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It has been a year since President Trump took office. What do readers think are the main changes, positive and negative, that can be attributed to him? (as distinct from stuff that Congress has done, e.g., cutting the corporate tax rate to a European level)

When Mom and I were on our September 2017 cruise, the non-Americans on the ship always asked us what we thought of Trump. My parents still live in Bethesda, Maryland where the only problem with Big Government is that it isn’t quite big enough. From Mom’s perspective, Trump is, like his supporters, deplorable. There is no need to look at specifics. I responded that I thought the biggest change occasioned by Trump was that he broke the pattern of Americans worshiping their President like an Egyptian pharaoh. As Trump was plainly mortal, Americans now realize that they will have to exert some personal effort if they want to become better off. The god-like Great Father in Washington is not going to do it all for them.

Readers: What do you see as the most significant effects from the first year of Donald Trump in the White House?

Related:

• Bill Murray in What About Bob? describing his psychiatrist (similar to how a lot of Americans would have described previous presidents)

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From our anonymous insider…

Hematology and immunology. Immunology is one of the class’s least favorite topics. Gigolo Giorgio: “I accept just taking a hit on the exam. It makes no sense to me.”

An enthusiastic 39-year-old immunologist kicked off the lectures. She explained, “We need about 100 million unique antibodies to be immune competent. We have about 30 billion B cells in the blood. That means we only have 300 potential B cells that need to become activated if we are to mount an antibody attack against a given antigen. This is the key dilemma in adaptive immunity: How do you find them!”

Our first-year perspective on the immune system was cell-centric. This week we learn that the story is more complex and includes smaller-scale proteins from the complement system and larger-scale tissues such as the spleen filtering blood-borne pathogens.

Our current understanding of a typical bacterial infection:

1. The innate immune system recognizes common pathogens. Complement proteins (smaller than cells and made by the liver) mark bacteria for opsonization (trigger for phagocytosis or cellular ingestion).
2. Resident macrophages (cells) phagocytose (ingest) marked intruders resulting in an inflammatory “cytokine storm”. This causes systemic changes such as fever and increased production of immune cells in the bone marrow (lymphocytosis) and local changes such as blood vessel dilation to increase tissue perfusion and neutrophil infiltration into the tissue.
3. Neutrophil infiltrate the inflamed tissue. Neutrophils, the most abundant leukocyte (white blood cell), are the immune system’s pawns that kill bacteria by eating them and producing high concentrations of hydrogen peroxide in the phagosome (walled off vesicle containing the bacterial cell inside the neutrophil). After the neutrophil has worn itself out, it will explode in a process called netosis. The neutrophil’s DNA acts like a spider web (called neutrophil extracellular traps) to prevent the bacteria from escaping the site of inflammation. Pus is dead bacteria and dead neutrophils.
4. Adaptive immunity activated (if needed).
5. If necessary, the spleen will filter bacteria in the blood (bacteremia) through small capillary beds called sinusoids.

The C3 protein is fundamental to the complement system and will bind to almost any biological molecule. How does the body avoid its own proteins being marked for phagocytosis? The liver releases anti-complement factors that bind to sialic acid, a component on human cell membranes. Streptococcus pyogenes, the bacterial strain causing strep throat and necrotizing fasciitis, expresses M protein to mimic sialic acid. The immunologist explained, “Although this molecular mimicry decreases the efficacy of the innate immune system, it is also Strep’s greatest weakness.” Our adaptive immune system readily produces antibodies that target M protein. The problem is that this antibody can cross-react with our own tissue causing a rare complication of sore throat: rheumatic fever (inflammatory disease that leads to skin rash, joint pain, and destruction of heart tissue).

If the innate immune system mechanisms are insufficient for clearance, the adaptive immune system will be activated. Resident macrophages will migrate to lymph nodes and present phagocytosed segments of foreign material on major histocompatibility complex (MHC) proteins to lymphocytes (T cells and B cells) that circulate among lymph nodes. Because the body can’t anticipate all of the epitopes (protein shapes) we might encounter, we use a game of probability. The immunologist explained, “We are finally unlocking the adaptive immune system. When I was an undergraduate in the late 80s, how our adaptive immune system generates this antibody diversity was still not accepted let alone in textbooks. MIT Professor Susumu Tonegawa won the Nobel Prize for discovering VDJ [variable, diversity, and joining] recombination. He showed that each B and T cell mutates its own DNA to rearrange the genes encoding the B cell’s antibody or T-cell receptor. Each B and T cell clone has different DNA than your typical cell in your body! If this B cell antibody or T cell receptor recognizes a sequence presented on MHC, it will become activated. The activated cell will undergo clonal expansion [reproduction by division], and, in the case of B cells, will differentiate into a plasma cell secreting gobs of antibody against this specific antigen into the bloodstream.”

Our patient case: Georgia, a 46-year-old female presenting to her internist for a routine physical. Medical history is unremarkable except for well-controlled hypothyroidism. She has swollen lymph nodes (lymphadenopathy) in her neck. Routine blood tests reveal elevated protein. Serum protein electrophoresis, a technique that separates proteins based upon electric charge, reveals an “M-spike” in the immunoglobulin (antibody) zone, suggesting an increase in concentration of a single clonal variant of immunoglobulin. “Georgia had a rogue plasma cell producing gobs of a single type of antibody. It is essential you understand the significance of clonal expansion to her condition versus the antibody response to an infection. During an infection, several B clonal species will get activated, each with a different antibody that binds to different sites of a pathogen. Infection causes a general increase in globulin concentration but not a spike.” The risk is as this single clonal variant continues to expand, it could push out the normal functioning bone marrow cells.

Georgia was referred to heme/onc (hematology/oncology) for further evaluation for this monogammopathy of unknown significance. One of my favorite lecturers, the young redheaded hematologist, followed Georgia for one year during which she began to have anemia, proteinuria (protein in urine), and bone lesions on routine tests. George was diagnosed with multiple myeloma (MM) at the age of 47 and, based upon her genetics and stage, given eight years to live. (Type-A Anita uses the helpful mnemonic “CRAB” to remember the classical signs of MM: hyperCalcemia, Renal impairment, Anemia, Bone lesions.) After her diagnosis, she quit her job as a secretary for a law firm and went on disability.

Georgia underwent several weeks of intense chemotherapy and a successful autologous hematopoietic stem cell transplant (HCT) over the course of a month-long hospital stay. She explained, “I never considered that I would die during the treatment.” She is now two years into remission and maintains an active life.

The HCT given to Georgia is the gold standard for MM treatment. “Why do we even give bone marrow transplants to MM patients?” asked the hematologist. She answered her own question: “The purpose of a bone marrow transplant is to be able to give higher doses of chemotherapy that would otherwise be lethal. We nuke the patient.” The hematologist recounted how bone marrow transplants were first investigated after the observation that individuals exposed to radiation from Hiroshima and Nagasaki developed pancytopenia (low blood cell counts). Bone marrow transplants were thought up as a way to reverse this aplastic crisis. “Leave it to the DoD to advance science. Pretty quickly oncologists applied the research to cancer treatment.”

“The scariest part of multiple myeloma is that you are never cured,” explained Georgia, as she broke into tears. “It will come back every time. This tragic fact makes MM different from other cancers. I go to an MM support group every two months as opposed to a more general cancer group. It is such a different beast.” Georgia grew up in a large mid-West family with five siblings. “My closest sister withdrew from me after the treatment. I think it is just hard for her to accept.”

The hematologist added, “Plasma cells are the cockroaches of the immune system. They survive everything. The unfortunate truth is that the question is not if MM will relapse, but when. Further, the traditional chemotherapy we use causes the plasma cells that do survive to have more mutations. Drug resistance develops after successive relapses.” She gave an impassioned speech on the importance of research. “The life expectancy for MM has increased dramatically. Maybe ten years ago, Georgia would have had to be maintained on melphalan [nasty chemo agent that acts via a similar mechanism to mustard gas] to contain her MM.” She turned to Georgia: “Could you imagine being on melphalan, the drug used during your bone marrow transplant experience, routinely?” “Oh, God, no. My hair, the diarrhea, the sheer pain. Mostly my hair though.” The class chuckled, and the hematologist continued, “This is changing because of the extraordinary advancements in targeted therapeutics. I love this field because it changes so quickly. Cancer years are dog years. A five-year-old article or clinical trial is thirty-five years old by my standards. Even the current issues of journals are a year late; you have to go to conferences to learn about the latest breakthroughs. It is frankly hard to stay up to date on every neoplasm [cancer]. The result is that oncologists convey out of date survival expectancy to patients.”

Jane had a slight hiccup with her mentee: the day after their first meeting, rumors surfaced that her mentee had disenrolled for personal reasons. The whole class joked that Jane made the helpless M1 quit. “What did you do to her!?!” We never learned the truth, but this classmate was quickly replaced by someone from the waitlist who became Jane’s new mentee: “Rebecca,” who had majored in electrical engineering at a large public university. Rebecca had spent a week at a DO (Doctor of Osteopathic Medicine) school: “I got a call from an unknown number. When I heard I got into this school, I almost fainted. My legs went weak. I packed everything back up and drove the next day eight hours. I really want to call my undergraduate prehealth advisor who told me I would never get into medical school because of my grades. Suck it!” An M1 told Jane, “I like your new mentee better than your last. Thanks!”

Statistics for the week… Study: 15 hours. Sleep: 8 hours/night; Fun: 1 day. Example fun: Dinner party with classmate and his wife, a marriage counselor. “My favorite patients at my old job were the couples with a schizophrenic.” A classmate who worked on a psych ward before matriculating at medical schools said, “Wow! I was scared out of my mind. I had this one patient who would say, ‘There is a woman standing behind you.’ I believed her! I could never do psychiatry.”

More: http://fifthchance.com/MedicalSchool2020

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The landline is dead, of course, but is apparently still live enough that Amazon makes the Echo Connect so that the constant stream of telemarketing calls can be fed directly to the Echo (and so that one’s outgoing calls aren’t mistaken for telemarketing due to having a legit caller ID!).

As long as Alexa is connected to the phone line and able to answer the phone, shouldn’t it be possible to say “Alexa, please answer my unknown calls from now on”? Alexa can then ask “Who lives in the house” and then, if an incoming caller is not asking for one of those people (or company names perhaps), Alexa can play a prerecorded message to the caller. The caller ID would be automatically whitelisted (but could be switched to a blacklist by the user in the Alexa App’s list of recent calls). On a second call from a whitelisted number, Amazon remembers the caller ID and lets the number go to the legacy phone for conventional ringing.

For a large house maybe there needs to be a beefed-up Echo Connect that can sit in front of the conventional phones and get them to ring after the actual call has already been picked up.

What do readers think of the above? It would seem that Alex already has 99 percent of the capability necessary to make a home landline useful again.

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We’re just done teaching an MIT Aero/Astro course that covers the FAA ground school material and also a lot of the engineering that goes into the systems.

In re-architecting the course for this year I decided to heed some advice from the book iGen regarding today’s young people:

Overall, iGen is good news for managers: iGen’ers are more focused on work and more realistic about what that entails than the Millennials just before them. iGen’ers want good, stable jobs and are eager to prove themselves. Contrary to popular belief, they don’t want to be entrepreneurs—in fact, they are less likely than previous generations to want to own their own business or be self-employed. That means iGen talent is ripe for the picking for the right businesses.

Whereas Millennials needed praise, iGen’ers need reassurance. Given their slow upbringing, many are also less independent. Give them careful instructions for tasks, and expect that they will need more guidance. Managers who learned to be cheerleaders for Millennials will find they are more like therapists, life coaches, or parents for iGen’ers.

Use the word safety or refer to your “safe environment.” iGen’ers have been taught to value safety more than any generation before them, and these words are not just comforting but expected. They want to know that they will feel safe and protected—not just physically but socially and emotionally.

It is this last part that I considered relevant. Flying light aircraft has an ugly reputation and that is backed up by some ugly statistics. So I added slides that explained how to come closer to airline-style safety by flying in pairs and using checklists, by doing recurrent training at frequent intervals, and by developing and maintaining instrument proficiency. Where a slide from an earlier semester had said “If you do X then you will crash” I would change it to “You can keep safe by doing Y”.

All of my co-teachers were experts and, except for the military pilots, I was surprised at how they would naturally gravitate to the dark side when it was time to explain something. Sometimes they wouldn’t even finishing explaining what something was before beginning to list the pitfalls. Oftentimes they would leave students hanging because they’d listed a bunch of hazards, but hadn’t described any simple ways to avoid them.

This was true even when it came to non-technical material. For example, in a 10-minute presentations about aircraft rental versus ownership, the expert pilot and happy co-owner of a plane in partnership said that aircraft partnerships were like “a marriage” and fraught with perils (not really explained to the students). Afterwards I said “Is that fair? Half of American marriages end with one partner suing the other. Do you know any aircraft partnerships that ended with one partner suing the other?” (answer: no) It was working great for him. These were young people whom we’re trying to inspire to pursue their existing dreams of becoming pilots. Why mention the possibility of a failed partnership that, in any case, is easy to get out of? (you can sell your half of an aircraft without going to family court and without paying a lawyer most of the rest of your assets!) [See this Plane & Pilot article for a complete description of aircraft co-ownership.]

I’m wondering if talking about the hazards of an activity requiring expertise is a way to highlight one’s own superior skills. If I make something sound easy and then say that I’ve done it, people will hear “Philip did something easy”. If I make something sound challenging and risky, people will hear “Whoa. Philip is courageous and super capable.”

Readers: Have you had this experience too? When you ask experts to explain how to do something do they tend to overemphasize the negatives and pitfalls?

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A Hillary-supporting friend has been complaining over the last year about Donald Trump’s use of Twitter. It is “unpresidential” in his view and he doesn’t understand why Trump would spend time publishing short and irritating-to-him tweets.

Modern U.S. presidents never seem to stop campaigning. Instead of sitting at their desks working, they’re constantly coming up with excuses to have taxpayers fund trips so that they can attend fundraisers or rallies for candidates from their party. President Obama used to shut down our flight school by coming up to the important election state of New Hampshire to talk at a high school (example) and then there would be a fundraiser in the evening.

Since Donald Trump built his support by using Twitter and other modern forms of media, is it reasonable to say that Trump’s continued use of Twitter is his way of doing what Presidents have always done? (with the bonus to the average resident of the U.S. that he stays in D.C. and/or Florida and perhaps gets more work accomplished or at least causes less inconvenience)

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A neighbor here among the Millionaires against Trump posted the following on Facebook:

I AM A FIRST GENERATION IMMIGRANT. FROM A SHITHOLE. Yes, Taiwan in the early 70s was not nearly as much of a shithole as, say, Haiti is today. And, yes, Haiti is a shithole, by any objective measure.

Compared to the United States in the early 70s, Taiwan was a substandard place to raise your children. The US was then — and is today — the best nation on the planet to where one can immigrate and build a better life, for yourself and your children.

I have ALWAYS been in favor of a (virtually) open border policy. One thing we can do for Haiti is to permit as many Haitians as possible to immigrate to America. And from Africa. And Vietnam and Indonesia and Turkmenistan. And, hey, from Norway too.

As an avowed “Never-Trumper” since day one, I am horrified by our President’s personal behavior, his loose affiliation with objective truth, and his unbelievable egotism.

[link to “Of Course Most Immigrants Come from Shithole Countries. So What?” (Reason)]

It try to be as agreeable as possible on Facebook, so I responded:

By the 1970s, Taiwan had only 8,000 years of world-leading education and culture to draw from (see the National Palace Museum for example).

(Alluding to the fact that Taiwan in 1949 became home to millions of people from the mainland’s most elite families.)

In response to his idea of open borders, I made my standard offer:

If you would like to host a Haitian family in your house for the next few years, I will be happy to pay for the JetBlue tickets from Port-au-Prince and the Boston Coach ride from Logan!

He responded with

Oh, please. If Haitians – or Norwegians – want to buy my house, I’d be happy to take their money.

He clarified that he expected immigrants to “find a job”. I asked why this was a reasonable expectation given that an immigrant under his proposed scheme might be a wheelchair-bound 80-year-old. Or the immigrant might simply prefer to live in public housing, subscribe to Medicaid, shop with an EBT, and talk on an Obamaphone. (Here in Massachusetts, one need not be a legal immigrant in order to be entitled to taxpayer-funded housing.)

His response was essentially that immigration of randomly-selected or even adversely selected (e.g., disabled senior citizens) was guaranteed to make existing Americans wealthier via GDP growth. I got him to clarify that he expected both the aggregate GDP and the per-capita GDP to grow. He focused in on one point from the Reason article: immigrants “use welfare at lower rates than their made-in-the-U.S.A. analogues”. He provided support for this with a link to “Poor Immigrants Use Public Benefits at a Lower Rate than Poor Native-Born Citizens” (Cato Institute). It turns out that immigrants are slightly less likely to receive at least one form of welfare, perhaps due to bureaucratic obstacles. It turns out the wording of the title has to be read carefully. The study is limited to poor immigrants. The Cato folks say “a greater percent of immigrants are low-income and, all else remaining equal, more eligible for benefits. Non-citizens are almost twice as likely to have low incomes compared with natives.”

I asked how it was possible for a society to be richer on average by bringing in people who are, on average, lower income than those already present. The answer turned out to be that, in the long run (yet to be measured), the grandchildren of today’s immigrants are guaranteed to be much more successful than the grandchildren of native-born Americans.

What about providing infrastructure for a country of, say, 1 billion people? How would that work given our current inability to build mass transit or highways economically?

Infrastructure follows demand, and is also heavily determined by population density. This country was built by-and because- of growing immigrant populations, and infrastructure followed. The *difficulty* in building infrastructure is entirely, wholly, and utterly, a result of BS political rules, in deference to, among other things, union featherbedding, environmental NIMBYism, etc.

[i.e., once we have more immigrants the political rules and unions will no longer inflate public construction projects]

One big question is why any immigrants are available to the U.S. If immigration is an economic panacea, why don’t other countries bid higher than we do? Norway is wealthier per capita than the U.S. Why aren’t they able to out-compete us to capture valuable immigrants, e.g., by paying Haitians to come live in Norway? (And, in fact, why do the Norwegians instead invest their time and money in deporting immigrants?)

His summary:

The world gets wealthier with more people — even as you divide wealth among more people.

The original poster remained confident in his theories, so I decided to see how much explanatory value they had.

You’ve proven that random immigration will make us richer per capita. But can you explain how emigration would make us poor? Suppose the US found a nice exoplanet and developed an exclusive technology for getting there. Only Americans can go and half of households decide to depart the solar system. It turns out to be a perfectly random sample. So now we are left with the same infrastructure, natural resources, real estate, but half as many people. Do individual incomes rise or fall?

His response:

Just think about it, logically. If the current population of the US generates $X trillion in GDP, and if the population drops to ZERO, then GDP would necessarily drop to $0, right? Now draw a graph between the two points.

The line may not, and almost certainly would not, be straight, but it’s hard to see how there would be a bump in the graph line such that productivity would be substantially higher if our population is randomly decreased by Y%.

I pressed

So the supply of labor decreases (because half the population has gone to the exoplanet) and the value of labor also decreases? (Note that wages rose in Europe after the Black Death reduced the supply of labor. See the Economist.

It turns out that he essentially rejects the principle of diminishing marginal product of labor (Wikipedia).

Sorry for the length of the post, but I think it is interesting for showing how Americans are able to think about immigration. At least some Americans seem to disregard the idea that natural resources are a source of national wealth and therefore, since all GDP comes from human effort, the U.S. could be just as wealthy (or wealthier!), per capita, if all 7.6 billion people on the planet lived here. It is kind of the opposite of Barack Obama’s “You didn’t build that.” We mark the value of the land, water, minerals, etc. that we stole from the Indians to $0. We mark the value of already-built infrastructure, such as the Interstates, the New York City subway system, etc. to $0. We mark the value of existing business assets, such as car factories, to $0.

Related:

• “As Labor Pool Shrinks, Prison Time Is Less of a Hiring Hurdle” (nytimes, Jan 13), suggesting that a smaller labor force is better for existing workers (someone didn’t clear this story with the rest of the editorial staff?)
• “What most frequently meets our view (and occasions complaint) is our teeming population. Our numbers are burdensome to the world, which can hardly support us…. In very deed, pestilence, and famine, and wars, and earthquakes have to be regarded as a remedy for nations, as the means of pruning the luxuriance of the human race.” (Tertullian, nearly 2000 years ago in Carthage, quoted in Wikipedia)
• Modern Malthusianism

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“Apple, Capitalizing on New Tax Law, Plans to Bring Billions in Cash Back to U.S.” (nytimes) says that Apple is going to pay $38 billion in tax to the U.S. Treasury on money that it has been stuffing overseas. Here’s the confusing part to me:

Timothy D. Cook, Apple’s chief executive, said in a statement, “We have a deep sense of responsibility to give back to our country and the people who help make our success possible.”

It makes sense that Apple is bringing the money in before the next Congress comes up with a new tax scheme that is less favorable. But why brag about the company’s “deep sense of responsibility”? It wasn’t quite deep enough to pay taxes at the old rates? But it is deep enough to pay some U.S. taxes at the new lower rates? Apple assumes that nobody will ask these (to me) obvious questions?

Maybe they can use some of the repatriated money to sit down with Honda and create a working version of Apple CarPlay?

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Today in our aviation class at MIT we are going to have a special talk by an expert from Avidyne about quality assurance and certification of software for avionics. To introduce the speaker I needed to create a sentence of the following form: “Look at this incredibly broken and failure-prone piece of software and contrast that with the near-bulletproof software behind your certified avionics.”

The best example turned out to be the Apple CarPlay system in our 2018 Honda Odyssey. It exhibits the following behavior:

• plug in phone: crash about 10 percent of the time
• arrive at the destination after navigating with Apple Maps: crash about 30 percent of the time
• phone calls: about 1 call out of 10, play sound through car speakers, but continue to rely on the microphone on the iPhone 7 Plus (result: person on other side cannot hear)

There are lots more quirks. Also plenty of design flaws, e.g., if you click on “phone” from the steering wheel controls it will say “no phone connected”. You can see that your iPhone is actually plugged into USB! What does this mean? That the iPhone is not connected to the legacy Bluetooth system, but only to the fancy new CarPlay system. If you want to make calls you need to use the center touch screen.

I’m not quite able to abandon CarPlay because (a) I like to listen to Audible books and there are strange skips in Bluetooth audio (worked nicely in the 2014 Odyssey), and (b) the car does not have its own navi system so I want to use Apple Maps (one sure way to develop greater appreciation for Google!).

I’m wondering if this works for readers. Who else has CarPlay? In a Honda? Does it work reliably?

The car can accept over-WiFi updates, but none have been made available in the past 6 weeks.

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I’ve been observing Americans fight in the media and on Facebook regarding immigration policy. A lot of people exhibit what seems at first like a logical inconsistency. They want laws to keep the majority of would-be immigrants out of the U.S. But they object to deporting people who are here in violation of immigration laws (cue “No Human Being is Illegal” T-shirt).

Deporting a person is certainly a dramatic step, but on the other hand immigration determines (1) the size of our population [and therefore how crowded our country will be, what kinds of traffic jam our grandchildren will experience, our impact on the planet, the intensity of competition for space to rent, etc.], and (2) the kind of society we will have (since the culture and values of the people are what make up “society”).

Why does it matter how long someone has been in the U.S. if he or she is in violation of the law? Is it that there comes a point where it is simply rude to kick someone out of the country?

I’m wondering if the legal concept of adverse possession can be applied here. Taking over someone else’s house is illegal. But if you do it for long enough (about 15 years in most states; Wikipedia has a map) then it becomes legal.

Most undocumented immigrants haven’t made any serious attempt to hide from the various police forces and government agencies that the U.S. operates. Thus this corresponds to the “open and notorious use” element of adverse possession.

Note that if we accept extending the idea of adverse possession to citizenship this restores logical consistency to a huge block of Americans.

Readers: What do you think? If we’re going to do absurd stuff such as claim that El Salvador is in some kind of temporary emergency for 16 years (it is slightly more dangerous than Detroit and significantly less dangerous than New Orleans) should we then lose the right to kick people out?

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Today is the official Martin Luther King, Jr. birthday. Domestic Senior Management is slaving away in the pharma mines (their tax home and corporate heart are now in Ireland so they no longer celebrate American heroes, apparently). My Facebook feed is full people discussing the Hollywood Cleansing and other stuff that adult men and women purportedly did behind closed doors. I’m working where we would be now if MLK, Jr. were alive in this Age of Harvey. There were plenty of stories about MLK, Jr. and various women (example: FBI file). How would the opposing Vectors of Sanctimony sum out?

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