The Reference Range Fallacy

Medical science has finally found a solution to the obesity problem in the U S. And, incidentally, the high cholesterol problem can be solved in exactly the same way; by applying the same standards and logic that are applied to so many other health factors; the reference range.

How would that help, you ask? Well, the standard reference range is set so that the middle 95% of those tested are withing range with 2.5% being below range and 2.5% being above range. The assumption is that 95% of the population is normal...or healthy...or at least ok.

The data available shows that the upper, or out of range, 2.5% in BMI is somewhere above 40. The lower, I would conjecture, is somewhere around 10. So the “expected” BMI range would fall between 10-45 or so. If doctors treated BMI the same way as they do so many other conditions, then there would be no problem for so many; they'd all be in range! Incidentally, a total cholesterol of 270 puts a person in the 95% range, so you can still increase your cholesterol, at that level, and be within range.

As an aside here, I would guess that the bottom 2.5% total cholesterol number would be around 75. Cardiologists would love this! Because if you could get your total cholesterol that low you would never suffer a heart attack/cardiac event! The heart docs would be high fiving and bragging about how well their treatments work. No cardiac events, you ask? That's right, because with total cholesterol that low you'd commit suicide or die from other maladies before the heart would have a chance to act up!

Of course, I'm not serious about using reference ranges with things like cholesterol and obesity. That would be silly and illogical. But then, why do doctors insist on using reference ranges in so many other areas that are just as silly?

Granted, there are some things for which doctors routinely check regardless of symptoms. For many of these, especially when the numbers tested are high enough to represent the general population, the 95% “ok” assumption might be valid. But for so many things, testing is only done when symptoms of a particular condition present. And for many of those conditions, the reference range is lab specific, not even adding in data from other labs. To assume that 95-97.5% of those exhibiting symptoms are really “ok” is rather a leap of faith.

As an example, let us look at what might be a typical lab associated with an endocrinology clinic. And let us look at the testosterone reference range. For a particular lab, the range is somewhere in the area of 175-750. Most labs give a low end number of between 250-350. Some labs even have a low end in the 400's. Why would this lab be so different?

Well, first ask yourself who gets tested for testosterone levels. I guarantee you, it's not the guy with no problems, whose parts are functioning well, and who has a happy and frequent sex life. So even the guys being tested by their family doctor are ones who have exhibited symptoms of low testosterone. Now who goes to the endocrinologist? That would be those worst case folks whose symptoms the family doctor hasn't been able to alleviate!

And we are going to assume that 97.5% of those being seen by an endocrinologist for symptoms of low testosterone are really ok because they are within the clinic's lab generated reference range? I have a really hard time accepting that! But many doctors take it as gospel! Never mind that studies show levels above 550 decrease cardiac events by 30%. Either the doctors haven't bothered to keep up to date on the latest studies, they don't believe the studies because it wasn't what they were taught, or they just refuse to change their methods.

Reference ranges say nothing about health, wellness, or functionality. They simply give an indication of the relative status of those being tested. In the land of the leper, the leper is normal!

I prefer to be healthy rather than normal!

The Lenten Season

One of my most favorite cartoons of all times depicts the comet Hale Bopp flashing across the sky with an alien spaceship hidden in its tail.  From the spaceship comes a dialogue cloud showing the aliens saying, "They did WHAT?".  For those of you too young and/or uninformed to remember what this was about, it concerned the Heaven's Gate religious cult who supposedly believed that an alien spaceship would be following the comet, coming to pick them up, presumably to go to a better place. But their bodies couldn't go with them.  So thirtynine of their members committed suicide in preparation of their departure.

Why, one asks (at least this one!) would a god, or even just humans advanced enough to travel through space to pick up passengers for Heaven, want you to give up your life?  Wouldn't that god or advanced people be capable of taking your "essence," for lack of a better word, without making you do the hard work of killing yourself?  How could people believe such a thing?

Well, I have the same question regarding the practice of giving up something you care about, sacrificing, for Lent.  If God did, indeed, give His son to death in order to save your immortal souls, why, then, would He turn around and want you to sacrifice something you enjoy?  Why wouldn't He want yo to rather celebrate,your life, your potential everlasting life, and the things that bring you joy during this mortal life?

Doesn't that seem awfully petty of Him?  Doesn't it almost seem more like something some HUMAN would think up?  "I killed my son for you!  Now I want you to give up something you enjoy; carrot cake, sex, Irish whiskey, FACEBOOK!" 

If He gave His son out of love for you, don't you think he'd be godly enough not to want such mundane shows of obeisance? Wouldn't He be able to see through your daily lives and your daily thoughts whether or not you love and obey Him and appreciate what He did for you?

Religion and The Military

RELIGION AND THE MILITARY

I have been following the story of the young man who just dropped out of West Point six months prior to graduating, citing intolerable persecution because of his atheism.  And I am in a personal quandary as to how to react to the situation.  As an atheist, I would like to be able to support a fellow non-believer.  I recognize that we atheists are among the most hated minority groups in our country.  All you have to do is read the hate filled comments coming from those who claim to belong to a religion that loves their brothers to see the truth of that.  But I am just not sure that I trust his motives and/or perceptions. 

Not having been there with him, the only thing I have to go by is my own personal experiences in the military, both on the enlisted and officer sides of the house.  Was I ever forced to attend religious services?  Depends on what you mean by forced.  First, everyone had to state a religious preference when entering boot camp.  At that time, late 60’s, your choices were catholic, protestant, or Jewish; maybe it was called other.  I’m not real sure.  And you either went to chapel or you cleaned the barracks.  That could have been considered a de-facto forcing to attend services.  It didn’t bother me.  I could sleep in church services and couldn’t while cleaning the barracks. 

In OCS I just don’t remember the subject of religious services even coming up.  I’m sure there were services for those who wanted to go, but if anyone did they kept their faith private.  The rest of my career was pretty much religion neutral.  Sure, there were change of command ceremonies and such where a chaplain would pray.  But I never listened to the chaplain any more than I listened to the farewell speech from the commander leaving or the introductory speech from the newly arriving commander.  It was all words for the sake of words and taking my liberty time. 

Occasionally, someone would ask me if I’d like to attend church or otherwise approach me about religion.  If they were polite about it, I’d politely say no.  If they were what I felt was overly aggressive, I’d tell them I had no intention of associating with a group of barbarians who advocated human sacrifice and cannibalism.  (The death of a perfect person-Jesus- on the cross to save the sins of the believers is no different in my eyes from tossing a perfect person-virgin-over a cliff or into the sea for the same reasons.  And if you believe the preachers that the wine and wafer of communion actually transmute to the blood and body of Christ, what else is that but cannibalism?)  So this young man’s being called a heathen doesn’t impress me as being overly abusive. 

What I have seen over the last few decades is actually a more open military, religiously.  The government has paid hundreds of thousands of dollars to pagans, whose religious freedoms were trampled for centuries.  Now, wiccans and other pagans can openly worship, and know that their supervisors can be court-martialed and reduced in rank if they try to persecute them for such worship.  Yes, there are some too dumb to understand that freedom of worship applies to all, not just them.  But they are easy to put in their place.  Their careers are the ones at risk, not yours.

Which brings us to the present case.  I could understand the young man’s dropping out of West Point after the first year or two if he felt that he was being mistreated.  I can understand a person of strong convictions STAYING IN and still bringing suit for what he perceived as persecution.  But to wait until he is told that his clinical depression will keep him from receiving a commission (which it should!), strikes me as being sour grapes. 

I am not proud to call this young man a brother atheist.  He brings shame to the rest of us.

Understanding Personal Worth And Respecting Differences (UPWARD)

Just found this draft that I had been working before and never got around to finishing.  I'll go ahead and post it as is and hope to get back to it later .....as soon as I remember which nail I was getting around to driving.




Probably the greatest aspect of our country, at least in my mind, is the stated belief that all persons are born with the inate rights of free expression of personal beliefs regardless of ones race, religion, political ideals, physical status, gender, sexual orientation...the list goes on.  All are "created" or born equal!

 But that's a tough one to live up to in the real world.

For purposes of this post, when I speak of some aspect, idea, cultural belief, etc as being "better" I will not mean more worthy of respect but simply easier in our society  to attain success.  For instance, it is "better" to be tall than to be short, at least for a man.  Tall men command more respect, are listened to more, and get promoted faster than short men.  Just a fact of life.  Tall men are not necessarily "better" at their jobs or smarter or even more pleasing to be around.  But it is "better" to be tall, all other things being equal.  Even so, short folk deserve the same basic human rights and the same dignity as tall folk.  Is a short man just as good as a tall man?  Definitely yes!  Is it just as good to be short as it is to be tall?  Definitely NO! 

So...the "ideal" person (the best thing to be) in our current society is a tall, white, straight male, attractive of features, having an above average IQ, BMI between 20 and 24, with moderate political and moderate Christian religious beliefs, and born of a well-to-do family. 

Obviously, very few Americans meet all ten of those qualifications.  (And those are only a random ten.)  I don't even meet half of them.  Therefore, if we want to have any kind of civilized society at all we have to learn to accept the differences of others and be willing to accomodate said differences.  This does NOT mean we should be blind to our own "better" aspects or that we should try to emulate the differences of others.  It means that we should first of all we willing to accept ourselves for who we are, good and bad...or desirable and undesirable if you prefer...  There is no need to be ashamed of our "good" traits.  We certainly wouldn't try to change them just to make others feel more comfortable.  Nor should we refrain from trying to change our "bad" traits where physically possible.

Some things just are and can't be changed.  Some things CAN be changed.  Some things are modified by environment. 

There is scientific evidence that alcoholism is a genetic trait.  Some people are born to be alcoholics.  That does not mean they have fewer rights than others.  It just means they have to work harder to overcome their handicap.  Non-alcoholics need to understand what factors make an alcoholic what he is and work toward treatment rather than condemnation.  But that does not mean that non-alcoholics must embrace the behavior of alcoholics. 

And just because some who abuse alcohol are genetic alcoholics, it doesn't follow that all who abuse alcohol have the same genetic trait.  Many, and I would submit most, alcohol abusers abuse alcohol as a learned behavior.

Religion and Politics

I am, as previously noted, an atheist.  When I describe myself politically as a republican I often get some weird looks.  "How can you be an atheist and a republican?" I am asked.  I usually respond by asking, "How could anyone possibly be a Christian and a member of the republican party?"  Examine the teachings of The Christ.  He directed that all goods are to be held in common.  The very origin of the expression "From each according to their abilities; to each according to their needs" is Christian teachings.  Some of our first colonies, in fact, were founded as communistic experiments; those being the Puritan/Pilgrim colonies.  It wasn't until those colonies embraced the capitalistic beliefs of private ownership of property, individual wealth attained for individual effort, and the like that our country began to grow and prosper.

So I believe we should all disabuse ourselves of the notion that a person's religion can determine the person's political beliefs.  It is also my belief that Christians have no business in the Republican party.

Note: this is just a stub article.  My thoughts and ideas haven't been fully developed and i'm sure i will want to rephrase what I already have.  I jst post this as is for now so that anyone following will get an idea where I am coming from.  (Later, David!  lol)

The Power of Prayer

WAIT!  Didn't you say you are an atheist?  And you are writing about the power of prayer?  Isn't that just a wee bit contradictory?

Not at all, my friend.  Just because I think prayer has power doesn't mean I think that power originates from a magical, supreme being.  Doctors have long known that placebos work (at least to a degree greater than one would expect from random happenstance).  Just as with prayer, the reason for this is not fully explainable with our current knowledge.  There are several possible explanations for why prayer might work, though.  I can't promise that those explanations are definitive answers to the question, but I feel any or most of the explanations make more sense that a mythical being granting your wishes.

Let us take an example.  Given two college students, both are of approximately the same mental acuity.  Both have the same comprehension level.  Both study the same number of hours.  Both approach test hour apprehensively.  One prays to a god, believes that god will help him, and goes into the testing room calmly and with a certainty of his knowledge.  The other is still apprehensive as he takes the test.  Is it any wonder that the one who prayed might do better?  Was it the hand of God?  Or was it the demeanor of the student?  It is my contention that while the prayer helped place the student into a "test taking" mode, rubbing a lucky stone or wearing lucky socks would have done the same thing if the person believed it would. 

So "prayer" worked.  It just didn't work because some magical being intervened.

Ok, that covers part of it.  But what, you ask, about prayer that heals the sick?

How about this?  IT JUST DOESN'T FREAKING HAPPEN!   Sure, some people who get prayed for get better.  But so do some people that no one in their right mind would want to get better.  Attitude of the patient has much to do with cure rate.  You can literally die of a broken heart.  Yes, you can think yourself dead!  And you can (often...or at least sometimes) think yourself well.  The human body is a wonderful thing and you can cure yourself (many times) just by deciding to get better.  No supreme being involved.  But if that belief in a supreme being, as wrong as it might be, is a true belief, then your prayers to the (false) supreme being can be fruitful. 

Confidence is a great healer.  It would be, in my mind, best if that confidence is based on the knowledge of human capabilities.  But even confidence based on a fallacious belief works to the same end.  It would be wrong (at least to my present thinking) to remove a crutch to confidence built on a fallacy (belief in a god) without replacing it with the confidence built on knowledge.  Healing is healing, even if the source of that healing is wrongly identified. 

There is one other possible explanation of the efficacy of prayer.  This explanation also explains to a degree why some might say divination methods such as crystal balls, tarot, or even esp might work.  I will leave an in depth discussion of that and those to another post.  For now, just a brief description of a, I repeat, possible! way in which prayer might be seen as working.

I think most people today are aware that the brain sends out energy in the form of brain waves.  Those waves  ARE energy and can be measured as energy.  Can those brain waves IMPART that energy to another?  Will others be influenced by the energy sent out by a strong sender? 

There are people who can walk into a room and people just KNOW that person has arrived.  Hey, there are used car salesmen who can sell a Ford to the local GM dealer!  My hypothesis is that there really are people with such strong brain waves that they can control (at least in a limited way) the actions, thoughts, and beliefs of others.  Billy Graham and Hitler are two examples.  What makes charisma?  Brainwaves?  I don't know.  But it's worth considering. 

WRONG AGAIN!

Let's see...where did I leave this?  Oh, yes, God had just gotten P'd O (the literally correct abbreviation for what the hoi polloi call po'd) and drowned the world.  Except, of course, for the most honorable and faithful Noah and family.  Noah...who, as soon as he knew it was safe...got drunk and knocked up his daughters.

GOT IT WRONG AGAIN, BIG G! 

God was real big on destroying His own creations.  (Remind you of a precocious, self-centered two year old?)
Take a look at Sodom and Gomorrah.  God decided to wipe out all them there evil folk and once again He's going to let His one faithful servant, Lot, survive.  So He sends down a couple of angels to warn Lot.  Lot meets them on the street and says, "Hey, cool.  Come on over to the pad for a cold one and lets talk about this."  The angels (who, you should remember, are immortal.  As in, they're not worried about where they're going to get a hot dog or a place to sleep, and muggers just aren't a realistic concern) say they're fine on the street, but Lot insists that they drop by the house.
So, they do, being polite angels of destruction that they are.  Now, seems the townspeople saw the strangers and went over to Lots demanding to know just who the heck they were; wanted them to come out and explain themselves. 
So what does Lot do?  Not wanting these indestructible angels to be inconvenienced in any way, Lot sends his virgin daughters out to the crowd and tells the crowd to have fun with them.  Just don't bother the visitors...who couldn't be harmed by the crowd in a million years.
Ain't religion fun?  How would YOU like to be the daughter of a righteous man like Lot?