Tuesday, 28 October 2014

Intellect and infectiousness

In terms of title deeds to the planet, bugs are the freeholders, and we humans hold a short lease. Bugs got started long before us. We humans arose very recently, as a combination of micro-organisms: a bolted together job, cannibalising tiny biological gadgets useful for survival into one large-headed, improbable, bipedal ape.

The basic reproductive rate of a communicable disease is the number of new cases over the course of infection, in otherwise uninfected person who have not been vaccinated.  When R0 is above 1 the infectious disease spreads, below 1 it dies out. The rate is affected by the duration of infectivity of patients, the infectiousness of the organism, and the number of susceptible people in the population that the affected patients are in contact with.

There is an another factor, not directly mentioned but subsumed into the “susceptible people” calculation, which is whether you can tell whether infected persons are carrying an infection, which then allows you to avoid them. Avoidance may be costly in other ways, but it is usually effective.

The usual R0 calculations show how easily the various bugs can reproduce in human hosts. This is good science, and also makes sense, in that the methods of transmission are comprehensible. No miasmas here. Airborne bugs move from human to human easily,  bugs are conveyed fairly easily in droplets, and in fluids they are transmitted least easily of all.


So, when people say that Ebola is hard to catch, and that measles is more of a problem, they are probably quoting these figures, tabulated by WHO and CDC from various sources. Bugs can be rated for their dangerousness (forgive me for lumping together bacteria, viruses, prions, and all the rest) to the prototypical average human.

That last concept is somewhat fluid. Some humans move around a lot, like truck drivers; interact a lot, like prostitutes and salespeople; or stay at home a lot, like the elderly, the fearful, and bloggers. In other words, the basic reproductive rate is a useful rule of thumb, but not sacrosanct, and subject to revision. For the sexually promiscuous, HIV is dangerous; for the faithful or uninterested, HIV is largely irrelevant. For that reason, the above estimate of 2-5 new HIV cases per infected person reflect behavioural differences between persons and groups, in which intelligence and conscientiousness play a part. For fearful people who act upon their worries about germs, the rate of infection may be lower. For those who never wash their hands the rate may be higher. For parents who do not ask other parents in the class whether their children have been vaccinated, the rates of infection for their own children are probably higher. You cannot have herd immunity unless the herd is willing to cooperate. Cooperative varies from one society to another, depending largely on trust.

Hence, although the bugs themselves vary in virulence, humans vary in their capacity to defend themselves. Not knowing about germ theory (ignorance); not working things out by observation and deduction (lack of intelligence); and not bothering to change habits or protect others (lack of conscientiousness) all affect the infection rate. So, the “pure” reproductive rate needs to be corrected for impure, messy humans, and the main variance seems to lie in conscientiousness and intelligence. The more a society implements the health advice of their brightest researchers, the better their chances of survival. In an evolutionary sense, if people do not quickly change their habits they are at risk of dying. So, the cultural habit of touching and kissing dead bodies, intended to convey respect and love, needs to change fast. Also, people who do not understand contagion, from ignorance, lack of intelligence or lack of conscientiousness, or a combination of all three, will probably die more frequently than those who do.  Denying a disease exists is not clever. So, at the very end, the factors of conscientiousness and intelligence are tested every time an infection gains access to one person. Will it gain access to another, or die out?

Of course, knowledge and good organisation can be imported from outside any community, so good peripatetic teachers can change local behaviours, given time. Some men who would not otherwise have used condoms in Africa will do so if Bill Gates provides them. Some countries organise well, others badly. Knowledge and skills are either home-grown or bought in, and in an open society the best brains, from wherever they can be found, will be applied to the hardest problems, wherever those are found.

The medieval age did not know what caused the great pestilence. One third of the world died as a consequence, or so Froissart thought. Some at that time worked out the bare bones of how it was transmitted from person to person. They imposed quarantine (40 days isolation) and in those cases many lives were saved. The Pope took advice, and sat between two large fires at Avignon, and survived. Some just trusted to luck, dancing, and booze. Not much use, but one way to face likely death. The poor died more than the rich, because they were closer to the disease vectors, rats and fleas; and probably because they had lower defences physiologically.

In some ways the reproductive rate is a typical statistic: it conveys useful information, and leaves out important caveats. Notice I had highlighted that the rates are calculated for unvaccinated persons. Of course, vaccination is the prime example of the application of intelligence to disease control. From a planetary perspective, intelligence aliens will look for civilizations that know how to control diseases. Perhaps, rather than the little green men saying: “Take me to your leader” when they land, they will demand from behind a biohazard barrier “What bugs do you humans carry on this planet?”

The current concern about Ebola is understandable. Ebola is at the stage when it can be almost stamped out, reduced to small recurrent outbreaks over the years which can also be stamped out. If we fail the test and get it wrong then it will spread and be a permanent hazard, rather like AIDS which claims 2.5 million new cases every year. Measles had plenty of time to spread before we could do much about it. That is why it currently infects more people and kills more people in absolute numbers than does Ebola, at present. However, when comparing diseases we need to understand compounding, which changes the statistics rapidly. In military terms we have to stop the invasion before the virus has established a beach head.   We are being tested for our collective intelligence and diligence right now, when a disease known for 40 years (nothing in biological time, but a reasonable period for solving a problem in cultural time) has surged into a larger urbanised population, further from the forests and closer to the airports.

But, apart from intelligent things like vaccination, sterilization, disinfection, epidemiology, and the organisation of public health measures, what does intelligence have to do with disease control? Do diseases really test our intelligence and personality? Questions of that size require a number of answers, so I think we need to step back from the specific issue of infectious disease, and first of all look at the link between intelligence and health more generally.

Modern epidemiology has always understood the impact of class. Social class is easy and cheap to measure, and can even be estimated from afar by looking at people’s occupations, clothing, manners and wealth indicators. Intelligence is harder and more expensive to measure, and casual estimates are likely to be biased towards verbal ability. For all those reasons, IQ as an explanatory cause of variance has taken a back seat. Lastly, genomic analysis has become available only very recently, and is still very expensive, but it is very likely that it will scoop up some of the variance previously ascribed to environmental factors.

How good is the link between intelligence, health and lifespan? Intelligence is associated with better health and longer lifespans, but it is not entirely clear why. The early explanation was that more intelligent people learned quickly how to avoid health hazards. They gave up smoking sooner in life, bothered to read the medicine labels, and followed health advice generally. All this makes sense, and leads to some simple prescriptions: take care, take advice, read the labels, wash your hands and avoid riding motorcycles and putting your fingers in mincing machines.


Currently, it seems possible that both intelligence and health reflect a general underlying bodily system integrity, a fundamental mens sana in corpore sana which, if you are lucky enough to have it, gives you health, intelligence and long life without much exertion on your part. This insight arises from the fact that simple reaction time measures taken in later life (but not the more complex choice reaction time tasks one would have predicted) also show predictive power when it comes to longevity, and partly moderate the effects of childhood IQ. I will come back to that another time.

Always wanting to be on the right side of the very best research, I turned to Stuart Ritchie to suggest the key reference:

Catherine M Calvin, Ian J Deary, Candida Fenton, Beverly A Roberts, Geoff Der, Nicola Leckenby, and G David Batty. Intelligence in youth and all-cause-mortality: systematic review with meta-analysis. Int J Epidemiol. Jun 2011; 40(3): 626–644.


The authors did a systematic review and found 16 independent studies with a combined total of 1,107,022 participants. They checked for publication bias, and were able to exclude it. The bare results are as follows: A 1-standard deviation (SD) advantage in cognitive test scores was associated with a 24% (95% confidence interval 23–25) lower risk of death, during a 17- to 69-year follow-up. There was little evidence of publication bias (Egger’s intercept = 0.10, P = 0.81), and the intelligence–mortality association was similar for men and women. Adjustment for childhood socio-economic status (SES) in the nine studies containing these data had almost no impact on this relationship, suggesting that this is not a confounder of the intelligence–mortality association. Controlling for adult SES in five studies and for education in six studies attenuated the intelligence–mortality hazard ratios by 34 and 54%, respectively.

Before going into any details, it is worth underlining how poorly social class of origin performs in studies which include measures of childhood intelligence. The idea that class, in the sense of family environment and culture, acts as a canon which shoots us out a variable distance into society (small, poor, feeble guns sending their canon balls short distances; large, rich, powerful guns propelling their progeny long distances) appears to be in error. As to adult SES, I think that is more likely to be a creation of prior intelligence than a confounder. Equally, education in societies where it is free is more a measure of intelligence than a fully independent cause of advancement.

Individual differences in intelligence (cognitive ability, mental ability) test scores, as measured by standardized IQ-type tests in childhood, show an inverse association with risk of death from all causes throughout adulthood. That is, higher intelligence appears to confer protection. This finding is replicated in prospective cohorts from several Westernized countries,1 across different ranges of intelligence,2 and in follow-up periods from early through to late adulthood.2–4

Mental ability scores from early life are associated with later adulthood morbidities, and before any somatic symptoms or risk factors of disease are manifest, provide evidence that cognitive abilities may be predictive of later health outcomes.

A second issue yet to be evaluated systematically is the extent to which intelligence as a predictor of mortality is confounded by early-life environmental influences including socio-economic factors. Socio-economic status (SES) is established as an important determinant of public health inequalities,15–18 including risk of mortality, and it can carry influence in childhood, via factors such as family income and parental education, to predict individual differences in childhood intelligence.19,20 In this context, therefore, intelligence may be considered a mediating variable on the pathway between early-life influences and adult health outcomes. If early social factors substantially confound the link between intelligence and longevity, then adjusting for childhood SES would sizeably attenuate the effect size of the association between intelligence and mortality. In their systematic review, Batty et al.1 identified three out of nine studies that adjusted for childhood SES: one of these showed no change from an unadjusted model, and two had modest attenuating effects, suggesting that intelligence has independent effects on .

In a fixed effects model, a 1-SD advantage in intelligence was associated with the lower risk of all-cause mortality (HR 0.76, 95% CI 0.75–0.77) (Figure 3)risk of mortality from those of early socio-economic influences.

Nine studies that included 18,733 deaths, reported effect-size models adjusted for childhood SES, measured either by father’s occupation or income, 2,36,50,51,56,59,61 the highest socio-economic index recorded for either parent,3 or father’s education.53 Heterogeneity was very low in unadjusted (Q =8.56, I2=6.6%, P=0.38) and adjusted models (Q=7.49, I2=0.0%, P=0.48). In a fixed effects basic model the HR for this subgroup of papers did not deviate from the HR for the 16 studies (HR 0.76, 95% CI 0.75–0.77). However, even after adjustment for childhood SES there was a very small attenuation (by 4%) of the effect size (HR 0.77, 95% CI 0.75–0.79) (Figure 5). Excluding the large study of over one million Swedish men had no effect on the aggregate effect size of the childhood SES-adjusted model, except to slightly widen the 95% CI parameters (HR 0.77, 95% CI 0.74–0.80). Compared with the unadjusted model of this smaller group of studies in which there were 4608 deaths (HR 0.77, 95% CI 0.74–0.80), controlling for childhood SES had no effect on the intelligence–mortality gradient when the influence of this largest weighted study was removed.

This is a very important finding, given that some psychologists, when presented with intelligence test results that predict later outcomes, are absolutely sure that intelligence is caused by social class, and thus dismiss the findings out of hand.

The authors go on to “adjust” for later educational attainment, as if it were an externally imposed factor. I think this is incorrect, because in any society which offers free education, attainments will have a very large component of prior intellectual ability. So, to “adjust” in this way is to remove part of the effect of intelligence. However, they may have been indulging in bending over backwards to show exactly how the results would look if this (questionable) procedure were applied, even if they may doubt the fairness of the “correction” themselves. In fact, they reveal the latter point in the discussion: the results to date cannot tell us for certain whether education and adult SES are simply partial mediators of the association between intelligence and mortality, or whether the results reflect over-adjustments if both factors are partial surrogates for intelligence, or if these variables confound intelligence–mortality associations.

Among the six studies that adjusted for educational attainment, there were 16,023 deaths out of 1,026,742 participants.3,51,53,56,63,65 Again, the aggregate effect size for this subgroup of studies in an unadjusted model (HR 0.76, 95% CI 0.74–0.77) was no different from that for all 16 studies. After adjustment for education (HR 0.89, 95% CI 0.86–0.91), the effect of intelligence on mortality was reduced by 54.2% (Figure 5). Exclusion of the large Swedish cohort3 from the model, as expected, widened the CI parameters (HR 0.87, 95% CI 0.81–0.93), but still reduced the intelligence–mortality gradient by 45.8% from the unadjusted model.

In summary, intelligence is a good predictor of later health and lifespan, and is far better than social class of origin. That general pattern has been confirmed in many studies of individual disorders. For example, patients in the UK believe that cardio-vascular problems can be controlled by statins, and they have been led into these beliefs by their doctors. The Deary gang know better.


Does IQ predict cardiovascular disease mortality as strongly as established risk factors? Comparison of effect estimates using the West of Scotland Twenty-07 cohort study are revealing.

When CVD mortality was the outcome of interest, the relative index of inequality (sex-adjusted hazard ratio, 95% confidence interval) for the most disadvantaged relative to the advantaged persons was (in descending order of magnitude for the top five risk factors): 5.58 (2.89, 10.8) for cigarette smoking; 3.76 (2.14, 6.61) for IQ; 3.20 (1.85, 5.54) for income; 2.61 (1.49, 4.57) for systolic blood pressure and 2.06 (1.07, 3.99) for physical activity.

So, after smoking, low IQ is the biggest risk factor in cardiovascular disease, and by prescribing statins doctors are playing about with a pill which may reduce what is only a minor factor.

As we have seen, brighter people tend to live longer, but only partly because they take clever precautions, and partly because of a possible common factor which creates a good brain in a good body.

We can show that childhood IQ predicts later health. We can show that the IQ effect is more powerful than the different environments provided by different social classes in Western countries. Clearly, this raises the obvious corollary, if we can show an IQ effect in UK, USA, Sweden, Australia and Denmark, can we show that the IQ/health relationship holds in other countries across the world?

More of that later.

Sunday, 26 October 2014

Inbreeding: Two Tribes?


Mohd Fareed has provided the sample sizes for each degree of relatedness, and an explanation for the larger number of first cousin marriages, which is the cultural norm in those communities. I have added in, from his paper with Mohammad Afzal, the degree of relatedness for each group and the mean IQ and standard deviations. The results are intriguing.

                                                           n         Relatedness  IQ       sd

Non-inbred                          225         .0000         96.51 (16.25)

Second cousin                       31          .0156          88.57 (13.99)
First cousin once removed   21          .03125        79.70  (6.51)
First cousin                         105          .0625          68.72   (7.15)
Double first cousin               26          .125             59.52 (14.99)

Mohd says: Now a question may arise in the mind of the public, why aren’t the sample sizes uniform? The answer is: among Muslims,  first cousin marriages constitute about 70% or even more of marriages, as compared to the other inbred categories.

Anyway, let me get stuck into these results, which are the sort of statistics I can understand. First cousins, the most numerous in the sample by far, have half the normal standard deviation, as do first cousins once removed. Why? The first cousin result cannot be a small sample size problem. Why this massive restriction in variation? Second cousins and double first cousins have the normal variation. Why? Variance reduces with degree of inbreeding and then bounces back again for the most inbred. Why? I can think of a possible psychometric hypothesis, suggested to me by an esteemed person of my acquaintance, but I haven’t got round to reading all the textbooks on population genetics kindly recommended to me by distinguished scholars (extremely expensive books, by the way) so could population geneticists please help?

That perplexing problem aside, the IQ for the entire inbred category comes out at IQ 72. The “marry your cousin” meme reduces the average IQ by almost 2 standard deviations. Cruelly, these believers will have been cast into such a state of mental weakness that convincing them of the downside of cousin marriage may take a long time, Bollywood notwithstanding.

If we put together the 225 outbred with the 183 inbred we get an overall IQ of 85.5. Given that Lynn’s mean value for India is about 82, Pakistan about 84 these results are within measurement error, and closer to the Pakistan figures. Lynn’s lists are not complete, and need updating,(he does the job himself, without any funds of the sort that PISA commands)  but they are given below for comparison anyway.

In summary, this sample seems very much like the other samples from India and Pakistan in terms of mental ability. What seems clear is that to get an understanding of the potential underlying ability we need to make a massive allowance for inbreeding. Scores of about IQ 96 should be possible in outbred groups.

To understand the regional social and political behaviours as they are at the moment, we need to understand that there are two tribes in contention: higher status outbreeds of average IQ 96, with considerable freedom from their cousins; and lower status inbreeds of average IQ 72, condemned by chains of obligation to perpetual, uncomprehending cousinhood.

Now, as Mohd Fareed says, Muslim India is not the only part of the world that encourages cousin marriage, but I hope that altruists not yet bound for West Africa could give Fareed and Azfal a call, to see if they can give them a hand with genetic counselling materials, training genetic councillors, and working with local researchers and activists to change the cultural meme of arranged cousin marriages. Better still, if you are a Hollywood actor or director, why not Tweet them now, or if that is too much effort, get your people to send their people a cheque?


Summary data from Lynn.

India     1,339       CPM      88             Gupta & Gupta, 1966

India    1,359        SPM       87             Chopra, 1966

India    5,607       CPM       81              Sinha, 1968

India    1,050       CPM       82             Rao & Reddy, 1968

India  3,536         SPM       84             Majumdar & Nundi, 1971

India      180         SPM       79              Mohanty & Babu, 1983

India      100         SPM       78              Agrawal et al., 1984

India      748         WISCR  79             Afzal, 1988

India      500         CPM       86            Bhogle & Prakash, 1992

India         29         CPM       82           Jyothi et al., 1993

India       569        SPM        82           Raven et al., 1996

India      828        CPM        80           Barnabus et al., 1995

India    8,040       SPM       88            Raven et al., 2000

India        569        SPM      81             Raven et al., 2000

India: median                   82


Pakistan    349     GEFT    84            Alvi et al., 1986

Pakistan    140      SPM     84            Rahman et al., 2002

Pakistan  1,662   SPM      82            Ahmad et al., 2009

Pakistan  2,016   SPM      86            Ahmad et al., 2009

Pakistan: median            84

Saturday, 25 October 2014

More sex, cousin?


Regular readers will remember this topic, but here is the link to a previous post:


Interesting work on the link between cousin marriage and intelligence has been published by Farid and Afzal who have collected Wechsler test scores on inbred children in Muslim areas of India. They chart a very substantial effect of genetically driven cognitive decline, with consequentially higher rates of mental retardation in the inbred families. The differences are enormous: 25 IQ points of retardation on average, and a massive, mind-bending 37 IQ points for the most inbred. Can it really be as bad as that? Has inbreeding caused different groups to diverge so much that they are an average 1.67 standard deviations apart? Think of the heated debates and the social and political ramifications of a 1 standard deviation difference between African Americans and European Americans in the USA. Intellectual differences of close to 2 standard deviations will be of greater consequence in the Muslim world and beyond.

Mohd Fareed and Mohammad Afzal. Estimating the Inbreeding Depression on Cognitive Behavior: A Population Based Study of Child Cohort. Published: October 14, 2014. DOI: 10.1371/journal.pone.0109585


They say: A cohort of 408 children (6 to 15 years of age) was selected from inbred and non-inbred families of five Muslim populations of Jammu region. The Wechsler Intelligence Scales for Children (WISC) was used to measure the verbal IQ (VIQ), performance IQ (PIQ) and full scale IQ (FSIQ). Family pedigrees were drawn to access the family history and children’s inbred status in terms of coefficient of inbreeding (F).

They summarise their results: We found significant decline in child cognitive abilities due to inbreeding and high frequency of mental retardation among offspring from inbred families. The mean differences (95% C.I.) were reported for the VIQ, being −22.00 (−24.82, −19.17), PIQ −26.92 (−29.96, −23.87) and FSIQ −24.47 (−27.35, −21.59) for inbred as compared to non-inbred children (p>0.001). The higher risk of being mentally retarded was found to be more obvious among inbred categories corresponding to the degree of inbreeding and the same accounts least for non-inbred children (p<0.0001). We observed an increase in the difference in mean values for VIQ, PIQ and FSIQ with the increase of inbreeding coefficient and these were found to be statistically significant (p<0.05). The regression analysis showed a fitness decline (depression) for VIQ (R2 = 0.436), PIQ (R2 = 0.468) and FSIQ (R2 = 0.464) with increasing inbreeding coefficients (p<0.01).

Inbreeding (consanguineous marriages among humans) produces homozygous offspring, since the mating of pairs occurs between genetically closely related individuals. The phenomenon of inbreeding or endogamy, increases the level of homozygotes for autosomal recessive genetic disorders and generally leads to decreased fitness of a population known as inbreeding depression which provides a major focus in clinical studies [21].

Parental consanguinity has been associated with increased risk of adverse prenatal outcomes including stillbirths, low birth weight, preterm delivery, abortion, infant and child mortality, congenital birth defects, cognitive impairments, malformations and many other complex disorders [12][32].

A study has revealed that the overall incidence of congenital malformations was 2.5 times higher amongst the children of inbred families when compared to that of non-inbred families [33]. Consanguinity has been associated with significant decline in mean values for height, weight and body mass index (BMI) and the subsequent depression on children growth, much influenced in proportion to their inbreeding coefficients with least variation for non-genetic factors [21].

Genealogical information (family pedigrees) up to five generations back (volunteered by the parents) helped in ascertaining the consanguinity persuasion of their marriage and thus, child’s inbreeding status was determined. The information provided by the parents was cross checked by seeking help from the elder members of the family. In case of ambiguity such data were omitted.

Wright’s path relationship method for calculating the coefficient of inbreeding (F) was used for all mating types following the order: double first cousin (F = 0.125) > first cousin (F = 0.0625) > first cousin once removed (F = 0.03125) > second cousin (F = 0.0156). In non-consanguineous families or for the distant marriages, the coefficient of inbreeding was effectively zero (F = 0.000) [21].

The authors did full Wechsler tests, so this is a gold-standard assessment, and somewhat unusual in standard publications on intelligence with large sample sizes. In another unusual move in contemporary publications, they have plotted out their data so as to show the distributions. Respect. I am almost reaching out to give them the, as yet mythical, Thompson Prize for Plain Statistics. The intelligence scores are massively shifted to the left (lower intelligence) in the inbred group.

The mean difference in VIQ, PIQ and FSIQ showed a significant inflation with the increase of the degree of inbreeding (p<0.05, using post-hoc tests) and followed the order: double first cousin > first cousin > first cousin once removed > second cousin > non-inbred. This indicates the risk for cognitive impairments or ID was more common among the subjects having greater value of inbreeding coefficients.

The Table below shows the massive drop in Verbal, Performance and Full Scale intelligence associated with consanguinity measured by the F inbreeding coefficient. For the guidance of those about to marry, the worst effects are when two double cousins marry (see list above for verbal descriptions) and check the figures below for the F coefficient categories.



The Full Scale results are drawn out here.

Figure 5

Actually, I may have to hold back the Thompson prize, because they have now reversed the direction of IQ scores, so that high scores are on the left, against usual convention. Pity the poor reader. Nonetheless, the wind blowing through these intellects is clear: the Double First Cousins peak in severe mental handicap, the Non-inbred are at virtually normal scores.

This is all pretty dramatic stuff. The authors have done well. Good sized sample, excellent quality intelligence testing, plainly described results. 

However, I am not one to let any researcher get away lightly. The authors do not give the final group IQ, nor do the answer the obvious question: if 45% of this Muslim sample are inbred, what would their IQs look like if they stopped inbreeding?

For general guidance, the overall group IQ would be interesting to compare with other measures of Middle East Muslim intelligence, and with Indian intelligence estimates. Lynn’s mean value for India is about 82, Pakistan 84. Specifically, in this sample it would appear that Muslims who avoid cousin marriage have IQs of 96.5 which is relatively close to Greenwich Mean IQs. Seen in this light, one bad cultural habit has damaged the intellects of normally able people.

I would like to see the sample sizes for each level of inbreeding, so that I can do a few more back-of-the-envelope calculations on what might happen over a few generations if we let loose that great Western invention: Romantic Love. This provides the perfect excuse to ditch your responsibilities to your pushy parents, up sticks and strike out into the blue yonder looking for True Love, far away from your cousins. Time for Bollywood to triumph over tradition.

Thursday, 23 October 2014

Bernadel Quartet


IMG_1939.JPG Bernadel Quartet



These boys and girls are good. Having them play three yards away is a privilege: each finger moving in vivid synchrony with the cascading sound in a gracious room by the river, all London forgotten in stately Haydn’s String Quartet No 55 and the more vivid and Slavic Shostakovich String Quartet No1 1. Then a quiet drink with the 21 other members of the audience, and finally Beethoven String Quartet No 7, at which the world must bow the knee, knowing that creation of that sort comes but once.

When Robert Graves went before the examiners as a young man one Don leant forward and said accusingly: “You have preferred some poets to others”. When four excellent young musicians play so well together I should simply enjoin you to follow the Bernadel Quartet. Do so. Nonetheless, although you will enjoy them all, I think you will find yourself watching violinist William Melvin.

And so to bed.

A demented government plan

As you will have noted in previous posts, I intend to write without fear or favour about mental prowess, and in that spirit can only describe as stupid a government plan to pay General Practitioners £55 for the next 6 months for every diagnosis of dementia they make.  First and foremost, getting a diagnosis of dementia can damage the life chances of elderly patients.  Second, dementia is not currently a treatable condition. Third, doctors cannot diagnose the condition accurately. Fourth, a proper assessment of dementia requires a base rate psychological assessment and then a re-test 6 months or more later. Fifth, a GP ought to be allowed to exercise some professional judgment without being suborned to meet the Flavour of the Month Five Year Plan.

So, to what do we owe this stupidity? The reasons given are that the Powers That Be have determined that dementia is under-diagnosed, and therefore family doctors need an incentive to label people properly, rather like pouring concrete walls to make rivers run in tidy straight lines. One of the things this silly policy intends is that doctors should “visit care homes to assess very elderly people who have not previously been checked for dementia”. What fools. How will this pointless paper exercise assist the brain function of the elderly? In the better homes they are already being given tasks and experiences to keep them mentally active (more in hope than because of established efficacy) and in the poorer homes they would do those exercises if they could afford to hire the staff.

Prof Sir Simon Wessely, who can always be counted on to make sensible remarks despite being President of the Royal College of Psychiatrists and a Knight of the Realm said “"at the moment the evidence favours either improving social care, or investing in research to find new treatments that actually modify the course of the disease. Until that happens I can see little point in this initiative.” By rights, that ought to stop the nonsense in its tracks, but here is a little further explanation.

When you try to diagnose dementia, you come up against g (general intelligence). It is simply inescapable. To get advance warning of memory problems you have to test memory. Because all mental abilities are correlated in a positive manifold, a bright person with memory problems will often still have a better memory than a duller person without memory problems. If you want any accuracy you have to do a full intelligence test and a full set of memory tests. By looking at both types of performance you can hazard a guess as to whether current memory abilities are worse than would be expected, given the estimated lifetime intelligence level of the person concerned. To improve on that initial opinion, you treat it only as a baseline, and test the person again after at least another 6 months, when practice effects should have faded, and the condition may have progressed. You draw the line of slope, and make some predictions about the rate of decline, distinguishing between the age related norm and the faster decline that may be part of dementia.

Of course, all this takes time, so standard NHS policy is often restricted to doing a one time screening test, coupled sometimes with a brain scan. The latter is pretty to look at, but of surprisingly little diagnostic help. Most of the observable changes are those seen in people of that age, and the correlation between the scan and real life capability is weak.  Nonetheless, a doctor then signs a form and bingo, your chances of getting into a pleasant nursing home are reduced to almost zero.

An elderly friend, of high ability and inquisitive mind, with failing physical health, selected a nearby nursing home, not far from his flat, which would keep him in touch with his friends and his old haunts. He had previously mentioned to his hospital doctors that he was worried about his memory, and so was given a screening test. On this slender basis he was diagnosed with dementia. The nursing home turned him down, on the basis that they would have taken him, given his presentation at interview, but that they could not take on someone with a dementia diagnosis. They were implacable when, late in the process, I found out what had happened, studied the psychological report, and pointed out that this conclusion was premature, to say the least. After some discussion he is now in his flat, with staff visiting daily, and the arrangement seems to be working for the time being. His memory is still good, his physical state rather frail. Should things get worse, he will not be able to go to his preferred nursing home.

Even if dementia could be diagnosed with a high level of accuracy (perhaps using annual symbol-digit subtest scores) diagnosis without an effective treatment is a baleful gift. Expectations are reduced, friends drift away, and normal decline becomes abnormal disease.

Of course, it is very likely that every single person associated with this stupid policy is probably well intentioned and perfectly capable of solving difficult intellectual problems in other contexts, and also kind to children and animals. However, some collective process seems to have drained the intellect out of them. Come to think of it, perhaps the policy was formulated in a moment of abstraction brought about by poor concentration and failing memory. Perhaps they all drifted into the conference room at the Dept of Health, forgot why they had come into that particular room, signed a document they found there because it seemed the sort of thing they had always done, and then tried to make their way down the maze of corridors to the room they half-recognised as their own office. I hope they will be treated kindly, kept warm and well fed,  and that absolutely no-one will stoop to denouncing them for £55 a head.

Wednesday, 22 October 2014

Lefties and the media


Pew Research have been looking at Liberals (lefties) and Conservatives (righties) and noting what media they consume in the USA. To my mind, the main finding is that the media are dominated by lefties. As I have explained, on leaving college the righties go into business, do the heavy lifting, make the money and pay taxes; and the lefties go into education and public service, and scribble the theory. 




When readers are asked to say which of the most notable 36 US news sources they follow, no fewer than 28 are trusted by liberals to express their point of view. The headline that Pew should have used is: “78% of US Media Socialist”. So rich is the array of Left inclined propaganda sheets that Lefties can pick and choose their brand of communism from 4 main outlets: CNN, MSNBC, NPR, NYT. In contrast, Conservatives cluster round the outpost of Fascism which is Fox News. They distrust 24 of the same notable 36 news sources. I regret that, as a BBC consumer, I cannot tell you much about any of these US offerings, but The Guardian is recognisably to the Left, and bills itself as such. The Economist is a bit surprising, because business publications tend to the right, but it is certainly far to the Left on intelligence.

I suppose that, from another perspective, US liberals could say that they are truly Liberal, and watch a range of outlets, including Fox News, while Conservatives, as the name implies, watch virtually nothing else but that preferred provider. To put matters in context, although viewers prefer particular news outlets, they are exposed to a wider range, even though they may not concentrate upon them, so it is not a case of complete tunnel vision.

Of even more psychological interest is that US Lefties are more likely than Righties to dump friends who do not hold to their political opinions. This is strange, and suggests that a strict “purity” or “solidarity” measure is being applied on the left. Expulsion from the party was certainly a Bolshevik control mechanism: declaring that former persons were now un-persons, which in modern times translates to un-friending and un-following errant comrades. Conservatives tend to congregate round those who hold similar views, so perhaps they select more carefully, and don’t have to eject many left-leaning souls.

One thing the hard left and the hard right have in common (as Eysenck noted) is that they take a tough-minded approach to politics: they think that action matters, pay money to political parties, organise, keep up with the news, and vote.

On a transatlantic note, I had no idea so many Liberal Americans watched the BBC and read The Economist.

The sample on which the survey is based seems to be representative. I see that the top third of Americans earn more than $75,000 a year, and that only 66% of all US citizens are now classified as White.

I cannot find any mention of the amount of time people spend consuming news, It is possible that Lefties devote more time to news because being connected in that way is more part of their core self perceptions “I ought to know where people are being oppressed” while Righties might feel “I don’t want to hear about other people’s problems, unless the present a threat to me”. If this is true to any extent it might explain why lefties consume so many different sources of news.

However, if Lefties really are brighter, then if follows that they will write more, read more, sample more opinions, and have more influence. They will dominate the intellectual landscape, and establish hegemony. My old party card should be knocking about somewhere.


Sadly, the Pew research does not give any intelligence estimates, not even a short Wordsum vocabulary test. This would give us additional data to check whether Lefties really are brighter than everyone else. If Pew has got intelligence estimates for their respondents, please let me know.

For the moment, this is the summary. Lefties find 78% of news outlets to their taste, presumably because the content is provided by Lefties in the first place. They shop around, mostly within the range of political views they accept, but also move out of that range. Lefties prefer their own kind but go further afield. They are more likely to dump politically deviant friends. Solidarity trumps friendship.

Righties find only about 20% of news outlets to their taste, and distrust most of the rest. They have gathered round the campfire of Fox News, and don’t stray far from it. Righties prefer their own kind, and mostly mix only with them. They are less likely to dump friends because of political differences.


Disclaimers: Most of my recent TV interviews have been on the BBC, a few on CNN. No money changes hands. Years ago I got paid for an article in The Guardian. Indeed, The Guardian once asked me to write a letter to the Editor about a clinical services matter, which they published just in time to cause embarrassment at the Conservative Party Conference, resulting in a former Conservative Prime Minister, Ted Heath, ensuring that more funding was available for British “human shields” who had been held by Saddam Hussein.  Years later, going into a BBC TV studio on a different news story I chanced to meet him and thanked him for his intervention, saying he probably didn’t remember it. To my surprise Heath stopped in his tracks, nodded in approval, and expostulated “and they are still suffering”.

Tuesday, 21 October 2014

Ebola: I don’t do policy, but…..

I know there are other subjects which require attention, but sorting out Ebola should have priority, because implementing a sensible policy could save lives. Every day counts when controlling an outbreak. I claim I don’t do policy, but I have a modest suggestion, which may simply show you why I should not be trusted with policy making.

What if we invited all the key government officials of Liberia, Sierra Leone, and Guinea to an all-expenses paid conference in some African location, say a luxurious Cape Town beach hotel, assuring them that for every day they spent at the conference their carnal and material desires would be fully satisfied, and in addition they would receive a generous per diem payment through the usual obscure channels, and also that they would never be taken to The Hague to answer to any tribunal.

Then, in their absence, we could hand over Ebola management in those countries to Medecins Sans Frontieres, assuring them that they have the lead role and full command over such resources as those countries have available, with no need to consult the World Health Organisation unless they wanted to, and that their money will come from charitable donations only. They might need a large police force and a cadre of health workers. They can bring in Nigeria and Senegal if they wish. Westerners can help, but only if they agree that in the case of getting infected they will be treated in local facilities with their African colleagues. Flights are banned until the outbreak is over, or until there is a reliable quick test for the virus. The new management is told that to fulfil their side of the bargain they must stamp out the outbreak in 210 days, which is ten times the presumed incubation period. That is, no new cases after 19 May 2015. They can use quarantine, isolation, tracing, tracking, and incineration of bodies and contaminated property. Failure means that they have to apologise to WHO, sack all their PR people, and keep quiet for 5 years.

One would expect that, given the welcome change of country management, the owners of Microsoft and Facebook would step up their already generous donations and channel them directly to MSF. However, if you have severe doubts about the quality of Microsoft software, and bemusement at the purpose of Facebook, and thus would not like these organisations to dominate the proceedings, then you could send the new MSF medical powers a pair of rubber gloves.


Monday, 20 October 2014

Wall Street Journal: Ebola a busted stock?


The Wall Street Journal is a reassuringly capitalist newspaper, and they have a reassuring article about Ebola by a distinguished epidemiologist, the talented Dr Larry Brilliant. There is much to commend in the article, based on his experience of the treatment and containment of smallpox and other infectious diseases. However, there are some points worth debating.

Dr Brilliant begins with a vivid description of an awful smallpox outbreak in 1974 in India. Yet, as he reassuringly points out, 6 years later smallpox had been eradicated. However, his article does not reiterate the obvious point that a vaccine for smallpox had been made available by Jenner in 1798. A commonplace in much of the world, (I still have my Uruguayan vaccination certificate somewhere) it had not been given to everyone in the world, and when mass vaccination achieved global herd immunity the last cases were tracked down. On 26 October 1977 a health worker dealt with the very last case, a moving moment in medical history. (I can remember the team being given an award at a medical conference I attended in the 80s).

Dr Brilliant says: The signs are optimistic that we will have an Ebola vaccine soon—hopefully in months. Even in its absence, we still have good tools. To fight Ebola, our tools are early detection, innovative diagnostics, isolation, epidemiologic tracing of contacts and good clinical care.

I did not know we would have an Ebola vaccine so soon. Hope so. At the moment we don’t have one, so our policies must be based on there being no vaccine. Isolation is important (though often not being achieved). Tracing of contacts appears to have been achieved in Nigeria and Senegal, but not elsewhere in West Africa. Good clinical care is also often not being achieved, and invasive clinical interventions might not be a good idea if they cover health workers in large viral loads of fluids.

Early detection: First, we must find new outbreaks faster. The current Ebola outbreak, initially misdiagnosed as cholera, had a head start of four to six months, enough to account for most of its unprecedented size.

Agreed. However, at the moment we have a big outbreak, and must deal with that.

Second, we need two kinds of technological innovations in diagnosis: one for the airports and points of entry, and one for the field and hospitals. For passengers and visitors, we need a rapid finger stick test that delivers results within minutes while a passenger is held at an airport.

Agreed. However, we don’t have one yet.

The second diagnostic breakthrough we need is for the hospital….tests that immediately diagnose if Ebola is present and suggest the best medical plan. The technology is also coming soon.

Agreed. However, we don’t have one yet.

Third, we need to learn from the past successes of smallpox, polio and Guinea worm how to contain an outbreak. In the smallpox program, we used rewards of a few dollars to stimulate reports of disease, a rumor register and searches and visits to temples and mosques, along with two billion house calls in India alone. When a case was found, we initiated complete isolation, including paying for a guard from the community to prevent anyone from entering or leaving the home. At times, WHO even paid for and sent meals to smallpox patients so they had no incentive to leave the house. If a patient still managed to leave a village, we notified next of kin and any place that person might be going, as well as health authorities. Along with vaccinating residents around each infected house, we monitored every infected village and patient for six weeks after each case.

Strongly agreed. I wish West African governments had followed these policies. The paid guard outside the isolated case’s home makes great sense. That policy would have saved lives in Guinea/Sierra Leone/Liberia. Implementing those sorts of policies has, as far as I know, not been agreed in West Africa. They have not handled the outbreak well.

Now, with mobile technologies, cloud computing and participatory epidemiology, we can make this a much more efficient process. Specifically, we need a modern, digital contact tracking system. Then travelers would answer questions about any symptoms and take their temperature, perhaps with their phone.

Agreed. I had suggested that last point myself, and am pleased to see it supported by an expert.

Fourth, we need improved coordination among public health systems, particularly across borders. The West Africa outbreak has put out in the open what many in the public health community have long feared: that fundamental impediments in the funding and structure of the WHO hamstring it at moments like this. There is no cavalry coming from Geneva when it comes to pandemics, no entity with a fully prepared SWAT team to tackle an outbreak. The WHO is not entirely to blame, but rather its member states, who have politicized the organization while also cutting funding.

Agreed. However, the national and international health authorities have not yet achieved that level of performance.

So far I have been agreeing that, once new technology is in place, things will be much easier than they are now, when the outbreak in not yet under control in West Africa.

Dr Brilliant says: Our real enemy is a hybrid of the virus of Ebola and the virus of fear. As the famous World War II British poster reads, we need to keep calm and carry on.

Here I have a point of disagreement. Fear need not be our enemy, and can be protective. Fear stops us walking into danger. The thoughtful approach is to balance alarm against too much calm. In the Second World War the authorities did not want the public to spend the night in the underground tube stations. They feared that they would never come out again. The great British public simply bought a ticket late at night, and camped down on the platforms with a thermos of tea and some blankets. The authorities capitulated. Citizens spent the night underground and came up to work in the day, and lives were saved during the Blitz.

Far from really panicking, all Western nations are carrying on with their lives at the moment, (not staying at home and hoarding food) but they are also trying to understand the risks and the best protective strategies to adopt. At this point most citizens would very probably like to see Ebola cases isolated, and a guard placed on their houses. Dr Brilliant makes an important point that this ought to be part of the armoury of disease control. It is right to be alarmed if the virus is carried to new territories. Why take risks just at the moment regarding travel, when better diagnostics may be available soon, thus making sure that the virus is not carried far afield? Better wait for a brief finger-prick test to become available than tracing hundreds of worried contacts.

Interestingly, Dr Brilliant does not mention another virus, HIV. Arising in modern times, even with all the armoury of diagnostics and pharmacological innovation at hand, it has killed 30 million, and infected another 36 million so far (rising by 2.5 million a year) all of whom are dependent on expensive medication for survival (one order of magnitude higher than an uninfected patient), and might well become infectious again if that treatment lapsed. It keeps spreading, but antiretroviral treatment seems to have reassured the public that the threat is over. In many ways current perceptions of Ebola mirror the perception of HIV decades ago, though not in the way that the authorities imagine. Far from panic, there is alarm that yet another virus will spread when it could have been contained in the early stages by strict measures of control. It looks as if an opportunity is being missed, and that saddens and alarms people, as it should.

On a brighter note, if Dr Brilliant’s policy advice about isolating cases in a guarded house can be implemented, that could make a major contribution to the control of Ebola. It will increase prompt human and financial costs in the hope of a future benefit, an example of deferred gratification: the public health equivalent of the famous “marshmallow test”.

Finally, on a more general note: none of us deserve to die because our personal or collective errors have given the virus an easy ride. Infectious diseases certainly test our intelligence and our personality, and collectively test the morality of the societies which we have created. Some governments will do their best to protect us. Others will do their best to protect themselves. Governments can be well organised and humane, or incompetent, indifferent, over-confident, untruthful and corrupt.  No deaths have to happen, nor is any purpose served by them. Nonetheless, many of us will have died stupidly if we are outwitted by a virus which is easy to control.

Sunday, 19 October 2014

Ebola: equal opportunity pestilence

A long time ago I decided to look at human error in the context of the risks of nuclear war. I read the published literature, including the US Congressional Record, and the work done by James Reason and others on the psychological underpinnings of mistakes. I was aware of journalistic accounts about nuclear accidents, drug-taking nuclear guards and the like, but did not give them much space. Eventually I was invited to a Pugwash Conference in Geneva, an East-West summit forum where I met US intelligence experts, Russian generals, think tank researchers and interested scientists. Chatting with senior figures about accidents they initially gave me to understand that everything was under control, but as the weekend progressed many told me that if I wanted to know what was going on then the alarmist journalistic accounts were probably closer to the reality than the official accounts I had been reading.

The official story on Ebola was that, nasty as it was, it would be controlled. Now, late in the day, courtesy of Associated Press, we have been given the internal WHO view as to why it was not controlled in West Africa. It said the heads of WHO country offices in Africa are 'politically motivated appointments' made by the WHO regional director for Africa, Dr. Luis Sambo, who does not answer to the agency's chief in Geneva, Dr. Margaret Chan.

Dr. Peter Piot, the co-discoverer of the Ebola virus, agreed that WHO acted far too slowly, largely because of its Africa operation. 'It's the regional office in Africa that's the front line. And they didn't do anything. That office is really not competent,' Dr Piot said. “What should be [the] WHO’s strongest regional office because of the enormity of the health challenges, is actually the weakest technically, and full of political appointees.” He also questioned why it took WHO five months and 1,000 deaths before it declared Ebola an international health emergency in August. 'I called for a state of emergency to be declared in July and for military operations to be deployed,' Dr Piot said.

In late April, during a teleconference on Ebola among infectious disease experts that included WHO, Doctors Without Borders and the U.S. Centers for Disease Control and Prevention, questions were apparently raised about the performance of WHO experts, as not all of them bothered to send Ebola reports to WHO headquarters.

WHO said it was 'particularly alarming' that the head of its Guinea office refused to help get visas for an expert Ebola team to come in and $500,000 in aid was blocked by administrative hurdles.

On 3 April, MSF first warned WHO about the outbreak, saying it was unusual because far from being in a forest village it was in an urban centre on the border of three countries, thus making control difficult because of different bureaucracies and a reluctance to admit to the Ebola infection because of the economic consequences. WHO responded by saying the numbers were still small. A dispute then broke out on social media between MSF and the WHO’s spokesman, who insisted it was all under control.

So, the West African national organisations screwed up. However, Nigeria and Senegal seem to have done well, so we need to do a discriminant function analysis sometime soon. The key patient is always Patient Zero. Nigeria seems to have had a sharp diagnostician, and sufficient toughness among key health workers to face down threats from the Liberian embassy. Nonetheless they lost 8 citizens because they tried to help an uncooperative infected Liberian diplomat. However, they have saved their fellow citizens, so far. A success story.

Next, the USA. Before launching into lamentation, we need to do a mini meta-analysis. The USA has been tested by an Ebola carrier who did not tell the truth about having been in contact with Ebola. This is the real test for the Western world. Not everyone fills in forms correctly. The US response has not been brilliant, but it might improve as they move their cases to specialist centres. What is clear is that one case can put 2 lives at risk even in supposedly competent hospitals. It can also damage the equanimity of many citizens, who are put at risk. Having worked on the Camelford water pollution case in the UK, I know that these health scares can be a source of medium term, low grade worry, even when the health authorities do their best to be reassuring.

Spain has less excuse for its record. They knew the returning priests had the disease, but did a poor job of protecting their medical staff. Britain handled its one case well, in a super-specialised unit. (He wants to go back, imagining that his having caught Ebola in the first place is an additional qualification). Germany and other European countries have handled their pre-booked cases well, in the sense of no further infections. These figures from the BBC may be a little out of date, but the overall Western death rate is 4, with 6 recovered, and 7 in treatment. It is much better than the African experience of 70% death rate, but it is a bit early to say that the fancy drugs, blood transfusions, and close contact nursing are winning the day. The death rate might turn out to be 4 out of 17, which would be very good. Currently it seems likely that all the infected new cases might survive.


So, we do not have a good estimate of how many new infections will be caused in the West by each unannounced Ebola carrier, but 2 per case seems likely, in line with the African estimate. There is evidence from Ng and Cowling (2014) that the virus lasts longer in cooler and moister climates, which might be relevant in the US and Spanish cases.


What now for the Western response to Ebola. Health services have not always made life easy for whistle blowers. On the contrary, the UK experience is that they can be ostracised. The airline industry was on top of this years ago. They allow pilots to admit errors anonymously, which means they can confess a mistake which acts as a warning to other pilots, and gives guidance to systems engineers as to what needs to be improved. We should have a similar system for health workers (and for car drivers, no doubt).


Above all, estimates of human-to-human transmission of any virus need to take into account human foolishness. For every “public awareness” health campaign predicated on average intelligence and average public spiritedness we have to apply a realism coefficient: an allowance for human error in following protocols, plus selfishness, indifference, egotism, deluded altruism and occasionally downright malevolence. Human stupidity is infection’s fifth column. From the viewpoint of any virus, we serve as useful fools. The stupider the human carriers, the higher the eventual human cost. So, every measure of the infectiousness of a disease is also a measure of our intelligence. Adjust the Ro calculations for the IQ calculations.

Finally, what are we to make of the view that the key to solving Ebola is to rush to Africa with trained staff and resources, in order to put out the fire at the source? From a global point of view, given the ubiquity of the wide body jet and the apparent political imperative to keep borders open at all costs, Ebola is being given a free ride, as if it were only fair that it should take hold across the planet: an equal opportunity pestilence. In that sense, going to Africa is an understandable policy, simply because it is the one way left to control the disease. However, health colonialism runs up against some contradictions. If local governments block the prompt rollout of resources, or refuse to publish the true death rates, or fail to pay their health workers, how should the Western health colonialist respond? Should these powers edge towards to imposing good governance, or should they try to battle to bail out the ship of failed nations while corrupt and incompetent local strongmen keep drilling holes in the hull of the sinking ship?

This probably a problem Western government should leave to the Chinese Politburo, who have taken over the colonialist mantle in Africa. 

Leading indicator: watch how many Chinese in Africa get Ebola. If all threats are the ultimate IQ tests, then the Chinese should have a low rate of infection. Equally, the virus should be controlled easily if and when it reaches the Chinese mainland.

Friday, 17 October 2014

Special offer to readers

Here is a little item I thought you might enjoy for the weekend. Three researchers want bright people to contribute raw genetic data for a study on high intelligence, by which they mean IQ at least 2.5 SDs above average. By my, admittedly shaky,  calculations that means an IQ of 138 and higher. As a general guide, in 1000 Europeans only 6 will be as bright. If we can spread the net to 100,000 Europeans we can expect 565. These numbers will be higher or lower according to ancestry, but intellect of that stature is uncommon. Naturally, the authors regard the readers of this blog as a likely source of suitable candidates, and in this assumption they show great perspicacity. All you have to do is send in your IQ results and your results from the 23andMe test to Davide Piffer. Please give them a hand, including doing some recruiting for them.

For your guidance, I will not be participating. Sunday papers, a little gardening and other important weekend matters preclude my attendance. However, I know that you will be stepping into the breach.

This research is conducted by Davide Piffer (Italy), Emil Kirkegaard (Denmark) and Bertram Gilfoyle (Norway).

We seek to identify genes that have an effect on general intelligence in humans. For that reason we need raw genome data from high IQ individuals.

The preliminary phase of our project (analyzing genomes from two scientists) has produced brilliant results and for this reason we want to follow up with genomes from more high IQ individuals.

Many people have already taken the 23andMe test, which enables its users to download raw data file. We’re looking for genomes from individuals whose IQ is at least 2.5 SDs above average.

The results of this study will be published on a pre-print, open access server (e.g. biorXiv, PeerJ) and will be available to everybody, in the true spirit of free science and scientific inquiry. Subsequently we may decide to follow up with a submission to a peer-reviewed scientific journal (e.g. PlosOne, Nature, etc.). Names of participants will not be disclosed (unless expressely requested by you or any other potential participant).

Genome files will be anonymous (a random code will be assigned) and will not be published. Please send genome raw data file (.zip) along with IQ score to: pifferdavide@gmail.com

Ancestry information (e.g. nationality and ethnicity) is needed (e.g. White American; Italian; German, etc.) to correctly match genomes to their reference population.If you have any questions, do not hesitate to contact us at the above email address. For the financial support of this study, a crowd-funding campaign is launched.

Best Regards,

Davide Piffer (Italy)
Emil Kirkegaard (Denmark)
Bertram Gilfoyle (Norway)

Wednesday, 15 October 2014

Ebola quarantine under-estimate?


An interesting paper by Charles Haas suggests that calculating the quarantine period for Ebola at 21 days may result in a 0.2% up to 12% chance of release of the virus.

The precise origin of this assessment (21 days) is unclear, however it is possibly based on the study of the either the 1976 Zaire outbreak11 or 2000 Uganda outbreak12 both of which reported (without detailed analysis) a maximum observed incubation time of 21 days.

The WHO Response Team17 has just published an incubation time distribution based on the first 9 months of the West Africa outbreak (total of 4010 confirmed and probable cases with usable data). They reported a mean incubation period of 11.4 days with an upper 95th percentile of 21 days — and they were able to fit the data to a gamma distribution.


For greater security, Haas argues, a quarantine period of 31 days is preferable. However, all quarantines run up against a trade-off:


So, we need to look at the cost of enforcing quarantine (Police wages plus cost of food and medical supplies plus loss of earnings for quarantined person) as opposed to the costs of treating contacts who may get infected, and the costs of lives that are lost. Time to call in the accountants.

Ebola: Errata

I need to correct three errors I have made.

Error 1

For some months I have been saying, based on expert advice from various trusted expert sources, that the Ebola virus would be easily contained in Western countries, particularly in Western hospitals. I now recognise that this was an error. Sorry.

It turns out that nurses at Texas Health Presbyterian Hospital in Dallas, according to the director of the National Nurses Union RoseAnn DeMoro, were given inadequate protective clothing; conflicting guidance about treatment protocols; were closely involved in dealing with the patient’s infected projectile vomit and explosive diarrhoea; and worked in rooms where soiled materials were piled up to the ceilings.  All this despite receiving many official directives from the CDC about how Ebola should be handled. It is said that 72 hospital workers may have come into contact with patient zero at some stage.

The nurses' statement (given anonymously, which is probably the best way to find out the truth in these fraught circumstances)  alleged that when Duncan  (US patient zero) was brought to Texas Health Presbyterian Hospital by ambulance with Ebola-like symptoms, he was “left for several hours, not in isolation, in an area” where up to seven other patients were. “Subsequently, a nurse supervisor arrived and demanded that he be moved to an isolation unit, yet faced stiff resistance from other hospital authorities,” they alleged. Duncan's lab samples were sent through the usual hospital tube system “without being specifically sealed and hand-delivered. The result is that the entire tube system … was potentially contaminated,” they said.

48 contacts in the community are being monitored for exposure. Health workers were not part of this group, because it was assumed they were not exposed. Another health worker has tested positive for the virus (announced today), so we have 2 hospital worker infections arising from the index case. This is stupidity of the highest order, and the management of the hospital need to explain themselves quickly. The union representative may be exaggerating, but she doubts that any US hospital is able to deal safely with Ebola at the moment.

Error 2

I said that HIV was easier to spread than Ebola because you can transmit HIV through sex while still looking healthy. I forgot that Ebola can remain in sperm for 60 days, and in one case probably up to 90 days, such that the 30% who survive Ebola  will be in reasonably healthy looking condition and might have unprotected sex. So, in calculating the spread of Ebola we should factor in some sexually transmitted infections.

Error 3

I retained the idea that, in the case of widespread global spread of Ebola, the Authorities had a Plan B somewhere, in which the conventional narrative about disease control would come into question, and stricter quarantine would be recognised as the one option that works, given strict enforcement. Privately, I assumed this might be found somewhere in the World Health Organisation. Now Dr Bruce Aylward, the WHO Assistant Director-General of WHO's work in polio eradication and humanitarian response, is quoted as saying that the 70 per cent death rate made Ebola "a high mortality disease" in any circumstance. The WHO target is to isolate 70 per cent of cases and provide treatment as soon as possible over the next two month in an effort to reverse outbreak, he said. "It would be horrifically unethical to say that we're just going to isolate people," he said, noting that new strategies like handing out protective equipment to families and setting up very basic clinics was a priority.

His comment on ethics seems to hinge on the concept that it would be wrong to “just isolate people”, in that they ought to be isolated (I presume) but provided with protective equipment. That is fine, but the phrase “horrifically unethical” reveals a one-sided approach to ethics. I assume that Dr Aylward would concede that it would be “horrifically unethical” to let infected persons spread the disease by coming into close contact with others. Therefore, ethics must balance the needs of infected persons against the need of other people not to become infected.

A reminder

If the World Health Organisation is in favour of handing out protective equipment to families and setting up very basic clinics it is now coming round to saying in public what just about anyone pointed out much earlier, as I did on 5th August:

If treatment is really unlikely to help victims, then in a big outbreak it might best to avoid attempts at close contact nursing, and rely on quarantine and subsequent disinfection as the best way to save more lives. Perhaps hydration packs distributed to homes under quarantine would be best, but that is for public health specialists to judge.

So, I have quickly corrected 3 errors, and drawn attention to a prior, modest suggestion for Ebola management.

If you detect any further errors in the way that experts are dealing with Ebola, please let me know of them as they arise, daily.

Tuesday, 14 October 2014

Ebola in 2040: will stigma save us?


One of the few perks of being a psychologist in a medical school (apart from occasionally running to a colleague to check a personal health matter) was talking to researchers about the real state of knowledge in any particular field.

The Middlesex Hospital Medical School, which started in 1746 and was subsumed into UCL in 1987, had a great talent for developing new services. In a very minor way I added to that trend by setting up, with two other colleagues, a national referral centre for post-traumatic stress disorder, which is still in operation as an NHS clinic.

However, of much greater importance was the clap clinic. At a time when the usual appellation was Venereal Disease, two clinicians got together and decided, over a glass of champagne, to move it from the dark basement to the full daylight. In 1964 Duncan Catterall established the first Chair of Genito-urinary Medicine at the Middlesex Hospital Medical School, and so when the first symptoms of a strange sexually transmitted disease showed up in the very early 80s, James Pringle House started seeing the first cases and was at the forefront of European research. I went to seminars, talked to colleagues, and sometimes met the guest speakers for a canteen lunch. The greater the expert, the quicker they were to admit that no-one knew what the hell was going on.

To my dismay, the public management of the disease quickly veered away from traditional public health concerns, and became a political battlefield. At the WHO headquarters in Geneva senior colleagues muttered that they had been criticised for saying the virus came from Africa: a colonialist perspective, they were told. Even years later, those who worked in the field in London talked sadly, and privately, of the difficulties they encountered with giving straightforward health warnings. I wanted to design a simple poster to illustrate the relative risks, but it got no further than a large page in my filing cabinet. Such, dear readers, were the difficulties of quickly disseminating an opinion before blogging became available.

It was clear to researchers that blood was the key vector of transmission (contaminated blood transfusions had a 90% chance of resulting in the recipient getting HIV), so that shared needle drug injecting and to a lesser extent anal intercourse without condoms were high risk activities, but public broadcasts talked vaguely about icebergs, and suggested everyone was at risk. I did some research on public perceptions of risk at that time, and AIDS figured high in the public mind. The common folk knew that it was a “gay plague” but the expert emphasis seemed to be on getting heterosexuals to use condoms. The great and the good were interviewed and asked to say the word “condom” on camera which they valiantly did. The correct way of putting on a condom was demonstrated on television, using a cucumber. This led to some worried calls about whether one could catch AIDS from a cucumber.

However, it was generally agreed that the UK government had done “rather well” and had got on top of the crisis. Now, with Ebola in the news, I thought it worthwhile looking at the current situation for the HIV virus in the UK, 30 years on from the first outbreak. This might give us a possible scenario for imagining what Ebola might look like in terms of prevalence.

In fact, the UK response to HIV seems to have been at the European average. Statistics vary in different parts of the world, but I imagine that European statistics have a modicum of accuracy. Finland, Germany, Malta, Norway (and Cuba, see below) did very well (0.1 %); Denmark, Greece, Netherlands and Sweden and Israel pretty well (0.2%) and Belgium, Iceland, Ireland, Luxemburg and the United Kingdom were average (0.3%). Austria, France, Italy, Spain, Switzerland were a bit worse (0.4 %) and Portugal very much worse (0.7%). Of course, these are not sub-Saharan African levels (as high as 25% in Swaziland and Botswana) but given that the governments knew what was coming, and had resources available, they are not stellar achievements.

Greg Cochran mentioned the case of Cuba, which had forewarning of the virus in the US and two years to prepare for their first case.


They quarantined patients for 8 weeks of health education, tracked contacts in a very determined way, and used their relative isolation to put public health before private liberty, an approach which comes naturally to the regime. Their resultant prevalence of roughly 0.1% is one-sixth the rate of the United States, one-twentieth of nearby Haiti.



HIV probably moved from monkeys to humans before the 1950s, although the first cases were recognised in 1981 in the US. About 100,000 people in the UK are infected, mostly homosexuals, and heterosexuals from sub-Saharan Africa. More than 20 per cent of them do not know it, and are several times more likely to transmit the virus to their partners than those who have a diagnosis. Half of the newly diagnosed cases in the UK seek medical help when they are in the late stages of disease. In 2012, there were 6,360 new diagnoses of HIV, which is 17 a day in case you find that more dramatic. In England the local authorities with the highest prevalence of diagnosed infections are London, Brighton and Hove, Salford, Manchester, Blackpool and Luton, and in Scotland, Edinburgh. Treatment with antiretroviral drugs reduces the risk of transmission by more than 90 per cent. The cost of these drugs is said to be £20,000 a year and given the current almost normal life spans of HIV patients, 20 years of medication seems a prudent minimum for budgeting purposes. The money spent per capita on NHS services in England was £1,979 in 2011, so each patient with HIV consumed at least 10 times the resources of an average patient every single year.



A possible explanation for the apparently lacklustre performance of the UK may be that many of the cases are imported: that is, brought in by Black Africans infected in Africa. Looking at the demographics of the UK in 2011 that shows that 55,730,000 persons are classified as White and 1,905,000 are classified as Black or Black British. Looking at the HIV figures (this is broad brush, because I have omitted the “mixed” groups) the HIV rates per 100,000 are as follows:

Whites: 93 per 100,000

Blacks: 2015 per 100,000

So, the rate seems to be 21 times higher among Africans. The fact that so many Africans have come to the UK cannot be blamed on the quality of UK public health warnings aimed at changing the behaviour of the local population. The White rate is exactly comparable with the best European nations at 0.1%

Nonetheless, considering that about 36 million people in the world are infected by HIV and that 30 million have died, the management of HIV is hardly a global success story. Does this give us any help in looking ahead to the prevalence of the Ebola virus in 30 years’ time? Prediction will depend on whether treatments or vaccinations become available, but my impression, no more than that, is that the spread of the virus should be much slower, very much slower. HIV can be passed on whilst the carrier still looks good for sex, and sex is fun, so HIV gets an easy ride. Ebola can only be passed on (if the experts are right) when the carrier is looking pretty ill and unattractive, and dealing with ill people is a duty, and not much fun. Furthermore, Ebola is so virulent at the moment that immediate death rates are high. With simple precautions it should be contained. Even when “protocols” fail, the reproduction rate of the virus in human carriers should be low. Despite all the worrying news, it should be a simple matter to avoid the spread of the disease.

On a more speculative note, perhaps we shall be saved by stigma. By fearing all people who look as if they are ill with Ebola, stigmatising them and avoiding all contact with them, definitely not putting ourselves at risk by helping them, particularly not touching them when they are dying or dead, the virus will die out. So, in one corner we have the virus, in the other corner the uncertain public, caught in an awkward tussle between altruism and abject fear. Ebola has its best chance of spreading in societies which don’t believe it exists (like in parts of Africa), and to a lesser extent in those which don’t believe that, given the virus does exist, the absolute priority is to change our behaviour quickly (parts of the wealthy West). Informed opinion ought to be right, but with every failure of both treatment and containment in Western hospitals public belief is eroded.

Although it goes against altruistic instincts, futile attempts at interventionist treatments may be making matters worse.