Health care is broken. In the US quality of care is tanking. Even in countries with successful universal health care systems costs are rising too fast for the systems to cope. So what do we do?

Atul Gawande, who knows a thing or two about improving healthcare, argues in his commencement address to Harvard that doctors need pit crews:

We are at a cusp point in medical generations. The doctors of former generations lament what medicine has become. If they could start over, the surveys tell us, they wouldn’t choose the profession today. They recall a simpler past without insurance-company hassles, government regulations, malpractice litigation, not to mention nurses and doctors bearing tattoos and talking of wanting “balance” in their lives. These are not the cause of their unease, however. They are symptoms of a deeper condition—which is the reality that medicine’s complexity has exceeded our individual capabilities as doctors.

Gawande has two main arguments. First, that when doctors use checklists they prevent errors and quality of care goes way up. Second, that doctors need to stop acting like autonomous problem solvers and see themselves as a member of a tight-knit team. Gawande ...

Maju pointed me to a new paper on the genetics of Sudanese today. My interest was piqued, then not so much when I looked more closely. Genetic variation and population structure among Sudanese populations as indicated by the 15 Identifiler STR loci:

Background
There is substantial ethnic, cultural and linguistic diversity among the people living in east Africa, Sudan and the Nile Valley. The region around the Nile Valley has a long history of succession of different groups, coupled with demographic and migration events, potentially leading to genetic structure among humans in the region.

Results
We report the genotypes of the 15 Identifiler microsatellite markers for 498 individuals from 18 Sudanese populations representing different ethnic and linguistic groups. The combined power of exclusion (PE) was 0.9999981, and the combined match probability was 1 in 7.4 1017. The genotype data from the Sudanese populations was combined with previously published genotype data from Egypt, Somalia and the Karamoja population from Uganda. The Somali population was found to be genetically distinct from the other northeast African populations. Individuals from northern Sudan clustered together with those from Egypt, and individuals from southern Sudan clustered with those from the Karamoja population. The similarity of the ...

Portion size of food affects energy intake in normal-weight and overweight men and women.

“BACKGROUND:
Large portions of food may contribute to excess energy intake and greater obesity. However, data on the effects of portion size on food intake in adults are limited.

OBJECTIVES:
We examined the effect of portion size on intake during a single meal. We also investigated whether the response to portion size depended on which person, the subject or the experimenter, determined the amount of food on the plate.

DESIGN:
Fifty-one men and women were served lunch 1 d/wk for 4 wk. Lunch included an entrée of macaroni and cheese consumed ad libitum. At each meal, subjects were presented with 1 of 4 portions of the entrée: 500, 625, 750, or 1000 g. One group of subjects received the portion on a plate, and a second group received it in a serving dish and took the amount they desired on their plates.

RESULTS:
Portion size significantly influenced energy intake at lunch (P < 0.0001). Subjects consumed 30% more energy (676 kJ) when offered the largest portion than when offered the smallest portion. The response ...

Is there any substantive difference between natural, sexual, and artificial selection? Or is it just semantic sugar, useful for humans in our own cognitive bookkeeping? I lean toward the latter proposition. To some extent I would think that this is an irrelevant issue, selection is selection, but I have encountered folks who seem surprised at analogies between “artificial” and “natural” selection quite regularly. Of course Charles Darwin famously elided the distinctions across the two categories in his original works in the 19th century (this was later a subject of controversy, insofar as Darwin’s conflation of the properties of artificial and natural selection may have misled him in terms of the weight of factors shaping evolution in the wild).

These are the questions which bubble to the fore of my mind when I encounter reports such as Elizabeth Pennisi’s in Science, On the Trail of Brain Domestication Genes:

Researchers have proposed that bonobos evolved domesticated behavior to encourage group living. By isolating a group of 40 putative brain domestication genes in the prefrontal cortex and comparing their expression in humans versus chimps and bonobos, researchers found that the activity of that gene group in bonobos was clearly “domesticated” compared with chimps, they ...

When physicists are asked about “parallel worlds” or ideas along those lines, they have to be careful to distinguish among different interpretations of that idea. There is the “multiverse” of inflationary cosmology, the “many worlds” or “branches of the wave function” of quantum mechanics, and “parallel branes” of string theory. Increasingly, however, people are wondering whether the first two concepts might actually represent the same underlying idea. (I think the branes are still a truly distinct notion.)

At first blush it seems crazy — or at least that was my own initial reaction. When cosmologists talk about “the multiverse,” it’s a slightly poetic term. We really just mean different regions of spacetime, far away so that we can’t observe them, but nevertheless still part of what one might reasonably want to call “the universe.” In inflationary cosmology, however, these different regions can be relatively self-contained — “pocket universes,” as Alan Guth calls them. When you combine this with string theory, the emergent local laws of physics in the different pocket universes can be very different; they can have different particles, different forces, even different numbers of dimensions. So there is a good reason to think about them as separate universes, even if they’re all part of the same underlying spacetime.

The situation in quantum mechanics is superficially entirely different. Think of Schrödinger’s Cat. Quantum mechanics describes reality in terms of wave functions, which assign numbers (amplitudes) to all the various possibilities of what we can see when we make an observation. The cat is neither alive nor dead; it is in a superposition of alive + dead. At least, until we observe it. In the simplistic Copenhagen interpretation, at the moment of observation the wave function “collapses” onto one actual possibility. We see either an alive cat or a dead cat; the other possibility has simply ceased to exist. In the Many Worlds or Everett interpretation, both possibilities continue to exist, but “we” (the macroscopic observers) are split into two, one that observes a live cat and one that observes a dead one. There are now two of us, both equally real, never to come back into contact.

These two ideas sound utterly different. In the cosmological multiverse, the other universes are simply far away; in quantum mechanics, they’re right here, but in different possibility spaces (i.e. different parts of Hilbert space, if you want to get technical). But some physicists have been musing for a while that they might actually be the same, and now there are a couple of new papers by brave thinkers from the Bay Area that make this idea explicit.

Physical Theories, Eternal Inflation, and Quantum Universe, Yasunori Nomura

The Multiverse Interpretation of Quantum Mechanics, Raphael Bousso and Leonard Susskind

Related ideas have been discussed recently under the rubric of “how to do quantum mechanics in an infinitely big universe”; see papers by Don Page and another by Anthony Aguirre, David Layzer, and Max Tegmark. But these two new ones go explicitly for the “multiverse = many-worlds” theme.

After reading these papers I’ve gone from a confused skeptic to a tentative believer. This happened for a very common reason: I realized that these ideas fit very well with other ideas I’ve been thinking about myself! So I’m going to try to explain a bit about what is going on. However, for better or for worse, my interpretation of these papers is strongly colored by my own ideas. So I’m going to explain what I think has a chance of being true; I believe it’s pretty close to what is being proposed in these papers, but don’t hold the authors responsible for anything silly that I end up saying.

There are two ideas that fit together to make this crazy-sounding proposal into something sensible. The first is quantum vacuum decay.

When particle physicists say “vacuum,” they don’t mean “empty space,” they mean “a state of a theory that has the lowest energy of all similar-looking states.” So let’s say you have some scalar field filling the universe that can take on different values, and each different value has a different potential energy associated with it. In the course of normal evolution the field wants to settle down to a minimum of its potential energy — that’s a “vacuum.” But there can be the “true vacuum,” where the energy is really the lowest, and all sorts of “false vacua,” where you’re in a local minimum but not really a global minimum.

The fate of the false vacuum was worked out in a series of famous papers by Sidney Coleman and collaborators in the 1970′s. Short version of the story: fields are subject to quantum fluctuations. So the scalar field doesn’t just sit there in its vacuum state; if you observe it, you might find it straying away a little bit. Eventually it strays so far that it climbs right over the barrier in the direction of the true vacuum. That doesn’t happen everywhere in space all at once; it just happens in one tiny region — a “bubble.” But once it happens, the field really wants to be in the true vacuum rather than the false one — it’s energetically favorable. So the bubble grows. Other bubbles form elsewhere and also grow. Eventually all the bubbles crash into each other, and you successfully complete a transition from the false vacuum to the true one. (Unless the universe expands so fast that the bubbles never reach each other.) It’s really a lot like water turning to steam through the formation of bubbles.

This is how everyone talks about the fate of the false vacuum, but it’s not what really happens. Quantum fields don’t really “fluctuate”; that’s poetic language, employed to help us connect to our classical intuition. What fluctuates are our observations — we can look at the same field multiple times and measure different values.

Likewise, when we say “a bubble forms and grows,” that’s not exactly right. What really happens is that there is a quantum amplitude for a bubble to exist, and that amplitude grows with time. When we look at the field, we see a bubble or we don’t, just like when we open Schrödinger’s box we see either a live cat or a dead cat. But really there is a quantum wave function that describes all the possibilities at once.

Keep that in mind, and now let’s introduce the second key ingredient: horizon complementarity.

The idea of horizon complementarity is a generalization of the idea of black hole complementarity, which in turn is a play on the idea of quantum complementarity. (Confused yet?) Complementarity was introduced by Niels Bohr, as a way of basically saying “you can think of an electron as a particle, or as a wave, but not as both at the same time.” That is, there are different but equally valid ways of describing something, but ways that you can’t invoke simultaneously.

For black holes, complementarity was taken to roughly mean “you can talk about what’s going on inside the black hole, or outside, but not both at the same time.” It is a way of escaping the paradox of information loss as black holes evaporate. You throw a book into a black hole, and if information is not lost you should (in principle!) be able to reconstruct what was in the book by collection all of the Hawking radiation into which the black hole evaporates. That sounds plausible even if you don’t know exactly the mechanism by which happens. The problem is, you can draw a “slice” through spacetime that contains both the infalling book and the outgoing radiation! So where is the information really? (It’s not in both places at once — that’s forbidden by the no-cloning theorem.)

Susskind and Gerard ‘t Hooft suggested complementarity as the solution: you can either talk about the book falling into the singularity inside the black hole, or you can talk about the Hawking radiation outside, but you can’t talk about both at once. It seems like a bit of wishful thinking to save physics from the unpalatable prospect of information being lost as black holes evaporate, but as theorists thought more and more about how black holes work, evidence accumulated that something like complementarity is really true. (See for example.)

According to black hole complementarity, someone outside the black hole shouldn’t think about what’s inside; more specifically, everything that is happening inside can be “encoded” as information on the event horizon itself. This idea works very well with holography, and the fact that the entropy of the black hole is proportional to the area of the horizon rather than the volume of what’s inside. Basically you are replacing “inside the black hole” with “information living on the horizon.” (Or really the “stretched horizon,” just outside the real horizon. This connects with the membrane paradigm for black hole physics, but this blog post is already way too long as it is.)

Event horizons aren’t the only kind of horizons in general relativity; there are also horizons in cosmology. The difference is that we can stand outside the black hole, while we are inside the universe. So the cosmological horizon is a sphere that surrounds us; it’s the point past which things are so far away that light signals from them don’t have time to reach us.

So then we have horizon complementarity: you can talk about what’s inside your cosmological horizon, but not what’s outside. Rather, everything that you think might be going on outside can be encoded in the form of information on the horizon itself, just like for black holes! This becomes a fairly sharp and believable statement in empty space with a cosmological constant (de Sitter space), where there is even an exact analogue of Hawking radiation. But horizon complementarity says that it’s true more generally.

So, all those pocket universes that cosmologists talk about? Nonsense, say the complementarians. Or at least, you shouldn’t take them literally; all you should ever talk about at once is what happens inside (and on) your own horizon. That’s a finite amount of stuff, not an infinitely big multiverse. As you might imagine, this perspective has very deep consequences for cosmological predictions, and the debate about how to make it all fit together is raging within the community. (I’m helping to organize a big meeting about it this summer at Perimeter.)

Okay, now let’s put the two ideas together: horizon complementarity (“only think about what’s inside your observable universe”) and quantum vacuum decay (“at any point in space you are in a quantum superposition of different vacuum states”).

The result is: multiverse-in-a-box. Or at least, multiverse-in-an-horizon. On the one hand, complementarity says that we shouldn’t think about what’s outside our observable universe; every question that it is sensible to ask can be answered in terms of what’s happening inside a single horizon. On the other, quantum mechanics says that a complete description of what’s actually inside our observable universe includes an amplitude for being in various possible states. So we’ve replaced the cosmological multiverse, where different states are located in widely separated regions of spacetime, with a localized multiverse, where the different states are all right here, just in different branches of the wave function.

That’s a lot to swallow, but hopefully the basics are clear. So: is it true? And if so, what can we do with it?

Obviously we don’t yet know the answer to either question, but it’s exciting to think about. I’m kind of inclined to think that it has a good chance of actually being true. And if so, of course what I’d like to do is to ask what the consequences are for cosmological initial conditions and the arrow of time. I certainly don’t think this perspective provides an easy answer to those questions, but it might offer a relatively stable platform from which definite answers could be developed. It’s a very big universe, we should expect that understanding it will be a grand challenge.

I should have blogged this a day ago but I was too tied up at our communications training in Norman, OK. But the latest Point of Inquiry is up, and here’s the write-up:

From Birthers, to Truthers, to Deathers—to occasional Liars—America seems to be crawling right now with fevered conspiracy mongers. What’s up with that?

To find out, Point of Inquiry turns in this episode to Jonathan Kay, author of the new book Among the Truthers: A Journey into America’s Growing Conspiracist Underground. In it, Kay provides a fascinating look at some of our indigenous kooks, and why they seem to be thriving right now.

Jonathan Kay is the managing editor of Canada’s National Post newspaper and a weekly columnist for its op-ed page.

Kay’s writing covers a diversity of subjects, and he’s been published in a variety of outlets including Commentary, the New York Post, Reader’s Digest, and the New Yorker. In 2002, he was awarded Canada’s National Newspaper Award for Critical Writing, and in 2004 he won a National Newspaper Award for Editorial Writing.

Once again, you can listen to the show here and you can order Kay’s book here.

We’re in a brave new world when it comes to our conception of property. I’m on the skeptical side when it comes to the current aggregate long term utility of IP law (I think the value of property rights may be overwhelmed by the abuse which large corporations are inflicting upon the spirit of the laws). But I thought I’d pass on what everyone is talking about in relation to Twitpic, Why I abandoned Twitpic photo-sharing:

- 1. If someone wants to use my photo commercially, they need to ask Twitpic (but not me) and then credit Twitpic (but not me).

- 2. Twitpic can use or change my photos, in any, way without asking me first.

The financial rationale for this sort of behavior on the part of firms providing free services is pretty straightforward. If you want some level of control and ownership of what you produce, you’ll probably have to pay for services which grant you these liberties in the future, at least if you want to utilize the cloud.

For the record, I don’t mind if people somehow make money with my genotype. But I would be very skeptical of individuals who somehow assert exclusive ownership. When ...

[Note: I expect to hear some disagreement over my statements in this post. If you are going to comment, PLEASE read the whole post first, and then read my post "When belief kills" before leaving your comment. That should minimize misunderstanding about where I stand on this. Thank you.]

In February, I wrote that in Oregon a bill was being proposed to the state legislature that would remove the defense of religious belief in the case of homicide. Specifically, if the bill passes, parents who use faith healing instead of real medicine for their children can face murder or manslaughter charges if the child dies due to lack of medical care.

In March, the Oregon State House unanimously approved the bill. On Monday, the Senate approved it 25 – 5. It will now go back to the House for any changes to reconcile the versions. After that, it will be sent to the governor where he will sign it, and it will become state law.

This law would apply to anyone who does not seek medical care for their child, but the situation has become urgent of late because a fringe group called Followers of Christ ...

It’s difficult for people to change their identities or careers, but it can be done. We don’t have to be stuck with one particular fate; with a bit of effort, we can become different people. The same is true for the cells that we’re made of. They come in different types, from brain cells to skin cells to muscle cells. Stem cells can produce all of these types, but once a cell commit to a particular role, it’s largely stuck there.

But not always. Scientists can convert one type of cell into another with the right cocktail of molecules – a process known as transdifferentiation. It’s a cellular makeover. The hope is that this technique will allow doctors to grow bespoke tissues and organs. If someone suffers from a disease that destroys their nervous system, like Alzheimer’s, you could theoretically take their skin cells, and transform them into a fresh supply of genetically identical neurons.

To do this, you need to work out the right recipe. Many groups are working on this. They’ve managed to change pancreatic cells into liver cells, skin cells into heart cells, and more. But no one ...

What’s the News: A modified antibody can make its way into the brain and target the development of Alzheimer’s-inducing plaques, researchers reported today in two animal studies in Science Translational Medicine. The blood-brain barrier usually keeps drugs and other compounds from entering the brain in large enough quantities to be effective, but these studies show a way to trick the body’s own defenses into letting the drug in, demonstrating that this obstacle to treating Alzheimer’s could potentially be overcome.

How the Heck:

Antibodies—immune proteins that attack disease-causers like viruses and bacteria—are far too big to fit through the blood-brain barrier under normal circumstances. But because of the brain’s need for iron, one protein is routinely ferried across the barrier: transferrin, which binds to iron in the blood.
So, the researchers added a molecular structure to the antibody that essentially fooled receptors in the blood-brain barrier into treating the antibody as though it were transferrin, picking it up from the bloodstream and releasing it on the other side, into the brain. Ten times as much of the modified antibody made it past the barrier, compared to a version of ...

What’s the News: Bacteria are everywhere—in us, on us, around us. But they’re also floating around in the atmosphere, and researchers cracking open hailstones have now discovered them at the core, lending credence to the theory that bacteria jump-start the atmospheric process of forming snow, hail, and rain as a way to hitch a ride down to Earth.

What’s the Context:

We’ve long known that bacteria are involved in precipitation—scientists have been studying the idea since the 60s. But only in recent years have we begun to piece the relationship together.
In 2008, a landmark study analyzed the bacterial populations of 19 snowfalls, running tests to see how the microbes affected the freezing of water. They found that some bacteria dramatically increased the temperature at which ice crystals form; for instance, in the presence of Pseudomonas syringae, ice crystals, which normal require a frigid –40 C, can grow at a balmy –2 C. Bacteria could be catalyzing the formation of ice in the atmosphere, helping cause precipitation. And such organisms are pervasive: the team found bacteria in snow from all over the world. The lead researcher of that study, Brent Christner of Louisiana State University, told ...

In Alice’s Adventures in Wonderland, the titular heroine quaffs a potion that shrinks her down to the size of a doll, and eats a cake that makes her grow to gigantic proportions. Such magic doesn’t exist outside of Lewis Carroll’s imagination, but there are certainly ways of making people think that they have changed in size.

There’s nowhere in the world that’s better at creating such illusions than the lab of Henrik Ehrsson in Sweden’s Karolinska Institute. In a typical experiment, a volunteer is being stroked while wearing a virtual reality headset. She’s lyng down and looking at her feet, but she doesn’t see them. Instead, the headset shows her the legs of a mannequin lying next to her.

As she watches, Bjorn van der Hoort, one of Ehrsson’s former interns, uses two rods to stroke her leg, and the leg of the mannequin, at the same time. This simple trick creates an overwhelming feeling that the mannequin’s legs are her own. If the legs belong to a Barbie, she feels like she’s the ...

My latest DeSmogBlog post is based on some reporting–and some storm-watching–that I got to do while here in Norman, Oklahoma. It starts like this:

Recently, I witnessed the destructive power of a tornado nearly firsthand. In Norman, Oklahoma on the evening of May 24, I watched the sky darken and unleash a battery of nickel sized hail. Then a funnel cloud twisted down from the clouds, even as the cloud line itself touched earth in the distance, where a tornado had landed. Later, grass and leaves came flying through the air and stuck to our window, debris propelled from miles away.

It was terrifying—and more than that, awe inspiring. But what happened in Oklahoma that day, while very destructive and deadly, was nothing near the death toll in Joplin, Missouri two days earlier, or in Alabama in April, a month that set a new record for tornado outbreaks. So much tornado destruction this year, and so many deaths, has inevitably led some to ask the question—could global warming be implicated here?

Fortunately, being in Norman, I was also in the place to ask one of our country’s top experts this question—Harold Brooks, a tornado specialist at the National Severe Storms Laboratory. Along with other mainstream scientists, Brooks agrees that “it’s abundantly clear that the surface temperature has increased, and will continue to increase, and the overwhelming evidence is that it’s due to human activities.” Brooks also thinks global warming is likely to impact many weather phenomena–increasing the risk of heat waves, for instance, and stronger precipitation events.

“But it doesn’t necessarily mean that every bad weather event is going to get worse,” Brooks continues, and when it comes to tornadoes, “I get really worried when people oversell the case.” After all, if we’re wrong and we go through a series of quiet tornado years in the coming years, it will be just another weapon with which to attack those who want climate action.

You can read the rest of the piece–where Brooks elaborates on why he doubts tornadoes are increasing in number–here.

The Wide-field Infrared Survey Explorer was turned off a few months ago, but the science it did lives on. NASA just released a gallery of nine spiral galaxy images taken by WISE, and they’re lovely:

[Click to galactinate.]

Several of my favorite big, grand design spirals are there, like M51, M81, and M83. Note that since WISE only sees infrared light, these are false color images; the colors used are blue for 3.4 micron IR light, cyan for 4.6 microns, green for 12 microns, and red for 22 microns. The reddest light a human eye can see is very roughly 0.75 microns, to give you a comparison. In the images, star-forming regions are yellowish and/or pink, dust (in the form of long-chain organic molecules called polycyclic aromatic hydrocarbons) is green, and old stars are blue.

While looking over the images, I actually recognized the name of the one in the lower right: IC 342 (here’s a full-res WISE shot of it). This is part of a small group of galaxies near our Milky Way that is heavily obscured by dust in our galaxy. I wrote about it a little while ...

Last week I posted Don’t buy AIBioTech Sports X Factor kit! I laid out my rationale explicitly:

I’ve been pretty vocal about the impending specter of genetic paternalism in relation to personal genomics, which I believe to be futile in the long term, and likely to squelch innovation in the United States in the short term. Like any new product category there’s a lot of hype and confusion in the area of personal genomics, but I think it’s important that we allow some mistakes and misfires to occur. Innovation and creativity isn’t failure-free.

With that said, I also think it is incumbent upon the personal genomics community, if there is such a thing, to “police” the flow of information. I have seen references in the media to a new personal genomics kit, Sports X Factor, selling for $180, from AIBioTech. My initial intent was to ignore this, as there is real science and tech to be covered. This is just another case of a biotech firm trying to leverage public confusion and gullibility into revenue. But if I think such a thing, I should make my opinion known, shouldn’t I?….

My intent was to come up high on Google searches for the ...

Now that the Thiel Fellows have been announced the media has been pouncing. If you don’t know, Peter Thiel is giving a bunch of bright-young-things some money to drop out of college (or not go to college). Here are the details:

As the first members of the 20 Under 20 Thiel Fellowship, the Fellows will pursue innovative scientific and technical projects, learn entrepreneurship, and begin to build the technology companies of tomorrow. During their two-year tenure, each Fellow will receive $100,000 from the Thiel Foundation as well as mentorship from the Foundation’s network of tech entrepreneurs and innovators. The project areas for this class of fellows include biotech, career development, economics and finance, education, energy, information technology, mobility, robotics, and space.

The media has expressed polite and impolite skepticism of the idea of not going the college route. They point out, correctly, that those who are college graduates have much higher earning power. If you think college is a waste of time, try getting a high paying job outside of manufacturing or high-risk labor. Since this is a site where I can express my own personal perspective, let me drop the mask of objective reportage and shift toward ...

Click here to view the embedded video.

Very nice!  Go here and watch this in full screen – definitely worth it.

Two of my favorite things in the world are Doctor Who and My Close Personal Friend Adam Savage™. So what could be better than a video combining them, and throwing in two giant Tesla coils and a Faraday cage?

I think I have nothing to add to this.

In the mid-2000s many regular folks knew that something was weird in housing. Of course everyone was aware that there was a short term windfall to be made if you could flip. But there were normal discussions about the bubble, and when it would burst, or if the weird arguments by some economists and the real estate industry that there wasn’t a bubble were true. In contrast regular people weren’t aware of the possibility of a financial crisis. I recall saying stupid things about the “Great Moderation,” parroting what I’d heard smarter people who I assumed knew better say, in the summer of 2008. Or take a look at some of the comments when I mooted the possibility of a recession in mid-2007: “They’re practically glorified hiccups nowadays. I don’t get what the big deal is.”

With that in mind I looked at Google Trends for two queries, “housing bubble” and “financial crisis.” The top panel is search query, and the bottom panel is news query. The financial crisis query is what you’d expect:

The housing bubble query is more interesting:

People ...

The blog 3 Quarks Daily awards an annual prize for the best science blog post of the year. This year, Harvard physicist Lisa Randall is judging the entries. The deadline is May 31 11:59 pm EST. If there’s a blog post that has really stood out in your memory from the past year (since May 22, 2010 to be precise), go here to nominate it.