Book review: Brain on Fire

I started and finished Brain on Fire: My Month of Madness last night. It is a very tightly written personal history by a woman who endured the disintegration of her mind, a month of flailing about by confused doctors, and then a seven-month recovery.

Susannah Cahalan, a New York Post reporter, was suffering from a rare autoimmune disorder that caused inflammation on one side of her brain. A variety of expert neurologists and psychologists, however, confidently diagnosed her as (a) normal, (b) suffering the effects of heavy alcohol consumption (despite no evidence that she had been a heavy drinker), or (c) a garden-variety mentally ill person. These misdiagnoses cause delays in appropriate treatment that result in her condition deteriorating to the point that she was probably just a few days from dying.

First, you’ll feel better about your own life after reading this book, unless you are suffering from a tough-to-diagnose and extremely rare medical condition. Second, you’ll learn just how random are the outcomes in the American medical system when the patient does not fit into a common box. Probably tens of thousands of folks with Cahalan’s problem have wasted away in mental institutions and/or died due to improper treatment. Certainly plenty of doctors with big reputations and enormous reserves of self-confidence worked on Cahalan’s case and failed to get any closer to the source of her problem. What’s worse, the doctors she consulted did not do any follow-up to find out whether or not their apparently-not-so-educated guesses were right. A famous New York neurologist, Dr. Saul Bailey, whom Cahalan had seen early in her journey through the world of medicine, did not keep sufficient track of the case to learn that his initial diagnosis of alcoholism was wrong. Because of that, when Cahalan followed up with him in the course of researching the book she discovered that Bailey remained ignorant of the disorder that had nearly killed Cahalan, despite the fact that her particular case had at that point been in lots of medical journals as well as the New York Times. With no feedback, how will Bailey ever improve?

Third, if you’re a blood donor you’ll feel better about your donation (email me if you want to meet at the Children’s Hospital donation center here in Boston; I’ll buy you lunch afterward and lunch for anyone else that you bring). Cahalan went through a lot of bags of immunoglobulin infusions, each of which costs $20,000 and requires 1000 blood donations.

Separately, the book contains some interesting father-daughter and men-women relationship angles. After corresponding with hundreds of patients and relatives of patients who’d suffered from the same “anti-NMDA receptor autoimmune encephalitis”, Cahalan concludes that “Paranoia, esepcially about the men in their lives, was also a common thread. A middle-aged woman believed that her husband had fathered a baby with a neighbor; a young teenager was convinced that her dad was cheating on her mother.” Cahalan herself suffered from similar paranoia but subsequently learned that the men in her life had in fact stepped up to the challenge.

Reading between the lines it sounds as though Cahalan’s mother triumphed over Cahalan’s father in a divorce lawsuit approximately a decade before the illness. The mother ended up getting the fancy suburban NJ house, the kids, and the river of child support money that courts can assign to the parent who wins the kids. This had resulted in some distance between Cahalan and her father, who moved to Brooklyn. The illness brought her dad to his daughter’s side every day: “Sensing that attitudes toward me improved and the level of care [at the NYU hospital] rose when company arrived, my dad … started to arrive first thing every morning. Alone, I could not fight this battle.” Dad, a successful financial industry worker of some sort, learns to respect Cahalan’s musician boyfriend, who showed up at 7 pm every day to take the night shift. The father wrote in his journal, which Cahalan mined for the book, “The one friend who did come everyday was Stephen. He was terrific. I wasn’t that sold on him when I first met him, but he grew in my respect and regard with every day that passed.” In the same journal Cahalan discovered an entry in which her father prays that “God would take him instead of me.”

More: read the book

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Recurrent training for general knowledge?

A friend who lives in a wealthy suburb of Boston posted this update on Facebook:

Parent/Student/Teacher night at school. Each child was assigned to teach the parents what they were learning. My son was demonstrating adding fractions. Several of the parents could not do it – 2nd grade math.

Coincidentally, as he was posting that I was in the middle of a couple of hours of recurrent training for instrument flying. A jet pilot friend who is a CFII graciously went up with me in a Cirrus SR20 and watched for other airplanes and monitored my performance while I wore a hood that restricted my view to just the instruments. It is a well-known phenomenon that pilots get rusty and there are embarrassment-free opportunities for refresher training. In fact, given that FAA regulations require at least some refresher training every two years, even the sharpest pilots can do a bit of training without anyone asking “How come?”

The Facebook posting above shows that most folks don’t remember everything that they learned in elementary school. But where can one get refresher training on fractions, state capitals, and the rest of the 1st-5th grade curriculum? The obvious answer would seem to be Khan Academy, but https://www.khanacademy.org/math/arithmetic/fractions seems to be geared at first-time learners and those who want to develop an exhaustive knowledge of a subject, not at those who just want some dusty neural pathways touched. A quick Google search turned up Homework for Grown-ups: Everything You Learned at School and Promptly Forgot, but 368 pages doesn’t seem like enough.

Is there a weekend course that grown-ups could take every 10 years?

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Tool for retrieving a subset of Gmail correspondence?

Folks:

It is pretty common in litigation for a party to demand, via discovery, “all email correspondence between the defendant and Joe Smith” or “all email correspondence in which ‘rebar failure’ is discussed.”

I’m wondering if there is a good automated tool for extracting this from Gmail or another IMAP source.

It would be nice if the tool could do the selection by sending a search term to Gmail. But it would also be acceptable if the tool were capable only of grabbing one IMAP folder. In that case the Gmail user could use Gmail tools to search for a particular recipient or subject line substring, then put all of the results in a folder named “JoeSmith” and have the tool pull all of JoeSmith.

Another nice-to-have feature would be to preserve the conversation threading, but I don’t think it is necessary to fulfill the requirements of the legal discovery process.

Output could be one text file per conversation, one PDF file per conversation, or one huge file with page breaks between messages or, preferably, between conversations.

To me the most obvious way to implement this is as an IMAP client to Gmail. However, given that Gmail already does most of what one would want I wonder if it wouldn’t make more sense to implement this as browser action scripts to simulate user actions and clicks within a Web browser.

Does this exist already? If not, does it seem like it would make a welcome open-source software product?

Thanks in advance for ideas.

Note: About a year ago, I developed a specification for software to do something fairly similar. This was for a friend’s startup that was going to build databases of corporate email, but the company ended up moving in a different direction: ExtractingConversationTimelinesfromEmail

[Update: I should note that the Gmail web interface already does virtually everything that is required above. All that the Google programmers would need to add is an option to “print everything to PDF” where “everything” is a set of a search results, a folder, or all the messages that are selected via  a checkbox.]

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Air traffic control cuts part of our government’s war on work?

Federal, state, and local governments have been waging something of a “war on work” in the U.S. over the last 50 years or so. Payroll taxes, paid only by workers, have skyrocketed. Regulations and paperwork related to all kinds of jobs has been dramatically increased. In cities such as Cambridge, workers are made to feel like chumps in mixed-income developments because the apartment next door is often occupied by a family none of whose members have ever worked and who yet enjoy more or less the same material lifestyle as the worker (but perhaps a much better overall lifestyle because the non-workers usually have the joy of parenthood whereas the worker often does not).

http://en.wikipedia.org/wiki/Tax_Freedom_Day calculates some of this, showing that a worker must now spend from January 1 through April 17 to pay taxes. In theory that means the worker is enjoying the fruits of his or her labor from mid-April through December. In practice I think it would make more sense to look at the marginal return to work. On what day of the year does the worker actually pull ahead of the typical non-worker (who may collect some combination of welfare, disability, food stamps, free health care, subsidized housing, etc.)? In Cambridge I think it might not be until October or November. So the worker does end up with some disposable income to spend on travel, etc., but the effective hourly wage compared to not working is quite low (2000+ hours of work for perhaps 125 hours of pay (after taxes) that is above what a neighboring family collects in government benefits).

On casual inspection it doesn’t seem to make sense that a tiny restriction in the growth of federal government spending (the “cuts” referred to by newspapers are actually a reduction in spending growth; in every case the government will spend more than in the previous year) would result in the government melting down one of the rare things that almost everyone agrees it does reasonably well (albeit spending rather lavishly). However, it might make sense if the air traffic control cuts and subsequent delays for business travel are just the latest battle in the government’s campaign against work. An insufficient number of workers were discouraged by seeing their stay-at-home neighbors enjoy their continuous streams of government checks and free services. A remarkable number of people have irrationally decided to persist in working. Many of those folks will have to travel on business, which often means air travel. So what can the government do to make work an even more miserable experience? Cut air traffic controllers in the busiest airspace and impose 1-2 hour delays on a lot of people who were hoping to make it to a meeting. So business travelers will be getting up at 4:30 am instead of 6 am and endure being squeezed into a coach seat for 3 hours instead of 1.

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Software produced by committee is less secure?

According to this article, Hugo Teso, German computer security expert, determined that the very latest communication systems and software approved by the FAA and its counterparts worldwide are “unencrypted and unauthenticated.” The end result is that he was able to write Android software to reprogram Boeing jets’ avionics from a mobile phone.

This is  somewhat surprising result considering that the software and systems in question are the subject of years of certification review by sizable committees of extremely risk-averse individuals. I would have expected that the committee-intensive nature of the process would slow development and innovation but would increase security due to the fact that this should be precisely the kind of thing that a reviewer would be looking for.

I was recently out at Robinson Helicopter Company for recurrent training. The CEO was asked why the company had not released any helicopters with glass cockpit instruments (LCD screens instead of mechanical gauges and gyros). Such instruments are actually approved for aftermarket certification, the CEO said, but the FAA keeps asking for more and more paperwork to justify why the factory should be able to install them. Keep in mind that this is for a helicopter that cannot legally be flown in instrument conditions and therefore the pilot can and does fly safely simply by looking out the window. An instrument failure in a Robinson helicopter has no safety consequence.

[According to the CEO, about three years ago the FAA simply stopped acting. Their former glacial pace changed to something more like plate tectonics. He didn’t have an explanation for this but I note that this roughly coincides with the collapse of the private aviation industry from 2008-2010. An FAA employee is now probably paid about 8 times per hour what he or she might earn in the private sector (the salaries are not 8X higher, of course, but consider the actual number of working hours demanded) so the consequences of being fired are enormous. The easiest way to avoid being fired is to avoid acting. If you don’t approve something you can’t be blamed when something turns out not to work.]

A single dissenting voice can hold up an aircraft design for years. The new Robinson R66, for example, caught the attention of a Canadian government worker (story). He looked at the 400 psi hydraulic system on the Robinson and said “There was a failure in a Sikorsky’s 2000 psi system a few years ago. Prove to me that the Robinson system doesn’t need some extra redundancy so as to avoid a situation like that.” Robinson pointed out that the R66’s hydraulic flight control assistance system was virtually identical to that which was flying uneventfully  in about 5000 R44s worldwide but this was unavailing. The Canadian dissenter did not hold up U.S. certification but he managed to get the Europeans and Russians to deny certification and that has cost Robinson perhaps $100 million in sales thus far (80 percent of Robinson’s sales are to foreign countries; supposedly 2013 will be the year when the helicopter is finally certified worldwide, three years later than in the U.S. due to this one Canadian guy; note that the original Canadian dissenter eventually took a closer look and apologized for making such a big fuss, but of course it is Robinson that bears all of the costs).

It seems reasonable to expect that a couple of trailblazing developers, excited to get their new protocols and systems into the hands of users, would leave open a security hole. But why doesn’t adding layers upon layers of review by committee and years of delay result in one committee member raising his or her hand to ask “Shouldn’t this be encrypted?”

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How to share photos with someone else’s Android tablet?

Folks:

Here’s something that I thought would be easy but in fact seems to be difficult….

A friend has an Android tablet. I want to push photos to a gallery on her tablet. I don’t want her to have to do anything other than open the “Gallery” application on the tablet. I want the pictures to be available when the device is offline. The source of the photos is my desktop computer and the most convenient application from which to share them would be Google’s Picasa.

I’m pretty sure that this would be dead simple on iOS. I would create a “Shared Photo Stream” and then share it with her. Once she accepted it the pictures would just trickle onto her device. Android has a “Google Photos” sync setting that, I think, will sync one’s own Picasa albums but it does not seem to sync any of the albums that have been shared with the owner of the tablet/Gmail address.

I don’t think it is practical to ask her to use Dropbox or similar and manually move files from one app to another or to mark individual photos to make available offline, etc.

Ideas?

[Note: Another way to rephrase this question is “How do I use an Android tablet as a remotely managed digital picture frame?” I recently purchased a Pix-Star digital picture frame and it offers this capability. It is a pretty nice interface if what you want to do is remotely manage the photos that a busy or naive user will be able to view. An Android app that had similar capabilities to the picture frame would be ideal, but given all of the fancy features of Picasa and Google+ I wouldn’t expect to need to install anything additional on the tablet.]

Thanks in advance for any help.

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Teenager shuts down city for a week

Things have calmed down in Boston with the arrest of a 19-year-old. The city’s residents spent nearly a week glued to the news. Our flight school was effectively shut down on Thursday when President Obama came to visit. Nearly all businesses were then shut down on Friday while literally thousands of police and other armed government agents, equipped with armored cars and helicopters, searched for this teenager.

The events that started with the attack on Boston Marathon spectators and runners got me thinking about how the 21st Century seems to be the age of the individual. For most of human history the power of the individual has been limited. Unless the individual inherited, seized, was elected to, or appointed to a position of power, e.g., head of an army, state, or church, there was not much that an individual could do to disrupt society. Our century, however, started with 19 visitors to the U.S. whose actions on 9/11/2001 transformed American society to a much larger extent than any politician within memory. So far in 2013 the trend of individual power seems to have continued. A student wearing a white blanket, mistaken for a Ku Klux Klansman, managed to shut down Oberlin College for a day. And now we have two young brothers from the Cambridge Rindge and Latin High School, not notably distinguished from their classmates, who managed to shut down a city of 3 million.

I’m wondering to what we can attribute this shift in power. It does not seem to me that guns or bombs have changed during my lifetime (I was born in 1963). Governments have become stronger rather than weaker. The typical police force in 1963 could not rely on security camera footage from thousands of sources, nor did it have a SWAT team, bulletproof vests, armored cars, or military-style rifles. If the police needed a helicopter they would have to ask the nearest Army unit to provide assistance and the Army pilots would not have night vision goggles or an infrared camera. The Internet did not exist in 1963 but nearly every American family had access to a television or radio and dramatic news was broadcast over these media.

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Gun-loving Americans

One thing that seems to be absent from the public debates concerning restricting gun ownership in the U.S. is the fact that so many Americans just love guns (see my December 2012 posting on the subject). I was at the Lincoln Memorial on Saturday and a group of U.S. Navy (?) sailors was performing some sort of drill/demonstration involving throwing rifles back and forth and twirling them. After the demo, they were mingling with the tourists:

Check out the big smiles on these folks of all ages and sexes. Apparently there is very little that they enjoy more than playing with rifles on a sunny day.

[Personally I was horrified by the demonstration. One thing that I definitely do not want to see is a rifle being twirled or tossed, especially next to a huge crowd of people. I was pretty confident that the rifles weren’t loaded, of course, and that the bayonets were not sharp, but this did not strike me as a good way to teach firearms safety!]

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