunami and $55 billion spent on fossil fuel imports due to the shutdown of almost all of Japan’s nuclear power plants.  Could that happen here?”

“A tsunami on the Great Lakes is quite unlikely, but consider what would happen if a terrorist somehow constructed a rudimentary nuclear weapon—a so-called ‘dirty bomb’—and detonated it over Chicago.  Everyone’s fear of all radiation would cause panic in the streets, and government regulators would probably issue stupid evacuation orders.  Recall that President Obama requested that the Japanese evacuate all Americans from within 50 miles of Fukushima (4).”

“Oh, Curmudge, I’m not surprised.  But wouldn’t a lot of good things happen if the government abandoned the LNT hypothesis and taught people that low doses of radiation were not to be feared and could be good for them?”

“The list would be long Julie, but here are a few examples.  Our electricity would come from nuclear power plants, many of which would use breeder reactor technology that would reduce the problem of radioactive waste.  That would resolve the controversy over greenhouse emissions from fossil-fueled power generation.  Our cars could have small atomic engines that would be fueled once by the manufacturer.  And there would be lots of research on the medical uses of low doses of radiation.  Imagine getting a mammogram for cancer prevention instead of diagnosis.  And maybe old guys like me will live longer.”

“I would be concerned about that, Curmudge.  One old geezer that I know quite well is flakey enough already.  So how is this low-dose radiation controversy going to be resolved?”

“Slowly, I believe.  Consider the stakeholders, beginning with the people and their governments.  An expansive government will take advantage of the people’s fears by promulgating regulations, e.g., a carbon tax, and by practicing crony capitalism, such as investing in solar energy schemes.  Remember, this is the age of policy-based evidence—not evidence-based policies.  NGOs thrive on people’s fears and concerns, so they will fight the concepts of a threshold and hormesis tooth and nail.  Scientists who have not read the literature will view data that fit a ‘J’-shaped curve as counterintuitive.  Nevertheless, it will be up to the scientists to gain an understanding of low doses of ionizing radiation and teach what they have learned.  These findings are too significant to be kept under wraps indefinitely.”

“Hey, Cumudge, that’s what you and I are doing.  It’s a perfect job for a jaded nurse and an old inveterate teacher.  So what issue will we tackle next?”

“We may have more to say about low doses of ionizing radiation, but not right away.  It will soon be May and time to celebrate our sixth anniversary.  À plus tard (see you later), Julie.”

“Ciao (‘bye), Old Guy.”

Kaizen Curmudgeon    

(1)  Dobrzynski, L. (p. 467) and Wilson, R. (p. 480) in Dose-Response 10, No. 4 (2012).

(2)   Mossman, K. L. Dose-Response 10, No.2: 190 (2012).

(3)   Muller, Richard  The Panic Over Fukushima  Wall Street Journal, August 18, 2012.

(4)   Wilson, Richard  Dose-Response 10, No. 4: 480 (2012).

Acknowledgements:  Curmudge and Jaded Julie gratefully acknowledge the personal communications (face-to-face and email) between Doc Mack and the following distinguished scientists: Douglas R. Boreham, T. D. Luckey, Ron E. J. Mitchel, and Charles L. Sanders.