What will humans look like in the distant future?

I recently finished reading Caliban’s War, the second in James S. A. Corey’s Expanse series of science fiction novels. Toward the end of the novel, two of the characters involved in a love affair sub-plot alluded to the possibility of marriage and children. James Holden was born and raised on Earth and Naomi Nagata was born and raised in the asteroid belt between Mars and Jupiter. Naomi’s physical attributes were that she was very tall and thin by Earth standards, and by virtue of living in a low gravity environment her entire life, her bone structure was not as strong as those that grow up on Earth. There is a short discussion in the novel about how women from the Asteroid Belt are not able to give birth in the same manner as Earth-bound women; they need some kind of assistance (the novel was not very specific).

NASA recently published preliminary results from its Twins Study. In that study, they compared the effects of one year in space on the International Space Station for one twin to his brother who remained on Earth. The International Space Station orbits the Earth inside the protection of the Van Allen Belt. The preliminary findings indicate that the twin in space not only had physical changes apparent to the naked eye – he was two inches taller – but also had undergone some changes in his DNA.

Being outside the Earth’s atmosphere changes us. Many of those changes may not be good for us. It may not just be morphological changes that need to be considered for humanity to travel and thrive beyond the Van Allen Belt. So how will humans deal with long term travel outside of the protection of the Van Allen Belt? Among the physical changes Humans would need to undergo a number of changes for space travel and planetary colonization; things like oxygen requirements, make up of muscle fibers, psychological tendencies, alternative means for nutrient absorption like photosynthesis or the ability to get essential minerals directly from rocks and dust rather than through food sources, the ability to see in low light, and physical size may all be necessary to improve the resiliency of humans in space. Then there is also the need to become more resistant to particle radiation from the sun and other sources.

With all these modifications, what will our space-exploring descendants look like? Maybe its like this:

National Geographic explores this with its series Year Million. This is definitely on my binge watch list.


Engineering the Perfect Astronaut

After secret Harvard meeting, scientists announce plans for synthetic human genomes

Mason Lab Ten-Phase, 500-year plan


Weekend Reading

Cuba mystery grows: New details on what befell US diplomats

Years ago, when my boys were still boys, I offered them an idea for an invention. A target sound-emitting device that would disrupt the molecular structure of a weapon such that it would either disintegrate or misfire. This is not quite what I had in mind, but it appears as though the Cuban government has developed something akin to the weapon I described to my sons.

Can yoga therapy stimulate stem cell trafficking from bone marrow?

The rejuvenating and curative effects experienced by yoga practitioners could be attributed to repair and regeneration of tissues by replacement and recruitment of cells differentiated from the stem cell which is beyond the drug action. Therefore, yoga practice can be looked upon as one of the best ways to facilitate stem cell trafficking essential for healthy living and improving the quality of life under the scenario of rise in longevity of human being.

Japan is so broke that its prisons are full of 80+ year old ‘felons’

I’ve heard of cruise ships as a form of assisted living, and I used to joke about prison as a retirement solution with friends, but I hadn’t heard of people actually retiring to the comfort of prison.

Patient satisfaction surveys constrain the practice of medicine

Press Gainey is not going to like this one.

I have a lot of family and friends who work in hospitals. On occasion, they will complain about a poor patient satisfaction score they received. There are several sides to the story, of course, but from their perspective the reason for the low satisfaction score received is because of some intervention, or lack of intervention, they are required to do (or not do) at the doctor’s orders. In the field of medicine, and other fields where professional expertise is what the customer needs and is seeking out, customer satisfaction surveys may be working against the best interest of the patient.

“Doctors feel pressured by what patients may say about them afterward. The fear of bad patient-satisfaction scores, or negative reviews on online sites, may be creating a “Yelp effect” that drives doctors to provide care that patients don’t actually need.”1

Antibiotics are often the over-prescribed medication, but in the Emergency Room and other areas of medicine, like dental visits, where pain management is common, opioids are often the sought after medication by patients that drive their response to a patient satisfaction survey. Doctors and dentists are then in an uncomfortable position of not meeting their customer’s needs, but for the customer’s own good. The patient can then just shop for a doctor or dentist that will prescribe the sought after medication. Drug seeking patients

“Some healthcare providers now sadly believe2 that ER patients with honest pain complaints are the minority.”3

Part of the problem is actually caused by government-mandated programs.

In order for a health care provider or hospital to be certified to receive payment from government-funded programs like Medicare and Medicaid, the provider must collect patient experience data, i.e. patient satisfaction, through the Consumer Assessment of Healthcare Providers & Systems (CAHPS) program. Physicians, hospitals and other health care providers must have sufficient scores from the CAHPS surveys in order to remain in good standing within the program they participate.  They can incur fines, reductions in reimbursement, or be removed from the program if CAHPS scores are too low. There is a real financial incentive for doctors, hospitals and other medical service providers to do the things that patient expects to insure a sufficiently high rating on CAHPS, contributing to over prescription of antibiotics and opioids.  and In the U.S. we have been indoctrinated with They may be so tightly scheduled that they get decision fatigue; physicians write more prescriptions at the end of their workdays than they do at the start.

As The Hippocratic Oath infers, “First, do no harm,” ending the CAHPS program may be the first step in giving back to physicians the ability to practice their art without undue retribution.

Government funding of health care services has numerous unintended consequences, and CAHPS is just one of them. Ending CAHPS will not solve the over-prescription epidemic in this country, but it is a solid, small first step.

The myopic American Dental Association

“It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

― Upton Sinclair, I, Candidate for Governor: And How I Got Licked

The American Dental Association’s (ADA) Health Policy Institute recently published a research paper4 addressing the need for a Loss Ratio for dental plans. In crafting their argument, the authors of the paper reveal their fundamental ignorance of how the dental insurance market works.

Using data made available by the State of California and through an exercise of tortured logic, the paper contends that because the dental insurance market is moderately concentrated, one solution to alleviating the effects of this moderate concentration would be to require all dental insurance companies to reach a minimum loss ratio for its dental policies sold in the state of California.

The study identifies that the dental insurance market is moderately concentrated based on the Herfindahl-Hirschman Index5. The major reason for this finding is the dominance of one company, Delta Dental of California. The authors identify two possible implications of a moderately concentrated market: higher premiums for consumers and lower reimbursement rates for providers.

Using the California data, they recognize that the dental premiums available to consumers has actually declined. over the two years of data they analyzed. Including data from a third year (made available after the paper was published) the trend of declining dental insurance rates is confirmed. So higher premiums is not the cause of their concern.

The American Dental Association’s concern is not the well-being of dental patients, but the well-being of dentists. Their primary goal is to protect the income of their members, dentists. With that in mind, they find some evidence that reimbursement rates for dental procedures paid by insurance companies may be declining modestly. The source of this data is from a lawsuit with Delta Dental of California. Reimbursement rates may be part of the problem.

Having been thwarted on their premium argument, and having inconclusive evidence on their reimbursement rate argument, they substitute medical loss ratio as a proxy. The medical loss ratio is simply:

Total claims paid


Total premium collected less taxes paid

The difference between Total Claims and Total Premium less taxes is administrative costs and profit.

In order to achieve the ADA’s goal of a medical loss ratio for dental insurance of 80% or 85%, there would have to be a decrease in administration costs, a decrease in profit, and/or an increase in provider payments.

Decreasing administration costs is most easily achieved through economies of scale. The bigger a company is and the more people it has to manage, the administrative cost per person will go down. So the large companies will have the advantage. Remember, Delta Dental of California is the largest.

Decreasing profitability can only be achieved through regulation. In economic parlance this is called price controls. Investors generally invest money in a business that has the possibility of making a return on their investment. Pension funds, like the California Public Employees’ Retirement System have a target return within their fund of 7%. So it stands to reason that investors in dental insurance companies would seek out a similar rate of return.

Right now, profitability for all dental insurance companies in California is around 6%. Limiting profitability beyond this level will only encourage business that are not achieving a sufficient return to leave the market. Fewer companies in the market will have the effect of causing additional concentration in the market, the cause of lower reimbursement rates according to the study authors.

Increasing provider payments, all things being equal, will require higher premiums. Clearly higher premiums is not good for the consumer. Higher premiums is also not good for the dentists. Higher costs means fewer people will spend money on dental insurance. Since most people rely on dental insurance to pay for their dental services, fewer people will seek out dental care. Lower demand without a concomitant reduction in supply will force dentists to charge lower prices, but since the prices are essentially fixed by the State, supply will have to shrink. Some dentists will either move out of state or just go do something else. The result is either lower income for dentists because of reduced demand, fewer dentists practicing or some mixture of both.

The Health Policy Institute, through its recommendations is more likely to harm the very constituency they aim to help, the dentists.

Monday links

Trends in Obesity and Severe Obesity Prevalence in US Youth and Adults by Sex and Age, 2007-2008 to 2015-2016

“Prevalence increased in men, women, adults aged 20 to 39 years and 40 to 59 years. There was no significant linear trend among adults 60 years and older. There were no significant quadratic trends. The adjusted model also showed a significant overall linear trend for severe obesity.”

Prevalence of Obesity and Severe Obesity in US Children, 1999–2016

“Despite previous reports that obesity in children and adolescents has remained stable or decreased in recent years, we found no evidence of a decline in obesity prevalence at any age. In contrast, we report a significant increase in severe obesity among children aged 2 to 5 years since the 2013–2014 cycle, a trend that continued upward for many subgroups.”

Body composition effects of short-term fasting using lemon and honey

“Of the 50 original participants, 44 finished the experiment.Those who remained lost a significant amount of weight, fat-free mass, and muscle mass, as well as reductions in their body mass index (BMI).”

The Myth of the Battle of Good and Evil

There is a small section in the book Sapiens: A Brief History of Humankind that discusses “The Battle of Good and Evil”. In this section the author, Yuval Noah Harari, argues that monotheistic religions struggle with the notion of evil. If there is only one God, he argues, then when humans are face to face with evil people, circumstances or things, then the only conclusion is that God must be evil.

There is another possible conclusion.

Up to this point in the book, Harari posits that all of human culture, and the thing that separates humans from all other species on earth, is the ability to believe in myths. This belief in myths is what allows us to band together in groups larger than about 150 individuals. Myth is a commonality that transcends personal connection allowing humans who do not know each other to work together toward a common end.

Harari’s inability to imagine a different conclusion about the nature of God with respect to good and evil belies his exploration of myth in every other aspect of human culture. The other possible conclusion that he fails to recognize is that the notions of good and evil are also mythological constructs. They are human creations to help understand the world around us and the competing goals of other people.

In the Jewish and Christian traditions, God is God of all things. That means that to God, there is no good and evil. This is clearly described in the Bible’s Book of Job. Humans created the myth of good and the myth of evil as a way to understand the actions of people, the circumstances and things preventing them from achieving their objectives.

The irony is delicious. The foundational premise of Harari’s book is the very thing he fails to apply to The Battle of Good and Evil and the understanding of the great monotheistic religions.