Medicine's blind spot

by liberal japonicus

The previous post was an invitation to talk about history and society. However, I found this article quite interesting and thought it might spark some interesting thoughts

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00333-9/fulltext

Medicine could arguably be described as man's greatest achievement beating out other fields of endeavor because it must have been a lot harder to present new theories because the old ones were so tied to our physical state. It also might be our greatest achievement because we can do so much despite knowing so little. Sending one object to meet another one to a point precisely in space and time is all a question of having the right math, medicine is still full of blind spots and things we have no idea about, yet we stumble along.

But the opinion piece above reminds us of those blind spots, and that our ability to do some things is predicated on ignoring other things is a rather systematic way. Which linked it to this piece

https://aeon.co/essays/africas-ancient-scripts-counter-european-ideas-of-literacy

As the example of Bourdieu shows, even the most intellectually committed, even the smartest – perhaps especially the smartest – of us can all too easily overlook the script of those lives, the language that might remain hidden for too long.

Comments

[CharlesWT]

There was a period of time in Europe and America that the wealthy had a shorter life expectancy than the poor due to something they had. George Washington and the wealthy of his time were near the end of that period. What they had were doctors.

[liberal japonicus]

Thank god they didn't do the libertarian thing and argue that we didn't need them.

[Nigel]

I’m not sure the two things are the same, though they may once have been.
While it’s true that doctors have a strong tendency to be conservative, and not recognise what they have not been taught to recognise, I don’t think that adequately characterises medical research any longer.

The explosion in information, and the means of multiplying that information, forces researchers to confront their areas of ignorance, and begin to chart ways through the thickets.

[liberal japonicus]

Though is there a gulf between practitioners of medicine and researchers?

Also, I realize that this was 30 years ago, but this story always stuck with me

https://www.discovermagazine.com/health/the-doctor-who-drank-infectious-broth-gave-himself-an-ulcer-and-solved-a-medical-mystery

I presented that work at the annual meeting of the Royal Australasian College of Physicians in Perth. That was my first experience of people being totally skeptical. To gastroenterologists, the concept of a germ causing ulcers was like saying that the Earth is flat. After that I realized my paper was going to have difficulty being accepted. You think, “It’s science; it’s got to be accepted.” But it’s not an absolute given. The idea was too weird.

His Nobel lecture is also interesting
https://www.nobelprize.org/uploads/2018/06/marshall-lecture.pdf

[wj]

You think, “It’s science; it’s got to be accepted.” But it’s not an absolute given.

Actually, the way science works is that, if you present a new idea, even including evidence to support it, other people go out and do their test. To verify your results. And to see if other implications of your idea pan out.

Just acceptance, on first hearing, rarely if ever happens. Especially if you are breaking new ground, or challenging existing theories.

[liberal japonicus]

If you dive into the above example, there was no testing, there was no consideration of evidence, there was no seeing if the implications of the proposal would pan out. That's why he had to use himself as a guinea pig.

[wj]

Well, himself as guinea pig does provide some evidence. Not a lot, certainly. But he wasn't just proposing a theory with zero evidence to support his idea.

[Pro Bono]

What they had were doctors.

I'm sceptical about that. In the UK, the life expectancy of ducal families overtook that of the general populace from about 1700.

What changed for the wealthy? Sanitation and smallpox innoculation. Added to that, 18th century nobility was (I'm guessing) much less likely to be killed in battle or executed for being in the wrong political faction.

Plus there was a lot of turnover in the nobility in the 17th and early 18th century. The newly created Dukes were to some extent chosen on merit (excluding Charles II's illegitimate sons, but he will have chosen their mothers for some sort of merit) and therefore will have been less likely to get themselves killed through stupidity.

[russell]

one of my friends who got the virus last year now has the long Covid thing. brain fog, fatigue. he mostly just tries to push through it.

it's a nasty virus.

What they had were doctors.

leaving aside the knee-jerk libertarian nature of this comment, I will say that given the quality and sophistication of medical practice of the time, I find it believable that no doctor might have yielded better outcomes than doctor.

simple diet and physical activity might also have been a factor.

What changed for the wealthy? Sanitation and smallpox innoculation.

As a historical aside, there's a small island just offshore of where I live that served as a smallpox clinic in the late 18th C.

Folks in town were disturbed by its presence, and also angry that most of the people being treated were wealthy.

So they burned it down.

In fairness to them, the idea that making you a little bit sick to keep you from getting really sick is somewhat counter-intuitive. Seems natural to us now, but maybe kind of weird and frightening at the time.

Hostility to public health measures, for a variety of reasons, has a long history.

[CharlesWT]

leaving aside the knee-jerk libertarian nature of this comment,

What's libertarian about it? It's just that wealth afforded people something that, at the time, could be counterproductive to their wellbeing. As in an earlier age, they could afford lead and pewter containers for their wine and other foods.

[russell]

What's libertarian about it?

a good question.

what prompted my comment was the combination of contrarian / counter-intuitive assertion, without any expansion of the argument.

just "they had doctors, that's why they didn't live as long".

so maybe less libertarian and more knee-jerk contrarian.

apologies if I'm being unfair.

[hairshirthedonist]

I think Charles' point was that people later on had doctors, starting around the time George Washington was alive, which was when the wealthy started living longer than the poor. Before that, the wealthy had goods that were detrimental to their health - things the poor couldn't afford.

I'm not endorsing it or arguing against it. I'm just putting forth my understanding of it.

[hairshirthedonist]

Along a similar line to Charles', I recall several years ago that studies of Americans' diets revealed that wealthier people's diets had gotten better while poorer people's diets had gotten worse. There was a time when wealthier people could afford a diet consisting of fattier meats and such (I tend to think of foods with lots of gravy), while poorer people had to eat cheaper foods like beans, which were healthier.

Now that the cheaper foods are processed and less healthy, that's what poorer people eat, while wealthier people can afford things like organic vegetables and pastured meat (I tend to think of sushi).

This would be a more recent phenomenon than care from doctors becoming a worthwhile resource, but the dynamic is similar.

[CharlesWT]

I need to stop repeating things I hear in interviews and discussions. Or, at least, varify in written form before repeating. In an interview, someone asserted that until about the nineteenth century a reason for the wealthy having worse life expectancy than the general population was their access to the medical practices of the period. I'm having trouble explicitly verifying that. It's generally believed that Washington would have lived longer if he had kept his doctors at bay.

In the UK, the life expectancy of ducal families overtook that of the general populace from about 1700.

Life expectancy for the English population and for ducal families

[hairshirthedonist]

Okay. So never mind.

[Russell]

No worries, Charles.

My comment was unnecessarily sharp and dismissive. We all post things here off the cuff from time to time. Please accept my apologies.

[Hartmut]

Let's not forget sugar (at Elizabethan times even put into the then equivalent of toothpaste). In olden times the main problems with teeth were abrasions from grit (from the millstones used to grind the grain). The real problems started when sugar became available in large quantities first for the rich then for everyone (still Hollywood medieval peasants tend to have ahistorical bad teeth as a general rule). Even earlier switching from hunting and gathering to agriculture led to a diet with more calories but lower nutritional value, so more food security but lower quality (of food and health). In the 19th century common people in the country had a generally healthier diet than those in the (big) cities but it was (I presume) also easier to starve in the country due to poverty and lack of charity than in the big cities (despite the more squalid living conditions there).
So, I think there is not one general valid answer.

Closer to the present time: I guess there were more rich victims of food and cosmetic items laced with radium (not to be confused with the plutonium laced milk the US government later used to experiment on unwitting children). That stuff was expensive and marketed as a boost for health.

[CharlesWT]

Every day a banquet...

"There is little doubt that the British aristocrats got more to eat than did the common people; courtiers of Henry VIII at Hampton Court consumed 4,500 to 5,000 calories a day in the sixteenth century, and the king himself eventually became so obese that he could not move without assistance. Henry was not alone, and in some other European courts, people consumed even more. Yet more food—or at least more food of the kind that the aristocrats consumed—did nothing to protect against the bacteria and viruses that brought plague and smallpox, or from the poor sanitation that did away with their children. So the comparison with the peerage suggests that, in England from 1550 to 1750, it was disease, not lack of nutrition, that set the limits to life expectancy. Of course, disease and undernutrition compound one another—it is hard to digest food when you are sick—but there is no evidence that the consistently high nutrition levels of the aristocracy protected them or their children against the infectious diseases of the day."
Life and Death in the Enlightenmen: page 3 (83)

[nous]

Charles' excerpt there is from:

https://press.princeton.edu/books/hardcover/9780691153544/the-great-escape

[Nigel]

Off topic, but I thought russell might like this.
https://tedgioia.substack.com/p/the-most-musical-man-in-the-world?

[Nigel]

Regarding the explosion in information, this is the kind of thing I was talking about:
https://nanoporetech.com/products

A kit that weighs about a pound that you can plug into a laptop, and you have your own mobile gene sequencing lab.

[CharlesWT]

So, how long will it be before there are DNA sniffers at airports and other public venues?

And what will the anti-vaxxers do if the powers-that-be decide to release contagious vaccines?

[liberal japonicus]

Morning all, I got the ball rolling on Charles' comment, so I should apologize as well, my take was the same as Russell's, which is why I wrote what I did. Though I did want to explain a bit more.

I feel like there is a pretty big audience for these sorts of contrarian takes, so you have Levitt's Freakonomics and Gladwell's Blink among others. They aren't bad books, but the underlying notion is 'I'm really smart because I disagree with the wisdom of the masses' and the entire book becomes a tortured attempt to prove how smart the person is (that it always seems to be a guy may also tell you something)

The logic and arguments are seductive, they aim to make the reader feel like they can be smart too by adopting similar patterns. I react to them strongly because I can feel myself being pulled in.

And, if you think about it, I feel like there is a deeper intuition to draw from the example of the rich living shorter lifespans than the poor. It's that when fashion drives health, you can often get poor outcomes. This isn't to suggest that some government agency needs to shape fashion, but if someone were to use that as an argument for libertarian thinking, I'd suggest that if you take another step back, you'd see that it is the complete opposite.

But to circle back, I apologize for starting the ball rolling on that and I'll try to rein it in a bit.

[wj]

And what will the anti-vaxxers do if the powers-that-be decide to release contagious vaccines?

Embrace a (probably totally ineffective; but expensive) vaccine against vaccines.

[Snarki, child of Loki]

"Embrace a (probably totally ineffective; but expensive) vaccine against vaccines."

There's always the homeopathic vaccine-against-vaccine, but make sure you don't overdose by injecting pure distilled water.

(BTW, does everyone know how insanely difficult it is to get *very* *very* *pure* water? The closest chemical analog to H2O is HF: it want to dissolve *everything*)

[Russell]

I thought russell might like this.

Thank you for sharing that Nigel!

Pascoal is just an amazing inexplicable phenomenon. He contains multitudes.

Brazil is an amazing stewpot of musical traditions and influences. Cuba is deep, America is wide, Brazil is inexhaustible. Pascoal kind of owns it all.

[novakant]

Thanks for the tip, the only Brazilian music I know is pretty old stuff (Gil/Jobim/Gilberto - initially via Stan Getz). If there are any other interesting artists I'd love to hear about them.

[Hartmut]

(BTW, does everyone know how insanely difficult it is to get *very* *very* *pure* water? The closest chemical analog to H2O is HF: it want to dissolve *everything*)

Yes, Indeed.
At least since I read about the German project after WW1 to pay the war reparations with gold extracted from seawater (it even involved Nobel laureates). One major problem was to get the water used for the analytics free of any contaminations that could distort the results. But even the cleanest vessels were insufficient since the water always dissolved small amounts of the material they were made of. And I assume that analytics of trace amounts was not as sensitive in the 1920ies compared to to-day (although it was truly cutting edge then and practised by some of the best chemists in the world). And that was for inorganic compounds. Our own senses are sensitive enough to detect some substances in air or water that are diluted 1: 10e12. And there are some catalytic effects depending on specific contaminations of the main catalyst of 10e-19. Purity of essence is really hard to achieve ;-)

[Nigel]

Pascoal is just an amazing inexplicable phenomenon

Gioia is also one probably the best writer on music I've come across.

[cleek]

there is no anti-vaccine vaccine division.

[cleek]

If there are any other interesting artists I'd love to hear about them.

also old, but: Os Mutantes

[nooneithinkisinmytree]

Thanks for the heads-up on Gioia.

Literature as well.

[russell]

If there are any other interesting artists I'd love to hear about them.

Off the top of my head:

Caetano Veloso, Gilberto Gil, Gail Costa, Tom Ze are notable tropicalia artists. Kind of like bossa but with later pop influences.

Olodum, bloco afro ensemble that appears on Paul Simon's Rhythm Of The Saints.

DJ Dolores, from Recife, mixes electronica with traditional rhythms.

Cartola and Martinho da Vila are (very) traditional samba artists.

Luciana Souza, a more modern bossa and jazz singer, now living in the US.

All of this is with the caveat that what I know about Brazilian music would fill a very small thimble. It's a big country, with many many cultural influences - a list of Brazilian musical styles alone would fill a couple of pages. Samba, forro, axe, maracatu, carioca, choro, on and on and on and on.

A very very deep and wide culture. You could spend a lifetime exploring it and never come close to exhausting it.

[russell]

The late Chico Science showing us all what mangue is about. Mangue is from Recife, which was the closest port to Africa back in slave days and has probably the deepest African influences, musically and probably otherwise. Stuff from Rio is more European, except for the samba school stuff, which is 100% drums and chanting.

Then there are a whole rack of rural and traditional styles. And styles that come straight out of African possession cults. And a smorgasbord of pop styles.

It's endless.

I gotta stop now, I can feel my productivity circling the drain....

[Michael Cain]

I recall several years ago that studies of Americans' diets revealed that wealthier people's diets had gotten better while poorer people's diets had gotten worse.

There is no question that if I were rich enough to have someone knowledgeable and skilled do the shopping, cooking, and taking care of the dishes, my diet would improve greatly. Ditto for exercise :^)

[wj]

Our own senses are sensitive enough to detect some substances in air or water that are diluted 1: 10e12. And there are some catalytic effects depending on specific contaminations of the main catalyst of 10e-19. Purity of essence is really hard to achieve ;-)

The human body is 60% water. (And the brain some 73% water.) Makes it clear why ideological purity is so hard to achieve. ;-)

[Michael Cain]

Forty-some years ago I was the schmuck from Bell Labs systems engineering going around telling project managers that it was a software world, and in the future their projects were much more likely to get in trouble because of software than hardware. This was an unpopular position.

And still is. IEEE Spectrum has a terrific article up titled "How Software Is Eating the Car". The bottom line is not unlike the situation I was facing back then: the software side of things has become the critical part, and none of the senior management has a clue about it.

[cleek]

There is no question that if I were rich enough to have someone knowledgeable and skilled do the shopping, cooking, and taking care of the dishes, my diet would improve greatly.

that's if you chose to hire a health-oriented chef. i'm sure someone like Trump has a chef who makes upscale-looking versions of Taco Bell.

[CharlesWT]

Software Is Eating the Car

Software also seems to be eating farm equipment. Such as a tractor zipping down a field at 8-10 miles an hour while towing a sixty-foot wide planter planting two dozen rows.

Each row is planted with seed a precise distance apart. And that distance changing with any changes in soil quality in different parts of the field. In the cab of the tractor is a display providing statistics for each row on how well the results are matching settings.

[cleek]

Software Is Eating the Car

i just got a Tesla 3.

while i'd ridden in them before, and had read tons of articles about them, i was still shocked by just how much that car is software. it's a cross between an iPad and a rocket.

[hairshirthedonist]

Even the 16-year-old small SUV my son "inherited" from me has computer-related problems. It failed inspection for an emissions code, but it drove fine. We had a sensor replaced and it passed. A few days later the light came back on, but this time it started running rough and has noticeably less power. So now we have to take it back to see what's wrong.

Why a 16-year-old vehicle is still expected to pass emissions, I don't know. They aren't even testing the emissions, just going by whatever codes the computer is producing. Given how it's now running after replacing the sensor, I'd bet the emissions are worse than they were before. But it has a good inspection sticker!

[russell]

random Braziliana, on the mellow tip - folks who dig Bonfa or Jobim should dig this stuff. the tunes should be familiar...

Caetano Veloso, For No One in bossa style.

Luciana Souza is more bossa and jazz, here she is with God Only Knows.

[russell]

Software Is Eating the Car

If I still have enough money left after we pay off the mortgage and before I wrap up my brilliant tech career, I really really really want one of these.

Probably one of the simplest cars ever made, from a mechanical point of view, but updated with an electric motor conversion.

Don't know if I'd fit in it, but it's probably a blast and a half to drive. It's like an electric skateboard, with seats.

[Michael Cain]

Why a 16-year-old vehicle is still expected to pass emissions, I don't know.

I live in a region that is about to go back on the EPA's list of severe violators for ozone. That will cost a lot of people money trying to implement plans to get back into compliance. All cars in the region are subject to emissions testing. The state keeps statistics, and older cars are responsible for a very disproportionately large amount of the pollution. At some point the state is likely to eliminate the exceptions currently in place for older cars and force them off the roads.

Alternatively we could try to stop people from moving here in large numbers, and bringing their cars with them, but the federal government frowns on that even more than air pollution :^)

[Michael Cain]

Software also seems to be eating farm equipment.

It's eating everything, which was largely my point 40 years ago. Some of us may remember the episode from a few years back when F-35 fighter jets were being delivered with a cannon; and a trigger on the control stick; but the software that detected the trigger had been depressed, ran through a list of situations where the gun shouldn't be fired, and if everything was okay actually fired the gun, wasn't going to be delivered for two years. The last three times we had a major household appliance fail it wasn't the software per se, but it was the (very expensive) computer board on which the software ran. The thermostat that came with our new townhouse whines if it can't reach the internet to check for firmware upgrades.

[CharlesWT]

It's eating everything, which was largely my point 40 years ago.

The smartphone and its software replaced 100s of pounds of various devices.

[Michael Cain]

If I still have enough money left after we pay off the mortgage and before I wrap up my brilliant tech career, I really really really want one of these.

Cool. If we ever hit one of the big lottos, I want a 1938 "hot rod Lincoln" with all of the body and interior fully restored, but an electric drive train with a "ludicrous" mode capable of zero to sixty in four seconds.

[wj]

Alternatively we could try to stop people from moving here in large numbers, and bringing their cars with them, but the federal government frowns on that even more than air pollution :^)

Happily, there's a workaround. Just revise the zoning rules to make it impossible to build more housing. At any price. (Maybe with an exception for very low end "affordable housing" for the homeless. If the state government changes.) If there's nowhere to live, they won't come. Pass thru, of course, but not stay. And the Feds have no say in that.

[CharlesWT]

And the Feds have no say in that.

That may not last.

[cleek]

speaking of blind spots...

Teslas have cameras mounted on their B pillars (posts behind the front seats that hold the middle of the roof up) to look at the sides of the car. Tesla recently made an over-the-air update to reduce the minimum level of detail the cameras need to see before they complain to the driver that there's a problem.

turns out that minimum is above what the cameras will see on an empty rural highway at night.

so i get alerts telling me the cameras can't see anything. really? neither can i! call the eye doctor! file a bug report!

[JanieM]

That may not last.

There's an LOTR quote for any purpose. At the inn at Bree:

"One of the travellers, a squint-eyed ill-favoured fellow, was foretelling that more and more people would be coming north in the near future. 'If room isn't found for them, they'll find it for themselves. They'a right to live, same as other folk,' he said loudly. The local inhabitants did not look pleased at the prospect."

[hairshirthedonist]

The state keeps statistics, and older cars are responsible for a very disproportionately large amount of the pollution.

I'd bet there are more much-older cars in CO than in NJ if the pattern I've witnessed in AZ holds. Much older cars rust away here a lot faster.

As an anecdote, I had a 1980 280ZX that, by the time I got rid of it, had body parts flapping in the breeze, and the rug would get wet if I drove on wet-enough road. I would visit AZ, even years after my 280ZX had bitten the dust, and see them almost completely intact. The paint and dash might have been faded and the dash splitting from the sun, but not much rust.

Also a lot of really old (and faded) pick-ups and Chevy Suburbans and such still on the road, which are rarities here.

[Michael Cain]

The smartphone and its software replaced 100s of pounds of various devices.

I'll agree that a contemporary smartphone is an amazing device, starting from the (to me, staggering) amount of signal processing that makes it work as a phone to all the other things that it can do. I've been noticing how many old detective stories and shows are aging badly because critical plot points wouldn't happen if the protagonist was carrying a smartphone in their pocket.

OTOH, Apple (iOS) and Google (Android) maintain very tight control of the operating systems and work very, very hard to put applications in sandboxes where they can't mess with each other. The car companies don't. That's how we get examples of academic hackers trailing a car, cracking the wifi-enabled entertainment system, then using that to inject commands on the system bus to put the engine and the transmission out of sync.

[novakant]

thanks, russel and cleek

[hairshirthedonist]

Something I just remembered about AZ, though, is that the cost of registration is at least somewhat in proportion to the book value of the vehicle. Here it's based on what type of vehicle it is, regardless of how much it's worth. You might pay hundreds of dollars to register an expensive new car in AZ.

Now I shall google.

From the AZ MVD website:

A vehicle license tax is included as part of the annual fee to register your vehicle. It is based on an assessed value of 60 percent of the manufacturer’s base retail price reduced by 16.25 percent for each year since the vehicle was first registered in Arizona (15% before 8-1-98). From there, the rate is calculated based on the assessed value. $2.80 per $100 of assessed value for new vehicles and $2.89 per $100 for used vehicles.

So a new $60K vehicle will cost over $1K to register the first year. After 4 years in AZ, that tax goes away and you're left with some fees that amount to around $40. So probably not something that pushes people all that much to keep really old cars, but it's something.

[Michael Cain]

I'd bet there are more much-older cars in CO than in NJ if the pattern I've witnessed in AZ holds. Much older cars rust away here a lot faster.

True. My wife's Honda Odyssey is 22 years old now. No body rust. Also went through emission testing last month and was way under the limits. The real problem is the 20-year-old car that hasn't been well maintained, or has a previously undetected problem. I am told that a surprising number of cars arrive here with a catalytic converter that has been poisoned at some point, and those are horrible on NOx, a ground-level ozone precursor.

[CharlesWT]

Governments and citizens could be saved a lot of time, trouble, and money if they set up roadside scanners for polluting vehicles and left everyone else alone. But testing centers would fight that tooth and nail.

[cleek]

they also test for lights, blinkers, horn, tires and mirrors.

[russell]

I was stopped at a light driving down into Cambridge a week or so ago. Car next to me was a mid-60's Plymouth Valiant V8.

You could smell the hydrocarbons wafting in the breeze, like some kind of toxic perfume. Reminded me of my days pumping gas back in high school. I'm surprised any of us who grew up back then still have any brain cells left.

Amazing how much better automobiles are now.

Governments and citizens could be saved a lot of time, trouble, and money if they set up roadside scanners for polluting vehicles and left everyone else alone.

Maybe it's just me, but this seems profoundly impractical. How would this work? Would you pull cars over to test them, like they do for weighing trucks? If you had to do it on the fly, how would you isolate the emissions from one specific moving vehicle accurately enough to know which one was the polluter?

On the whole it just seems a lot simpler to check it when you check all of the other basic functions of the car. As cleek notes.

[Michael Cain]

How would this work? Would you pull cars over to test them, like they do for weighing trucks? If you had to do it on the fly, how would you isolate the emissions from one specific moving vehicle accurately enough to know which one was the polluter?

Colorado sets theirs up on busy single lane on-ramps to the interstates. Measurements are more accurate if the car is accelerating. U of Denver originally developed the technology the state uses: lasers at selected frequencies shine across the lane and bounce off a mirror and back to the sensors. Lots of lab and field work to show that the measurements yield the same mean as the test centers, with slightly wider error bars. In practice, there aren't very many borderline vehicles: the large majority either pass easily or obviously fail. A separate camera shoots a picture of the front license plate when the sensor says it has the reading (we're talking milliseconds here, that part is trivial). Misses -- eg, a lifted truck -- are also determined properly. If moving above a critical speed, turbulence disperses the exhaust between vehicles. If you pass a drive-by test twice in the six months before your registration comes up for renewal, no emission test is required. Test site locations are published weekly.

When I was working I drove by one at least once per week. Now that I'm retired I don't, so go to the test center and pay the $25. Last month, the wait was about five minutes. The workers are invariably polite.

[CharlesWT]

Maybe it's just me, but this seems profoundly impractical. How would this work?

This article is from 2015 so things may not have changed enough to invalidate the emissions testing solution it suggests.

"What’s really needed is a truly independent emissions-testing system that measures pollution where it occurs, on the open road, and not just in a laboratory or emissions-testing station.

In fact, this technology already exists. Remote sensing devices on the roadside can measure emissions as a vehicle passes by, without impeding traffic flow, often without the driver or vehicle knowing they have been tested, and without the vehicle owner waiting in line at an inspection station.

Most important, this technology measures vehicle emissions where vehicles actually pollute, on the road. These are real-world emissions, as opposed to what is measured in vehicle-certification laboratories or at testing stations, where it has become clear that those scheduled and scripted tests can be thwarted.

A single roadside remote sensing device can capture thousands of vehicle emissions measurements a day in free-flowing traffic. These machines use infrared scanning technology to measure emissions, speed and acceleration. A camera records the license plate number, which can be matched to state vehicle registries."
Test Emissions Where Cars Pollute: On the Road: Sept. 30, 2015

[Michael Cain]

I should add, Colorado has emissions testing. The state doesn't test other functions.

[wj]

Governments and citizens could be saved a lot of time, trouble, and money if they set up roadside scanners for polluting vehicles and left everyone else alone.

How is this not a horrible intrusion of the government into people's personal lives? I mean, scanners on the public roads? Shocking idea. Even more shocking that it is, apparently, supported by libertarians.

[cleek]

The state doesn't test other functions.

it should.

[russell]

lasers at selected frequencies shine across the lane and bounce off a mirror and back to the sensors.

ok then. carry on!

The state doesn't test other functions.

?!?!?!

brakes, lights, directionals? nothing?

go for it, I guess. just don't tell folks in NH about it, they'll want it, and they drive around here.

[Priest]

Georgia is also emissions only testing, and it's not statewide, just 13 metro Atlanta counties. The three most recent model years are exempt, as are vehicles over 25 years old.

[CaseyL]

Washington state is phasing out emissions testing altogether for newer cars (I don't which model year), and have not tested for anything else for at least 23 years, that being when I first bought a car here.

I mean: yes, part of the driver's test is making sure you know how to work the lights, brakes, turn signals, etc. But SFAIK, once you're licensed, that's it. No later car you buy needs function testing.

Florida, of all places, used to require inspection. But that was back in the 1970s, when "safe driving in a safe car" wasn't a partisan issue.

[CharlesWT]

Vehicle inspection in the United States

Vehicle Inspection Requirements by State (2021)

Car Inspection Requirements By State: A Compendium

[Russell]

part of the driver's test is making sure you know how to work the lights, brakes, turn signals, etc. But SFAIK, once you're licensed, that's it.

I guess what I was hoping for was an inspection to make sure that all of that stuff works ON THE CAR.

Not that you know which knobs and levers and pedals to turn and press, but that if you do, the right thing happens. You know, car stops, road is illuminated, turn signals signal.

I may never leave MA again. Not in a car, anyway.

[Russell]

Of course, in MA, while we check to make sure the turn signals on the car work, we immediately ignore them - ignore using them and ignore others using them - until inspection rolls around again.

So, even stevens, I guess.

[CharlesWT]

I think in Texas using turn signals is telling other people too much about your business...

[wj]

Different places have different cultural (for lack of a better word) attitudes towards rules. Which is reflected in their driving.

Some places, drivers religiously pay attention to lane markings. Other places they treat the marlings as various levels of advisory. But you haven't lived until you've driven in Saudi Arabia. Lane markings? Not even advisory; strictly decorative. NOT a fun place to drive IMHO.

[CharlesWT]

But you haven't lived until you've driven in Saudi Arabia.

It takes a number of generations for people to internalize the use of, to them, new technologies like motor vehicles.

I've seen videos of Chinese drivers driving like they're the only vehicle on the road. Like, when missing an exit, they'll stop and back up to the exit. Or make a U-turn in the road and drive back to it.

People drive much better than when I was a kid. Visitors from other countries often comment on how smooth and orderly traffic is in the US. They would probably say the same about most other countries who have had the automobile for four or five generations.

[Snarki, child of Loki]

Driving in Napoli is good preparation for driving in Boston, IMO.

LJ, want to fill everyone in on car inspections in Japan? My info is out of date/misunderstood?, but I recall a very tough every-2-year inspection, that gets progressively more expensive until it's better to just junk the car.

[CaseyL]

Russell - As I recall, the license tester does look to be sure the lights, etc., are actually working, not only that the new driver knows which switches are which.

I switched from a Honda to a Scion, and the windshield wiper controls are the opposite of what I was used to. In the Honda, pushing the lever up turned the wipers on (intermittent, regular, maximum). In the Scion, pushing the lever *down* does all that.

I still find myself reciting "Less is more" to remember which way the lever needs to go.

[Nigel]

Annual test for cars over three years old in the UK.
https://en.m.wikipedia.org/wiki/MOT_test

And driving standards, particularly lane discipline, have got worse over the last couple of decades.

[pro bono]

RTA fatality rates per 100,000 population, by country (from wp, may be a bit out of date):

Norway: 2.0
UK: 2.9
Japan: 4.1
Italy: 5.2
USA: 12.4
Saudi Arabia: 27.4
Liberia: 35.9

[Marty]

I think in Texas using turn signals is telling other people too much about your business...

In Mass, a turn signal to change lanes simply ensures everyone speeds up to prevent it. The only use for a turn signal is,when at a red light, to let the people going the other way know you are going to cut them off and go first.

In Florida it most often means the signal wasn't turned off after the last turn. It is pretty common to see a left turn indicator in the high speed lane on the highway.

[cleek]

I switched from a Honda to a Scion, and the windshield wiper controls are the opposite of what I was used to

it took me five minutes to find the switch to turn off the hazard lights in my new car as i drove it off the lot. because everything is controlled by the computer, and you interact with the computer by using the touch screen, i looked at page after page after page after page of controls. but i couldn't find it. i googled "turn off hazard lights telsa 3". there was a video!

well, the control is up on the ceiling by the rear view mirror - where it is in a lot of cars. it never occurred to me it would be a physical button, since nothing else is.

[hairshirthedonist]

Meta comment: This thread has been particularly unstable in terms of subject matter. (Not that there's anything wrong with that.)

[russell]

Driving in Napoli is good preparation for driving in Boston, IMO.

not just your opinion.

my wife and I went to Italy back in 2018. I wanted to know what were in for, driving-wise, so I checked some guidebooks.

the guidance was: if you're good with driving in Boston, you'll probably be OK in Italy.

everything is controlled by the computer, and you interact with the computer by using the touch screen

my wife's car - Honda Insight - is similar, and has the touch screen in the middle of the dashboard.

I hate hate hate it. no tactile feedback, and you have to take your eyes off the road to use it. I don't know who thought the touch screen controls in an automobile was a good idea. my guess is that it was a touch screen vendor.

it wasn't and isn't a good idea.

gimme knobs and buttons and levers, please. anything that lets me operate the car without taking my eyes off the road.

[McKinneyTexas]

Driving in Napoli is good preparation for driving in Boston, IMO.

not just your opinion.

my wife and I went to Italy back in 2018. I wanted to know what were in for, driving-wise, so I checked some guidebooks.

the guidance was: if you're good with driving in Boston, you'll probably be OK in Italy.

Depends. I can't speak to Napoli, but I'd never drive the Amalfi Coast because the roads are so damn dangerous. Tuscany is fine. Florence is fine. Never in Rome or Paris. But the worst, by any measure? Sicily.

Sicilian drivers are insane--cancel me, I don't care. We had multiple near-death experiences in Sicily to the point where I dropped our car off in front of the rental agency, put the keys in the drop box and walked off.

In Sicily, on two lane highways, a car desiring to pass straddles the middle line and the car ahead and the oncoming vehicle move slightly to their right, leaving an opening down the middle of the road for the passing vehicle. When we were there (2017), Sicily had the highest death rate per 100,000 on the highway in Europe.

It's a beautiful island with amazing sight-seeing, but either save up enough to hire a driver or stay home. And, be current on your life insurance premiums.

[liberal japonicus]

My info is out of date/misunderstood?, but I recall a very tough every-2-year inspection, that gets progressively more expensive until it's better to just junk the car.

Yep, though there are some interesting wrinkles. Cars need to do a shaken, and people often think it is just the inspection, but it also requires mandatory insurance policy, which then avoids the problem of uninsured drivers. There are a few people who keep up very old cars and I've never figured out how they do it, I think they pay a lot and they have to pass an emissions test.

You can do the tests yourself and fill out the paperwork and if your tests are ok, you can save money, but that requires some pretty intense automotive skills and really good language skills.

A new car gets three years and after that, every 2 years, so it's cheaper to buy a new car after a couple of turns. I've always relied on my dealer to tell me, so I'm not sure about what the timing is.

If you drive with an expired shaken, you face about a 3000 dollar fine and if you can't pay that, 6 months in jail. You also get 6 points knocked off your license, which means that you lose your license for 30 days with no other offenses, lose it for 120 days if it a second offense (and anything that gets you knocked down, from going down a street that is set to be 1 way for particular times in a day or if your kid isn't wearing their seatbelt in the back counts). 3rd offense and your license is revoked and you have to reapply and do everything after a year.

Driving under the influence is also very strict, with between a 0.03 and 0.04 (essential a swig of beer I think) you could be imprisoned for up to three years, suffer a $5,000 fine and lose your driver’s license for 3 months. And after you served your time, you'd be eased out of your job.

Get caught with a level exceeding 0.04 percent, and you will face up to five years in prison, a fine of $10,000 and a cancellation of your license altogether. And that would come with immediate firing.

[Michael Cain]

it never occurred to me it would be a physical button, since nothing else is.

The federal vehicle safety rules require a physical button, appropriately marked, that toggles the flasher system on and off. I believe that the rules also require the flasher system to be physically distinct -- beyond the lamps, of course -- from the rest of the car's systems.

[Girl from the North Country]

McKinney's comment made me smile: I've driven in France, mainland Italy, and Sicily (the latter three summers running), and the only serious trouble in Sicily was occasionally ending up on tiny streets barely wide enough to take a car in ancient towns. But it was worth it.

Israeli drivers are appalling (we used to joke that the rule there is you ONLY overtake on blind curves), but the most terrifying driving I ever saw was in Hanoi. Hell, even crossing the road on foot there was taking your life in your hands. I never even tried to drive; when I went to Ha Long Bay I hired a driver for the two day trip.

[McKinneyTexas]

I wonder how well the Japanese regime would travel. As background, for an average male, 1 oz = .02, so two "regular"* drinks gets you to .04, but at the end of an hour, assuming no additional intake, the average male has metabolized/eliminated .02. The average elimination rate for a male is .02 per hour. I don't recall the female numbers because that's never come up in one of my cases.

That said, if TX had a .04 zero tolerance level, our prisons would be full way beyond capacity, and the impact on POC's (blacks and Hispanics) would be way disproportionate. Ditto with have insuring requirements. So, I'm thinking what works on one country may not work in others. I'm personally fine with a hyper aggressive anti-drinking regime (because, in the long run, with enough people paying a very high price, our deaths/injuries on the highway would hopefully plummet), but I'm guessing others may not be so happy as they see it play out.

*a 'regular' drink at Casa McKinney starts at 3 oz, so I'm a stay-at-home imbiber or I do Uber. My personal observation is that the average, regular consumer of adult beverages drinks 1.5-3.0 oz per drink (a single or a double), so the average person is going to exceed the .04 threshold pretty quickly.

[hairshirthedonist]

*a 'regular' drink at Casa McKinney starts at 3 oz, so I'm a stay-at-home imbiber or I do Uber.

Go big or go home! Or, um, go big and stay home? ;^)

[wj]

An amazing look at vaccination rates across the country.
https://www.eastbaytimes.com/2021/06/22/california-covid-vaccination-uneven-as-state-reaches-milestone/

Percent who have at least one shot are highest in places like Vermont, Hawaii and massacre, and lowest (like 40%) in deep red states across the deep South and the mountain West.

Here in California we have lots of variation within the state. Some counties are above 80% vaccinated. Other counties (typically rural and deep red) are in the low 30s. Amazing what some people will risk in order to show that they won't listen to the government.

[CharlesWT]

Just got back from a walk where I saw a car almost its entire length up the bracing cables on a powerline pole.

[CharlesWT]

Vehicle crash porn.

Bad Driving Asia

[nous]

Here in California we have lots of variation within the state. Some counties are above 80% vaccinated. Other counties (typically rural and deep red) are in the low 30s. Amazing what some people will risk in order to show that they won't listen to the government.

Good ol' Lassen. Half of the 30% that is vaccinated is probably Hmong. May this turn out to be the start of the demographic shift we all dream of.

And the rest of the state is being pulled up by San Diego, which seem to be entirely populated by military families and essential workers.

Also, it's fitting that 1/3 of Yolo is unvaccinated. YOLO, bruh.

[wj]

May this turn out to be the start of the demographic shift we all dream of.

With the Delta variant spreading in the US, the culture of determined ignorance may turn into a self-correcting problem. Rough on their minor children (if any). But otherwise, hard to work up much sympathy. Which, I realize, doesn't speak all that well of me, but there you are.

[Michael Cain]

I've seen videos of Chinese drivers driving like they're the only vehicle on the road. Like, when missing an exit, they'll stop and back up to the exit. Or make a U-turn in the road and drive back to it.

My sister was living in Korea when they were going to have the Olympics. She told me that at some point early that year, the legislature was suddenly, "Hundreds of thousands of people from other countries are going to be coming to Korea, and at least some of them will want to drive. Perhaps we should have actual traffic laws."

[cleek]

you can lead a Trumper to a life-saving vaccine, but you can't make him smart enough to take it.

[cleek]

when DeSantis runs for Pres, "conservatives" everywhere will think thought policing by the state is an awesome idea.

TALLAHASSEE — In his continued push against the “indoctrination” of students, Gov. Ron DeSantis on Tuesday signed legislation that will require public universities and colleges to survey students, faculty and staff about their beliefs and viewpoints to support “intellectual diversity.”

The survey will discern “the extent to which competing ideas and perspectives are presented” in public universities and colleges, and seeks to find whether students, faculty and staff “feel free to express beliefs and viewpoints on campus and in the classroom,” according to the bill.

The measure, which goes into effect July 1, does not specify what will be done with the survey results. But DeSantis and Sen. Ray Rodrigues, the sponsor of the bill, suggested on Tuesday that budget cuts could be looming if universities and colleges are found to be “indoctrinating” students.

anyone want to bet against me?

[Snarki, child of Loki]

"anyone want to bet against me?"

The Ghost of McCarthy sez "oh hell NO"

[wj]

anyone want to bet against me?

Sorry, cleek. You're not winning any sucker bets today.

[Hartmut]

If you ask the Berlin police, the most reckless drivers in the world are Saudis connected to the embassy. They have thousands of serious violations on record including fatal hit-and-runs. If the perpetrators have actual diplomatic immunity, they're asked to leave the country, otherwise they are put on a plane home quickly by the embassy while stalling (e.g. by falsely claiming that the culprit had an official status). The worst offenders seem to be the kids of diplomats who know exactly that they will not be held accountable (at least not by the German state).

[CharlesWT]

If you do this video search,

(bad OR crazy) Saudi drivers

you get links to videos of people doing jackass stunts like driving on the highway with the vehicle balanced on two wheels.

[liberal japonicus]

I wonder how well the Japanese regime would travel.

It is important to note that the regime has been the result of a gradual process of tightening the laws. Drunk driving was only made illegal in 1970. When I first came, people were still drinking a small glass of beer for the initial kampai of a party. I understand that the initial impetus was when two court cases involving drunk driving with roughly similar circumstances were decided and one received a light sentence and another, the judge basically threw the bookshelf at the person. This led to a campaign and other changes in the laws have been the result of public anger at similar incidents.

The first laws led to a big drop.
https://www.sciencedirect.com/science/article/pii/S0386111219300470#bb0025

Even more stringent rules came into effect in 2000 and again in 2007 as a result of some high profile accidents where children were killed.

https://www.jstage.jst.go.jp/article/jea/advpub/0/advpub_JE20120134/_pdf
The models did not consider police-enforcement activities. However, the police usually undertake only short-term (typically 1-week) crackdown campaigns after high-profile crashes. The number of drivers charged with drunkdriving, which had been quite constant for more than 10 years, decreased by 24% in 2000 (ie, before the law amendment)29–31; this suggests that the reduction in drunkdriving occurred without an increased likelihood of being caught. Although some drivers may have equated law enactment with automatic enforcement and changed their behavior when the law amendments were reported by the media, the observed change started many months before the amendments passed the Diet (road-traffic law in June 2001 and criminal law in November 2001).

Obviously, this sort of model depends on access to public transport, which is why drunk driving has been more of a problem in rural prefectures (like mine!) However, the laws 10 years ago gave rise to daiko, which are basically taxis with 2 drivers, and the second driver drives your car and then then go back. The cost is about 1.5 times the cost of a taxi to your place.

When coupled with public gestures, this is quite powerful. This is from the neighboring prefecture
https://japantoday.com/category/crime/first-arrests-made-under-new-fukuoka-drunk-driving-regulations
Fukuoka Prefecture has been running a high-profile anti-drink driving campaign since August 2006, when a 22-year-old man drove his vehicle into the back of an SUV containing a family of five. The collision pushed the SUV through a bridge railing, and the vehicle plunged into Hakata Bay. The two parents survived with minor injuries, but their three children, aged 4, 3 and 1, died.

Further initiatives were tested to raise awareness of the dangers of drunk driving. In May 2012, all Fukuoka city employees were ordered to abstain from drinking any alcohol for a month by Mayor Soichiro Takashima, after a scandal involving two city officials.

[...]

Under the new regulations, establishments that serve alcoholic beverages could be fined up to 50,000 yen and have their names made public if they fail to adequately uphold public safety commission regulations.

That two month pause pales in comparison to what a previous mayor did

Imabayashi [arrested and convicted for causing an accident] was a municipal employee in Fukuoka City’s Animal Control Center, and a higher level of care is expected of public officials, even at Imabayashi’s level. The mayor’s office received nine hundred complaints, leading the mayor to hand Imabayashi a disciplinary dismissal, cancel events related to Fukuoka’s Olympic host city bid, give himself a 20 percent pay cut, and issue pay cuts and reprimands to departments and officials connected with the Animal Control Center.

There is a lot to unpack in terms of cultural gestures and expectations, but simply put, it's not just you who will get punished, it can be everyone you work with. I often have problems with that, but when dealing with problems like drunk driving, it works quite effectively.

The new laws also punished people who loaned their cars to people who were involved in a drunk driving accident, with the penalties going thru the roof if there was a death involved. There was a lot of discussion about this and concerns of the unfairness of it. However:

Japanese drunk driving laws are among the strictest in the world and are stricter than those of any U.S. state. Yet despite considerable drinking in Japan, drunk driving arrests and prosecutions are relatively rare. When cases reach the courtroom, Japanese judges apply an extraordinary range of tests to determine liability. Sometimes they rely on blood alcohol or breath alcohol results, and sometimes they don’t. Sometimes they rely on subjective observations of intoxication, and sometimes they don’t. Sometimes they rely on factors unrelated to drinking or driving to determine liability both for drivers and for passengers alike.
https://oxford.universitypressscholarship.com/view/10.1093/oso/9780190070847.001.0001/oso-9780190070847-chapter-4

So, while taking the Japanese regime and simply moving it to the states might seem to provide clarity, if you don't know the context and cultural factors, it can often lead you astray.