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My standing bet with Trumpenfuhrer-hating pilots is that I will buy them dinner if the target of their hatred is able to get even a single FAA regulation changed in 8 years.

All kinds of friends have been asking me about “President Donald J. Trump’s Principles for Reforming the U.S. Air Traffic Control System”:

the FAA’s ATC operations are currently mired within a Federal bureaucracy that hinders innovative operations and the timely introduction of new technology. In order to modernize our ATC system, the Administration supports moving the FAA’s ATC operations into a new non-governmental entity. This will enable ATC to keep pace with the accelerating rate of change in the aviation industry, including the integration of new entrants such as Unmanned Aircraft Systems and Commercial Space Transports. A more nimble ATC entity will also be able to more quickly and securely implement Next Generation (NextGen) technology, which will reduce aircraft delays and expand the availability of the National Airspace System (NAS) for all users.

The new ATC entity would grant FAA-certified users access to the NAS, subject to their participation in the system’s user fees,

America’s growing aviation system demands a new, independent, non-government organization to operate our Nation’s airspace. The new entity should have access to capital markets in order to spur capital investment, technology adoption, and innovation faster, more effectively, and securely. Over the last 20 years, more than 50 countries have already successfully transitioned their ATC operations.

Here’s where the proposal begins to go off into the realm of fantasy, in my opinion. It can cost the U.S. 5-10X as much to do anything involving the government, whether run by the government itself or run by a crony (“privatized”), compared to what other countries spend (see New Yorker, for example). We would be bankrupt if we tried to operate a huge subway system that runs every minute like they do in Moscow, for example. We spend 4X as much, as a percentage of GDP, as Singapore on health care. Any argument of the form “people in Country X can do Y” is irrelevant, in my opinion, unless the plan is to import people from Country X to run Y here in the U.S.

Two members [of the Board] should be selected from the airline list, two members should be selected from the union list, one member should be selected from the general aviation list, one member should be selected from the airport list, and two members should be selected from the Department of Transportation list. Those eight initial Board members would then select a Chief Executive Officer. Those nine Board members would then select four independent Board members.

Why does the union for air traffic controllers support this proposal? Under the current system, controllers are civil servants so it is tough for them to get paid more than $400,000 per year (the President’s salary). Under a privatized system in which they have a monopoly on labor and board seats on the monopoly entity that pays for labor, there is no limit to what controllers might get paid. It could be the $500,000 per year that stage hands can get in New York (Forbes). It could be the $1.2 million per year that controllers in Spain are able to get (previous post).

Harrison Ford spoke in Boston on Sunday (People). Regarding ATC privatization, he said “What is the problem that we’re trying to solve?” Considering all of the things that the government does, running a 1950s-style ATC system is probably one of the best. Controllers are competent, energetic, helpful, and reliable. They get a lot more than private-sector workers (as with others in the federal government), but not so much that taxes on aviation fuel and airline tickets have to be cranked up to insane levels. The 1950s-style radars are up and running most of the time.

The Trump proposal is to hand over to a government crony a monopoly on running a 1950s-style ATC system and let the crony charge whatever fees it wants. There is a hint regarding new technology, but the U.S. track record in this area is terrible. The contracts regarding the fancy new ADS-B system ($20 billion?) have completely stifled innovation according to the FAA employees with whom I’ve spoken. The contract specifies a minimum level of performance and therefore the performance is fixed at that level indefinitely (e.g., this brand-new system won’t give you weather information for airports that are farther than about 500 miles away, so the people who paid for this new system still have to keep installing and paying subscription fees for XM satellite weather).

It would be interesting to see a rethinking of ATC that used modern technology and clean-sheet engineering. One small example: Americans have paid and are paying billions of dollars for ADS-B, which streams digital information into aircraft avionics systems. Why are aircraft operators having to swap out SD cards with updated databases every 28 days? The databases contain information on airports, navigation beacons, and intersections (lat/longs) that changes at a geological pace. For airline and charter operators, the FAA and DoT requires that the work of swapping out SD cards be done by maintenance (not pilot) employees who are on random drug testing. If an aircraft is based remotely from the maintenance facility, therefore, mechanics or avionics technicians must drive out to where the aircraft lives. It might cost $5,000 per year to keep the database in a GPS (functionally the same as the GPS in your smartphone) current. Why aren’t the handful of bits that are updated streamed to aircraft either in flight via ADS-B or on the ground via LTE?

It would be interesting to see a proposal for a system that starting from the following goals:

• separation of human-occupied aircraft from drones, including drones sold to consumers for $500
• zero humans in the loop for en-route operations by Date X
• zero humans in the loop for approach control by Date Y
• zero humans in the loop for airport (tower/ground) operations by Date Z
• only a single communications method required for in-flight operations (not VHF voice radio plus transponder plus ADS-B)

How challenging is this? There are only about 7,000 aircraft in the sky at once spread across 5 million square miles of U.S. airspace (FAA). Admittedly these tend to be clustered in certain areas, especially around the busiest airports. Nonetheless, we are not discouraged from working on self-driving cars despite the fact that a single Interstate highway might carry 7,000 cars in one hour in one direction.

So… the Trump Administration proposal doesn’t seem to address the real safety hazard that has developed over the past 10 years, i.e., drones. In fact, the proposal probably makes it worse. The organization that has the power to regulate what equipment is included in a drone sold to consumer (federal government) will become disconnected from the organization that has to deal with the potential for mid-air collisions.

[What has the FAA been busy with instead of managing the drone hazard? One example is the FAA’s huge staff devoted to hassling aircraft manufacturers and owners regarding extremely unlikely problems, e.g., forcing Bell to put an $18,000 backup attitude indicator into a VFR-only 505 helicopter, which already has two huge G1000 screens that offer attitude information. These themselves are unnecessary because under VFR the pilot looks out the window to see if the helicopter is pitched up or down. It is not legal to fly the 505 into the clouds and it would only be in exceptional situations when a pilot would refer to the extremely reliable G1000 for basic aircraft control. The old Bell Jet Ranger, which the 505 replaces, was legal to operate without any attitude indicator (“artificial horizon”). If an operator stuck a mechanical gyro in the panel the FAA required no backup to the unreliable mechanical instrument. Now that the new 505 Jet Ranger comes with a bulletproof electronic attitude indicator, a backup is required, and it can’t be the $500 backup that is available in the world of kit aircraft or portable electronics that Cessna pilots might use. (Thus does an ever-larger fraction of GDP get devoted to stuff that has no value to Americans, making GDP an even less reliable indicator of economic progress.)]

The Trump Administration proposal locks Americans into paying for a unionized labor force of 24,500 people (BLS) to do a job that, in a clean-sheet design, likely wouldn’t be done by humans at all. If the controllers are able to use privatization to boost their salaries to $300,000 per year and total comp (including pension and health care benefits) to $500,000 per year, this will be a $12 billion cost to the U.S. economy (some comparison numbers).

The Trump Administration proposal contains no metrics for how we would know whether or not the implemented privatized/cronyized system was actually better. The people will be able to declare “success” and “mission accomplished” as soon as this is spun out. Currently there is no metric for FAA success or failure, but at least they are subject to Congressional oversight if the lack of accomplishment becomes too obvious.

If the government can’t resist privatizing something related to aircraft this year, I suggest starting with aircraft certification. Due to our comparatively ponderous bureaucracy, the U.S. is at a competitive disadvantage to countries such as Switzerland and Austria where new aircraft designs can be tested and approved quickly. The FAA can turn over aircraft certification to a competing group of UL-style companies, maybe with some involvement by the insurance industry. Unlike with ATC there is no need for a “big bang” change due to the fact that the team certifying a new Boeing 787 variant need not talk to the team certifying a new helicopter.

If Congress can’t resist privatizing ATC, I suggest starting with Alaska, Hawaii, and Puerto Rico and giving those three disconnected airspaces to different organizations. There is no reason that multiple private ATC operators can’t cooperate with existing government ATC and/or each other. The FAA controllers already cooperate with privatized Canadian and governmental Mexican, Cuban, and Bahamian controllers (for example). If this goes well, let these three competing vendors start bidding for one center (out of 20) at a time within the continental U.S.

Whatever we do, it needs to be done with some high-level goals (such as the elimination of in-the-loop humans and redundant legacy communications systems) and metrics so that we can evaluate our progress against those goals. We also should be humble with respect to our repeated failures at executing projects like this and consider that government-run ATC is one of our government’s few success stories. If the goal is, as it seems, to continue running a 1950s-style system (humans primary, augmented by radar and computers), I don’t see how it can be worthwhile. If the goal is to run a system that takes advantage of modern technology, the proposal should start with “let’s redesign this from a clean sheet.”

[Comment from a friend: “Think of the last time the ATC system went down? Vs private airline scheduling and reservation systems? (Two weeks ago)?”]

Related:

• The potential train wreck of privatized air traffic control (2016 posting showing that this terrible idea is not original to the Trumpenfuhrer)
• Atlantic article on Trump’s proposal

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One of the things that I’ve been spending money on for the last 25 years or so is heroin. Recently I discovered that heroin is not part of a healthy lifestyle. My dealer has been getting pretty rich from all of the money that I and other customers have been handing over. So I’m planning to sue him for selling me the heroin that I didn’t realize was bad for me.

One other tidbit: One of my part-time activities is educating children about how they shouldn’t use heroin and other narcotics.

Ladies and gentlemen of the jury: How do you like my lawsuit?

Okay… now how is the above-described hypothetical different from the real lawsuit by the state of Ohio against five vendors of heroin pills:

The state of Ohio sued five pharmaceutical manufacturers Wednesday, arguing the companies fraudulently marketed addictive prescription painkillers and seeking hundreds of millions of dollars to address Ohio’s opioid crisis.

Attorney General Mike DeWine said the drug manufacturers knowingly misled physicians and patients into thinking OxyContin, Percocet and other opioids were nonaddictive and safe in large quantities. Although the state has cracked down on prescribing the drugs, DeWine said, they were and are a gateway to more dangerous heroin and fentanyl, street drugs now responsible for most opioid overdoses.

So… the state regulates doctors, deciding which can and cannot practice within Ohio. The state also runs anti-opiate classes in its schools. The state decides what pills can and can’t be purchased with Medicaid (see Who funded America’s opiate epidemic? You did.). But the drug manufacturers are responsible?

Related:

• “Generations, disabled” (Washington Post), about the government paying Americans to stay home and take pills: “They were the fourth generation in this family to receive federal disability checks…”

 

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Antonio Garcia Martinez (of Chaos Monkeys fame) recently made a Facebook posting from Havana:

The detailed how-to on how to bring home prostitutes from my Airbnb hostess is worth recording.

I should call her once I know I’m coming home with a ‘chica’, so she can be there to officially register her as ‘visitante nocturno’, which implies taking her identification details and sending them to the state. Once the girl robs me in my sleep, which she’ll inevitably do, the señora will report her to the police, and the full machinery of Cuban state suppression will be engaged to hunt her down. And hunt her they will: the señora reported that a guest of hers had a bottle of expensive cologne stolen, and the police found the girl and returned the cologne. Totalitarianism has certain advantages.

Lastly, Cuban sexual mores are evidently rather less than evangelical. ‘Las chicas…es lo normal,’ she intoned (‘the girls…it’s normal’), punctuated with that resigned shrug common among Habaneros. Note, this is a stately and briskly competent older lady well into her 50s.

I see a five-star Airbnb review in your future, Margarita.

This is consistent with a 2013 Miami Herald story:

easy access to young women willing to ignore age differences — in exchange for as little as $30 for the night.

Today, prostitution may well be the most profitable job in an island where the average monthly salary officially stands at less than $20 and a bottle of cooking oil costs $3.

What if the embargo collapses and it is straightforward to JetBlue to my home town of Boston, for example? Under the Massachusetts child support guidelines, the Cuban tourist who has sex with a local earning $50,180 will get $30 per day ($210 per week; $10,920 per year) for 23 years. If the Cuban tourist can find a partner who earns $250,000 per year, revenue per the guidelines is $40,000 per year ($920,000 over 23 years). (See “American Child Support Profits Without an American Child” within “Child Support Litigation without a Marriage” for how U.S. taxpayers will fund the administrative and legal costs of getting the cash flowing over the border.)

[Nearby Florida has similar laws, but child support ends at age 18 or 19 and the revenue is only about half of what can be obtained in Massachusetts or New York, so the return on investment in a few extra hours of air travel is substantial.]

It seems that some of this already goes on with respect to Canada, though if the biological parents had sex in Cuba rather than in Canada, the Canadian child support formula would not necessarily apply. From Havana Times:

a prostitute in Bayamo who gives birth to a Canadian client’s baby and receives just $100 per month from Canada will live better than the OB/Gyn who delivers the baby.

Readers: What happens when/if Cuba-U.S. travel is completely open?

Related:

• Cuban divorcee moves from Cuba to Florida and seeks modification of child support from $1.50/month to $8,000/month (2001) [but if the pregnancy had occurred in Florida she would have been able to collect at Florida rates even while remaining in Cuba]
• Where New York Times readers don’t want to follow Europe: Legalized prostitution

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Exam week and most of us are feeling burned out. “I just want to get this over with,” lamented one classmate. “Studying another few hours won’t change anything.”

We had four exams, three hours each, one per day, from Monday through Thursday, starting at 8:00 am or 9:00 am. All were computer-based.

The main NBME exam was challenging and surprisingly clinically-focused. Example: “Where is the lesion for someone who has right-sided intention tremor?” (Answer: right cerebellum; not everything in the brain is cross-wired.) Type-A Anita complained, “I thought it would be much more detailed and less big picture. I studied all the wrong things.” There were numerous questions on peripheral nerve deficits as a result of disk herniation. Students complained that this subject was not covered in “significant detail” during lectures.

The anatomy exam, developed locally by Doctor J, was a blend of challenging second-order questions and basic identification questions, with both multiple-choice and short-answer styles. Students complained that the second-order questions as not testing only “anatomy material”. For example, three students complained about questions asking to locate the lesion site for various visual field deficients. Several memorable questions started with a group of stroke symptoms and asked the student to identify the blood vessel most likely affected. Students were outraged at these applied questions. “I cannot believe Doctor J put that question in. He put that in just to screw us over.”

Students were also frustrated by the locally-developed clinical exam covering the HEENT (head, ear, eye, nose, and throat) exam, the neurological exam, and child development. We looked at computer images of different retinas. Given a description of a patient’s reflexes, we had to name the peripheral nerve or spinal nerve roots that might be damaged. We looked at a computer screen image of an ear canal that we would have seen through an otoscope. We were asked to identify the age of kids based on certain observable skills and behaviors. Type-A Anita complained to several classmates, “I don’t need to know this for Step 1” (the board exam we will take at the end of our second year). The classmates echoed back, “I don’t need to know this because I don’t want to be a pediatrician.” Students complained about the image quality of the ear canal, even though a higher quality image would not have helped them answer the question. Students complained, “This material overlapped with our other exams.”

The patient case exam asked to propose hypotheses for various clinical scenarios. What tests would you order? What diseases should be on your differential for this given test result? What other information would you want to know? How would you manage this patient with Parkinson’s? What other symptoms and test results would you expect from this patient? Most students do not study for this exam. Students complained about the drugs that were covered.

After our last exam, Jane and I went to a brewery. Students trickled in as people finished. “Cheers to another step to becoming a doctor!” Dorothy Disinterested responded, “I have lost so much faith in our medical system. It scares me to think that we are one-quarter of the way to doing stuff to patients.”

Statistics for the week… Study: 15 hours. Sleep: 5 hours/night; Fun: 1 night. Example fun: We met at a classmate’s apartment for pool and darts around 8:00 pm before heading downtown for an “End of M1” celebration. My classmate and I went to a less crowded part of the bar to get another beer. We were listening to a bartender’s conversation with some of her friends. A friend asked the bartender, “What have you been up to since you graduated college?” She responded, “Working here pretty much.” My friend commented afterwards, “That’s too bad she went to college with all that debt. She could have been the manager by now if she started after high school.”

More: http://fifthchance.com/MedicalSchool2020

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A friend sent me “Who is Reality Winner? Accused leaker wanted to ‘resist’ Trump” (Fox News, so should I de-friend this guy for being Deplorable?). The substance of the case doesn’t interest me too much. I have to assume that “a [U.S. government] classified intelligence document” is mostly speculation and misunderstandings. What I am curious to know is whether the National Security Agency hired an employee (even through a contractor) named “Reality” and expected things to work out.

Readers: Was this spirited gal actually working in an NSA facility?

Related:

• Code Warriors (book about the NSA): “On an Army sergeant’s salary of $100 a week, [the NSA employee who turned out to be selling secrets to the Soviets] owned two Cadillacs, a baby-blue Jaguar sports car, a thirty-foot cabin cruiser, and a world-class racing hydroplane; he told coworkers a series of contradictory and patently fantastic stories to account for his sudden wealth, including that his father owned a large plantation in Louisiana, that he had made a successful investment in filling stations, that he owned land containing a valuable mineral used to make cosmetics, and that he had won the money as prizes in boat races.”
• article about tracing source of this document via laser printer dots

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Apple, Facebook, and Google have soaked up a huge percentage of humanity’s wealth. Why aren’t they enriching our lives more?

Since I’m a Gmail user, let’s take Google as an example. Google knew that I was going to Moscow (itinerary emailed to my Gmail address). Google knew my schedule (Calendar). Google should know my various interests by now, from reading my Gmail messages and Docs content. Due to me being of such an advanced age that I still use email rather than text, Google definitely knows my real social network (the people with whom I correspond via email).

Why didn’t Google suggest to me a whole bunch of cultural events? People to meet? Groups to join? The stuff that Google tries to help with is stuff that was already pretty easy to do in the pre-Internet days, e.g., book a hotel or airline ticket. Even in those areas, Google is simply following the mid-1990s leaders such as Expedia.

I don’t think that one can argue that enriching lives is unprofitable and therefore these profit-seeking companies aren’t interested. Selling tickets to events should lead to commissions. Connecting people to meet in public places, such as restaurants or bars, should also lead to commissions. These could be a lot more lucrative than what Google gets from selling mouse clicks.

Readers: if we assume that human boredom leads to a lot of purchases, e.g., of movies and games, why aren’t companies such as Apple, Facebook, and Google chasing this market through actual social connections?

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Three hour-long lectures on child development. A student commented, “Who knew that children are blind as a bat when they are born. 20/300 vision!” Afterwards, several instructors brought in children aged one month to five years for a workshop. Each pediatrician noted specific tasks, behaviors and skills. Dorothy Disinterested was reprimanded for “not being interested in the subject material and being on her cellphone”. Dorothy explained afterwards, “I am just not interested in children.”

Also three hour-long lectures on cerebrospinal fluid (CSF) circulation. The brain is surrounded by an outer connective tissue called the meninges (meningitis is the inflammation of this connective tissue) composed of three layers (outer to inner): dura, arachnoid, and pia. The dura, a fibrous white sheet, is strongly adhered to the inside of the skull and, via dura folds, divides the cranial cavity into quadrants. The falx cerebri divides the brain into left and right hemispheres. The tentorium cerebelli is a horizontal sheet that separates the cerebrum (above) from the cerebellum (below). These dural folds are tightly adhered to the arachnoid, named for its resemblance to a spider web, a clear membrane that wraps around the exterior surface of the brain. The innermost layer is the pia, another thin membrane, follows the contours of the brain into its crevices (sulci and fissures). The subarachnoid space, the space between the arachnoid covering and the tightly adhered pia, is filled with CSF.

CSF is produced in four connected brain cavities called ventricles. The left and right lateral ventricles connect to the third ventricle through a thin constriction called the interventricular foramen of Monro. The third ventricle drains through a narrow constriction called the Aqueduct of Sylvius into the fourth ventricle of the brainstem. CSF exits the fourth ventricle into the subarachnoid space through three foramina (the two lateral Foramina of Luschka and the medial foramen of Magendie). Students appreciated that the early 19th-century anatomists who discovered these respective structures have last names whose first letters correspond to the structures’ anatomical positions: Francois Magendie for medial; Hubert von Luschka for lateral.

The CSF suspends the brain in fluid, thereby protecting the delicate tissue structure from small shocks and providing a buoyancy effect, which turns a 1500-gram brain into 25 grams. Without the buoyancy effect, the weight of the brain would crush itself. Each ventricle contains a choroid plexus where 500mL CSF, enough for four complete daily changes, is produced by ependymal cells. CSF circulates through the ventricles, draining metabolic waste products of neurological activity, such as glutamate (excitatory neurotransmitter) and potassium, into the subarachnoid space.

My favorite trauma surgeon explained the different types of hemorrhages. Blunt trauma can fracture the skull causing an epidural hemorrhage, rupture of the meningeal arteries that travel along the inside surface skull. After a car crash, the patient will go unconscious. They will then wake up for a “lucid interval” of roughly 30 minutes, then suddenly go unconscious again as the ruptured meningeal artery leaks into the brain. A subdural hemorrhage typically occurs in old age. The brain shrinks, which stretches the small veins that drain blood from the brain to the large venous sinuses in the dura. Slight trauma can then cause the veins to rupture, starting a slow bleed that brings the patient into the ED days or weeks later with headache and confusion. Both types of hemorrhages can result in sufficient elevation of pressure to cause herniation of the brain, in which parts of the cortex protrude through holes in the skull.

Our patient case: Greg, a 23-year-old male with Mike, his cardiologist father and Jennifer, his nurse mother. Jennifer’s pregnancy was completely normal until a 30-week ultrasound. The obstetrician noted an enlarged skull with a protrusion on the right side. The mother explained, “My OB told me, ‘Something came up on the ultrasound that we need to take another look at.’ I knew something was wrong. Whenever a physician sees something bad that they have to refer you out to a specialist, they refuse to tell you a definitive answer..” Jennifer waited several hours in the waiting room until the specialist could see her. “I did not want to call Mike because he was dealing with a tough heart case.”

Further ultrasound examination confirmed that Greg’s Aqueduct of Sylvius had narrowed, causing hydrocephalus (abnormal accumulation of CSF). The choroid plexus continues to produce CSF despite the increasing ventricular pressure in his lateral and third ventricles. The increased ventricular pressure and size was damaging developing brain tissue and preventing the skull from closing. The physicians told Mike and Jennifer that Greg would unlikely be able to survive and that, if he did, he would have severe cognitive deficits.

“We knew this was bad,” continued Jennifer. “We both have medical backgrounds so we were imagining the worse. Mike immediately became an expert on this condition. Keep in mind in those days Google was not around. Mike went to medical libraries to scour the limited literature on this condition and its outcomes. Our doctors recommended we terminate the pregnancy. But when I saw the ultrasound, I could not terminate. He was my boy.” Jennifer was immediately scheduled for a cesarean section. Greg was whisked away to the NICU for intensive treatment. He had a ventriculoperitoneal shunt (tube inserted through brain tissue into a ventricle to drain CSF into the peritoneal cavity) and several cranial skull surgeries to release the increased intracranial pressure.

Greg is 5’5 with a cheerful smile. He speaks slowly but carefully. “More articulate than some of our classmates,” commented one student afterwards. He chuckles after his jokes. He has terrible vision as a consequence of visual cortex damage.

Most of Greg’s medical care occurred in his infancy. He had two additional surgeries to restructure his skull at age 8 and 14. He lives with his parents and works part-time as a clerk at a local grocery store. His mother said that Greg’s social life is more active than their own: “There are all these support groups for disabled people. I feel like every week I am ferrying him to an event downtown.” He is intellectually disabled but has an encyclopedic knowledge of the Harry Potter books. Several female classmates tested his knowledge after the session.

One week before exams and Pinterest Penelope, our class social chair, released the results of “class superlatives”, one per student. One student complained about the distraction from studying: “She is just trying to sabotage us.” I received, “Most likely to ask Low Yield Questions in Lecture”. Type-A Anita got, “Most Likely to Complain About Said Low Yield Question Asker”. Our lone Canadian (we have no other foreign students) got “Most likely to curse in front of a patient.” Our class president received, “Most likely to use ‘I’m a Doctor’ line at the bar”. The shy Asian received, “Most likely to ruin his/her white coat and need to order another”. Dorothy Disinterested apparently does have at least some interests. She received “Most likely to hook-up with a patient” (as the social chair is also female, this did not generate any complaints to the deans).

Statistics for the week… Study: 20 hours. Sleep: 7 hours/night; Fun: 1 day. Example fun: a “finisher prize” for the last day of class, beer and burgers with four classmates.

More: http://fifthchance.com/MedicalSchool2020

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One of my friends in Berkeley, California recently linked to “The Invisible Workload That Drags Women Down” (TIME, December 29, 2016). She has previously used Facebook to heap scorn on the stupid, racist, sexist, and anti-gay Americans who voted against Hillary. Also to throw rocks at skeptics of published climate change predictions. After the election of the Trumpenfuhrer, she condemned the “anti-intellectualism” to which America was now doomed (a country that produced Britney Spears can be considered somehow anti-intellectual?).

The research described (from 1996, so it is unclear why the editors of TIME thought it was news in 2016) is based on 23 data points, all from couples with infants:

She interviewed 23 husband-wife couples, finding them through the rather quaint method of reading birth announcements in a local newspaper. All had brought a baby home in the last year.

The author’s thesis is that women are wearing out their brains ensuring stocks of toothpaste and peanut butter in the house. In a private message, a male reprobate asked for his opinion wrote

“wrong toothpaste is the kind of thing that can seriously ruin a child’s morning—not to mention their parents.”

If my kids tried to whine about toothpaste, I would make them eat it. Wtf.

The poster’s female friends, however, were impressed with this article and the underlying research. The post was showered with “likes” and comments in agreement.

Of course, given the topic of my recent talk at the economics university, I felt that I should question this celebration of social science…

Even if you accept that 23 is a statistically significant sample and that the sample was appropriately random, this covers only those couples with an infant. The vast majority of couples do not have an infant at home (owing to the tendency of infants to age out of infancy). Would you expect the division of labor to be different among couples with an infant compared to couples with no children or couples with teenagers? Why would it be reasonable to apply these findings to all male-female partnerships?

Women in lesbian couples would be a lot more productive, then? Because there is no man to “drag them down”?

(And gay male couples wouldn’t have essential supplies in their house because there was no woman to notice that they were running out?)

In a society where there is little social pressure and no legal requirement to be part of a couple, any study that concludes that some class of people are exploited within couples leads to the questions “Why would they agree to join a couple?” and “If part of a couple, why wouldn’t they go back to being single?”

These questions generated a flurry of ad hominem attacks from the warm-hearted pussyhat-wearing Hillary supporters. Despite their professed reverence for the scientific method, and contempt for those Trump voters who purportedly reject it, none of them seriously addressed the substance of the above questions.

From the inability of these folks to entertain any questions regarding their beliefs, can we concluded that faith in American female victimhood is now a religion?

Getting back to the substance of the study, is it actually kind of insulting to women? The TIME author assumes that men can manage household inventories: “If she were gone, you bet her husband would start noticing when the fridge went empty and the diapers disappeared.” If that assumption is correct, then women just need to do is stop worrying/noticing because a male partner will pick up the slack. Why aren’t women intelligent enough to do this?

If the assumption is false and men are hopelessly inept and managing toothpaste and peanut butter is preventing women from being successful in their careers, working women could hire someone (another woman?) to handle this management task. If women adopted this strategy they would be as or more successful than men in the workplace, but have a slightly lower spending power (since some after-tax income would be going to the toothpaste/peanut butter manager). If women aren’t adopting this strategy, why aren’t they intelligent enough to adopt it?

I’m in agreement with part of the article (not the “women are too stupid to see how badly they are being exploited” part!). I think that Americans of both sexes have their brains filled up with clutter that is the result of owning and managing too much stuff. By owning a house instead of renting, for example, the typical American is forced to think about plumbing, electric, paint, appliance repair, etc. By owning a car, the American is forced to manage recall notices, re-registration, property tax payments, etc. Let’s not get started on what it is like to own an aircraft, be a pilot, or renew one’s airport security badges periodically!

Readers: What do you think? Are American brains filled with non-work task-related clutter? If so, is there is a substantial gender difference? [Is the 1996 research obsolete due to Amazon Prime (2-day) and Prime Now (2-hour) services?]

Related:

• How feminists explain the phenomenon of women voting for Donald Trump

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One of the first slides for the three hour-long lectures on higher cortical function involved an updated Gallz’s phrenology for 21st century tasks (https://blakerivers.files.wordpress.com/2010/06/male-female-brain.jpg). Tattooed Talia, sitting next to me, expressed outrage: “Shopping! Jealousy!” During a break, Pinterest Penelope, a female classmate and social chair whose laptop screen is often filled by Amazon or Pinterest during lecture, said to Talia, “I love your boots! Where did you get them?” Talia and Penelope spent the rest of the break discussing the challenges of ordering the right shoe size online.

A psychiatrist in his 50s came in to present research on schizophrenia. Schizophrenia runs in families. According to the NIMH, “The illness occurs in less than 1 percent of the general population, but it occurs in 10 percent of people who have a first-degree relative with the disorder, such as a parent, brother, or sister.” According to the latest research, a region of the prefrontal cortex (surface area of the brain) is less metabolically active in individuals with schizophrenia. Unfortunately, nobody knows whether this is a cause or effect of schizophrenia. Nonetheless, the psychiatrist suggested screening individuals at risk of schizophrenia with fMRI(functional Magnetic Resonance Imaging) to measure prefrontal cortex activity. If below normal, preventative interventions could be attempted.

After lecture, the psychiatrist talked about his interest in the mental health of incarcerated individuals. “Society is committing genocide against these prisoners, primarily blacks. They develop terrible mental illnesses in childhood. When they become incarcerated these illnesses spiral out of control. It is a sick cycle.” He was lobbying state legislature for more extensive mental health programs in state jails. He also talked why he loves psychiatry. “It is a surreal experience to witness some of these disorders. Bipolar disorder causes patients to swing between fits of mania and extreme depression. We can predict these cycles with almost pinpoint accuracy.”

We had two hour-long lectures on cerebral blood regulation. The brain always needs 750mL of oxygenated, glucose-rich blood per minute. That’s 15 percent of resting cardiac output, which totals roughly 5L per minute. When you begin to exercise, stroke volume and heart rate increase causing a surge in cardiac output to about 12L per minute. How does the brain maintain constant perfusion (blood supply to tissues) while cardiac output varies? The increased pressure is sensed by stretch receptors in arteriole walls of the brain. The increased wall tension causes the arteriole smooth muscle to constrict to relieve this increased wall tension. This myogenic (muscle) response increases the vascular resistance of the brain tissue, thus maintaining the 750mL-per-minute perfusion, and diverting flow to other areas of lower resistance, for example, muscle. The opposite occurs when there is a decreased cardiac output from, from example, hypovolemic shock or cardiac insufficiency.

The two lectures that followed detailed anatomy of cerebral blood supply. The blood supply to the brain originates from the carotid arteries and the vertebral arteries. These form a miraculous structure at the base of the brain called the Circle of Willis. If one contributory artery is blocked, the brain will still get plenty of flow from the others. Doc J commented, “Evolution clearly valued ensuring the brain gets its oxygen and glucose.” The Circle of Willis feeds the six bilateral (left/right) arteries of the brain: left/right anterior cerebral artery (ACA), left/right middle cerebral artery (MCA) and left/right posterior cerebral arteries (PCA). The MCAs supply most of the brain. Unlike other tissues such as muscles, the brain does not have any energy reserves. Without a continuous supply of glucose (or ketones in the fasting state) and oxygen, brain tissue begins to die within minutes. A classmate and his girlfriend are passionate about fitness and supplements. They fast for three days every two months to “reset the system”. He thinks a brain diet of ketones will help prevent Alzheimer’s Disease.

Anatomy lab investigated the contours of the cranial cavity and the main blood structures. Due to time constraints, the instructors decided to perform the time-consuming removal of the brains from our cadavers’ skulls. Next week we will explore “brains in buckets”. Some students were disappointed. “I’ve been looking forward all year to removing the brain.” One of our favorite labs was during the heart unit. We were simply asked to “remove the heart”. A student commented how he found removing the structures that anchors the organ of interest helps build understanding of the anatomic relationships.

With the brains removed, we saw the holes (termed foramina and fissures) in the cranial cavity through which structures such as nerves and blood vessels pass. There are 12 holes per side that we need to know, e.g., foramen magnum (for the spinal cord), superior orbital fissure (optic nerve and ophthalmic artery), foramen rotundum (sensation of the face), and the hypoglossal foramen (nerve to tongue muscles). About half the cadavers still had their Circle of Willis. It looks more like a pentagon. You quickly appreciate how anatomic variations can lead to immense clinical differences for the exact same stroke. Some cadavers have more developed connections within the Circle of Willis (posterior communicating arteries and anterior communicating artery). These individuals would have a less severe stroke with an occluded carotid artery.

My favorite trauma surgeon discussed the two different types of strokes. An embolic stroke is caused by a decrease in blood perfusion to a part of the brain. This is commonly caused by a blood clot traveling up to an artery of the brain or from the slow accumulation of plaque causing stenosis (narrowing) of an artery that supplies the brain. A hemorrhagic stroke is caused by blood leaking out from a vessel, typically from a ruptured aneurysm or prolonged hypertension causing small tears in a capillary bed. We viewed different MRI and CT scans of strokes. She described the “Death-Star” sign. A subarachnoid hemorrhage (“sudden worst headache of your life”) in the Circle of Willis leads to a five-pointed star on CT scan as the blood pools in the contours of the cranial cavity.

A first-year vascular surgeon fellow attended the dissection. He described the carotid endarterectomy, a procedure to treat Atherosclerosis (hardening and narrowing of arteries) and thereby reduce the risk of stroke. The common carotid artery bifurcates into an external and internal carotid artery typically a few centimeters above the thyroid cartilage at a bone called the hyoid bone. The turbulent flow at this bifurcation makes this a high risk site for plaque build-up and intimal (innermost layer of blood vessel) thickening causing stenosis (narrowing) of the internal carotid. The increased blood velocity and shear stress on the plaque wall increase the chance that a small calcium deposit will chip off. As this silent killer travels from the large diameter carotid to smaller arteries, the small deposit begins to enlarge as the body’s clotting system takes over. This blood clot can then get lodged in a small artery. If it gets lodged in the ophthalmic artery, for example, it would causing sudden “curtains to fall” as the retina becomes starved. If it occludes part of the middle cerebral artery, it might cause weakness of the upper extremity and face.

Carotid plaque can decrease overall perfusion pressure to the brain. The Circle of Willis can maintain normal cerebral perfusion pressure with 85 percent stenosis of single internal carotid artery. Above 85 percent, the brain tissue supplied by the end of the main arteries begin to get less flow, leading to a “watershed infarct” with slurred speech and poor comprehension of words.

The carotid endarterectomy is analogous to snaking out a slow bathtub drain. The vascular surgeon detailed the steps while making cuts into a cadaver. He made an incision along the neck exposing the sternocleidomastoid muscle (SCM). The SCM was retracted to reveal the carotid sheath. He opened the carotid sheath and retracted the internal jugular vein and vagus nerve before clamping the carotid arter. In a live patient, he would then have measured the back-flow pressure distal to the clamp. “I need to ensure there is enough perfusion from the Circle of Willis to maintain perfusion of the entire brain without one carotid artery. If the pressure is below about 40 mmHg, I need to create a shunt [install a bypass] of this clamped flow.” He then opened the carotid artery and scraped away some plaque. He gave us the opportunity to feel the vessel. The cadaver’s carotid artery had severe stenosis (greater than 85 percent). The plaque, hard due to the calcium deposits, comes off in sheets. Over half the thickness of the artery was plaque! He then sutured together the carotid vessel incision and closed the wound.

What’s the biggest risk of this stroke-prevention surgery? Postoperative stroke. “It’s impossible to get all the plaque because it goes all along the vessel. You have to decide where to stop.” The surgeon described how he has to ensure that the interior of the artery is smooth. Otherwise these plaque edges will stick out and become dislodged from the shear stress of the blood flow.

The vascular surgeon urged us to follow our interests: “I am still in disbelief I get up every morning and get to perform what I love. It’s just crazy to think about. There is nothing like surgery. Don’t let the amount of time for training turn you off of surgery or any other speciality. Follow your passion.” (Fortunately we’re all in medical school, so the economic consequences of this advice are not as potentially disastrous as following our passion for painting or poetry.)

Our patient case: Jerry, a fit 42-year-old male presenting to the ED for upper extremity weakness and slurred speech. Jerry noticed he had trouble holding his toothbrush before bed. “When I grabbed the cup of mouthwash, I dropped it. I thought to myself, ‘Huh? This is weird.'” I forgot about it and went to bed. When I woke up, my wife said that I was slurring my words. She rushed me to the hospital where everything went black.

Jerry was having a stroke in his MCA. His wife described how furious she was with the doctors. “It seemed like they were just sitting around twiddling their thumbs.” The neurologist added, “Because we did not know when the stroke really set in, we could not use TPA. [Tissue plasminogen activator is a potent clot buster.] Guidelines state that unless you can identify the occlusion occurred within an hour, TPA administration could cause hemorrhagic stroke causing more harm than good.” [A recent article in NEJM recently disputes this time restriction. (http://www.nejm.org/doi/full/10.1056/NEJM199512143332401#t=article).]

Jerry had a relatively minor stroke in a small branch of the left MCA. It still took months to recover from it. He had trouble with his right arms, swallowing and speaking. “I could barely speak for three weeks.” He went to occupational therapy for two months. Most people would now have a hard time realizing Jerry had a stroke. “The main issue I have is that I cannot feel my entire right chest, shoulder and upper back. Some words seem to have just left me. I cannot seem to recall a lot of complicated words.”

“What scares me the most is why this happened. I am a pretty fit person.” The neurologist explained that the Jerry does not have the main risk factors for a stroke. “He does not smoke, does not have afib [atrial fibrillation]. We could not even find an ASD [atrial-septal defect].” He brought up the ASCVD risk estimator to show he was doing pretty well (http://tools.acc.org/ascvd-risk-estimator/). This nagged at Jerry. “I did not know what to tell my two kids.” The neurologist recommended he join a clinical trial with a new drug to prevent strokes. “This clinical trial has given me confidence, even though I don’t know if I am on the drug or the placebo. I just believe it is doing something.” After one year, Jerry will know to which group he had been assigned and, regardless of his original group, will have the option to be

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My Facebook friends are excited about condemning anyone who questions the propriety of movie theaters holding “all-women” screenings of Wonder Woman. The main attack leveled at the Neanderthals (Deplorables?) who suggest that movies should be open to patrons of all genders is that they are “sexist” and that “sexism” continues to pervade our society.

Wikipedia:

Sexism or gender discrimination is prejudice or discrimination based on a person’s sex or gender.

It would seem that the theater owners are discriminating (sell/don’t sell) on the basis of sex or gender. But it is the people opposed to this who are guilty of “sexism” in actual English usage.

Does this mean that the dictionary definition of “sexism” is now obsolete? People seem to be using the word in a new way.

Separately, my friends are saying that the depiction of a female superhero is “game-changing” and “revolutionary”. Yet Wikipedia says that the character dates back to 1941 and that “The Wonder Woman title has been published by DC Comics almost continuously except for a brief hiatus in 1986.” What’s game-changing about this particular movie? (of course I cannot go myself because it is not targeted at 3-year-olds; maybe if there is a Masha and the Bear and Wonder Woman movie I will be able to watch it)

Finally, if a theater admits only people who identify as “women” at 7:30 pm, how do they know that at 8:30 pm the entire audience will continue to identify as “women”? So I don’t see how it would be possible to have an “all-women showing”. Maybe they could have an “all-women ticket sale” since they could ask people for their gender ID at the time of purchase.

One movie, many questions!

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