Saturday, January 14, 2012
Friday, January 13, 2012
Tonsillectomy Confidential: doctors ignore polio epidemics and high school biology
Seth Roberts is the author of The Shangri-La Diet and posts at Seth's Blog about personal science, self-experimentation, and the scientific method.
In 2008, Rachael Hoffman-Dachelet's eight-year-old son started having frequent sore throats. He'd run a fever, feel stiff and tired, and miss a few days of school. After six sore throats in a year, her pediatrician said This is crazy. I'm going to refer you to an ear nose and throat specialist. I think he'll recommend a tonsillectomy (tonsil removal).
Rachael and her son saw the specialist, who did recommend a tonsillectomy. Tonsils are part of the lymphatic system, a network of tiny tubes and nodes all over the body. It is mostly a drainage system. Lymph drains into the tubes, which carry it to the heart, where it reenters the blood. En route to the heart, lymph passes through nodes. How can lymph move through the system if you remove part of it? Rachael asked the specialist. If there were any bad long-term consequences we'd know because so many tonsillectomies have been done, he said. The correct answer is that lymph does not pass through the tonsils. Rachael asked about the benefits of the surgery. Your son will miss a lot less school, he said.
Rachael teaches art at a Minnesota middle school. Her experience with doctors had made her skeptical of their predictions. To decide for herself if a tonsillectomy was a good idea, she googled "pubmed tonsillectomy meta-analysis" and found a Cochrane Review about tonsillectomies and tonsillitis. There are thousands of Cochrane Reviews. Each tries to summarize the evidence about the effect of a treatment on a health problem (e.g., "Antibiotics for sore throats"). They are meant to be practical -- to help everyone, including outsiders like Rachael, make treatment decisions (such as "should my son have a tonsillectomy?"). They are produced by the Cochrane Collaboration, a British non-profit, which says its reviews are "internationally recognised as the highest standard in evidence-based health care".
The Cochrane Review that Rachael found ("Tonsillectomy or adeno-tonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis") was published in 2009. It describes four experiments that compared tonsillectomy to the care a sick child would otherwise receive. All four involved children like Rachael's son, and all four had similar results: Tonsillectomies had only a small benefit. (Contrary to what Rachael was told.) During the year after random assignment to treatment -- the point at which some children had their tonsils removed, other children did not -- children whose tonsils were removed had one less sore throat than children who were not operated on (two instead of three for children like Rachael's son). Because the benefits were small, the decision was easy. "The time, expense, and risk of surgery vs. one [sore throat]," Rachael wrote on my blog, "Not a tough choice."
Rachael believes "when things are going badly with your body, nutrition is a good place to start" looking for help. After she decided against tonsillectomy, Rachael and her son went to see a naturopath that a neighbor had recommended. The naturopath was especially knowledgeable about nutrition and supplements. After an hour interview, she suggested Vitamin D3 (5000 IU/day), a multivitamin, Vitamin C (500 mg/day), and powdered larch bark. Rachael searched for research about these recommendations. She found many studies that suggested Vitamin D might help. Her son is a pale redhead and used sunblock a lot. It was easy to believe he wasn't getting enough Vitamin D. Because Vitamin D won't work properly without other vitamins (called co-factors), a multivitamin was a good idea. Rachael found studies that implied that a multivitamin was very unlikely to be very harmful. She found few relevant studies about Vitamin C. Maybe extreme claims about its benefits had scared off researchers -- "Linus Pauling burned that bridge," said Rachael. But she took the Vitamin C recommendation seriously because the naturopath had made other reasonable recommendations, the recommended dose was not large, Vitamin C is easily excreted in urine (in contrast to building up in the body), and Rachael had never heard of anyone having trouble at that dose. The naturopath had said that larch bark had reduced ear infections in children with chronic ear infections. A little bit of theory supported this, Rachael found, but overall the larch-bark research was "dodgy," she said. A considerable virtue of the naturopath's recommendations was that if they didn't work or had bad effects, you could stop them (e.g., stop taking Vitamin D). A tonsillectomy is forever.
As it happened, the larch bark tasted awful and her son only took it for a few days. He took Vitamin C for a month or two. He still takes Vitamin D3 and a multivitamin. Because he took the Vitamin D3 at 7 am, maybe it improved his sleep (and better sleep = better immune function). He had no more sore throats.
Tonsillectomies are ancient and, as the ear nose and throat doctor said, very common. "For much of the twentieth century," says this book,"tonsillectomy (generally with adenoidectomy) was the most common surgical procedure in the United States." They are still very common. In 2006, half a million were done just in America.
What do tonsils do? Tonsils, like other parts of the lymphatic system, contain large numbers of lymphocytes. Lymphocytes are usually called a type of white blood cell, but that is misleading because relatively few are in the blood. Almost all your lymphocytes are in your lymphatic system, which is why they're called lymphocytes. As recently as the 1950s, their function was unknown. In 1953, for example, this ignorance was called "a disgraceful gap in medical knowledge". Failure to understand what lymphocytes do made it unclear what tonsils do. It is dangerous, to say the least, to cut off part of the body whose function you don't know. In spite of this, tonsillectomies were extremely popular from the 1920s through the 1940s. Tens of millions were done.
Around 1900, America started to have frequent polio epidemics. Starting in 1916, they happened every summer, which came to be called "polio season". Over the years, they got worse. In 1951, thousands of children died, and tens of thousands were crippled. The level of fear can be seen from a booklet called Polio Pointers for 1951. Along with practical advice ("keep [your children] away from new people"), it tried to reassure: "Remember -- at least half of polio patients get well without any crippling." As both tonsillectomies and polio increased, a horrifying correlation emerged: Children who'd had a tonsillectomy were more likely to get a certain type of polio (infection of the bulbar region of the brain stem) than children who had not had a tonsillectomy. This became common knowledge. Polio Pointers said "don't have mouth or throat operations during a polio outbreak." In 1954, the American Journal of Public Health ran an editorial summarizing the link between tonsillectomy and polio. The main evidence was that within a group of children with polio, the ones with bulbar polio were about three times more likely to have had their tonsils removed than the ones with spinal polio (infection of the spinal cord). This resembles some of the first evidence connecting smoking and lung cancer: Hospital patients with lung cancer were much more likely to be heavy smokers than hospital patients with other diseases. Although Polio Pointers implied that tonsillectomies were unsafe only "during a polio outbreak," this was false. The data implied they were always unsafe: "This higher proportion of bulbar cases in tonsillectomized persons occurs at all ages regardless of the time elapsed since operation," said the editorial. A 1957 paper about the tonsillectomy/polio association cited 19 studies that had observed it. "The association is generally regarded as an underlying causal relationship," said the paper, meaning that the usual explanation was that tonsillectomy increased risk of bulbar polio. The paper found more evidence for this explanation. Researchers considered other explanations for the polio/tonsillectomy association (for example, are tonsillectomies more common among rich children? among sickly children? ) but failed to find supporting evidence. The tonsillectomy/polio connection is probably why tonsillectomies became less popular starting in the 1950s. They declined from extremely common (the most common of any operation) to very common (the most common operation done on children).
By 1960, the tonsillectomy/polio association was firmly established, but its explanation was a mystery. If it reflected cause and effect, why would tonsils protect against infection? Around this time, work by James Gowans and others started to answer this question by figuring out that lymphocytes are the main cells of our immune system. They detect bacteria and viruses and make antibodies against them. T cells, B cells, and natural killer (NK) cells -- all lymphocytes. In one experiment, Gowans and his co-workers drained the lymphocytes from rats. The rats lost the ability to make antibodies. When the researchers put the lymphocytes back into the rats, they regained the ability to make antibodies. That's just an example. Our understanding of what lymphocytes do comes from thousands of experiments.
When the function of lymphocytes became clear, the lymphatic system made much more sense. Lymph washes germs out of tissue and into lymph nodes, where lymphocytes detect and try to kill them. The high density of lymphocytes in the nodes ensures that germs will bump into them and be detected. When lymphocytes detect more germs than usual, they multiply and the nodes enlarge. Tonsils do not filter lymph, as I said, but like lymph nodes are full of lymphocytes. Their shape and placement causes them to sample the bacteria in your mouth, so they protect you against the bacteria in your mouth. Tonsils become swollen and sore during infections because the number of lymphocytes inside has increased -- the lymphocytes are fighting off the infection. These facts about the immune system and the lymphatic system, including the function of lymphocytes, are part of high school biology. For example, this lecture.
Removal of your tonsils is removal of part of your immune system. Our understanding of the immune system implies that removal of tonsils reduces ability to fight off infection. We cannot say exactly what tonsils do, just as we cannot say exactly what many parts of the brain do, but our general understanding of the immune system (based on thousands of experiments) implies that removal of any part of it is very dangerous, just as our general understanding of the brain (based on thousands of experiments) implies that removal of any part of it is very dangerous. When a child gets a sore throat, it suggests that his immune system is not doing a good job fighting off infections; a better-functioning system would have killed the germs sooner. Cutting off part of the body that fights infections because of too many infections makes as much sense as getting rid of fire houses because of too many fires. If your outcome measure is narrow, you may conclude that damaging a vital organ is beneficial. For example, prefrontal lobotomies were once claimed to be a a good thing (some people became less disruptive). In rare cases, the benefits of removing part of a vital organ may outweigh the risks. If I were in intractable pain, I might agree to have part of my brain removed. But not because of six sore throats.
The tonsillectomy/polio association was the first large batch of evidence that tonsillectomies do serious harm. The studies that showed what lymphocytes do was the second large batch -- so large and clear that tonsillectomies should have stopped. But they didn't, and the evidence that they do serious damage has increased. In recent years, they have been repeatedly associated with obesity. A 2011 review of nine articles found that "a large population of normal and overweight children undergoing [adeno-tonsillectomy -- removal of both adenoids and tonsils] gained a greater than expected amount of weight postoperatively." Another study concluded "risk of overweight should be mentioned as a probable undesirable outcome of adenotonsillectomy." A third study points in the same direction. To see more evidence, search "obesity tonsillectomy".
Another recent association is with heart attacks. A 2011 study found that people who had had tonsillectomies before age 20 had a much higher rate of heart attacks (about 50% higher) than matched controls over the next twenty years. The study cites other evidence that immune dysfunction increases heart attacks. The same study found that hernia operations at a young age were not associated with heart attacks. A 2010 study based on different people found that "tonsillectomy before age 7 years was associated with a 1.5-fold increase in mortality" from age 18 to 44. This supports the association of tonsillectomies with a large percentage increase in a common cause of death (heart attacks). That tonsillectomies increase heart attacks is made more plausible by the well-established association of gum disease and heart disease. Gum disease is caused by bacteria in the mouth; tonsils protect against bacteria in the mouth.
After Rachael read the Cochrane Review about tonsillectomies, she decided they're a bad idea. This is like Vladimir Putin's party getting only 49% of the vote in the recent election in spite of ballot stuffing. Cochrane Reviews are supposed to be unbiased, but this one omitted (without saying so) a great deal of anti-tonsillectomy information:
1. It does not say that tonsils are part of the immune system, nor that removing the tonsils damages the immune system. It says nothing about lymphocytes and their function. It does not say that the tonsils are full of lymphocytes. It does not say that the nodes of the lymphatic system, including the tonsils, are the main places the immune system does its work.
2. It says nothing about the tonsillectomy/polio association. It says nothing about the tonsillectomy/obesity association.
3. "Those who choose surgery for themselves or their child must be fully informed of the risks of the procedure," say the authors. I agree. Do the authors follow the advice they give to others? Here is how they answer the question "what are the risks of [tonsillectomy] surgery?": "Tonsillectomy is associated with a small but significant degree of morbidity in the form of primary and secondary haemorrhage and, even with good analgesia, is particularly uncomfortable for adults." That's their whole answer.
If you search tonsillectomy/adverse effects on PubMed, you will get more than 1000 references. There is no sign in the review that the authors did that search or any other search for bad effects of tonsillectomies. If the authors had looked at the PubMed articles published before their review (about 900), they would have learned that the risks of tonsillectomy include polio, weight gain, vomiting (many articles), taste distortion (here, here, here), Hodgkin's disease (here, here, here, here, here, but here is evidence that disputes the association), Creutzfeld-Jacob disease (e.g., here, here), inflammatory bowel disease and Crohn's disease, rheumatoid arthritis, severe spine infection, neck infection (here, here), speech problems (here, here), hearing loss, ear pain, visual loss (here, here), depression, several other serious problems, and immunological abnormalities (e.g., here, here, here). They would have learned that tonsillectomy "is associated with a relatively high risk of postoperative complications" and that "the actual post-tonsillectomy haemorrhage rate is much higher than that recorded in hospital statistics." (The Cochrane Review says this risk is "small".) They would have learned, if they didn't already know, that "the tonsils have a large immune function."
4. At the end of the review, it says, "If adeno-/tonsillectomy has an effect on aspects of an individual’s health other than sore throats - general well-being, for example - these outcomes should also be evaluated." "If"? This is misleading. By 2009, as I've shown, there was plenty of evidence of bad effects.
The Cochrane Review deserves credit for summarizing some relevant evidence. It deserves criticism for silently omitting a large amount of anti-tonsillectomy information (polio, lymphocytes, obesity, and so on) and posing as a reasonable guide to the value of tonsillectomies. (It comes with a "plain language summary" that says nothing about omitted information.) The review is by Martin Burton and Paul Glasziou, both at Oxford at the time. Both declined to comment for this post on my criticisms. Burton now heads the United Kingdom Cochrane Centre. Glasziou specializes in evidence-based medicine (which I have criticized). He has co-authored a book on systematic reviews and a consumer's guide to evidence-based medicine. He now heads the Centre for Research in Evidence-Based Practice at Bond University in Australia.
Any review must omit information. The Cochrane Review, however, omits a vast amount of anti-tonsillectomy information that could easily have been included. It does not omit a vast amount of pro-tonsillectomy information. There has been no series of devastating epidemics in which tonsillectomy was associated with less disability and death. There have not been thousands of experiments that imply tonsils reduce resistance to infection. In that sense, the review is badly biased. One reason may be conflict of interest. Burton is an ear nose and throat surgeon; he does tonsillectomies for a living. This is not disclosed in the review. I don't know if his finances depend on how many tonsillectomies he does, but I am sure he has done many of them (biasing him to think they are good) and has many tonsillectomy surgeons among his friends and colleagues. He must care what they think. Negative comments about tonsillectomies would surely displease them. Burton declined to comment on this criticism.
In its omission of anti-tonsillectomy information, the Cochrane Review reflects this area of medicine. While doing research for this post, I was unable to find a single instance in which any doctor -- including pediatricians, ear nose and throat doctors, and tonsillectomy surgeons -- or doctor-run website told any parent (or anyone else) anything like the truth about the risks of tonsillectomies. On the Mayo Clinic website, for example, a pediatrician tells parents that "the decision to remove a child's tonsils must be weighed against the risks of anesthesia and bleeding, as well as the missed school days to recover from the procedure." That's all he says about risks.
False claims about tonsillectomies are nothing new. In 1933, an American writer named Kenneth Roberts (no relation) visited England. His shoulder started to hurt. It became so painful he had trouble sleeping. He consulted a London surgeon, who recommended a tonsillectomy:
"Then you think this pain in my shoulders is due to my tonsils?" I asked him.
"My dear boy!" he expostulated. "Of course! You're poisoned! It might crop out anywhere! Arms, legs, body, head, feet, brain -- positively anywhere! Not an instant to lose, my dear boy."
Roberts encountered similar behavior by other doctors. His account of it is called "It Must Be Your Tonsils". Given this history (overstatement of the benefits of tonsillectomy), it is especially remarkable that the Cochrane Review is so biased. Professional groups are worse. The American Academy of Otolaryngology-Head and Neck Surgery currently recommends that "children who have three or more tonsillar infections a year undergo a tonsillectomy". The corresponding Canadian group has a higher threshold: six infections in a year. Those are low bars for cutting off part of a vital organ. Both groups claim that a good solution to too many infections may be removal of part of the body that fights infection.
Overtreatment -- wasteful and harmful medicine -- is an enormous problem. It is the subject of two recent books (Overtreated and Overdiagnosed) and a Newsweek article. Tonsillectomies are an example. The last sixty years have produced a mountain of anti-tonsillectomy evidence (polio, lymphocytes, obesity, heart attacks, and so on) that doctors, such as the Cochrane reviewers, seem to ignore. People like Rachael suggest a solution: help non-doctors look at evidence.
Judge orders Zucotti Park barriers removed, jubilant Occupiers return
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Judge orders Zucotti Park barriers removed, jubilant Occupiers return
After a judge ordered the removal of the barriers around Zucotti Park (a privately owned space that is open to the public, built as part of a deal to allow a property developer to put up more buildings), jubilant #Occupy protesters streamed into the "spiritual home" of the Occupy movement. Puzzled private security guards are now jostling for space as the place refills with protesters.
#Occupy Wall Street Returns to Zuccotti Park (#OWS) « naked capitalism
Thursday, January 12, 2012
Videogame for pigs and people
This is Pig Chase, a concept for an interspecies video game for pigs to play with humans. Researchers at Wageningen University and the Utrecht School of the Arts designed the game to make farm life more stimulating for swine.
"Playing With Pigs project page"
"Pigs Playing Video Games = Ethical Farming?" (Mother Jones)
Filling Robert Anton Wilson in on what he's missed in the last five years
Tiny Homes
This book will convince you to build your own house. The key is to make it small. A really small house costs less, liberates time, and encourages you to spend that time making the details personal. Because everything is scaled down, the space is much more customized. The result is a home that grows out of your life.
Tiny houses are the norm for most people in the world, but have been out of fashion in the US for many decades. Recently some Americans are rediscovering the joys of very tiny homes for several reasons: hard economic times, a reaction against modern excess, and a realization that a digital world does not require a lot of space. There are now a handful of blogs and a whole shelfful of books about tiny homes. Mostly good stuff.
This new book is the best of those guides and eclipses the previously recommended The Tiny Book of Tiny Houses. Lloyd Kahn has built several of his own small homes, and has edited a number of great books celebrating owner-built shelters, including the previously reviewed Home Work. Here he focuses on tiny homes, which he defines as shelters 500 square feet or less. Some are on wheels, a few float, some are pre-fab, but most are handmade shelters placed in odd corners in cities, suburbs and the country. Their variety is stunning. This large book erupts with a cornucopia of 1,300 photos featuring 150 different tiny homes, showing you how they were built, giving resources and helpful tips of their construction, supplying design solutions and inspiration for others, but also conveying WHY they were built. Tiny though they are, they are much more than mere shelter.
What I love most about this book -- as a tool -- is the way it explodes the possibilities of what a tiny house can be, and how every page conveys the important message that the challenge in building such a tiny structure is not the material, which is almost trivial by definition, but the immaterial. A tiny home is a matter of gumption, resourcefulness and imagination. This book, like all Lloyd Kahn's work, cultivates those virtues.
You leave the book realizing, knowing for sure, that you, yes you, can build a tiny house. And should.
-- KK
Tiny Homes: Simple Shelter
Lloyd Kahn
2012, 228 pages
$15
Available from Amazon
Sample Excerpts:
Sample excerpts:
The theme of our eco-resort has always been Adirondack Style, which translates to "built with time and no money." Each year we renew our contract with the state to harvest "dead and down trees." It's like building structures in the middle of Mother Nature's lumberyard.
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[This 97 sq. ft. house] was originally a pump house built over a well in 1900. At some point in the '70s it was converted to a chicken coop. A couple of years ago I converted it to a stationary yacht. The design was inspired by living on a small sailboat in Alaska. It's superior to a sailboat in that it needs less maintenance, is unlikely to sink, has lots of windows, and is surrounded by a garden so you don't need to row ashore. It's inferior to a sailboat in that it can't sail anywhere.
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I did a quick sketch of what I needed.
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The key to designing my happy home was designing a happy life, and the key to that lay not so much in deciding what I needed but in recognizing all the things I could do without.
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It is not a building. It's MY building.
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The pentagonal floor is made from lumber milled on site. At center is a pentagon. On Mike's birthday, October 29, a beam of light shines through a hole in a 5-pointed star in the door, and falls on the central pentagon!
Wednesday, January 11, 2012
RAW Week: Mindfucking Since 1976, by Gareth Branwyn
Above: Gareth's original copies of The Illuminatus Trilogy.
“It's not true unless it makes you laugh, but you don't understand it until it makes you weep.” -- Illuminatus!
The first few chapters in and I knew I wasn't reading sci-fi, not any kind I recognized, anyway. Reading the first book, The Eye in the Pyramid, then the second, The Golden Apple, and then the third, Leviathan, was like going on an extended acid trip, complete with that phasing delirium of humor and the absurd, flashes of diamond clarity and numerous a-ha moments, awkward sexual arousal, plenty of cartoonery, fear, paranoia, and maybe a little out-and-out terror. (It's no coincidence these books are divided up into ten “Trips.”) There is so much to Illuminatus!, an almost fractal density, that you have to unhinge your mind (like a serpent would its jaw) to fit it all in. I read the trilogy, and then read it again. (When my late-wife and I hooked up, we read them out loud to each other, and after Bob died, I read them for a fourth time.)
There are few works of art or pieces of media that have altered my nervous system to the extent that Illuminatus! has. In 1976, I was this awkward, alienated Wiccan teen, a restless seeker. But I was also a science and space nerd. I could never reconcile these two and constantly switched between them, rejecting one for the other, at least for a time. But here was a world where these points of view were not mutually exclusive, a playfully plastic world where open curiosity, creativity, absurdity, and skepticism leavened all explorations, whether religious/mystical/artistic or scientific. It was Robert Anton Wilson who turned me onto the concept of “hilaritas” (what he described as being “profoundly good natured”). These books (and all of RAW's oeuvre) are steeped in that spirit.
Illuminatus!, and all of the Robert Anton Wilson books that I read after that (which is all of them), have formed an amazingly steady through-line in my life. I've gone through many intense changes since that 18 year old kid scammed free reading material, and my belief systems (or “BS” as RAW called them) have oscillated wildly, but most of my takeaways from Wilson have remained. His basic approach of being “open to anything, skeptical of everything” is how I've tried to live my life. This allowed me to finally embrace both parts of myself, the part that wanted to be open to magick and spirit and the part of me that needs extraordinary evidence for extraordinary claims.
In recent past, I'd somewhat fallen out of touch with RAW's unique brand of “guerrilla ontology” until a few years before he died. Some friends were on their honeymoon, traveling through the deserts of Utah. They found the 5-volume set of audio interviews that Bob had done called Robert Anton Wilson Explains Everything: Or Old Bob Exposes His Ignorance, in the bargain bin of a truck stop. They aren't particularly into this sort of thing, but more based on my interest, they bought the set. They listened to it on their honeymoon and enjoyed it so much, they bought me a copy. I now listen to it regularly and can't recommend it highly enough.
At one point in Robert Anton Wilson Explains Everything, the interviewer asks Bob why he's so into conspiracy theories. He'd spent the better part of his life studying them, writing about them, but he doesn't seem to actually believe any of them. So, why the intense interest? Bob thinks about it for a moment and replies: “It keeps the mind supple.”
Thank you, Mr. Wilson, for pulling an uptight, overthinking teen out of his constrictive reality tunnels and for a lifetime of “keeping the mind supple.”
Bonus Bob!: There are many threads and themes shot through Illuminatus!: Puzzles, parodies, bad puns, conspiracy theories, synchronicities, Burroughsian cut-ups, libertarian politics, occultism, sex, drugs, and rock n' roll. One of these themes is pranking, part of what Wilson and Shea dubbed “Operation Mindfuck” (or OM); what they describe as the only serious conspiracy in the book (of which the book is the principle manifestation). OM is the art of confusing consensus reality with plenty of pranks, misinformation, and mindfucks. In the appendices, a rubber stamp is described that reads “See Mental Health Records.” On any bills, junk, or other mail that one of the Discordian characters didn't like, he'd use this stamp on the envelope and return to sender. After reading about this, I had a stamp made up that read: “This is Not Art” (a statement from the Fluxus movement). For years, I stamped this on tax returns and business envelopes, on the backs of endorsed checks, on much of my daily correspondence. I loved imagining what the various worker bees who processed my paperwork made of this puzzling statement.
So, give the world's sad sonambulism a wakeup call. Put some OM (whether “trivial or colossal”) in your day. Bob would have wanted it that way.
Sunday, January 8, 2012
World building 301: some projections
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World building 301: some projections
Right now, over at the venerable discussion board known as the WELL, Bruce Sterling and Jon Lebkowsky and having their regular annual State of the World pow-wow, this time for 2012.
I always find these fascinating, because Chairman Bruce is the pre-eminent thought leader of modern near-future SF.
He's been one jump ahead of the pack ever since the early 1980s (when I avidly subscribed to his pseudonymous crit zine Cheap Truth, the house self-criticism session of the early cyberpunks), then the mid-1980s when he basically invented the New Space Opera and moved on before anyone else had time to notice, and then the early 90s when he got the implications of the internet and climate catastrophe in Heavy Weather ... seriously, if I'm ever at a loss to know what the big near-term global issues are, I look for his footsteps and follow them. (It's no accident that a few years ago he seemed to lose interest in dying media and high-tech environmentalism and went after industrial design and 3D printers.)
Anyway.
I'm going to use some of his mojo as a jumping off point for asking: what is the world going to look like in 2032? And in 2092?
It's an important question. I expect to be around in 2032, albeit somewhat more creaky (I'll be 68) — the state of the world in 2032 is a matter of personal interest. By 2092 ... well, if I'm still alive in 2092 there will have been medical breakthroughs, because I'd be 128 years old, and that exceeds the current boundary with which human life expectancy converges (which is roughly 121-122). My grandfather died a couple of months short of his 70th birthday; my father is still going strong at 87: a straight line extrapolation would peg me at making it past 104, although I don't think I'm as healthy as dad. So it's a matter of rather more theoretical interest to me, but nevertheless worth worrying about just in case the next 20-80 years bring us some massive breakthroughs in life prolongation.
What do I predict for 2032?
Climate: the current remaining question marks over climate change will have been answered, and the answers won't be anything pleasant. Climate change denialism will probably be about as respectable as Lysenkoism is today — an intellectually corrupt pseudo-science emerging at the behest of a bankrupt ideology. Chunks of the world will be suffering heat stress with damaging effects on agriculture (notably Australia, where imported European-style agricultural prac...