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The Second Brain: A Groundbreaking New Understanding of Nervous Disorders of the Stomach and Intestine
The Second Brain: A Groundbreaking New Understanding of Nervous Disorders of the Stomach and Intestine
by Michael D. Gershon
Edition: Paperback
Price: $9.31
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2.0 out of 5 stars This is a 300 page scientific paper. A rather unreadable book., May 25, 2016
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I am used to reading very dry working papers in mathematics, medical research, econometrics and other scientific endeavors. Usually, such papers are 20 pages or less. A few are up to 50 pages. However, this book is pretty much a 300 page scientific paper! In other words, it is rather unreadable. There is way too much detail to impart the key information to a general audience. As an example, the entire Part I of the book that covers 80 pages can be summed up in the following paragraph.

In Part I, the author discloses that he rediscovered that human beings have essentially a third nervous system or rather nervous/motor system. The first one is the voluntary skeletal one whereby your brain essentially controls all your voluntary actions through orders transmitted with the acetylcholine neurotransmitter among many others. The second one is the involuntary automatic one that controls most of your physiological necessities and responses (breathing, cardiovascular system functioning, glands, visceral muscles, etc.). It is governed by the peripheral central nervous system (spinal cord, etc.). This system is subdivided into two. One is the sympathetic one that responds to the neurotransmitter noripenephrine (a precursor of adrenaline) and is responsible for the flight-or-fight mechanism among many other reflexive reactions. The other one if the parasympathetic nervous system that responds to the acetylcholine neurotransmitter that governs many physiological activities. In addition, the author’s contribution to the field is his rediscovering a third and pretty independent nervous system: enteric nervous system governing your digestive system (your gut) through the neurotransmitter serotonin. He states that he “rediscovered” the enteric nervous system because it was first discovered by an earlier set of scientists a long time ago. Bayliss and Starling came up with the “Law of the Intestine” in the 1890s; Langley publishes his seminal book on the subject “The Autonomic Nervous System” in 1921. Both treaties described the workings of the enteric nervous system in detail. And, Gershon graciously gives them full credit for their work.

If you find the above paragraph too heavy going, this book is not for you. The above paragraph is a piece of cake compared to the real thing: an 80 page Part I with many more details describing cellular level physiological reactions entirely unfamiliar to a lay public. Also, the author imparts some drama regarding the rather Galilean reception he got from other neuroscientists for re-advancing the theories of the gut having its own independent nervous system. Later, when he is able to turn things around and finally convince the world that the enteric nervous system is real, he spends an entire 33 pages on a single event, a neuroscientist convention workshop that took place in Cincinnati, where he presented his theories and they were finally well accepted. He describes in extensive details his friends and foes participants at this convention. It is interesting to a certain point. Lay readers will probably feel that this topic warranted no more than 8 pages instead of 33.

The remainder of the book, beyond Part I, continues to read as something like a graduate school biochemistry textbook. The New York Times Book Review that is quoted on the cover page as stating regarding this book: “Persuasive, impassioned… hopeful news [for those] suffering from functional bowel disease” has most probably had no staffer actually reading this book. That’s because it has very little practical health advice. It mentions that modern anti-depressants (SSRIs) are really bad for your intestine because their reuptaking serotonin does reduce the amount of serotonin generated by your intestine and greatly affects your digestive function. Also, dietary fiber is really good for you because it enhances the muscular fitness of your colon. And, that’s it as far as practical health advice goes. As far as Irritable Bowel Syndrome (IBS), the author goes on an entire chapter (chapter 8. A Bad Bowel) how that disease is really ill-defined and is a catch all for all sorts of digestive ailments that the medical profession does not understand and does not know how to cure. In view of that the anthological comments by The New York Times Book Review are really inaccurate.

Follow Your Gut: The Enormous Impact of Tiny Microbes (TED Books)
Follow Your Gut: The Enormous Impact of Tiny Microbes (TED Books)
by Rob Knight
Edition: Hardcover
Price: $11.80
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4 of 4 people found the following review helpful
4.0 out of 5 stars A wonderful book on the subject. However, be warned the related science is very young and uncertain., April 30, 2016
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This short book written by Rob Knight, a scientist, and cofounder of the American Gut Project (engaged in studying the microbiome of the US population), is a wonderful extension on his TED talk on the same subject.

The book imparts a ton of information on an invisible, unknown world to most of us that has an enormous impact on our health and our mood: the microbiome. By reading this book, you get an immense appreciation for it. You also get a very different perspective on bacteria and microbes. The book creates an interesting tension between the germ theory and the hygiene theory.

The germ theory has dominated health care and medicine ever since Pasteur in the 1800s, whereby germs, bacteria, viruses are all bad and are powerful agents of diseases (often lethal and dreadful ones). Such illness-inducing agents should be wiped out at all costs through antibiotics. On the other hand, the hygiene theory advances that exposure to bacteria and microbes in the natural environment (farms, rural environments, nature, dirt, gardens) is actually really good for you. Interaction with many other groups of people and with pets is also good for you. It will render your own microbiome richer, more diverse, and will enhance your own health to be much more resilient than otherwise. It also warns against the excessive use of antibiotics for two reasons. The first one is that even when they are necessary they wipe out just as many good bacteria than bad ones. The second one is that the broad based use of antibiotics in soaps, other hygiene products, food for cattle has led to the antibioitic-resistance crisis.

After reading this book you will think twice about the germ theory vs hygiene theory tension. And, you will probably be on the hygiene theory side more often than you would have before reading the book.

The impact of the microbiome on just about everything is well documented within the book. The author in addition to his short and breezy narrative has included extensive notes and reference to the scientific literature. So, not only any of his arguments are very well supported; but, he readily facilitates you reading the scientific literature on the subject.

One of the most intriguing impact of the microbiome is on body weight (the obesity crisis). We give cattle a lot of antibiotics so they grow bigger and are more valuable in the marketplace. Strangely enough, there is a parallel in human beings. They uncovered that babies and toddlers that received more antibiotics than others as preventive measures to exposure to bad bacteria ended up with a lot higher probability of being overweight. They had also much higher rate of asthma, immune system disorders, and other ailments. The author had a really amazing first hand experience on the subject. On a trip to South America, he experienced a severe bout of gastro-intestinal problem (not unusual in that part of the World for American tourists with microbiome not diverse enough to withstand the local microbiome communities). To resolve his health issues he took a course of antibiotics. And, within just a few short months of coming back home he lost effortlessly 80 pounds! This triggered serious health concerns among his colleagues. They thought maybe he had cancer or something. It turns out he was perfectly healthy in all regards. However, his microbiome had profoundly changed after the trip as a result of his severe gastro-intestinal ailment and the antibiotics.

Microbiomics (if that is a word?) is a very young science faced with many conundrums. When you read the book you get a sense that the microbiome is very deterministic. In other words, a certain bacteria precisely has an impact on a certain disease or ailment; just like they have on weight and obesity. You also get that the microbiome of babies is radically different than the ones of adults, and the ones of women different than men. You also get that there are clear scientific categorical demarcations between good bacteria and bad ones. Also, throughout the book you get that diet is the most dominant causal driver of microbiome differentiation between individuals.

All of the above is most probably directionally correct. However, after reviewing some of the findings of the American Gut Project you realize the above statements are not so categorical. We are not talking of Yes/No or 100%/0% type binomial answers to anything. We are probably a lot closer to 51/49% type answers with a commensurate error margin leaving us with less than great confidence that anything is so Yes/No type situation. Let me give you a few examples.

When studying a large population of over 3,600 volunteers at the American Gut Project (AGP), they found that the recent use of antibioitics overall had very little impact on the overall microbiome composition of families of bacteria. In such, you could see a slight increase in Firmicutes and commensurate decrease in Proteobacteria when people first take their antibiotics. But, just a few weeks later their microbiome returns to some sort of original equilibrium (just a few percentage point different) and stay there.

Also, the influence of age is interesting and very nuanced. The microbiome mix of bacteria changes the most between babies and young children. During those few years, it does change quite a bit. Thereafter, strangely enough the microbiome mix gravitates very slowly towards the original mix at birth. So, by the time we reach our 80s our mix is fairly similar to what it was near birth (at least when observed over a large sample).

The influence of gender, appart from women having very different microbiome communities within their genital area than men, does not appear that pronounced. Women have typically a slightly more diverse overall microbiome than men. Does it contribute to women's longer lifespan in addition to obvious behavioral differences?

The influence of diet types when observed over a large sample is far less than one would think. Reading the related graph shown at the AGP, you really have to watch very closely for any visual difference between the microbiome mix of omnivores vs. vegetarians and even vegans.

The influence of exercise is actually a bit more noticeable than the influence of diets. The more people exercise the more Firmicutes they have.

Oddly enough, if we focus on Firmicutes… the more recently you have taken antibiotics the more Firmicutes you have. The more you exercise, the more Firmicutes you have. The more vegetarian/vegan diet you eat the moe Firmicutes you have. That’s even though the diet dimension, as mentioned before, is much harder to visually distinguish than the other ones.

So, what are those Firmicutes? In view of the above, you would think they have positive health implication. After consulting with Wikipedia this seems like a rather ambivalent proposition. Here is Wikipedia on the subject: “Firmicutes make up the largest portion of the mouse and human gut microbiome. The division Firmicutes as part of the gut flora has been shown to be involved in energy resorption and obesity.” From this take you would not necessarily derive that more Firmicutes is necessarily better.

So, what to do about all of this? At first early in the book, you get a sense that overall bacteria are so good for you that you should run straight to Whole Foods and load up on Probiotics. Not so fast, the author indicates that bacteria in a living form that would have any benefitial impact on your health are very fragile. It is unclear that such bacteria could survive the processing, packaging, transportation, and store shelving that facilitates your conveniently purchasing them at your local store. Additionally, if you take probiotics daily you may ingest about half a trillion good bacteria a year. That seems like a lot. But, your body has 100 trillion bacteria. This means over a year you would have ingested only 0.5% of the bacteria in your body. Also, the ones you ingest may be somehow half-dead for the mentioned reasons. How much are they likely to influence your overall microbiome over a year that is probably far more influenced by other behavioral and environmental factor over that same year. Given that, you may not need to spend much money on general probiotics if any.

Additionally, things are even more confusing than you think. They found that 30% of people that are perfectly healthy have bacteria that are dangerous pathogens. Why “bad” bacteria affect some people and not others is rather unclear. However, it seems that cultural genetic heritage can play a role. For instance, they uncovered that the biomarkers for several diseases are completely different for the Swedes vs. the Chinese. In other words, a bacteria that cause no problem in one population can be a dangerous pathogen in the other.

The above creates further uncertainty regarding what actionable steps you could take to enhance your microbiome.

There are a few simple steps you can take and that is to eat more yogurt, nuts and fiber rich foods (fruites and vegetables) that both enhance population of good bacteria. Pick up gardening, camping, hiking in nature, farming, get pets, and interact with people. Spend as much time outside instead of indoors. That’s all good.

Also, there seems to be one very specific bacteria recommendation. If you suffer from very severe and chronic gastro-intestinal problem (IBS, etc.) you may consider buying some VSL#3 probiotic. This is supported by an extensive number of scientific studies. Those are not your usual probiotics you buy at the store. They are a lot more specific, focused on seven types of bacteria that are very powerful in healing your gut. They are also offered in mega dose. Each dose contains a staggering 450 billion bacteria. That is up to nearly 500 more than your pain vanilla probiotic supplement at the store. They are also treated specially to be more "live" than otherwise. They are sent to you in a cool thermal or refrigerated package. And, you are supposed to refrigerate them immediately. Otherwise, they are obsolete after just two weeks. As you can imagine they are also a lot more expensive than your regular probiotics at the market. One dose of those probiotics can cost up to $3 dollars. While, regular probiotics are rather underpowered and immaterial relative to the scale of your own microbiome; one may wonder if those are at the opposite end. And, may be too much in certain circumstances. If you take one dose a day of VSL#3, you would ingest 164 trillions of bacteria a year? That is more than one and a half the amount of your entire microbiome. One would have to have pretty severe IBS or related disease before seriously considering such a remedy. So, it is not something you would casually take as a supplement just because you have a mild case of disturbance downstairs.

Social Security, Medicare & Government Pensions: Get the Most Out of Your Retirement & Medical Benefits
Social Security, Medicare & Government Pensions: Get the Most Out of Your Retirement & Medical Benefits
by Joseph Matthews Attorney
Edition: Paperback
Price: $22.60
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4.0 out of 5 stars Very good coverage in adequate details, April 25, 2016
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This book compares favorably to similar books in the “For Dummies” series. Even though I am a big fan of the latter, I feel this Nolo book is slightly superior for several reasons. It is a little bit more detailed. At about 450 pages of material, it runs about 100 pages longer than your typical For Dummies book on the same topic. It has a lot of tables and text boxes that encapsulate a lot of information in a condensed space. Also, it is not subjugated to some of the quirks of the For Dummies format that is completely outdated (the For Dummies series typically has one or two chapters with lists of 10 items to remember, or 10 mistakes not to make, etc. Most often those lists are completely redundant or really artificial in nature).

As suggested above, this book is a very good information resource on the subject.

The Patient Will See You Now: The Future of Medicine is in Your Hands
The Patient Will See You Now: The Future of Medicine is in Your Hands
by Eric J. Topol
Edition: Hardcover
Price: $18.15
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1 of 1 people found the following review helpful
5.0 out of 5 stars An iconoclastic doctor scientist attacks the medical industrial complex, April 25, 2016
This is a remarkable book that describes the present and future of medicine. Within his analysis and vision, doctors are not the gatekeepers of information, but rather the consultants providing guidance to patients that are and will interact with their nearly live 24/7 medical data and records.

This medical revolution or more precisely democratization is associated with the rapid advent of the smartphone. For Topol, this is as revolutionary a development as the development of the Gutenberg press in the 1400s.

The author is an expert at the intersection of medicine, health sciences, and technology. He is rather uniquely qualified to advance and explain the fascinating themes detailed in his book.

Beating Patellar Tendonitis: The Proven Treatment Formula to Fix Hidden Causes of Jumper's Knee and Stay Pain-free for Life
Beating Patellar Tendonitis: The Proven Treatment Formula to Fix Hidden Causes of Jumper's Knee and Stay Pain-free for Life
by Martin Koban
Edition: Paperback
Price: $18.59
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1 of 1 people found the following review helpful
4.0 out of 5 stars Great stuff, but it may be too much for most of us, April 25, 2016
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There is no question that Martin Koban has put one of the most authoritative and inclusive well researched material on the subject. My rating reflects that the book, although short in appearance is pretty overwhelming. I read and studied the book in detail, took 10 pages of copious notes and was left baffled about what to do next in order to treat my recurring case of patellar tendonitis.

Imagine you go to a physical therapist to treat your tendon, and he gives you a “basic” recommendation of more than 20 different exercises and stretches to do slowly, diligently, every single day. Many of those exercises are for each leg. So, your basic physical therapy routine is certainly going to take you over an hour every day and may well take you an hour and a half or so. How realistic is such a therapy program for common mortals? Granted if you are a professional volleyball or basketball player (which I gather the author played at close to that level), such a commitment is both warranted and easy to make. Your sport is your full time job. It is your life. For the rest of us with often a full life as is with a 50 hour job and a family life such a therapy program’s intensity is just not realistic.

I still give the author a pretty high rating for the commitment to his topic, the abundance of info he provides, and the generosity and engagement he conveys towards his audience. He demonstrates all of the above by maintaining the most informative blog on the subject, including excellent videos, and responding to readers’ questions personally. I had problems accessing some of the materials from his blog. And, he sent me a personal note with the attached pdf files. Those included very helpful visual info on all the different exercises concentrated in just a few pages.

The additional info the author does provide at his blog helps streamline a lot the overall information provided within the book. And, it assists in your formulating your own personalized physical therapy that will be more manageable. Also, you probably should focus on your most pressing imbalances and do the eccentric squats (with or without a board) as soon as your knee can take it. It appears several other sources recommend such squats as the main therapeutic exercise. By doing so, you may streamline your personalized programs to 15 to 20 minutes a day and hopefully get about 80% of the results you would get by doing the 90 minute program thing as outlined within the book. This is an individual empirical thing. You may have to try a few different iterations and see what works best and how much time you are comfortable committing to on a sustainable basis. The key is sustainability. I think that even Martin Koban would agree that there is no point starting on the 90 minute program if you have time to doing it only once a week. In such circumstances, I would think you would be a lot better off doing a much shorter program that you can actually maintain at least four or five times a week without stress. If it is stressing your time, than it is counterproductive.

A Survival Guide to the Misinformation Age: Scientific Habits of Mind
A Survival Guide to the Misinformation Age: Scientific Habits of Mind
by David J. Helfand
Edition: Hardcover
Price: $21.18
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2.0 out of 5 stars Does not share that many useful habits of mind, April 14, 2016
The author indicates that he will present eight scientific habits of mind. Those are critical thinking tools that allow one to filter out misinformation. Do you know the difference between a billion and a trillion? Do you know what a scatter plot is? Do you know what a theory is? And, do you understand what is a positive or negative feedback loop? If you answer those questions positively you already know four of his eight scientific habits of mind. Another one is not an explicit critical thinking tool but a world-class analytical essay on Climate Change (chapter 10). The latter makes for excellent reading. But, it does not leave you with any practical thinking tool. It simply suggests getting yourself a PhD in Physics because it allows you to understand the natural world in great technical detail.

In terms of practical thinking tool you are left with a basic introduction to probability (chapter 6) and statistical distributions (Normal, Binomial, Poisson) (chapter 7), and an essay on “correlation does not entail causation.” Regarding the latter, I share the opinion of another reader who felt this treaty was meandering and rather pointless (not in a bad way, but literally). If correlation just about never entails causation, is everything we analyze truly just a set of binomial associations without any directional causality to such relationships? The answer is no. If you want to explore this subject further I recommend “Causality” by Judea Pearl.

This book is too long to present so few thinking tools and often in inadequate detail.

I forgot to mention the author states near the end that astrology, homeopathy, acupuncture, and parapsychology are not part of the scientific domain. This is a good thought. But, if you entertain reading a book on this specific subject you most probably already know that.

Dynamic Linear Models with R (Use R!)
Dynamic Linear Models with R (Use R!)
by Giovanni Petris
Edition: Paperback
Price: $59.98
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3.0 out of 5 stars Really challenging, April 8, 2016
This book is not for the faint of heart. Heck, DLM is a pretty complex model structure to master. It requires a solid background in Matrix Algebra, Bayesian statistics, Markov chain, statistical distribution computation to actually understand the reading material. In absence of such a background, DLM in R will be a most cryptic cognitive endeavor.
Unlike many other quantitative complex methods (such as VAR, PCA, Discriminant Analysis, Robust Regression, etc.) DLM is not accessible to the click of a button or to a single line of R codes. You have to specify a lot of matrix parameters, line-by-line. This may be a piece of cake for the professional statistician with extensive proficiency in R. For others, as mentioned above this is a really challenging domain.
In view of the above, I don’t have the adequate mathematical background to fully assess the quality of this book. But, I can set up realistic expectation and warning for the reader. If you have just your average math background, or even belong to a pretty advanced quantitative group, you could really struggle absorbing the material in this book unless you have a solid footing in the very specific mentioned disciplines.
Besides the above caveat, this book appears to be a good reference on the subject. It provides information on many types of models including some really useful ones like multiple regression (with DLM) that are not included within the dlm R package reference written by the same author.

My rating reflects my opinion that I think there must be a way to render the DLM in R method somewhat more accessible than as presented in this book. I may be wrong or not. And, that is why my rating falls within the neutral range.

The Episodic Career: How to Thrive at Work in the Age of Disruption
The Episodic Career: How to Thrive at Work in the Age of Disruption
by Farai Chideya
Edition: Hardcover
Price: $17.47
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1 of 2 people found the following review helpful
2.0 out of 5 stars Get yourself a good career guide instead, April 7, 2016
This book is not absent of content. The extensive narrative of people’s experience is at times pretty interesting. But, how relevant, focused, and actionable is the majority of the material in the book? Very little.

The author devised her own matrix of 16 career-life temperaments. She funded a survey of 2,000 people to determine and study those 16 different types in order to provide specific career guidance to the reader. Your career-life temperament is determined by four binomial questions (two choices), which turns into 16 different profiles. Although the questions are interesting, I found that 3 out of the 4 were rather ambivalent for me. Nevertheless, following my instinctive nature to get to an authentic answer I could narrow my relevant types to two of them that seemed fairly close to whatever would be my own profile.

Unfortunately, the depicted matrix really does not work. I read the sections detailing those two profiles most relevant to me. Remember, they were very close (only one different response out of the four questions, and the question seemed to be the least important of the four). Yet, when I read about those two profiles through the first-hand experience narratives of people classified within those two buckets not only they seemed very different from each other; but, they seemed completely different from who I am and what I have done, and how I have done it within the career field. The last straw was the related career recommendations which seemed nearly random and very few (typically just four or five choices). For one of the two types I focused on the career recommendations included business consultants and board member. For the other one it was administrative assistant and retail food service. The former seemed almost utopian (board member… really!); meanwhile, the latter seemed almost insulting (admin or retail food service is really the best that type could do?!).

One may argue the book has a lot more than the mentioned failed matrix. But, the “lot more” includes common sense (that is truly very common) regarding job searching, the chronic uncertainty in the job market, the need for ongoing lifelong learning, and a bunch of economic statistics thrown around for good measure with little insight and analysis to back them up.

Instead, I recommend get yourself a good career guide. I remember a few years ago I got one from The Princeton Review (unfortunately I could not readily find it at Amazon anymore). The guide asked you tens of questions (not just four), and recommended numerous different careers. Everyone in our household took the questions-survey, and in each of our cases it pretty much got us right on the money. It recommended careers that we had either taken or that did appear truly appealing to us. It also provided a ton of very specific information about all those different careers (how to get into them, academic requirements, expected career trajectory, earnings, etc.). I am sure there are numerous competing career guides out there that do provide that information. Within one of those guides you will get a lot more and precise information in a fraction of the time that it gets you to read “The Episodic Career.”

The Accidental Superpower: The Next Generation of American Preeminence and the Coming Global Disorder
The Accidental Superpower: The Next Generation of American Preeminence and the Coming Global Disorder
by Peter Zeihan
Edition: Paperback
Price: $11.40
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1 of 1 people found the following review helpful
4.0 out of 5 stars Geography, Demography, and Energy are Destiny. But, where is the capital surplus?, March 18, 2016
For decades many foreign policy authors have written about the inevitable decline of the U.S. and the emergence of other powers. In the late 80s, Japan was to take over the world with its high saving rate, superior manufacturing, and surging exports. In the early 90s Europe with the creation of the Euro was to become the supreme power with its superior soft power and its currency that would end the dollar domination. In the early 2000s others touted Russia’s comeback near the top with its abundant energy supply, competent military, and strategic leaders. Now, it is all about China taking over the world as the lowest cost manufacturer and biggest exporter.

The above narratives have one thing in common. By the time their respective themes reach Media consensus, they had often reached a tipping point. The forces of mean-reversion and unanticipated changes were already at play dismantling the geopolitical theme of the day. Another thing in common is that the end of the U.S. as the superpower is still yet to come.

Now comes Peter Zeihan with a really original and daring book.

And, he advances that the U.S. is very likely to maintain its status as world leader for a very long time due to very strong competitive advantages that few if any economists are aware of. The most important advantage is superior waterways including thousands more miles of navigable rivers (facilitating extensive cheap internal transportation of goods) and an extensive coast line with the most prevalent natural harbor sites facilitating commerce with all countries surrounding the Pacific and Atlantic. Those waterways advantages enhance the U.S. formidable agricultural sector and its related exports. Zeihan acknowledges that the U.S. population is aging. But, on a relative basis it won’t age that much. In Appendix II, it shows that in 2040 the U.S. demography will still be a lot younger than Japan, Germany, and Italy today! And, the U.S. demographic profile will remain economically vibrant. This is because the emerging Gen Y is actually much larger than the Baby Boomers, and will easily replace them as main consumer spenders, capital creators, etc. Now, regarding energy the advent of U.S. shale oil has transformed the whole geopolitics of oil. The U.S. will increasingly become energy independent and progressively depend less on either rogue states or Middle Eastern countries for its energy needs.

Meanwhile, most other regions of the world do not fare nearly as well on those key dimensions (geography, demography, agriculture, energy).

Russia has a rapidly shrinking population combined with a collapsed education system for decades. As a result, the youngest members of the well-educated intelligentsia (engineers, scientists, etc.) are currently 51 years old. When they retire or pass away (average male life expectancy 59 years old), there will be a huge shortage of engineering skills to maintain, and run Russia’s infrastructure including the military. Zeihan suggests Russia has very few years left as a power player.

Europe and the Eurozone are anticipated to experience chronic demographic aging and economic crises. The creation of the Euro in the absence of united financial and banking systems was a devastatingly bad idea. The area has only one main economic engine left: Germany. And, it is aging very rapidly. That engine is will sputter soon. Germany’s fiscal support of the European Community and the Eurozone may not be sustainable. The future of Europe is Japan, a shrinking population, industrial base, and economic power.

Canada faces some interesting challenges of its own. It has its own equivalent of Germany with actually a much brighter prospect because of more favorable demographics. It is the province of Alberta associated with the shale oil boom. But, just as Germany may question having to bail out the rest of Europe, Alberta may question having to do the same for the other Canadian provinces and Quebec in particular. Those respective issues are critical to the long-term survival of the European Community and Canada.

China appears to have unsurmountable demographic problems. The aftermath of its one-child policy has resulted into one of the most rapid population aging among major countries. As a result, its young labor force is hollowing out. And, its labor costs have sextupled since 2002. Its days as a low-cost manufacturing export-led economy appear numbered. Additionally, it will never be a consumer-led economy (rapid population aging, lack of pension and social support, burden on young generation, etc.). It only leaves an investment-led economy as an option. And, the entire Chinese economy funded by state controlled banks with no regards for solvency and profitability is the equivalent of a subprime bubble (building of empty ghost towns, etc.).

Given the U.S. advantages Zeihan advances that the U.S. will become increasingly insular. Besides taking care of its NAFTA partners (Canada and Mexico), it will return to isolationism. It will retreat from engaging in the Middle East and elsewhere because it won’t be dependent on foreign energy suppliers. It will retreat militarily and spend less on Defense to secure world peace. It will also retreat from shoring up the Bretton Woods world trade framework whereby it secured the world seas to shore up the safety of international naval trade. Those supranational efforts were hugely costly. And, the U.S. has much less need for those. That’s because international trade represents a small portion of its overall economy. Thus, with the largest consumer market with deep capital markets, it does not rely on trade unlike export-led economies like Japan, China, Germany, Russia that do not have much of a consumer market and capital markets.

Is Zeihan overestimating the U.S. prospect just like other authors had done earlier for Japan, Europe, and China? Given the track record of such optimistic prognostics it is tempting to answer “yes.” One area of Zeihan’s theory that is somewhat puzzling is the concept that a country with a combination of great waterways and arable land is bound to be extremely capital rich. Zeihan supports this case through history convincingly. However, where is the U.S. domestic capital surplus in recent times? For the past several decades the U.S. has run huge Current Account Deficits. Americans finance their domestic consumption with massive foreign capital inflows from export-led economies (China, Japan, etc.). The Congressional Budget Office (CBO) and General Accounting Office (GAO) both forecast an unsustainable fiscal situation with chronic and rising Budget Deficits pushing the Debt/GDP ratio ever higher. Given that, isn’t the U.S. going down Japan’s path in terms of debt level and stagnant economic growth? Zeihan states that by 2030, the Baby Boomers will shrink and that the fiscal situation will rapidly improve. That’s not what the CBO and GAO forecasts indicate.

On another count, Zeihan states near the end of the book that the U.S. is going to remain the dominant magnet for attracting immigrant talent as it is reindustrializing. Meanwhile, Australia and Canada distant seconds in the competition for human capital are deindustrializing. However, this does not factor that both Australia and Canada have far superior immigration policies that are far better at attracting and retaining human capital. Talented students now often go to Australia and Canada where they can readily emigrate and settle down upon graduation. Meanwhile, in the U.S. such students are sent back home after collecting their degree.

In view of the above, it is possible that Zeihan is a bit too optimistic about the U.S. and pessimistic about everyone else. Nevertheless, this does not detract from the originality of his insightful geopolitical research. It runs so against the grain of what you read everywhere else (US relative decline, etc.).

Medical Decision Making
Medical Decision Making
by Hal Sox
Edition: Paperback
Price: $48.45
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5.0 out of 5 stars An excellent reference on the subject, February 27, 2016
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Over the past decade and a half I have read and studied numerous quantitative books to essentially better understand math in its various aspects. As you know, this is an intellectual exploration without a finish line. And, this book is a treat.

The four coauthors do an excellent job of building and aggregating the building blocks underlying medical decisions. Those main blocks consist of Bayesian statistics, Utility theory, and Decision Analysis. Invariably, the authors start out slow introducing the concepts in a very user friendly and visual way. This renders the subjects easy to absorb and learn even for the non-mathematicians. But, as the subjects do call for it, the coauthors build on those simple foundations and go into the complexities of the respective topic. And, there is plenty of that.

This is a book to read, study, and review with an open Excel spreadsheet to replicate their example in order to truly absorb the material. This is somewhat inevitable given the nature of the subject.

In view of the above, the authors have covered basic Bayesian statistics as well as anyone else I have read, and, most often in more depth too. For instance, I find their coverage of that subject much superior to Nate Silver’s "The Signal and the Noise" which was an outstanding book on many other counts. But, if you really want to understand Bayes theorem this book is much better.

Reading this book, I have to wonder what is the percentage of doctors that understand the math of decision analysis in their practice even with the assistance of a computer program. I feel that as a responsible patient, it most probably behooves one to learn and understand such math. Inevitably, we will have to contribute at some point in making very difficult medical decisions for ourselves, a close relative or friend. And, at such time the knowledge imparted in this book may be very helpful.

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