Category Archives: Networks and Systems

Tall poppies, tall corn and creating the right environment

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All opinions my own and do not necessarily reflect those of Novo Nordisk.

The first time I heard the saying, “Cutting down the tall poppies,” I was in Australia, over 20 years ago, talking to an Professor who was a US expatriate and working at the University of Queensland.  I’ve heard it since in conversations with people from the UK, Denmark and other countries.  The specific connotation in each culture differs somewhat, but the general underlying meaning is that those who rise above the crowd should in some way be brought back down to the level of everyone else. This might be in a physical and material sense, or in an attitudinal way, as in, “don’t think you are better than us just because of your (choose one) wealth, success, position, knowledge, etc.” An egalitarian sentiment, to be sure, but one that sounds odd to someone raised in the US, where individual attainment and excellence are among the key values.

I often contrast that idea to the following story about tall corn.  I first heard it from Professor Michael Freeling when I was a graduate teaching assistant at UC Berkeley, and assigned to TA for his class on Genetics and Society. This was an undergraduate survey class and on the first day, a freshman stood up (aren’t freshmen cute?  Always so earnest and ready to play “stump the Professor.”) and asked Michael where he stood on the question of Nature versus Nurture.

Michael’s answer was to describe his own work in maize genetics. Take a handful of genetically diverse maize kernels, he said, and sow them in a field and see what happens.  You get plants growing to a variety of heights, and each plant will give you different yields. Take another handful of kernels from the same batch and plant them in a greenhouse.  Give them fertilizer, gro-lights, plenty of water, keep out bugs and other pathogens. Then you’ll see the plants growing to more or less the same height, and yielding similarly, every ear on every one.

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One small, wistful story about the shutdown

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Seattle, like San Francisco, like New York City, is a city of water and bridges.  I remember reading Winter’s Tale by Mark Helprin back in college. I think it’s a book that I’d benefit from reading now, again, but one of the concepts that struck me even in my callow youth was his observation about cities that have bridges as part of their fundamental being.  He described how a city, to be magnificent, must “project, extend, fling itself in all directions–over the water, in peninsulas, hills, soaring towers, and islands linked by bridges.”

Seattle is that kind of city.

And it made me sad when I heard that one of our bridges, albeit a small and specialized one, was closing because of the government shutdown. Continue reading →

Transparency and the invisible hand in hospital and healthcare costs

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All opinions are my own and do not necessarily reflect those of Novo Nordisk

One of the things that sometimes seems to get lost when people talk about the power of the market to create efficiency is that a free market requires that information be shared and freely available and understandable by everyone.  When information is withheld by one side or the other of a transaction, or when different customers for a service or product are unable to compare prices, the metaphor of the invisible hand breaks down.

You can see, this, interestingly enough, in sports as it relates to both the trading of players under contract and the signing of free agents.  Since I’m a baseball fan, let me link here to a discussion of research that’s been done looking at Major League Baseball.  The studies looked at players traded or signed by a different team as a free agent and how those players performed in subsequent years versus players whose original team re-signed them.  It turns out that players who switched teams did, indeed, perform more poorly relative to projections than players who stayed.  This suggests that the original teams have proprietary information that allows them to make better decisions about which players to retain.  Thus the market for baseball players isn’t quite free and efficient because of information asymmetry.

And unfortunately, information asymmetry is also rampant in other industries such as healthcare. Continue reading →

Fear versus fear: understanding vaccination rates

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All opinions are my own and do not necessarily reflect those of Novo Nordisk.

h/t to @edyong209 for the heads up on the study.

If it seems like plagues from bygone years are coming back, well, you’re right!  Due to growing objections within the United States to vaccination efforts, we are seeing a number of infectious diseases arising that even ten years ago we might have said were eradicated in the US.   The problem may seem larger than it is simply because we get so much more news so much more quickly and easily than we used to.  However, so far there have been 159 cases of measles, which is the highest yearly count since the mid-90s.  And there are still 3.5 months to go in 2013.  Texas has been in the news quite a bit recently for clusters of measles and whooping cough–both diseases with good vaccines that prevent infection when used correctly.

There are a number of reasons why parents choose not to vaccinate their children and one of these seems to be a lack of familiarity with these preventable diseases.  Once almost everyone got the measles and kids got really sick; some died.  Now, the idea of infectious diseases might seem quaint, distant and nonthreatening to parents with no frame of reference.  And of course, once a child gets a disease it’s too late.  A particularly scary report suggests even some younger doctors feel that infectious diseases aren’t such a big deal.

So you might think that this recent study, and others like it showing that the Human Papilloma Virus (HPV) vaccine is clearly reducing HPV infections throughout the body should be promoted even more strongly by public health officials.  Why?  Because HPV is known to cause cancer.  And if there’s anything that evokes the immediacy of fear in the area of health issues, it’s cancer.  That may not be the correct path however, and I’ll get to that in a minute, but first I just want to talk about the research.

The research study was a double-blinded clinical trial in which  7,466 women were inoculated at random with either an HPV vaccine or a control vaccine to hepatitis A.  At the end of the trial, the women were checked for evidence of oral HPV infections.  The vaccine had an estimated vaccine efficacy of about 93%, meaning it reduced infection rates about 14-15 fold.  This study is the first to demonstrate that HPV vaccinations can prevent oral HPV infections in addition to those at the cervix and other locations, as has been shown previously in other research.

That HPV infection is linked causally to the development of some cancers has been shown repeatedly.  Oral HPV infections contribute to the majority of oropharyngeal cancers. When these vaccines were developed, this was the basic argument:  that giving this vaccine to women would result in a decrease in HPV infections and subsequently a decrease in various cancers.  However, as has happened with many vaccines such as the Measles-Mumps-Rubella (MMR) shot, the scientific rationale became overshadowed by a number of other, unanticipated societal factors.

With the HPV vaccine, as Beth Skwarecki (@BethSkw) astutely pointed out on PLOS Blogs, maybe the key issue that wasn’t given enough attention in planning the vaccine rollout is that they way you get HPV is by having sex, and the age at which you should ideally give a person a vaccine is when they are 11 to 12 years old.  Or, to think about it another way, just when girls are starting to begin the maturation process into young women and parents have to face the reality that there is a good chance their child will be having sex sometime in the next 5-10 years.

And that’s scary.  Scarier than the possibility that your child might get cancer 20, 30 years down the road because he or she did not get vaccinated for HPV.  Beth also helpfully links to writing by David Ropeik about how fear can trump common sense with respect to things like, for example, vaccines.

It’s already known that people are lousy about understanding probability, and when you add an element of fear to this misunderstanding, one can see how vaccination campaigns even for something as straightforward as HPV face an uphill battle.

I mean, cancer!  If you can’t get people behind a preventative measure for cancer, what can you do?

And that is the question.  It’s not enough to just say that vaccinations should be mandated.  Sure government could do that, but the consequences could be quite large in terms of anger and pushback.  Would it have helped if in the beginning Merck had not pressed so strongly for every girl to be vaccinated?  Maybe, as some analyses after the fact suggest Merck involvement increased suspicion that all this was just some Pharma boondoggle.  That’s a post-hoc justification though, which I tend to distrust.

Ultimately it seems the answer will have to come from some combination of using subtler methods for incentivizing parents and better understanding of what people are afraid of.  Because right now it seems like even the fear of cancer isn’t enough.

Acid burn: how ocean acidity might make climate change worse

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All opinions my own and do not necessarily reflect those of Novo Nordisk.

I was at the University District Farmer’s market this past weekend, thinking about making paella, and so I stopped by the shellfish booth and bought a pound of clams.  As I wandered around, looking for some tomatoes and onions, I swung my canvas bag, now heavy with thick-shelled Manila clams, and thought back to some time I spent in Spain during my first postdoc.  That’s when I learned to make paella.  That’s also where I studied calcification in the green alga Acetabularia acetabulum, which grows thick in the shallows of the waters of the Mediterranean.

Calcification is the process of depositing calcium carbonate along, within or around a biological structure.  It’s an important process in the oceans, contributing to ecological roles like protection via the shells of mollusks like the clams in my bag.  And it’s getting harder to do for ocean creatures to do because the oceans are becoming more acidic. Continue reading →