EndNote: "All" means "some"

EndNote has a weird concept of what the word all means. When searching pubmed, you have an option of narrowing your search to specific fields, like year, author, PMID, etc. Or, you can select "All Fields" and assume that EndNote will search through all listed fields. You know, as the word all would have you believe.



If you do this with a PMID number, however, you learn that the folks at Thomson Reuters were consulting a different dictionary than the rest of us when they were creating the bloated monster that is EndNote.



Weird, right? I happen to know that this is an actual PMID. If you tickle EndNote a bit, it'll laugh (at you) and admit that it, too, knows that this is an actual PMID, you silly goose.

How do you tickle EndNote to admit this? Simple, select PMID. It's right there: the second line below All Fields:



Cute, right?

Human Emotions

Right now, our neighborhood is up in virtual arms (on NextDoor) about the homeless. The lines have been drawn between people who think the homeless need tough love to force them to deal with their social, mental health, and/or drug issues, and others who feel that they just need love and support, especially during Christmas. Both sides claim to have the homeless' best interests at heart. But, the tough love camp is accused of being closeted homeless-haters, and the love love camp is accused of caring more about how charity makes them feel inside than for what is best for the homeless. Both sides have a point.

Statistics get thrown about by both sides supporting their position. When you look into the data, you see that they are at best from sloppy or underpowered experiments. At worse, they have biases inherent to studies put out by advocacy groups.

So, how do you solve practical problems in a world with noisy data? Simple. Treat the world as if it gives you noisy data and keep your judgments and emotions to yourself. This post from Less Wrong on classification of social and biological ills as diseases hits the nail on the head:

People commonly debate whether social and mental conditions are real diseases. This masquerades as a medical question, but its implications are mainly social and ethical. We use the concept of disease to decide who gets sympathy, who gets blame, and who gets treatment.

Instead of continuing the fruitless "disease" argument, we should address these questions directly. Taking a determinist consequentialist position allows us to do so more effectively. We should blame and stigmatize people for conditions where blame and stigma are the most useful methods for curing or preventing the condition, and we should allow patients to seek treatment whenever it is available and effective.

Applying this to our homeless question: Don't concern yourself with whether that guy on the corner is homeless because he's an undisciplined hedonist who wants to be constantly high and can't live by civilized society's rule, or an abused former child who occasionally has to use drugs to self-medicate away his pain and longs for the warm home and stability we have. You want him gone, and you want his issues solved so he doesn't come back. Spend your energy on that.

P.S., I don't have a solution to the homeless problem.

Modern Medicine (Radiology)

#
1	This is a cat.	This is a hemangioma.
2	This is most likely a cat.	This is most likely a hemangioma
3	This is consistent with a cat.	This is consistent with a hemangioma.
4	This is most likely a cat, but get a follow-up picture to make sure it wasn't a baby tiger all along.	This is most likely a hemangioma. Recommend follow-up to document stability.
5	This is most likely consistent with a cat.	This is most likely consistent with a hemangioma.
6	This is likely a cat, but can't exclude a tiger hiding behind it way in the distance.	This is likely a hemangioma, but can't exclude malignancy, sarcoid, etc.
7	This is likely a cat. Why don't you take a look for yourself and stop bothering me?	This is likely a hemangioma. Recommend clinical correlation.
8	This is likely a cat, but get a saliva sample and send it in for genetic analysis. Better yet, kill the cat and dissect it.	This is likely a hemangioma. Recommend biopsy. Open biopsy may be required.

One of the biggest crap apps out there is the modern radiology report. In the real world (with the cat), anything other than statement #1 will get you laughed at. In radiology, as it's practiced in The United States at least, statement #1 is rare. Instead, we teach our residents and fellows, by our own weak examples, to be as non-declarative as possible.

Statements #2 and #3 are as declarative as most radiologists get. "I said most likely. What more do you want from me?!"

Statement #4 just passes the figurative buck to the next radiologist and the literal buck from the patient or 3rd party payer to the radiologist's practice. A great example of Arnold Kling's concept of Premium Medicine: Added cost with no (or negative) benefit.

Statement #5 (a real-world example!) manages to stuff 2 different hedge words into one sentence!

Statement #6 is the reason Bayes rolls in his grave every time a radiologist signs a report.

Statement #7 is basically saying, "Thanks for the money suckers! This report was useless." We have access to so much patient data these days that it baffles me to see this in reports. Of course, this doesn't apply to cases where we're reading in isolation and when the only history we get from referrings is "pain," or some random ICD code. This negligent absence of data in a requisition borders on (is?) malpractice. I've seen it in referrals my family members get from their doctors and it aggravates me to no end.

Statement #8, I don't even... For a cat/hemangioma?

Look, sometimes we have to hedge. Sometimes we are no better than Plato's cave captives, squinting at shadows with no idea of what's behind us. We know that two or more widely disparate entities can have identical imaging features. But when you know something can only be one thing, just say so. Save the patient some anxiety. And, save the rest of us some money by reducing unnecessary imaging.

Trust no one. Assume nothing

"Trust no one. Assume nothing."

This was the constant refrain of one of my attendings in residency whenever I answered any of his questions about patients by referring to what a prior radiology report had said. His advice has served me well in radiology, where you can expect a certain rate of things that go unreported.

Its application in real life is even more important, where we're dealing not with honest mistakes, but with un-noticed biases and even deliberate misrepresentation. That's why I simply don't take at face value any figure put out by advocacy groups. This is easy for groups I disagree with, but I'm making it a point to treat the groups on my side with the same skepticism.

As an example of an advocacy group on my side of things misbehaving, take the case of the British children's cancer group (Children with Cancer, UK). According to this episode of the More or Less podcast, the group basically pretended an increase in absolute numbers of cancers in young adults and children (driven by increase in population and earlier detection) was an increase in cancer rate in children. The program asked for an explanation from Professor Denis Henshaw, the scientific director of the charity, who in interviews with the popular press, had said things like "We were shocked to see the figures, and it’s modern lifestyle I’m afraid."

In response to whether the popular headlines conflating absolute numbers with rate were correct or if it was right to use the more anxiety-inducing total number in the headline of the society's press release, even though mortality from childhood cancers are falling, even though the rate is much lower than 40%, Dr. Henshaw said "We are certainly interested in drawing attention to figures whatever they are...Prevention is better than cure...so we think drawing attention to this issue either in general or in particular is the right thing to do...I think the purpose of this press release was to encourage people to come to the conference."

"Trust no one. Assume nothing."

Google's Car Pipe Dreams

If Google/Alphabet is to be believed, we'll be safely and comfortably zipping around in driverless cars in a few years' time.

This may be so, but I'm skeptical. There are philosophical and scientific arguments against this possibility (see for example, David Mindell's arguments against full autonomy). But even if driveless cars become part of our future, they won't come from Google/Alphabet.

But don't take my word for it. Just spend a day with Google's latest half-baked attempts at moving from the ether to the physical: A pair of ChromeCast devices. One is designed to hinder your attempts at watching videos. The other, optimized for frustrating your efforts at listening to audio.

Google's unhelpful minions and fanboys on discussion boards blame wifi strength (never mind that the tablet sitting next to the ChromeCast can flawlessly stream the same content without so much as a hiccup) or things like microwave ovens and cordless phones. Whoever heard of a home with wifi weak spots or (gasp) a microwave oven. None are unexpected features of a home that Google had no way of planning for.

Chos is the Farsi word for "silent fart," making ChosCast an apt name for a device that spends most of its time in obstinate silence.

This, however, is exactly what Google/Alphabet's driverless future is looking like. Their nominally flawless cars haven't really challenged themselves with things like, you know, snow, and are barely getting their skins wet under the light drizzles of Washington State. Their poor ChromeCasts can't deal with expected home appliances or being a little far away from a router. Why subject their poor cars to perfectly expected things like a little limited visibility?

Finally, I ask you to imagine what software updates will be like for these poor, helpless, little cars. One of the early updates on my current Android phone, a non-exploding Samsung S5, made using it feel like walking through molasses. If Google can't plan for the storage space on the number 1 device of their number 1 Android pimp, just wait till they stuff their helpless cars' positronic brains with updates.

If you've enjoyed watching Google's hardware fails (Glass, ChromeCast, GoogleTV), you'll love watching their delicate fleet of little snowflake cars blow away at the first perfectly anticipated hardship.

Cisco VPN App

Cisco (NASDAQ: CSCO) is, according to its website, "the worldwide leader in IT that helps companies seize the opportunities of tomorrow by proving that amazing things can happen." One of the amazing things that happens when you launch the Cisco VPN app is that subtle dotted outline you see below (yellow arrow):

When you hit Enter after launching the VPN app, that dotted outline, that miracle of design, helps you "seize the opportunities of the future" not by connecting, as you'd expect, but by bringing up this no-information gem:

Bravo, Cisco Engineers. Thank you, you geniuses of design, for taking away an expected shortcut and punishing me with 2 extra mouse clicks.