What’s My Age Again?

One of my favorite weird genre of news story occurs when the journalist/editor/newsroom all forget how old they are in relation to the people they are writing about. This phenomena is what often gives rise to articles about millenials that don’t actually quote millenials,  or articles about millenial parents of small children that compare them to Boomer parents of teenage children. I also see this in the working world, where there are still seminars about “how to manage millenials”, even though the oldest millenials are nearing 40 (and age discrimination laws!) and new college grads are most likely “Gen Z”.

Anyway, given my love for this genre of story, I got a kick out of a Megan McArdle Tweet this week that pointed out a Mother Jones article that fell a bit in to this trap.

She was pointing to this article that explained how Juul (an ecigarette manufacturer) had been marketing to teens for several years. As proof, they cited this:

Now for many millenials, this makes perfect sense. How could you screen three teen movies like “Can’t Hardly Wait”, “SCREAM” and “Cruel Intentions” and say you were marketing to adults? Well, that depends on your perspective. Can’t Hardly Wait came out in 1998, SCREAM in 1996 and Cruel Intentions in 1999. Current 14-18 year olds were born between 2001 and 2005. Does a party featuring movies made 5 years before you were born sound like it is trying to attract current teens? Or is it more likely that it would draw those who were teens at the time they were released….i.e. those in their early 30s?

As a quick experiment, subtract  5 years from your current birth year, Google “movies from ______”, take out the actual classics/Oscar winners and see how many of those movies you would have gone to an event to see at age 16. I just did it for myself and I’d have gone to see Rocky (though that’s an actual classic) and that’s pretty much it. I enjoyed the Omen, but not until later in college, ditto for Murder by Death and Network. In thinking back to my teen years, I did attend an event where Jaws was screened at a pool party, but I suspect the appeal of Jaws is more widespread/durable than “Can’t Hardly Wait”.

To be clear, I have very little insight in to Juul’s marketing plan or anything about them other than what I’ve seen on the news. What I do know though is that some movies appeal to broad audiences, and some appeal to a very narrow band of people who saw them at the right age. Teen movies in particular do not tend to appeal endlessly to teens, but rather to continue to appeal to the cohort who originally saw them.

There is an odd phenomena with some movies where they do poorly in the box office then pick up steam on DVD or cable broadcasts. The movie Hocus Pocus  (1993)is a good example. It was a flop at the box office, but was rebroadcast on ABC Family and the Disney Channel and then landed on a kids “13 Nights of Halloween” special in the early 2000s. This has caused the very odd phenomena of kids who weren’t born when it was released remembering it as a movie of their childhood more than those in the “right” cohort would have.

So basically I think it can be a bit of a challenge to triangulate what pop culture appeals to what age groups, particularly once you are out of that age group. Not that I’m judging. I struggled enough to figure out what was cool with teens when I actually was one. I have no idea how I’d figure it out now.

 

Diagnoses: Common and Uncommon

There was an interesting article in the Washington Post this week, about a man with a truly bizarre disorder. Among many other terrible symptoms, he essentially never has to go to the bathroom while he’s standing up and going about his day and appears to be dehydrated no matter how much he drinks, but the minute he lays down at night he has to urinate copiously and shows signs of being overhydrated. He has so many bizarre symptoms that he ended up in something called the Undiagnosed Disease Program, a fascinating group run by the NIH that seeks to find diagnoses for people who have baffled other physicians. They conduct all sorts of testing and try to either find people a diagnosis or to add their information to a database in the hopes that eventually they’ll get some information that will help them figure this out. The overall goal is to both help people and add to our collective knowledge about the human body.

Outlier medical cases are truly fascinating to many people, myself included. The WaPo column is actually part of a series called “medical mysteries“. Oliver Sacks made a whole writing career out of writing books about them. These cases make it in to our textbooks in school, and they are the stories that stick in our minds. These aren’t even one in a million cases, they are often one in 10 or 100 million. The guy in the WaPo story might even be 1 in a billion or 10 billion.

I am also fascinated by these stories in part because last year I started in on a medical mystery of my own. It started innocuously enough: random bouts of nausea, random bouts of extreme fatigue, then noticeable increased sensitivity to smells, tastes and pain. I assumed I was pregnant. I wasn’t.

I followed up with my doctor who confirmed that my hormone and other blood levels were fine. She ran tests to see if I was being poisoned, if I had a weird vitamin deficiency or had ODed on something accidentally.  She referred me to a couple of other doctors. The bouts came and went, but they actually started to get very disconcerting. My increased sense of smell meant that my car would frequently smell strongly of gas…something most of us take to mean there’s a problem. I couldn’t wear certain clothes because it felt like the seems or zippers were cutting my skin, but my skin showed no signs of redness. I couldn’t drink my coffee some mornings because I was convinced it was scalding my mouth. When I ate food I was convinced I could still taste the wrapper. Sensory information is supposed to help us make our way through the world, and to have it suddenly shifting around on you is incredibly disorienting.

Over the course of 6 months I saw 7 different doctors, all of whom were baffled. Since I work at a hospital I informally talked to half a dozen other NPs/PAs/MDs, and none of them had any idea either. The nausea and fatigue could come with hundreds of disorders, but nervous system hypersensitivity is a much less common symptom.

In the course of all this, the Assistant Village Idiot made a comment about how I should remember that strange symptoms were more likely to be an uncommon presentation of a common thing than an uncommon thing. The most experienced doctors I saw also mentioned the limitations of diagnosis. We build diagnoses based on the most common presentations of things, but we often don’t know if there are other possible presentations. We give names to clusters of symptoms because we see them together often, but it’s possible the biological underpinnings of the disorder could end up different places we don’t see as often. One doctor mentioned that in 6 months or a year I might add more symptoms that made things much clearer.

After about 6 months I still had no answers, but got some relief when I discovered that a magnesium supplement I’d taken to help me sleep seemed to help my symptoms. My doctor told me I could increase the dose and take it daily, and over the course of 6 weeks it mostly worked. I had relief, even if I still had no answers.

That was in January, and for the last 8 months I’ve seen small flares of symptoms that magnesium seemed to help. Then, about a month ago a new symptom started that made the whole thing much clearer: I got a headache. A one sided, splitting “gotta go lay down in a dark room” headache. A week or two later I got another one, then I got another one. I had always gotten a handful of migraines a year, but with the sudden change in frequency I started to notice something. For two days before I would be extra sensitive to light, pain, and smell. Sound too. Then during the migraine I would be incredibly nauseous, then the day after I would be so fatigued I could barely get out of bed. I looked back at my journals of my mystery symptoms I’d started keeping last year and realized it fit the same pattern. The symptoms that seemed so mysterious were actually part of the very classic migraine prodome/aura/postdrome pattern. It was then that I learned about the existence of acephalgic or “silent” migraines…..migraines that occur with all of the symptoms except the classic headache. My doctor confirmed my suspicions. I had been having chronic migraines with the headache, that now had developed in to chronic migraines with the headache. Once the headache appeared, my case was textbook. I got prescriptions for Imitrex and Fioricet along with a prophylactic medication.

Now per the Wiki page (and everything else I’ve read), acephalgic migraines are uncommon. It’s not particularly normal to get them as badly as I did without regular migraines, though they admit the data may be flawed. Since most people wouldn’t identify those symptoms as migraines, they might have an underreporting problem. Regardless, the AVIs point stood: this was an uncommon presentation of a common thing, not an uncommon disorder.

I like this story both because I am relieved to have a diagnosis and because it is relieving to have a diagnosis and because it is an interesting example of the entire concept of base rate. Migraines are the third most common disease in the world, after tension-type headaches and dental caries (cavities). One out of every 7 people get them. If we assume that my symptoms are highly unusual for migraine sufferers….say 1% of cases….that still means about 15 out of 10,000 people will get them. For comparison, schizophrenia is 1.5 out of 10,000.  Epilepsy is 120 out of 10,000, or about 10% the rate of migraine sufferers. A small percentage of a big number is often still a big number. An uncommon presentation of a common disorder can often be more common than uncommon disorders.

See, everything’s a stats lesson if you look hard enough. While I’m relieved to have a diagnosis, the downside of this is that the more frequent headaches are impacting my ability to sit in front of a screen as often, which may impact blogging. While we figure out what works to reduce the frequency of these, I may end up doing some more archives posting, maybe a top 100 post countdown like the AVI has been doing. We’ll see. While my doctor is great, any good resources are appreciated!

From the Archives: Birthday Math

Three years ago on my birthday, I put up a post of 5 fun math related birthday things. One of these was the “Cheryl’s Birthday” math problem which had gone viral the year prior. Here it is:

I was thinking about this recently, and found out it now had its own Wikipedia page.

The Wiki informed me that there had been a follow up problem released by the same university:

Albert and Bernard now want to know how old Cheryl is.
Cheryl: I have two younger brothers. The product of all our ages (i.e. my age and the ages of my two brothers) is 144, assuming that we use whole numbers for our ages. 
Albert: We still don’t know your age. What other hints can you give us? 
Cheryl: The sum of all our ages is the bus number of this bus that we are on. 
Bernard: Of course we know the bus number, but we still don’t know your age. 
Cheryl: Oh, I forgot to tell you that my brothers have the same age. 
Albert and Bernard: Oh, now we know your age.

So what is Cheryl’s age?

It’s a fun problem if you have a few minutes. I thought it was easier than the first one, but still requires actually sitting down and doing a few steps to get to the answer. Very hard to short cut this one. It also retains the charm of the original problem of making you flip your thinking around a bit to think about what you don’t know and why you don’t know it.

The answer’s at the bottom of the Wiki page if you’re curious.

There’s More to that Story: 4 Psych 101 Case Studies

Well it’s back to school time folks, and for many high schoolers and college students, this means “Intro to Psych” is on the docket. While every teacher teaches it a little differently, there are a few famous studies that pop up in almost every textbook. For years these studies were taken at face value, however with the onset of the replication crisis many have gotten a second look and have been found to be a bit more complicated than originally thought.  I haven’t been in a classroom for psych for quite a few years so I’m hopeful the teaching of these has changed, but just in case it hasn’t, here’s a post with the extra details my textbooks left out.

Kitty Genovese and the bystander effect: Back in my undergrad days, I learned all about Kitty Genovese, murdered in NYC while 37 people watched and did nothing. Her murder helped coin the term “bystander effect”, where large groups of people do nothing because they assume someone else will. It also helped prompt the creation of “911” the emergency number we all can call to report anything suspicious.

So what’s the problem? Well, the number 37 was made up by the reporter, and likely not even close to true. The New York Times had published the original article reporting on the crime, and in 2016 called their own reporting “flawed“. A documentary was made in 2015 by Kitty’s brother investigating what happened, and while there are no clear answers, what is clear is that a murder that occurred at 3:20am probably didn’t have 38 witnesses who saw anything, or even understood what they were hearing.

Zimbardo/Stanford Prison Experiment: The Zimbardo (or Stanford) Prison Experiment is a famous experiment in which study participants were asked to act as prisoners or guards in a multi-day recreation of a prison environment. However, things got quickly out of control and the guards got so cruel and the prisoners so rowdy that the whole thing had to be shut down early. This showed the tendency of good people to immediately conform to expectations when they were put in bad circumstances.

So what’s the problem? Well, basically the researcher coached a lot of the bad behavior. Seriously, there’s audio of him doing it. This directly contradicts his own statements later that there were no instructions given. Reporter Ben Blum went back and interviewed some of the participants who said they were acting how they thought the researchers wanted them to act. One guy said he freaked out because he wanted to get back to studying for his GREs and thought the meltdown would make them let him go early. Can bad circumstances and power imbalances lead people to act in disturbing ways? Absolutely, but this experiment does not provide the straightforward proof it’s often credited with.

The Robber’s Cave Study: A group of boys are camping in the wilderness and are divided in to two teams. They end up fighting each other based on nothing other than assigned team, but then come back together when facing a shared threat. This shows how tribalism works, and how we can overcome it through common enemies.

So what’s the problem? The famous/most reported on study was take two of the experiment. In the first version the researchers couldn’t get the boys to turn on each other, so they did a second try eliminating everything they thought had added group cohesion in the first try, and finally got the boys to behave as they wanted. There’s a whole book written about it and it showcases some rather disturbing behavior on the part of the head researcher Muzafer Sherif. He was never clear with the parents what type of experiment the boys were subjected to, and he actually both destroyed personal belongings himself (to blame it on the other team) and egged the boys on in their destruction. When Gina Perry wrote her book she found that many of the boys who participated (and are now in their 70s) were still unsettled by the experiment. Not great.

Milgram’s electric shock experiment: A study participant is brought in to a room and asked to administer an electric shock to a person they can’t see who is participating in another experiment. When the hidden person gets a question “wrong” they are supposed to zap them to help them learn. When they zap them, a recording plays of someone screaming in pain. It is found that 65% of people will administer a fatal shock to a person as long as the researcher keeps encouraging them to do so. This shows that our obedience to authority can override our own ethics.

So what’s the problem? Well, this one’s a little complicated. The original study was actually 1 of 19 studies conducted, all with varying rates of compliance. The most often reported findings were from the version of the experiment that resulted in the highest amount of compliance. A more recent study also reanalyzed participants behavior in light of their (self-reported) belief that the subject was actually in pain or not. One of the things the researchers told people to get them to continue was that the shocks were not dangerous, and it also appears many participants didn’t think what they were participating in was real, and it wasn’t. They found that those who either believed the researchers assurances or expressed skepticism about the entire experiment were far more likely to administer higher levels of voltage than those who believed the experiment was legit. To note though, there have been replication attempts that did find comparable compliance rates to Milgram’s, though the shock voltage has always been lower due to ethics concerns.

So overall, what can we learn from this? Well first and foremost that once study results hit psych textbooks, it can be really hard to correct the error. Even if kids today aren’t learning these things, many of us who took psych classes before the more recent scrutiny of these tests may keep repeating them.

Second, I think that we actually can conclude something rather dark about human nature, even if it’s not what we first thought. The initial conclusion of these studies is always something along the lines of “good people have evil lurking just under the surface”, when in reality the researchers had to try a few times to get it right. And yet this also shows us something….a person dedicated to producing a particular outcome can eventually get it if they get enough tries. One suspects that many evil acts were carried out after the instigators had been trying to inflame tensions for months or years, slowly learning what worked and what didn’t. In other words, random bad circumstances don’t produce human evil, but dedicated people probably can produce it if they try long enough. Depressing.

Alright, any studies you remember from Psych 101 that I missed?

Absolute Numbers, Proportions and License Suspensions

A few weeks ago I mentioned a new-ish Twitter account that was providing a rather valuable public service by Tweeting out absolute vs relative risk as stated in various news articles. It’s a good account because far too often scientific news is reported with things like “Cancer risk doubled” (relative risk) when the absolute risk went from .02% to .04%. Ever since I saw that account I’ve wondered about starting an “absolute numbers vs proportions” type account where you follow up news stories that compare absolute numbers for things against proportional rates to see if they are any different.

I was thinking about this again today because I got a request from some of my New Hampshire based readers this week to comment on a recent press conference held by the Governor of New Hampshire about their recent investigation in to their license suspension practices.

Some background: A few months ago there was a massive crash in Randolph, New Hampshire that killed 7 motorcyclists, many of them former Marines. The man responsible for the accident was a truck driver from Massachusetts who crossed in to their lane. In the wake of the tragedy, a detail emerged that made the whole thing even more senseless: he never should have been in possession of a valid drivers license. In addition to infractions spread over several states, a recent DUI in Connecticut should have resulted in him losing his commercial drivers license in Massachusetts. However, it appears that the Massachusetts RMV had never processed the suspension notice, so he still was driving legally. Would suspending his license have stopped him from driving that day? It’s not clear, but it certainly seems like things could have played out differently.

In the wake of this, the head of the Massachusetts RMV resigned, and both Massachusetts and New Hampshire ordered reviews of their processes for handling suspension notices sent to them by other states.

So back to the press conference. In it, Governor Sununu revealed the findings of their review, but took great care to emphasize that New Hampshire had done a much better job than Massachusetts in reviewing their out of state suspensions. He called the difference between the two states “night and day” and said “There was massive systematic failure in the state of Massachusetts. [The issue in MA was] so big; so widespread; that was not the issue here.”

He then provided more numbers to back up his claim. The two comparisons in the article above say that NH found their backlog of notices was 13,015, but MAs was 100,000. NH had sent suspension notices to 904 drivers based on the findings, MA had to send 2,476. Definitely a big difference, but I’m sure you can see where I’m going with this. The population of MA is just under 7 million people, and NH is just about 1.3 million. Looking at just the number of license drivers, it’s 4.7 million vs 1 million. So basically we’ve got a 5:1 ratio of MA to NH people. Thus a backlog of 13,000 would proportionally be 65,000 in MA (agreeing with Sununu’s point) but the 904 suspensions is proportionally much higher than MAs 2,476 (disagreeing with Sununu’s point). If you were to change it to the standard “per 100,000 people”, MA sent suspension notices to 52 people per 100,000 drivers, NH sent 90 per 100,000.

I couldn’t find the whole press conference video nor the white paper they said they wrote so I’m not sure if this proportionality issue was mentioned, but it wasn’t in anything I read. There were absolutely some absurd failures in Massachusetts, but I’m a bit leery of comparing absolute numbers when the base populations are so different. Base rates are an important concept, and one we should keep in mind, with or without a cleverly named Twitter feed.

Math aside, I do hope that all of these reforms help prevent similar issues in the future. This was a terrible tragedy, and unfortunately one that uncovered really gaps in the system that was supposed to deal with this sort of thing. Here’s hoping for peace for the victim’s families, and that everyone has a safe and peaceful Labor Day weekend!

 

Are You Rich?

A few weeks ago the New York Times put up a really interesting interactive “Are You Rich?” calculator that I found rather fascinating. While I always appreciate “richness” calculators that take metro region in to account (a surprising number don’t), I think the most interesting part is when they ask you to define “rich” before they give you the results.

This is interesting because of course many people use the word “rich” to simply mean “has more than I do”, so asking for a definition before giving results could surprise some people. In fact, they include this graph that shows that about a third of people in the 90th percentile for incomes still say they are “average”:

Now they include some interesting caveats here, and point out that not all of these people are delusional. Debt is not taken in to account in these calculations, so a doctor graduating med school with $175,000 in debt might quite rightfully feel their income was not the whole story.  Everyone I know (myself included) who finishes up with daycare and moves their kid in to public school jokes about the massive “raise” you get when you do that. On the flip side, many retirees have very low active income but might have a lot in assets that would give them a higher ranking if they were included.

That last part is relevant for this graph here, showing perceived vs actual income ranking. The data’s from Sweden, but it’s likely we’d see a similar trend in the US:

The majority of those who thought they were better off than they were are below 25th percentile, but we don’t know what they had in assets.

For the rest of it, someone pointed out on Twitter that while “rich people who don’t think they’re rich” get a lot of flack, believing you’re less secure than you are is probably a good thing. It likely pushes you to prepare for a rainy day a bit more. A country where everyone thought they were better off than they were would likely be one where many people made unwise financial decisions.

Interesting to note that the Times published this in part because finding out where you are on the income distribution curve is known to change your feelings about various taxation plans. In the Swedish study that generated the graph above, they found that those discovering they were in the upper half tended to be less supportive of social welfare taxation programs after they got the data. One wonders if some enterprising political candidate is eventually going to figure out how to put in kiosks at rallies or in emails to help people figure out if they benefit or not.

Blue Zones Update: the Response

After my post last week about the pre-print paper calling the “Blue Zones” (aka areas with unusual longevity) in to question, an anonymous commenter stopped by to drop the link to the Blue Zones groups response. I thought their response was rather formidable, so I wanted to give it a whole post. They had three major points, all of which I was gratified to see I had raised in my initial read through:

  1. Being designated as a Blue Zone is no small matter, and they have well published criteria. Some places that come to their attention are invalidated. There also are some pretty extensive papers published on how they validated each of the existing 5 regions, which they linked to. Sardinia here, here and here. Okinawa had a paper written on it literally called “They really are that old: a validation study of centenarian prevalence in Okinawa“. Dr Poulain (who did much of the age validation for Sardinia) wrote a paper 10 years ago called “On the age validation of supercentenarians” where he points out that the first concerns about validating supercentenarian ages were raised in 1873. This book has more information about their methods, but notably starts with mentioning 5 regions they were unable to certify. Basically they responded with one big link dump saying “yeah, we thought of that too”. From what I can tell there actually is some really fascinating work being done here, which was very cool to read about. In every place they not only looked at individuals records, crosschecking them with numerous sources, doing personal interviews with people and their families, and then calculating overall population metrics to looks for evidence of fraud. In Okinawa, they mention asking people about the animal for the year of their birth, something people would be unlikely to forget or want to change. It seems pretty thorough to my eye, but I was also struck that none of the papers above were included as references in the original paper. I have no idea if he knew about them or not, but given that he made statements like “these findings raise serious questions about the validity of an extensive body of research based on the remarkable reported ages of populations and individuals.”, it seems like a gap not to include work that had been done.
  2. Supercentenarians are not the focus of the Blue Zones. Again, they publish their criteria, and this is not a focal point. They have focused much more heavily on reaching 90 or 100, particularly with limited chronic disease. As I was scanning through the papers they linked to, I noticed an interesting anecdote about an Okinawan man who for a time was thought to have lived to 120. After he got in the Guinness book of world records, it came out that he had likely been given the name of an older brother who died, and thus was actually “only” 105. This is interesting because it’s a case where his age is fraudulent, but the change wouldn’t impact the “Blue Zone” status.
  3. Relative poverty could be correlated with old age. I raised this point in my initial post, and I was glad to see they echoed it here. Again, most of the way modernity raises life expectancy is by eliminating child mortality and decreasing accidents or repairing congenital defects. Those are the things that will kill you under 55. Over 55, it’s a whole new set of issues.

Now I want to be clear, no one has questioned the fundamental mathematical findings of the paper that in the US the supercentenarian records are probably shaky before birth registration. What’s being questioned is if that finding it’s generalizable to specific areas that have been heavily studied. This is important because in the US “old age” type benefits kick in at 65 and there is no level after that. So basically a random 94 year old claiming to be 111 might get a social bump out of the whole thing, but none of the type of benefits that might have caused people to really look in to it. Once we start getting to things like Blue Zones or international attention though, there’s actually whole groups dedicated to looking in to things. One person faking their age won’t cause much of an issue, but if your claim is that a dozen people in one town are faking their ages, that’s going to start to mess up population curves and show other anomalies. The poorness of the regions actually helps with this case as well. If you’re talking to people in relative poverty with high illiteracy, it’s hard to argue that they could have somehow been criminal masterminds in their forgeries. One or two people can get away with things, but a group deception can be much harder.

I’m still going to keep an eye on this paper, and my guess is it will be published somewhere with some of the suggestions of generalizability toned down, and more references to previous work at validating ages added.