Blind Spots

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March 27th, 2025 (Permalink)

New Book

Quote: "This book may change your life. It did mine. You may forever view everything from menopause to microbiome health differently. You may also develop a reflex to ask for the underlying evidence or rationale to support a health recommendation…before you blindly abide by it. Having spent many hours with top doctors sorting scientific evidence from opinion on some of today's biggest health questions, I realize that much of what the public is told about health is medical dogma―an idea or practice given incontrovertible authority because someone decreed it to be true based on a gut feeling."1

Title: Blind Spots

Subtitle: When Medicine Gets It Wrong, and What It Means for Our Health

Comment: I would expect it means bad things for our health.

Author: Marty Makary

Comment: Makary is a physician and professor of medicine who has just been confirmed to head the Food and Drug Administration2. The only time I've written about Makary previously was in February 2021 when there was a large drop-off in Covid-19 cases3. Makary wrote an op-ed piece suggesting that the pandemic might be largely finished by April of that year due to the development of herd immunity. As I suggested at the time, this was overly optimistic. That prediction was, I suppose, the result of extrapolating out the then-current downward trend, but the only thing we know for sure about trends is that they don't continue4. At the time, it appeared that the decline might indeed be due to herd immunity, given that other explanations―such as bad weather, decreased testing, increased masking, and seasonality―didn't stand up to examination. Since herd immunity no longer seems to be a reasonable explanation, that leaves the decline unexplained.

Date: 2024

Comment: This book is not brand new since it was published last year before Makary was even nominated; what is new is that he will now have a powerful position in the health bureaucracy.

Summary: This book has an unusual structure: in the "Preface", Makary writes:

After the initial chapters, we'll pause and examine the human psychology of why we resist new ideas. You'll learn the mechanics of how our minds process new information when it conflicts with what we previously thought to be true. The human brain can do amazing things…[b]ut when it comes to receiving new information that conflicts with old information, it's predictably lazy5.

The initial chapters that Makary refers to appear to be discussions of specific medical errors about peanut allegies (1), hormone replacement therapy (2), over-use of antibiotics (3), and cholesterol (4). After that, we have a few chapters discussing why such mistakes are made, including intellectual inertia (5) and groupthink (10). In addition, there's a chapter on how the medical establishment works (6) and one on civil discourse (11). There are a few more chapters on specific medical issues, including birth (7), ovarian cancer (8), and silicone breast implants, autoimmune diseases, and opioid abuse (9).

Usually, in a book of this type, the general, theoretical chapters would be at the beginning, prior to those applying the generalities to specific cases; or, they would be at the end, deriving the generalities from the specific cases. Here, the generalities are sandwiched in between the specifics. I don't see any explanation by Makary for this odd structure, but perhaps the editor or publisher thought that a general readership would be discouraged if the book began by diving into theoretical discussions. Naturally, I'm most interested in those general chapters, but case histories of errors can be enlightening about the processes that lead to such errors.

Disappointingly, there is very little in the book about Covid-19 and the many errors made in dealing with the pandemic, with Makary writing: "This book does not discuss the Covid pandemic (people have become too tribal on the topic)….6" I certainly understand reluctance to deal with it while the wounds are still raw, but there's a danger of waiting too long, namely, that it will become a matter of purely historical interest.

Tribalism―in particular, political tribalism―is one source of medical error. For instance, taking seriously the idea that the novel coronavirus may have originated in a lab―the so-called lab leak theory―was taken as a sign of one's politics. Now, it's shedding its political force and becoming what it should have been all along, namely, a legitimate hypothesis7. Similarly, mask-wearing became as potent a political symbol as wearing a campaign button or a MAGA hat. How are we to fight such tribalism if we shy away from even discussing it?

Disclaimer: I haven't read this book yet, so can't review or recommend it, but its topic interests me and may also interest readers. The above remarks are based only on a sample of the book. I am not a physician. This entry is not intended to provide medical advice to individual readers. To obtain medical advice, the reader should consult a medical professional who will dispense advice based upon the reader's medical history and current medical condition8.

Notes:

  1. "Preface", p. xiv. All citations of just page numbers are to the New Book.
  2. Misty Severi, "Senate confirms Marty Makary to lead the FDA", Just the News, 3/26/2025.
  3. Have you heard of herd immunity?, 2/24/2021.
  4. See: Over-extrapolation.
  5. P. xv.
  6. P. 92.
  7. See: Kelsey Piper, "America―and the media―needs a Covid reckoning", Vox, 3/21/2025. I don't entirely agree with this article, but it's an admirable, if not totally successful, attempt on Piper's part to face up to past mistakes.
  8. The last two sentences are based on a "Publisher's Note" at the beginning of the New Book; p. ix.
Doublespeak
March 12th, 2025 (Permalink)

21st Century Doublespeak, Part 3

Last month, I discussed the use of the phrase "immigrant living in the country without legal permission" as a euphemism for "illegal immigrant"1: I doubted that such a long phrase would catch on with the writers and editors at influential publications as a substitute for "undocumented immigrant" or "undocumented worker". Despite my doubts, an article earlier this month was published under the following headline:

What we know (and don't know) about immigrants living in the Houston area without legal permission2

As I mentioned in the previous entry, the careless use of the adjectival phrase "without legal permission" often leads to ambiguous sentences. Here, it sounds as though it's just living around Houston that's the problem, whereas I suspect that the immigrants in question lack legal permission to be anywhere in the country.

The first paragraph of the article under the headline includes the sentence: "No one knows exactly how many immigrants live in the U.S. without legal permission", which confirms my suspicion. The article repeatedly uses the phrase "without legal permission" and "undocumented" occurs only once in the phrase "undocumented immigrants", which is additional evidence that "undocumented" is on its way out.

The article even includes a helpful sidebar explaining the meaning of the phrase "without legal permission":

What does it mean to live in the U.S. without legal permission?

This population, sometimes referred to as the "unauthorized" population, includes those who entered the U.S. illegally (for example, by crossing the U.S.-Mexico border) and those who overstayed or violated the terms of their visas. …

The sidebar initially explains "without legal permission" with another euphemism, "unauthorized", but it helpfully explains that both euphemisms refer to those who either entered or remain in the country "illegally". Why can't they just say so, then? Interestingly, the article includes the following passage:

Put simply, researchers took a U.S. Census estimate of the total number of people who were not born in the U.S. and subtracted from that the total number of legal immigrants, as tallied by the Department of Homeland Security. The result gives a rough baseline of the number of people living in the U.S. without legal permission.

Why does the article refer to "legal immigrants" instead of "people living in the U.S. with legal permission"? Perhaps that's a bit too long-winded. However, if it's permissible to write "legal immigrants" why is it impermissible to write "illegal immigrants"? If there are legal immigrants then there are illegal ones: otherwise, the adjective "legal" servers no purpose. For consistency's sake, one should write both or neither; for clarity's sake, both.

Notes:

  1. 21st Century Doublespeak, Part 2, 2/4/2025.
  2. Matt Zdun, "What we know (and don't know) about immigrants living in the Houston area without legal permission", Houston Chronicle, 3/5/2025.
Unauthorized immigrant repatriations from the US
March 8th, 2025 (Permalink)

How to Tell Half-Truths with Charts & Graphs

Graphics must not quote data out of context.1

We saw in a previous entry how it's possible to tell half-truths with photographs2, and in this entry we'll see how to do it with charts and graphs. A chart that tells a half-truth is not one that lies; instead, it's one that tells the truth but not the whole truth.

A bar chart appeared in an article in Newsweek about a month ago3 unfavorably comparing the numbers of deportations during Trump's first term to those under Biden's only term. A similar chart, shown above, appeared in Barron's about a month earlier4. The main difference between the two charts is that the Newsweek one breaks the data down by month, whereas Barron's one is broken down by year. Since I don't have the monthly data, I will concentrate on the above one in the rest of this entry, though the points made apply equally to both charts.

As far as I can tell, the statistical data displayed in the chart shown is correct5, but even so, the graph tells only half the story. The chart shows that many more "unauthorized"―that is, illegal―immigrants were repatriated to their countries of origin under the Democratic Biden administration as opposed to the previous Republican Trump administration.

Why is this data interesting? Given that the former and current president has been so gung-ho on expelling those who came here illegally, it's perhaps surprising that the previous one seems to have deported many more such immigrants. Based on the chart, should we conclude that Biden was actually a much more aggressive enforcer of the immigration laws than Trump, despite the latter's bluster?

What's wrong from this picture? The chart shows us only half of the picture: it only shows those being sent out of the country, not those coming in. Yet, the number of repatriations is partly a function of how many cross the border illegally and are subsequently "encountered" by agents of U.S. Customs and Border Protection (CBP). Of course, not all illegal border crossers are encountered by the CBP, but this is the only measure we have of the number of such crossings. Everything else being even, the more who cross illegally, the more who will be encountered, and the more repatriated.

So, what is missing from the chart are the numbers of encounters by the CBP in the relevant years. Thankfully, the Office of Homeland Security Statistics (HSS) provides a chart showing the number of encounters for the past ten years6. Below, I've revised the above chart to incorporate the total number of encounters nationwide for each year based on the HSS's data7. Unauthorized immigrant repatriations from the US

It's not a pretty chart: if I were constructing it from scratch, I would use a more compact scale, and only lines for comparisons, but at least the revised chart tells the other half of the truth. As you can see for yourself, the most notable feature of the revised chart is the huge spike in encounters for the years 2021-2023, that is, in the first three years of the Biden administration. The number of encounters almost tripled from the high in 2019 under Trump―1.1 million―to the high under Biden in 2023―3.2 million. So, no wonder there were so many more repatriations during the Biden administration than during Trump's first term: there were many more to repatriate.

Notes:

  1. Edward R. Tufte, The Visual Display of Quantitative Information (1997), p. 77. This is the last of Tufte's six principles of graphical integrity.
  2. How to Tell Half-Truths with Photographs, 2/12/2025.
  3. Dan Gooding, "Trump Migrant Deportation Numbers Compared to Obama, Biden", Newsweek, 2/11/2025.
  4. Corin Faife, Valentina Breschi & Omar Kamal, "Unauthorized Immigrant Repatriations From The US", Barron's, 1/17/2025. A French version of the graph can be viewed here: "Investiture de Trump: les migrants, un marché à plusieurs milliards de dollars pour les mafias", La Croix, 1/19/2025.
  5. It's difficult to be sure since the only precise number given is for part of last year, and otherwise one has to try to read the numbers off the scale at the left, but the amounts appear to be approximately correct.
  6. See: "CBP Encounters", Office of Homeland Security Statistics, 2/11/2025.
  7. 2014 is not included because that year is not included in the table―see previous note; also, I've left out the number of encounters for last year, since the chart includes only partial data for the year and the table is not broken down by month.
Poll Watch
March 6th, 2025 (Permalink)

Oh, Snap!

Here's a recent headline from Newsweek based on two "snap" polls1 conducted right after Trump's big speech a couple of nights ago:

Donald Trump's Congress Speech Was a Huge Hit With Americans2

These polls, which are the only ones I could find that were done since the speech, showed similar results: in one sponsored by CBS News3, 76% of respondents approved of the speech; in one from CNN4, 69% had a positive reaction.

The target population for both surveys was those American adults who watched the address, and not American adults in general. In public opinion surveys, a sample is taken of the "population", which is the group you want to know about, then the results for the sample are extrapolated to the population as a whole. In both of the snap polls, the population sampled was American adults who watched the speech, not American adults in general. For this reason, the poll results can only be extrapolated to the population of those who watched the address, and not to Americans as a whole, contra Newsweek. This is a fundamental point about sampling: a sample can only tell you about the population sampled, and not some other population, not even a larger one of which the sampled population is a subgroup.

Given that Republicans and Trump supporters are more likely to watch a speech by the president than Democrats and Trump opponents, adult address-watchers is a self-selected subgroup of the more general class of adults. This fact is reflected in the CBS survey in which slightly over half of those polled were Republicans and only a fifth Democrats; for the CNN poll, 44% were Republicans and also about a fifth Democrats. So, Republicans were over-represented in the samples and Democrats under-represented.

CNN's report did a good job of explaining this point:

Good marks from speech-watchers are typical for presidential addresses to Congress, which tend to attract generally friendly audiences that disproportionately hail from presidents' own parties. In CNN's speech reaction polls, which have been conducted most years dating back to the Clinton era, audience reactions have always been positive. The pool of people who watched Trump speak on Tuesday was about 14 percentage points more Republican than the general public.5

Another drawback of CNN's poll is its small sample size―only 431―and correspondingly large margin of error (MoE)―5.3 percentage points. In contrast, the CBS poll had a more usual sample size of 1,207 and MoE of 3.4 points. This is something to keep in mind about any snap poll, since such polls must be put together quickly and are, therefore, likely to have smaller samples and larger MoEs than standard polls.

Given the above considerations, there's not much news in either of the two snap polls. Mostly, what we learned is that people who watch Trump's speeches tend to agree with what he says. Big deal.

Notes:

  1. The word "snap" applied to a poll does not appear to have a technical meaning, but seems to refer to a topical poll taken quickly.
  2. Ewan Palmer, "Donald Trump's Congress Speech Was a Huge Hit With Americans", Newsweek, 3/5/2025.
  3. Anthony Salvanto, Jennifer De Pinto, Fred Backus & Kabir Khanna, "Poll on Trump's 2025 joint address to Congress finds large majority of viewers approve", CBS News, 3/5/2025.
  4. Ariel Edwards-Levy, "CNN poll: Trump address to Congress gets modestly positive marks, changes few minds", CNN, 3/5/2025.
  5. See the previous note. Paragraphing suppressed.

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Recommended Reading
February 28th, 2025 (Permalink)

Too Good to Fact Check?

  • Jamie Whitehead & Francesca Gillett, "BBC review finds 'serious flaws' over Gaza documentary", BBC, 2/28/2025.
    The BBC has apologised and admitted "serious flaws" in the making of a documentary about children's lives in Gaza. The documentary, Gaza: How to Survive a War Zone, was pulled from iPlayer last week after it emerged its 13-year-old narrator was the son of a Hamas official. It said it has "no plans to broadcast the programme again in its current form or return it to iPlayer". … The BBC removed the documentary after concerns were raised that it centred on a boy called Abdullah who is the son of Hamas's deputy minister of agriculture. … It also launched a review into the film, and the BBC's Board met earlier on Thursday to discuss it.

    In the statement, a BBC spokesperson said both the production company and the BBC had made "unacceptable" flaws and that it "takes full responsibility for these and the impact that these have had on the corporation's reputation". It added the BBC had not been informed of the teenager's family connection in advance by the film's production company. The spokesperson says: "During the production process, the independent production company was asked in writing a number of times by the BBC about any potential connections he and his family might have with Hamas. "Since transmission, they have acknowledged that they knew that the boy's father was a deputy agriculture minister in the Hamas government; they have also acknowledged that they never told the BBC this fact. "It was then the BBC's own failing that we did not uncover that fact and the documentary was aired."

    If this account is correct, the documentarians concealed the boy's familial connection from the BBC. However, it's obvious that the Beeb also didn't fact-check the documentary with any care, which is underlined by the fact that the boy's relationship to the Hamas official was uncovered in short order after it aired by journalist David Collier1.

    … The BBC spokesperson said the incident had "damaged" the trust in the Corporation's journalism―and "the processes and execution of this programme fell short of our expectations". … A separate statement from the BBC Board added: "The subject matter of the documentary was clearly a legitimate area to explore, but nothing is more important than trust and transparency in our journalism. While the board appreciates that mistakes can be made, the mistakes here are significant and damaging to the BBC."

    This damage was self-inflicted: the documentarians may have deceived the BBC, but the Beeb was either incompetent or wanted to be deceived.

  • Katie Razzall, "Questions still remain for BBC after damaging Gaza documentary", BBC, 2/28/2025. Emphasis in the original.
    After an initial investigation, the BBC said the programme, which had been commissioned by the BBC and made by an outside production company, "fell short of our expectations". … It's a reputationally damaging mess, but how could it have happened? How did the commissioners of the programme not know that the child narrator's father was a deputy minister for agriculture in the Hamas-run government?

    The BBC says it had asked the production company "a number of times" in writing during the making of the film about any connections he and his family might have with Hamas, a proscribed terrorist organisation by the US, UK and others.

    This is the BBC's way of admitting that Hamas is a terrorist organization without actually saying so2.

    In a statement on Thursday the BBC said Hoyo Films, the maker of the film, acknowledged it "never told the BBC this fact". But what did it tell the BBC about the child? Crucially, the BBC failed to uncover the information itself.

    Embarking on a documentary about one of the most polarising and contested issues of our age was always going to be challenging. … The BBC commissioners in current affairs will have known the programme wasn't without risk. In circumstances like this, it's even more difficult to understand how the failings that have driven headlines for days―and done terrible damage to the BBC's reputation―could have occurred.

    Programme-makers and commissioners have previously told me they draw up risk grids to ensure they have the answers to any criticism thrown at them about their documentaries. They check and check and check to ensure they won't face problems after their programmes go out―or if they do, that they have the counter-argument ready.

    Dorothy Byrne, Channel 4's head of news and current affairs until 2020, told BBC Radio 4's Media Show she would have done her own checks rather than relying on the independent company. "If I was making this film, I wouldn't just ask who the boy was, who his father was, who his mother was, I would ask for the entire family tree. They could easily have found out about him, it shows that due diligence was not done. …I didn't wait for people to inform me of things," she added. "I asked them the right questions." …

    The BBC brand is based on impartiality―on being trusted around the world. All of us in news and current affairs take fact-checking very seriously. Mistakes are sometimes made, of course. But on this occasion both the independent production company and the BBC made serious errors which threaten trust in the corporation. …

    This isn't the end of the story and questions still remain. What exactly did the BBC ask about the boy and his family's potential connections to Hamas? Hoyo Films has said it's "co-operating fully with the BBC and Peter Johnston to help understand where mistakes have been made". … What's happened has damaged trust in the BBC in so many ways. Those who argue the corporation is biased against Israel will feel vindicated.

    It's certainly the most obvious explanation of what happened.

Notes:

  1. "BBC put on a Hamas Propaganda Pantomime", David Collier, 2/18/2025
  2. Fighters, Gunmen, and Militants?, 10/22/2023

Disclaimer: I don't necessarily agree with everything in these articles, but I think they're worth reading as a whole. In abridging the excerpts I have sometimes changed the paragraphing.

February 26th, 2025 (Permalink)

Quaffed or Coiffed?

A webpage for a collage sold by Christie's auction house contains the following sentence: "At the heart of the composition is an elegantly quaffed, bobbed head of hair, carefully cut out to preserve the shape and style of the hair-do, which looms large above all the other elements in the scene.1"

Since "to quaff" means to drink deeply2, this would seem to mean that someone not only drank the "bobbed head of hair", but did so elegantly, which seems unlikely. In contrast, "coiffed" is an adjective meaning carefully arranged, invariably referring to hair3. Surprisingly, there seems to be no corresponding verb, "to coif", in the English language, though there is a noun, "coiffure", referring to a hairdo4. As far as I can tell, "quaffed" and "coiffed" are pronounced exactly the same, which would seem to account for the confusing sentence. Presumably, the author meant that the hair was "coiffed" elegantly.

Both "coiffed" and "quaffed" are uncommon words, which may partly explain their confusion in this sentence. Anyone who has only heard the word "coiffed", and never seen it, could easily think that it was spelled the same as "quaffed". Considering that both words are uncommon, this mistake must be even more uncommon. Unsurprisingly, none of the reference books that I usually consult lists it as a confusion to avoid. Nonetheless, I found it funny and interesting.

Searching for other examples of the phrase "elegantly quaffed", I came across one from, of all people, the late actress Ingrid Pitt of Hammer horror movie fame. In a column describing her attendance at a film premiere, she wrote that she: "Made sure I was photographed with all the right people, elegantly quaffed champers and told outrageous lies about the Hollywood producers who were lining up to offer me gainful employment.5" "Champers", in case you don't know, is English slang for "champagne"6, so Pitt was indeed gracefully drinking the stuff. That may be the only time in the history of the world that the phrase "elegantly quaffed" has been correctly used in a sentence.

As usual, I checked the sentence from Christie's in several online spelling and grammar checking programs. While none objected to "quaffed", two did object to the hyphen in "hair-do". Also as usual, I checked the sentence with an "artificially intelligent" program, namely, Grok. Here's a transcript of the interaction:

Me: Can you check an English sentence for spelling and grammar?

Grok: Yes, I'd be happy to help! Please share the sentence you'd like me to check.

I pasted in the example sentence and Grok replied:

Grok: Your sentence is well-written and grammatically sound, but there's one word that seems out of place: "quaffed." "Quaffed" means to drink something heartily, typically alcohol, and doesn't fit the context of describing hair. I suspect you meant "coiffed," which means styled or arranged, especially in reference to hair. Here's how the corrected sentence would read:

"At the heart of the composition is an elegantly coiffed, bobbed head of hair, carefully cut out to preserve the shape and style of the hairdo, which looms large above all the other elements in the scene."

A couple of minor notes:

  • "Hair-do" could simply be "hairdo" (no hyphen), as both are acceptable, but "hairdo" is more common in modern usage.
  • The sentence is a bit long and could be split for clarity if desired, though it's fine as is.

Let me know if you'd like further adjustments!7

Yet again as usual, the AI chatbot was a better copy-editor than the dedicated spelling and grammar checkers.

Notes:

  1. "Das schöne Madchen", Christie's, accessed: 2/26/2025.
  2. "Quaff", Cambridge Dictionary, accessed: 2/23/2025.
  3. "Coiffed", Cambridge Dictionary, accessed: 2/23/2025.
  4. "Coiffure", Cambridge Dictionary, accessed: 2/23/2025.
  5. Ingrid Pitt, "The Ingrid Pitt column: when Ingrid met Hammer Films", Den of Geek, 1/15/2008.
  6. "Champers", Cambridge Dictionary, accessed: 2/23/2025.
  7. "Chat with Grok", Grok, accessed: 2/26/2025.
Puzzle
February 25th, 2025 (Permalink)

A Puzzling Bookshop

A small bookstore that I occasionally visit specializes in three types of book: mysteries, puzzle books, and philosophy. On a recent day, forty people visited the shop, though one of them just browsed and didn't buy anything*.

Mysteries, of course, tend to be the most popular books sold, but on this occasion fifteen people did not buy any. As you might expect, philosophy is the least favorite category, and just three customers bought philosophy books only. In contrast, seven patrons bought both mysteries and puzzle books but no works of philosophy. An equal number of people bought books of all three types as bought both mysteries and philosophy but no puzzle books, whereas half as many bought only puzzle books as bought just mysteries. Finally, one less person purchased philosophy books only as bought both philosophy and puzzle books but no mysteries.

How many customers bought all three types of book?

* That was me.

Disclosure: The above puzzle is a work of fiction as is the bookstore.

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