Blow out the candles

It's sometimes hard to tell who is for real and who is just volunteering to act as a foil, but the question arises of the age of the earth. What the heck, I'll bite.

Creationists sealed their own doom when they decided to try to meet science on its own turf, through the movement called "Creation Science." If you Google the phrase "age of earth" you'll get a pretty even mixture of sites touting actual facts and logic, and sites maintained by creationists that attack the scientific consensus. Some of these just claim that the Bible is literally true and leave it at that, but many of them try to discredit scientific conclusions using arguments that appear to be scientific and rational. Actually they are completely nonsensical but evidently some believers don't have the necessary reality base to see why.

However, there are some creationists who do sincerely try to engage reality and they have conceded this point. Creationists are now split between young earthers who generally claim that the earth is less than 10,000 years old, and old earthers who accept its great antiquity -- about 4.5 billion years -- and simply say that this is consistent with Genesis because that first "day" of creation could have been -- indeed, evidently was -- really, really long. (I've had long days but nothing like that.) And of course, many of them have now fallen back even further, to "Intelligent Design," which does not dispute the evolutionary chronology but insists it must have gotten a boost from, uhh, somebody or other. In other words, once they decided to enter the arena of reason, they found themselves steadily giving way. Now they are up against the wall.

It would be redundant and repetitive for me to review all the evidence for the age of the earth, the solar system, and the universe. An overview of the "controversy," such as it is, with additional links, can be found here. It's pretty dry, though, and I can see why some people just don't get into reading stuff like that and find preaching more exciting and satisfying.

While radioisotope dating may seem like mumbo jumbo to some people, it's very easy to prove that the earth is well over 160,000 years old, and once you've done that, why not go all the way? In 1970-74, a Russian expedition drilled a core of ice in East Antarctica to a depth of 950 meters -- almost a kilometer. In 1982 they returned and continued drilling down to a depth of 2,083 meters. They didn't even get close to the bottom of the ice sheet, which is 3,700 meters thick.

The antarctic ice sheet is created by snowfall. The new snow is exposed to the sun and comparatively warm temperatures of the antarctic summer, then comes the long antarctic night and colder temperatures, and the deposition of new snow. Eventually the weight of overlying snow crushes what is beneath into solid ice. The seasonal cycle causes changes in the properties of the ice which can be discerned as annual layers. The Vostok ice core contains 160,000 of them. Okay, they didn't literally try to count them all, but they dated sections of the core at intervals using several different methods, all of which are in excellent agreement, and determined that the age of the lowest layer was about 160,000 years. You can read all about it here.

The antiquity of the earth is established by numerous lines of evidence -- including various methods that depend on radioactive decay; the laying down of sedimentary rock; the very obvious and consistent presence of characteristic fossils in geologic layers of particular ages which clearly shows the evolutionary chronology -- all the way back to those 3.5 billion year old stromatolites; observations of the stars which place the solar system in the context of known processes of star system formation and development over time; the observation of distant galaxies whose light required billions of years to reach us, thus putting the solar system into the context of an even more ancient universe; and more.

Furthermore, it simply defies common sense to assert that a human population of two (and where did Adam and Eve's sons get their wives from, anyway?) could have expanded from a single location 10,000 years ago, presumably somewhere in the Middle East, to populate the entire earth including all of Europe out to the farthest Hebrides, all of Africa, remotest Siberia, the Americas from Alaska to Tierra del Fuego and the Pacific Islands (all of which places can conclusively be proved to have been populated from prehistoric times), create great civilizations in China and India in less than 6,000 years, and oh yeah, even though there's no such thing as evolution people in different places have different pigmentation according to the amount of sun they are exposed to . . .

So the actual puzzle here is why so many people determinedly believe something so transparently ridiculous. Believing in the Tooth Fairy and the Easter Bunny is easier to understand than this. It strikes me as particularly odd that people who believe the universe is God's creation would insist on such a limited, puny creation. Isn't God supposed to be grand and glorious? Then why shouldn't He make a grand and glorious universe, one that is really old, and really big? Why do you want to put him down?

For decades, scientists generally elected not to dignify these people with a response. But it's obvious to me that we have to take them on. Intellectually, it's like crushing a flea, but that's not the issue.

Scientists are always careful in their discourse, going out of their way to emphasize the uncertainties and limitations of their data, the provisional nature of all conclusions, the potential weaknesses in their chains of logic. They just can't help using specialized vocabulary and impenetrable forms of mathematical discourse, and they spend most of their time arguing rather uncivilly with each other over what are usually quibbles. Hence they appear at the same time elitist, arrogant and exclusionary; internally divided; and unsure of themselves. That's fine when they're talking to each other, but when you are debating charlatans and meshugeners, that's the wrong style. We need to stamp out this idiocy, without mercy.

That's my final answer.

Kick start?

We don't know how life on earth got started. Creationists seem to consider this a major embarassment, but is it really so surprising that we can't be certain of what happened more than 3 1/2 billion years ago? I think I might have committed a typo a few days back and said 2 1/2 billion, but in fact, the oldest fossils -- of mats of cyanobacteria called stromatolites -- are 3 1/2 billion years old. As I said, that is not long, in cosmic terms, after the rain of big rocks from the formation of the solar system slowed down enough for the crust to cool and the oceans to condense -- maybe a couple of hundred million years, at the most, probably less.

Well, cyanobacteria are fully formed, complicated prokaryotic cells. They didn't just appear, they must themselves be the product of some process leading from nonbiological chemistry to a self-replicating system capable of evolution. On the one hand, that doesn't seem at all hard to believe: once you get a molecule that can catalyze the creation of copies of itself, but with the possibility of imperfect copying, you have the possibility of evolution leading to greater complexity. It only needs to happen once. It could be a very low probability event, but with trillions of chemical reactions going on all over the earth every day, improbable events happen a lot. Once you have a self-replicating evolving system, obviously, if it can reproduce faster than it is destroyed, the rest is history, or rather paleontology.

On the other hand, it has turned out to be hard to come up with an example of such a self-replicating system that can be shown to arise spontaneously, under conditions likely to have existed on the early earth, and not just any self-replicating system will do. We need a pathway to the actual life we have, Life on Earth, LoE. Now, there are fun parts to thinking about this, and there are boring parts. You're just going to have to accept a little bit of both.

The part that I'm afraid may be relatively boring is understanding the essential components for LoE, so I'll do that in this post and get it over with. (Those of you who already know all this, go read Effect Measure.)

First, you have an enclosed compartment formed by the cell membrane. This is essential to keep the complex biochemical sytems inside together, in a small volume where the parts can interact effectively, protected from chemical hazards or other life forms that would eat them, with control over what gets in and what goes out. All LoE has cell membranes formed from a double layer of compounds called phospholipids, but the kinds of phosopholipids in the membranes of archaea are different from those in bacteria. (Eukaryotic membranes are more like archaeal membranes, which is why it seems probable that the Eukaryotic cell arose from an archaean enclosing symbiotic bacteria.) Because the two early domains of life have different membrane lipids, it may be that the membranes arose after the rest of the system was in place. If this is so, it demands that we explain how the biochemical system was enclosed and protected before the development of the cell membrane.

Second, you need peptides. These are strings of subunits called amino acids. Very long ones are called proteins. (Chemicals consisting of such strings of sub-units are called polymers.) Depending on the sequence of amino acids, the proteins fold in complicated ways in solution to make all sorts of shapes. Proteins constitute basic structural elements of cells; catalyze (i.e., cause to happen or greatly accelerate) various chemical reactions including those involving other proteins, DNA and RNA; proteins and shorter peptides carry signals within and between cells; and basically carry out the business of life. There are hundreds of kinds of amino acids in the universe, but only 20 occur in LoE and make up biological peptides.

Third, of course, you need genetic information stored in the form of DNA. DNA, as you probably know, consists of two very long strands made out of four kinds of units called nucleotides, named Adenine, Cytosine, Guanine, and Thymine -- A,C,G,T. A binds with C, and G binds with T, so the sequence of one strand determines the sequence of the other. One strand contains the information which specifies the structure of the proteins - in a code consisting of three "letter" units of A,C,G, and T, which specify amino acids -- and the complementary strand is essential to reproduction of the DNA.

Fourth, you need the mechanism of transcribing proteins from DNA, which is carried out by three forms of RNA, called messenger, transfer, and ribosomal RNA. RNA is like a single strand of DNA. (Thymine happens to be replaced by the molecule Uracil, probably due to some ancient accident, but it scarcely matters. U, like T, binds with G.) Messenger RNA is assembled by "reading" its sequence off part of an active strand of DNA -- and proteins do the business of activating the strand and separating it from its complement so it can be read, so as you can see there are all sorts of complicated feedback loops. In the ribosome, a structure made of RNA, proteins are assembled by transfer RNA, which consists of small pieces with just three nucleotides, corresponding to the code for an amino acid. Each piece of transfer RNA binds to the appropriate amino acid, so, as the transfer RNA lines up along the strand of messenger RNA, the amino acids are assembled in the correct sequence to make a protein.

Whew. This is all very complicated. Every living thing works this way, however, using the same DNA code, the same RNA, the same 20 amino acids -- although, as I have said, there are two basic kinds of cell membranes. So we conclude that every living thing has a common ancestor. The Last Common Ancestor, a single cell, or perhaps a biological system enclosed in some other sort of cavity, whose descendants sallied forth and conquered the earth. How do we know all this? We learned it by studying nature, by looking very hard at reality. You won't find it in ancient books because people in ancient times didn't know as much as we do now. Learning more over time is called growing up.

How do you get the LCA in a few tens of millions of years, from a warm ocean and an atmosphere full of methane and carbon dioxide? Stay tuned.

Lies, damn lies . . .

Peter Gotzsche in the BMJ confirms something that I've always sorta kinda noticed, but every time I just got annoyed and figured it was an anomalous screwup, without putting together that it was actually fairly typical.

A while back I bored everybody with a discussion of the concept of statistical significance. Check it out if you are really interested in a statistical primer. It's a term everybody has heard a million times but most people, I would venture to say, don't know what it means. In a pistachio shell (and this statement is imprecise but it's all that will fit) it is the probability that an observed difference between two groups taken as samples from a larger population is due to chance alone, instead of some real difference between the groups. It's called the P value. P=.05 means there is a 5% probability the difference just comes from randomly picking people in group A who happen to be different from people in group B, as opposed to representing an effect of the variable which distinguishes the two groups, and that you are trying to study.

For some reason, the hive mind decided at some point before I was born to call any P value less than or equal to .05 "statistically significant," and any value greater than that "not statistically significant." In other words, if a study shows there is a 94% chance that talking on a cellphone causes brain cancer, the author is supposed to conclude that talking on a cellphone does not cause brain cancer. (I kid you not.) On the other hand, if it's a large study, a result that is statistically significant could nevertheless represent a very tiny difference, one that nobody would really care about, even though it's "significant."

There are more problems. If you make several comparisons, chances are that one of them will appear to be statistically significant (i.e., P < .05) just by chance. As Gotzsche points out, if you make 200 comparisons in which there is, in fact, no real association, you will get at least one "significant" P value 99.996% of the time, which is awfully close to always.

Well, it turns out, according Gotzche's review of published studies, that in abstracts of clinical trials, a significant P value for relative risk was the first result reported 70% of the time; and 84% of the time in both cohort and case-control studies. (In a clinical trial, you assign people to at least two different groups, hopefully randomly, one of which gets a treatment and the other doesn't; in a cohort study, you follow groups of people who happen to be different in some way over time; and in a case-control study, you match people who have some condition with people who don't, and look for differences in their pasts that might account for it. Again, imprecisely and in a pistachio shell.) Even higher percentages of abstracts gave at least one significant result (i.e., counting not just the first result reported).

Also, there were lots of studies that had P values at or just under .05, but hardly any that had values just above .05.

There are a whole lot of problems with this. First of all, an ethical requirement for conducting clinical trials is called "equipoise" -- you have to really not know whether condition A is better than condition B. Therefore, significant results should not be found in such a high proportion of trials, there should be lots of "negative" findings as well. The high percentage of significant results is even more surprising given the small size of most trials -- the chances of finding a significant result go up with sample size.

Second, most of the studies included multiple comparisons, but no attempt was made to correct for this. If you fish around in data, comparing various sub-groups (just the women, just the people under 40, just the Latinos, etc., and mixing and matching) you will almost always be able to find some statistically significant results -- but again, the P value in such cases is essentially meaningless because it doesn't reflect the true probability of a real difference.

Third, in observational (cohort and case control) studies it is common to construct multivariate models. If you fool around with the "control" variables, you can pretty much always get some sort of a significant result to come out. This is not exactly the same idea as the second point, but it's analogous.

Fourth, since in observational studies the groups are not randomly selected, they are bound to be different in some ways other than the variable you are looking at, and if you have a large enough sample size, you will just about always have a significant result. (People who use cell phones a lot are bound to be different from people who don't in other ways as well -- so how do you know it's really the cell phones that are causing cancer after all?)

Fifth, it's pretty weird that you have a lot of P values just under .05, and hardly any just above. The proportion ought to be about equal. Gotzsche doesn't quite connect the dots, but the explanation for this is probably some combination of publication bias ("negative" findings are less likely to get published); cherry picking of results by authors, guided by the arbitrary .05 standard; and fudging or torturing of data to get the P under .05.

Sixth, when Gotzsche did his own calculations, he found that a lot of the published results were just plain wrong.

He concludes: "Significant results in abstracts are common but should generally be disbelieved."

What he doesn't quite get around to pointing out is that in most published biomedical research, the point is to evaluate the effectiveness of some drug or treatment. We should conclude that the literature consistently, systemically, relentlessly, overstates the effectiveness of treatments.

Yup.

Autonomy and Beneficence

I'm going to take a brief break from the ongoing series about Life On Earth and get back to the main business here. One reason is that my next assignment -- about the origin of life -- turned out to be a tough one when I actually tried to do it as a blog post. I'm working on it, it may have to be split into two or more pieces.

Meanwhile, I want to talk a bit about the question of the autonomy of the person as patient. Until the mid 20th Century, the generally accepted relationship between physicians and patients in the West was of a nature now characterized as "benevolent paternalism." The expertise and wisdom to choose the appropriate treatment of disease resided entirely with the physician. The patient's role was to trust the physician and to follow "doctor's orders" --a condition analogous to childish dependency.

That's all changed. Now we are expected to have a partnership with our doctors. They have biomedical expertise, which they are supposed to share with us, so that we can make informed choices about our own treatment. They are supposed to tell us the risks and benefits of proposed treatments, of alternatives, and of doing nothing. Then, based on our tolerance for risk, aversion to disease symptoms or drug side effects, lifestyle, etc., we're supposed to decide what is best for us.

Right. As in "Riiiiiiiiiight." Research shows that in routine prescribing situations, nothing like that happens. Typically, the doctor says, "Here's a prescription, take this." In the case of serious or chronic diseases, there is typically more discussion, but how much do people really understand of the considerations that go into the physician's recommendations? And how do people really make decisions about their own treatment in complicated and serious situations?

I started the whole thread on evolution precisely because of this problem. I interviewed people living with HIV about their treatment decision making,* and it turns out that most of them thought of themselves as making their own decisions, but they had very little understanding of the biomedical reasoning that should have been important in making those decisions.

Well, the funders for this study weren't the NIH or another typical research sponsor that doesn't get involved in the findings and publications. It was funded by a state agency whose director got mad at me for pointing out, in my report, that some of the ideas respondents had were not exactly scientifically sound. For example, one woman said that she hadn't been able to understand the concept of viral load until some guy told her that "it's like how many babies the mother virus is having. Now I feel like I understand it." Another respondent told me that she was holding off on taking antiretrovirals because she had liver damage, but she was taking one AZT per day so her body would be "ready" when it came to start a full regimen. (That is actually the absolutely worst thing she could be doing -- and her doctor is evidently a quack.) Another said she had to stay away from the kitty litter because of "toxic gases." Actually, her doctor had probably warned her about toxoplasmosis, a fungal infection.

Supposedly, according to the Comish, it is against the "parameters" of qualitative research to say that the respondent is "wrong," and it was "punitive" for me to point out that these ideas were unscientific. Here is part of my response:

HIV infection is a biomedically defined condition. HIV, and all viruses, are entities known only to biomedical science, which are understood and defined only in biomedical terms. The only reason anyone believes such things as viruses exist is because scientists say they do. Until this century, no-one had ever heard of a virus. The only reason our respondents believed themselves to be HIV infected was because they have been told so by someone reporting the results of a laboratory test, and all of our respondents had had that information confirmed by one or more licensed allopathic medical doctors. Homeopaths, naturopaths, and Foucaultian philosophers do not make diagnoses of HIV infection.

Furthermore, the antiretroviral treatments which most of our respondents were taking . . . are legally obtained only by a prescription from a licensed medical doctor. They were developed in scientific laboratories using biomedical theories of viral replication and disease processes. In prescribing them, physicians rely on data and consensus guidelines developed by other physicians and biomedical researchers on the basis of biomedical scientific theories. There are people who do not believe that HIV is the cause of AIDS, and who do not believe that these drugs are effective or work in the way their manufacturers claim they do -- but these people do not prescribe such drugs or advocate their use. . . .

The information and understanding which our respondents were attempting to gain for themselves was scientific understanding. They were not operating within alternative belief systems -- they were trying to understand the scientific theories of HIV disease and treatments. These were the terms which they had accepted, not terms which I imposed on them. Since there is no justification I know of for taking protease inhibitors or reverse transcriptase inhibitors other than biomedical knowledge (in the sociological sense in which other "knowledges" are also possible), then it follows that if people are to make an informed, autonomous decision about taking these particular medications, they need information that is consistent with biomedical information. If they do not have it, then it is appropriate to point that out. There is nothing judgmental or "punitive" about doing so.

Here is the problem though. In the real world, it is still the case that most people don't have that information. But doctors are pretty well convinced that they know what is best for their patients. Therefore, doctors as a rule don't fully disclose information about side effects to patients, or present the arguments against the treatments the doctors prefer. They fear, with considerable justification, that if they do so, the patients will choose not to follow the course the doctor has decided upon -- not because they are truly making an informed choice, but because they will misinterpret or misapply the little bit of information they get.

According to standard doctrine of medical ethics, doctors have four obligations to their patients, headlined non-malificence, beneficence, autonomy, and respect for persons. Do no harm, do good, allow patients to control their own lives and bodies (the basis for the doctrine of informed consent or informed choice), and do not use people as a means to ends they have not chosen. But these principles often come into conflict. In particular, the principles of beneficence and autonomy are in constant conflict for physicians. This conflict is probably inherent in the nature of expertise. It can only be managed, and reduced through the democratization of science.

*Actually, interviews were mostly done by my very talented staff.

For those who may be interested

I got this from our friends at the Community HIV/AIDS Mobilization Project (CHAMP). Sounds like it may get lively.

TimeToDeliver.org is an independent, uncensored blog project at the International AIDS Conference being held August 13-18 in Toronto, Canada. The blog will go live on August 8.

TimeToDeliver.org will provide highlights from conference sessions and related events, bring reports and materials from direct actions, rallies and community efforts, and talk back to coverage of the conference. We will expose misinformation and hypocrisy, promote open debate, and bring the real voices and images of people with HIV and allies at the conference through multimedia postings.

The blog will be open to public posting and comment. It will include coverage on:
-- United States domestic and global policies
-- prevention research and policies:
including funding issues, HIV testing, prevention technologies, and links between prevention and treatment
-- discrimination and stigma as not just individual attitudes but as promoted by public policies and programs
-- drug users issues and research
-- jails, prisons and the system of incarceration
-- racial justice
-- women living with HIV
-- gay men and other men who have sex with men
-- youth

TimeToDeliver.org is a blog by and for AIDS activist, who know that there is no debate on whether HIV is the cause of AIDS. This is not and will not be forum for AIDS denialists. For more information, see AIDSTruth.org

TimeToDeliver.org is sponsored by the Community HIV/AIDS Mobilization Project (CHAMP) and Harm Reduction Coalition, but our contributors are solely responsible for their content.

It's already up and running. Comments, it turns out, are in fact moderated, so I don't know about the "uncensored" part. But hopefully they're just checking for spam.

Weekly Vocabulary Builder

terrorist (ter' ər ist), n 1. A person who commits violence in pursuit of political goals we oppose.

hero (hē' rō) n 1. A person who commits violence in pursuit of political goals we favor.

Bonus questions: Who are "we"? How do "we" decide which goals we favor, and which goals "we" oppose?

Proposals for alternative definitions are welcome. These are the best ones I could come up with.

Some Responses

Several people made comments on my recent posts about evolution that I feel are worthy of response in a top level post. So here goes. intgonnatakitnomore asks:

are you alive? what does that mean? are you aware? how does that work? do you wake up every day the same person as before you went to sleep? are you intelligent? are you emotional? are you human? what is that? do you believe anything other than what you trust that you see? I too can see how the hypothesis of evolution might work. Is it testable on the macroscopic scale? Why does something exists instead of nothing? If you are alive as a result of a cause / effect relationship that started from nothing and according to quantum mechanics could have resulted in any number of outcomes, each with a given but unknown probability, then how do you justify your place in this world. How do you justify what you believe that you know for sure. I guess that's enough to get you thinking beyond the spoonfed obvious.

That's probably too many questions to answer all at once, actually, but I think the correspondent is mostly invoking three major problems. The first is the problem of consciousness. ("Are you aware? How does that work?") Consciousness is indeed a profound mystery and it seems to me entirely possible that it will remain, for the foreseeable future if not forever, at best on the border and arguably outside the realm of scientific explanation. The main reason is that we have to depend entirely on self-reports in order to describe and measure it. Our consciousness belongs exclusively to each of us, and is detectable to others only to the extent they are willing to believe what we say about it. Nobody else can perceive my consciousness directly. That is all worthy of pondering. So, what is the point vis a vis evolution?

The second problem invoked by Mr. or Ms. takitnomore is the fundamental epistemological problem. How do we "know" anything? Of course that applies to religious explanations too. The scientist's response is essentially pragmatic. We accept truth only on a provisional basis, insofar as our theories a) make testable predictions which turn out to be vindicated, and b) our observations can be shared by others and come out the same no matter who is looking -- or at least for the vast majority. (The problem of people who are psychotic, or have sensory disturbances, or are just too stubborn to see what others see can't go away completely, but we deal with it in science in more or less the same way we do in everyday life.) The degree to which we are certain about any proposition increases as it holds up to more and more tests. For example, Copernicus's proposition that the planets revolve about the sun was used to predict that if you sent a robot into space on a trajectory calculated in accordance with the Copernican model of the solar system and Newton's laws of gravitation, it could go into orbit around Venus or land on Mars, and take pictures. It worked! That's pretty convincing to me.

The third takitnomore problem is the problem of meaning. How do I "justify" my place in the world. I don't. Why should I have to? Here I am. Nah nah nah nah nah. What it means to me is up to me. What it means to you is up to you.

Ken says:

i believe evolution is part of God's plan, like karma and photosynthesis. still, your charming description of the leap from prok to euk reminds me of one of those myths where the sun and the moon got it on and peopled the earth. like einstein said, "imagination is more important than knowledge".

I can't stop anybody from believing that evolution is part of God's plan. But, in the first place, it isn't clear what that means -- you have to define God. If you mean the God of the Torah or Old Testament, there is certainly no evidence for that, and in fact, the Bible argues clearly and convincingly against it, since it tells a story of creation which is not consistent with evolution. If you mean some intelligent entity, I can't rule it out, but there is no reason to suppose so and certainly no need to invoke intent or intelligence to explain evolution. If you think that God is the whole universe or something like that, you're just redefining the word. Okay if you want to do that, not sure what the point would be. The evolutionary origin of the eukaryotes is not comparable to myth. It's a deduction from evidence.

Armen writes:

I'd have to disagree with your hope in the theory of evolution. Surely you don't really believe that continual steps in micro evolution can lead to macro evolution? It's impossible!

Not much of an argument, there obviously, but Armen is referring to the fall-back position creationists have recently adopted. Since the evolution of drug resistant pathogens, laboratory experiments, and natural history observations have now indisputably proved that Darwinian evolution does indeed happen and is happening on earth right now, they have conceded the existence of something they call "micro evolution." This doesn't exactly mean anything, it's just a semantic trick that can be translated as "yabbut just because evolution is real and is happening, that doesn't prove that evolution explains the diversity of life on earth." Well no, it doesn't, but it sure doesn't hurt. The rest of the overwhelming proof is now better than ever.

Eric writes:

Here's the rub: DNA is information. I don't know anyone who seriously denies that. However, if that is true, then information has to imply an "Informer." While 'design' does not have necessarily imply a "Designer," information clearly requires an intelligence.

Not at all. If I see footprints in the sand, I can deduce that a bobcat walked on the beach. That's information, but no intelligence put it there. If I see lightning, I know to expect thunder. Technically speaking, the concept of "information" corresponds to the degree of order in a system, or put another way, it refers to "non-randomness." Lightning contains the information that thunder is coming because the workings of the atmosphere are non-random. There are orderly, describable mechanisms which produce lightning, and they inevitably also produce thunder. The second law of thermodynamics says that the universe moves relentlessly to greater disorder over time. However, the earth is not a closed system. The sun continually pumps in energy. This produces highly ordered events such as thunder and lightning. It also means that that the biosphere, over the eons, has developed counterentropically. Its information content has increased, in part in the form of DNA. No intelligence or intent is needed to explain this.

I love science asks:

Why is the idea that an intelligent being was involved in ordering the universe unscientific in theory?

and

Why does God have to come from somewhere?

The idea that an intelligent being was involved in ordering the universe is not unscientific. If you can show me evidence for it, I'll consider it. So far, nobody has.

"Why does God have to come from somewhere?" Why not? If you don't need to explain God, you don't need to explain anything. Saying, "God did it, and I don't have to explain God," is just giving up. It's saying you have no need for understanding, you don't want to know anything, and you don't care about truth or meaning. If that's how you feel, there's nothing else I can say to you.

So, that's it for now. Keep those cards and letters coming, folks.

The Deep

In ancient times, people looked up at the sky and it appeared that the sun, moon and stars were revolving about them. The ancient Greeks studied the heavens more closely and noticed that, along with the sun and moon which wandered among the apparently fixed stars, there were a few stars that also wandered. Based on the geocentric assumption, Ptolemy devised a mechanical model of the universe in which the heavenly bodies were embedded in crystal spheres, rotating about the center of the earth. (By the way, the Greeks were well aware that the earth was spherical, and even produced a very accurate estimate of its diameter.) Obviously, something must keep the heavenly bodies from falling to the earth as everything does, but that something must be invisible, so crystalline spheres seemed to do the trick.

Over the ensuing centuries, closer observations of the planets challenged Ptolemy's model. They would acclerate and decelerate, even briefly reverse direction. The solution was to make the centers of their spheres themselves rotate about other centers, rather than being fixed. Even these solutions failed upon more exact measurements, and so the epicycles needed epi-epi-cycles of their own.

In 1514 the Polish mathematician Nicolas Copernicus gave a handwritten book to a few of his friends. In it he declared seven of what he called "axioms," though they are in fact deductions:

There is no one centre in the universe.
#
The Earth's centre is not the centre of the universe.
#
The centre of the universe [i.e., solar system] is near the sun.
#
The distance from the Earth to the sun is imperceptible compared with the distance to the stars.
#
The rotation of the Earth accounts for the apparent daily rotation of the stars.
#
The apparent annual cycle of movements of the sun is caused by the Earth revolving round it.
#
The apparent retrograde motion of the planets is caused by the motion of the Earth from which one observes.

In 1543, shortly before his death, he published the full elucidation of his theory under the title "On the Revolutions of the Heavenly Bodies." He had deduced a much simpler explanation of astronomical observations than Ptolemy's.

Galileo then used a new invention, the telescope, to make observations which conclusively proved the theories of Copernicus. For example, he observed the phases of Venus, which demonstrated that it revolves around the sun. He also discovered moons of Jupiter, which would have smashed its crystalline sphere, although neither he nor Copernicus had any way of explaining what else held the heavenly bodies aloft.

As we know, the Pope and his lieutenants refused to look through the telescope. They threatened to torture Galileo to death, in the name of Christ, if he continued to defend the Copernican system, and he relented. But the truth could not be denied. Kepler improved on Copernicus by determining that orbits were not circles, but ellipses. Newton developed a mathematical theory of gravitation which, among other achievements, finally demolished the conception of any "center" of the universe (something which Copernicus had somehow intuited, but not pursued). By the late 19th Century, improved telescopes and observational and analytic methods had made it possible to prove that the stars are trillions of kilometers from the earth, and are objects similar to the sun. By the 1920s, astronomers had determined that the stars occupy a volume a few hundred thousand light years across, the Milky Way galaxy, which they believed constituted the entire cosmos.

Then Edwin Hubble discovered that most of the objects known as nebulae are not, in fact, clouds of gas, but other galaxies beyond our own, millions of light years away. Then he discovered that distant galaxies are moving away from our own at substantial fractions of the speed of light -- that the universe is expanding. From this astonishing revelation, scientists were able to begin to deduce the history of the universe, and to speculate on its ultimate fate.

Our universe -- everything we can observe, that is, although quite possibly not everything that is or has been or may be -- is about 13 1/2 billion years old. The earth came along much later, about 4 1/2 billion years ago. The universe is so vast that there is no referrent to human experience in the distance to even the closest star, while that distance is but a hundred thousandth of the width of the galaxy. The nearest galaxy (other than two satellites of the Milky Way), Andromeda, is almost 3 million light years away.

Here is a portion of an image called the Hubble Deep Field, looking out in space and back in time nearly 12 billion years. This is a tiny piece of the sky, smaller than the end of a pencil held at arms length:














Each of the galaxies in the image -- and the tiny red dots are very distant galaxies -- contains on the order of 200 billion stars (as does our own).


These discoveries have smashed completely, and forever, the biblical cosmos. If there is a sentient creator of the universe, the purpose of the creation cannot have had anything to do with us. The universe is indifferent to our existence. A million galaxies like our own could vanish in an instant, and the universe would go on, not recognizably changed. This is the cosmos that we have discovered with our senses, and our reason, and our wondrous tools. But it is very difficult for most people to accept, and most people do not accept it. Two hundred thousand years of cultural development, of attitudes about the world, of explanation, of belief; the bedrock of the social order in religious authority, the answer to the terror of death and the futility of bereavement, the anchor of purpose; all swept away in a few hundred years, in a devastating avalanche of nearly incomprehensible truth.

It is no wonder that we are experiencing a turning away from reason, and truth, a flight into comforting darkness. Perhaps we have elevated such a limited, willfully ignorant man to our highest office precisely because his limitations are comforting. But the dark ages must be over now. If we are going to survive the challenges ahead of us, we must step out into the light, no matter how painful, and never turn back.

There is still a source of hope, of meaning, and purpose, and social order. That is, or course, humanity -- our astonishing selves. We are on our own, but that does not mean that we cannot find our own meanings, our own purposes, and succeed.

Essential Housekeeping

First of all, I'm very pleased to have so many interesting comments from new visitors. It's great to hear from people who have something to add to what I say, but it's also great to hear from people who don't necessarily agree with me about one issue or another, or who wish to challenge ideas presented here. That's the only reason for doing this -- to promote discussion.

An essential rule for me is that the discussion civil, and respectful, which for the most part it has been. That means commenters need to be respectful to each other as well as to me. For example, it is true that scientists do not believe that people are descended from apes. However, that is a very common misconception and people who hold it are not fools, they've just gotten the wrong information somehow. It's great to point that out -- that's what we're here for, to get the story straight -- but please do it nicely. After all, every one of us has one or another mistaken belief or recollection.

For the record, people are not descended from apes. Rather, chimpanzees and humans share a common ancestor, from which our lines diverged sometime a little more than 5 million years ago. If you go to the zoo and watch the chimpanzees (or the closely related bonobos) our kinship is obvious. Of course there are also many differences, the most important being that we can talk -- and by extension, read and write. That is indeed a remarkable capability, one virtue of which is the existence of this blog. so let's keep doing it.

Second, people may ask why a site devoted to health and health care policy is spending so much time on evolution. The answer is that this discussion arose in the context of health literacy -- by which we mean how well people can learn and understand information that's essential to staying healthy, and to working effectively with their doctors and other health care professionals to make decisions and take action to keep themselves healthy and treat disease.

In this era of drug resistant pathogens, understanding evolution is important very directly and specifically. But it's also important more broadly, because it is the central organizing principle of biology, and you really can't understand biology properly without understanding evolution. It is essential to the health of individuals, and the general well-being of people in society, which we call public health, that people understand biology, psychology, and sociology. Health is generated at the intersection of biology, psychology, and biology. In shorthand, we say that it is a bio-psycho-social phenomenon. Therefore, I talk about all three here. And I also talk about ethics, because we can't think about how to improve public health and welfare if we don't think about right and wrong -- we need an idea of the right, or the good, to define health and welfare and evaluate our means for getting there.

So, here's the plan for the next few days. First, I'm going to repost one of my greatest hits, which is about cosmology, and recounts one of humanity's greatest intellectual voyages. That puts life on earth, and the story of evolution, in context. Next, I'll pause to answer some of the questions and challenges from commenters. (If you're out there waiting for my answer, don't worry, you're on the list.) Then, I'll talk about the origin of life; more on the origin and consequences of sexual reproduction; then more on human evolution and some of the ways in which our evolutionary origins are relevant to some of the important contemporary challenges in public health.

I hope that some of you who are skeptical of all this will stay with us, as well as people who know as much or more about these issues as I do. For the record, I have made a serious study of biology, but my degrees are actually in environmental and social policy. If I make a mistake, I want to be corrected. If people have questions, I want to try to answer them. If people disagree, I want to hear about it.

And thanks for visiting.

It's Hard Work

So where am I going with this? I think that people find evolution hard to accept principally because it only makes sense when you have enough information, enough pieces of the puzzle, to put together the big picture. Our schools aren't giving people enough of those pieces, so the fragments they do hear about just don't make sense to them.

My previous post had a lot of fairly mind boggling information, and it assumes that people already have a lot of background. Some ideas I would venture to say that the large majority of Americans do understand, for example that all life consists of microscopic elements called cells, and that the big things we can see, including us, cosist of vast numbers of cells, while some organisms consist of only a single cell.

But the basic idea of DNA -- that it is a chemical which somehow encodes the instructions for making chemicals essential to life, that in the multicellular organisms, it somehow controls the developmental process that creates the structure of the body and the functioning of its various organs, and that it is sometimes copied imperfectly, making changes in the organism possible over time -- is probably pushing the envelope. (Actually, it's even a bit more complicated than that. Development depends on the interaction between DNA and the cellular environment that unfolds beginning with the zygote, that cell formed from the fusion of the gametes.)

I also invoked events that happened more than a billion years ago. Who can really grasp such a vast extent of time? But appreciating the time scale is essential to the credibility of evolution, because evolution depends on improbable events. Suppose something happens only once in a thousand years. During the lifetime of 95% of humans, it will never occur. But in a million years, it will occur a thousand times, and in a billion years, it will happen a million times.

Finally, I asked people simply to accept the existence of prokaryotic cells. But where did they come from? In fact, they had at least a billion and a half years or so to evolve between the time when the cosmic bombardment of the earth by debris from the formation of the solar system slowed sufficiently for life to exist, and the emergence of the eukaryotes. But how did the whole thing get started? How could life come about from warm, polluted water?*

We don't know, but we do have plausible ideas. As Prospero asked Ariel, "What seest thou else, in the dark backward and abysm of time?" As regular readers know, I don't normally post on Saturdays because I'm busy with a project. But I will return to this thread on Sunday.

*I note that it is only in very recent times, and thanks to science, that people actually started to find this implausible. Just a couple of hundred years ago, it was widely believed that flies developed spontaneously from rotting meat, and that mice appeared de novo in piles of grain.

You Karyote, You

Now that Kansas voters have put the so-called "opponents of evolution,"* as the Boston Globe headline had it, into the minority on the state Board of Education, this seems like a good time to ask why God designed life on earth to look exactly as if it had evolved over billions of years.

The vast majority of living organisms on earth are of a kind called prokaryotes. In fact, there are more prokaryotes living in your colon than there are cells in your body, by a substantial factor. That is possible because prokaryotes are much smaller than your cells, which are called eukaryotic cells. Prokaryotic cells consist of the bacteria which you have no doubt heard of, and the archaea, which resemble bacteria but have differences in their genetic transcription methods and lipid chemistry, and are often found in extreme environments -- very hot, very cold, very acidic, etc. However, some live in our bowels and give off gas that makes us fart. Unlike bacteria, archaea do not cause disease.

The prokaryotes are not only smaller than eukaryotic cells, they are much simpler. They lack the internal structure -- the membrane bound organelles of eukaryotes. Their biochemistry takes place in an undifferentiated soup. They have only a single main strand of DNA, unlike the multiple twinned chromosomes of eukaryotes, although many also have smaller fragments of DNA floating around in rings called plasmids. Our eukaryotic cells store their chromosomes in a central structure called a nucleus. They carry out metabolism in special compartments called mitochondria. Our cousins the plants also have special compartments called chloroplasts which carry out photosynthesis, making sugar from C02 and sunlight -- which is where we ultimately get our own sustenance.

Sadly, prokaryotes never came up with sex, per se. That's a eukaryotic innovation as well. However, it may be that prokaryotes have something even better in some ways -- they can exchange DNA by swapping plasmids, even among different species, and they can even pick up plasmids from dead cells. So they have all sorts of opportunities for picking up genetic information that we don't. On the other hand, without the patterned inheritance of sex, they have never been able to generate the informational complexity and developmental processes needed to create multicellular organisms. The closest they come is aggregations of slime, basically.

But here's the kicker. Some time around, oh, a billion years ago or more, there weren't any eukaryotes. But then, according to one possible scenario, one cell, presumably a large one as prokaryotes go, most likely an archaea, ingested another cell, probably of a kind called a proteobacterium, but didn't manage to digest it. Instead the proteobacterium started living and reproducing inside the big cell, and its progeny went along with the larger cell's descendants when it divided. Whether immediately or after a period of co-evolution, these two organisms developed a symbiotic relationship that benefited both. Today, the descendants of the proteobacterium live in our own cells, as the organelles called mitochondria. On some other occasion, apparently at around the same time (in geological terms, i.e. within a few millions or tens of millions of years) one of these double organisms developed a second symbiosis, with a type of prokaryote called a cyanobacterium, which is capable of photosynthesis, and its descendants became the chloroplasts of plants. It is possible, though probably less than 50/50, that a similar event created the nucleus of the eukaryotic cell.

Very soon after they originated, eukaryotes began to, ahh, do it. For early sexually reproducing organisms, however, that wasn't actually any fun. In the normal method of reproduction of a single cell, in the case of those fancy new eukaryotes, all of the chromosomes would reproduce themselves, the now four sets of chromosomes would move apart to form two sets of two, and the cell would then divide to form two cells, each with two full sets of chromosomes. (How there got to be two sets in the first place is a mystery, of course, but you need them for sexual reproduction.) In sexual reproduction, however, the chromosomes do not reproduce; they first go through a sort of swap meet in which segments may be exchanged between members of each pair, then the pairs are pulled apart and two new cells form each of which has only one set of chromosomes, instead of the usual two. These unusual cells are called gametes. Two gametes, presumably from different parents, then fuse, to form a new cell with a complete double set of chromosomes.

The mitochondria, by the way, kept their own DNA, and continued to reproduce the old fashioned way, just going along for the ride.

Note that you don't need sex organs, or any organs at all, to do this. Single cells can do it. But why do it? It seems like an awful lot of unnecessary trouble. To understand the point of all this, you need evolution.

More on that later.

* Being an opponent of evolution is sort of like being the cartoon version of King Canute, who purportedly ordered the tide to recede. Actually the original version of the story is that he did so to prove that kings are only human, not that he thought he would succeed.

Wanktastic!

I don't usually take the trouble to deconstruct the sputtering synapses of the wankocracy here -- that's how marquee bloggers draw much of their traffic but I try to stay above it all and set an example of constructive and forward looking discourse. However, I have always made an exception for the slime mold Christopher Hitchens.

The editors of Free Inquiry were evidently on vacation when a temporary office worker accidentally mixed up some whiskey stained waste paper with the package going to the printer. The resulting bizarre insertion (not available on line), like the upside down airplane on the penny postage stamp, will no doubt make this issue a prized collectors' item.

Hitchens awakens from his drunken stupor long enough to notice that an obscure publisher has come out with a compilation of writings by Osama bin Laden, with an introduction by somebody named Bruce Lawrence, a professor of religion. Lawrence, it seems, describes bin Laden as a radical, and, according to Hitchens's selective quotations and paraphrases, apparently describes him as having literary and leadership gifts. It is not clear from Hitchens's synopsis whether Lawrence personally admires bin Laden, or merely wishes to explain why some people do, although Hitchens clearly wants us to believe the former. Whatever the case, based on the existence of this artifact, our profound social critic draws the following conclusion:

"I would not bother to expose these illusions . . . if they were not fairly commonly accepted among liberals. In some ignorant and subliminal way, leftists identify bin Laden with the third-world and anticolonialist policies of, say, Franz Fanon."

Now, I don't know what ideological label people might wish to place on me, and I don't claim any for myself. But I know dozens of people who probably would describe themselves as liberals or leftists if asked, and I read what scores of them write every week. I have never encountered a single one who thinks that Osama bin Laden is anything but an odious criminal.

Hitchens goes on to denounce bin Laden on various grounds, apparently believing that he is somehow distancing himself from those ignorant leftists and liberals in doing so. He asks how anyone can describe bin Laden's expressed goal of creating a neww caliphate as "radical" (although that certainly would seem to accord with the dictionary definition of the term) "and how can anyone describe its victims -- the workers in the World Trade Center, the Dutch filmmaker Theo van Gogh, the Palestinian wedding party in Jordan [etc.] as 'powerful wrongdoers'? Yet garbage like this is spouted from all over the so-called antiwar movement, which provides excuse-making at its highest level of leadership, from Ramsey Clark to George Galloway to Michael Moore (who described the Zarqawi 'insurgents' in Iraq as the moral equivalent of the minutement of 1776)."

This is all, of course, completely delusional. We can't tell exactly what Hitchens means by the "so-called antiwar movement," but he usually directs his venom at people who condemn the U.S. occupation and invasion of Iraq. That "so-called" movement, according to public opinion polls, now consists of the majority of the people of the United Kingdom and the United States. With the exception of a single obscure professor of ethnic studies at the University of Colorado at Boulder, I have never heard of any person publicly describing victims of al Qaeda as "powerful wrongdoers." I was not aware that any of the three people named are at the "highest level of leadership" of anything, let alone the masses of the people.

Ramsey Clark is a lawyer who has taken to defending highly unpopular people, notably Saddam Hussein. I don't know what he thinks of Osama bin Laden, but he is not the leader of any organization or any group of people. He's just a slightly nutty old guy that most people have never heard of.

George Galloway is a member of Parliament who represents a district in London with a historically unconventional electorate. He is known for having opposed the sanctions on the Saddam Hussein regime, and later the Anglo-American invasion, and has been accused of gaining financially from the Saddam regime, althhough he denies it. He has also bitterly criticized Saddam for suppression of democratic rights, and opposed Anglo-American support for Saddam in the Iraq-Iran war. As far as I have been able to determine, he has never uttered the slightest praise for Osama bin Laden, and as a secular socialist presumably has only opprobrium for him. He leads a tiny leftist party in the UK.

Michael Moore is a filmmaker whose work some people enjoy. He does not lead any organization or movement. His comparison with the minutement was not, as Hitchens fraudulently states, applied to Abu Musab al Zarqawi and his organization, but to the secular Iraqi resistance to the U.S. occupation. Whether or not one finds it apt, it has nothing whatever to do with Osama bin Laden.

Hitchens is, of course, simply aping the Rovian trick of pretending that Saddam Hussein and Osama bin Laden are, in fact, one and the same person (ever see them together?) and that opposition to the war in Iraq equates with love for bin Laden. Such slanderous fabulism has no place in the pages of Free Inquiry, nor should anyone pay the slightest attention to Christopher Hitchens. What a waste it is to lose your mind.

Reporting for Duty?

John Kerry, whose last campaign for president fell short because he was for the war before he was still for it even though he was kind of against it except that he wasn't really, has an equally bold plan to bring about universal health insurance by 2012. His plan? Implement a few half-assed measures such as increasing Medicaid reimbursement to the states and letting people buy into the federal employees health program. If that doesn't (i.e., inasmuch as it won't) bring about universal coverage by 2012, then we should do something about it. Or, as the visionary, plain spoken champion of the people fearlessly proclaimed, "The coverage guarantee would come through some form of a government mandate, Kerry said, though he added that it's too soon to say how that would happen."

Now that we've settled that thorny issue of public policy, all that's left is to mop up the easy ones, like for instance building a genuine opposition party in the United States. It's a beautiful dream, anyway.

This obviously doesn't apply to you

As readers have undoubtedly noticed, the leading medical journals are starting to make more content free to non-subscribers. The cynical view -- i.e. the correct one -- is that they are hoping to mollify the critics cheaply; they still keep most of the good stuff behind the wall. Anyhow, I have to take what they'll give me so here's an essay in the new NEJM by Erin N. Marcus about illiteracy and health.

Actually she tends to conflate general illiteracy -- limited ability to read -- with health illiteracy, which may affect people who can read some kinds of materials but who have trouble with specialized medical concepts or vocabulary. As Marcus notes, according to a large scale study about 14% of U.S. adults lack even basic literacy skills. Obviously, they can't read medication labels or the informational brochures the doctor hands you.

In my own research, however, I have found that many people who are perfectly well able to read the Boston Herald or a Tom Clancy novel lack basic knowledge of biology and as a result can't communicate effectively with their physicians. Of course their doctors are utterly obvlivious to this problem.

For example, I have interviewd dozens of people with HIV. One woman, who was smart, articulate, and professionally employed, told me that she couldn't understand what "viral load" meant until somebody explained to her that it's "how many baby viruses the mother virus is having." Now she felt she understood it. Most of the people I interviewed didn't understand the concept of viral drug resistance -- they thought that it meant that their bodies would become resistant to the drugs. Out of 60 people who we interviewed for one study, exactly one understood that drug resistance resulted from Darwinian evolution, and could explain how it worked.

This information isn't just for fun, either -- it is absolutely critical for people living with HIV, so they can understand the importance of strict adherence to medication regimens and avoiding re-infection or re-transmission of the virus, even with partners who are already infected. As a matter of fact, I wonder whether all of my readers feel comfortable that they fully understand all of these concepts. Should I explain them here?

How many people understand the basic design of the eurkaryotic cell -- or even know that there is such a thing? How many people really comprehend what DNA is or why it is important? Without this knowledge, you can't understand cancer, for example. So let me add that to the poll -- are there readers out there who aren't completely sure they know what eukaryote means?

I find myself in a minority, but it really offends me that many health care providers and health educators try to jury rig a solution to this problem by talking to patients in metaphors. For example, one man told me that his doctor had told him to think of the virus as "enemy soldiers" and his meds as "our soldiers." We have to keep as many soldiers in the field as the enemy or the enemy will gain territory. Actually, military metaphors are very popular in medicine.

These metaphors are misleading and patronizing, as far as I'm concerned. People deserve to have access to scientifically accurate information. We need to work harder to get it to them. Anybody who can find his or her way to the doctor's office is capable of understanding basic ideas of biology, they've just never had them explained properly. And the place to begin, obviously, is by teaching biology in school, and that means teaching evolution. Evolution, in the era of drug resistant pathogens, is life and death to us all. Actually, it is our life. It's our essence. Denying children knowledge of evolution is child abuse.

Belief

A basic requirement for scientific belief is intersubjectivity. We need to all be able to look at the same evidence and agree on what we are seeing. While some people have looked at scientists as a kind of new priesthood, this is a highly imperfect analogy. Priests claim to have a private channel of communication with the truth. Scientists may depend on expertise that few people share, and some of them, who work for private industry or military agencies, may try to keep secrets, but ultimately, widespread acceptance of scientific belief depends on accessibility and public demonstration of its explanatory power.

Many people fervently support George W. Bush because he describes himself as a Christian and says that he is guided in his conduct of office by Christian belief. He goes further than that: he claims to take his orders directly from God. He told Palestinian President Mahmoud Abbas "God told me to strike at al Qaida and I struck them, and then he instructed me to strike at Saddam, which I did, and now I am determined to solve the problem in the Middle East." Unfortunately the original report is no longer available on-line, but he later told a group of Amish that "I trust God speaks through me. Without that, I couldn’t do my job."

The problem for me is that I don't have the opportunity to listen in on these conversations. Evidently God told Bush to oppose a cease fire in Lebanon, so that Israel would have the opportunity to continue creating a new Middle East. God's will is evident in this picture from Qana.

A man cries next to dead bodies after Israeli air strikes on the southern Lebanese village of Qana. At least 51 people have been killed, many of them children, in an Israeli air blitz on the Lebanese village of Qana, triggering outrage across the region and warnings of retribution for Israel's "war crime."(AFP/Nicolas Asfouri)


Now, quite possibly God is telling you something different. But why should I believe that either? I stopped listening a long time ago. So should everybody else.

Culture of Life

You know, having someone harm your child is one of the worst nightmares a parent could face. . . .Protecting our children is our solemn responsibility. It's what we must do. When a child's life or innocence is taken it is a terrible loss -- it's an act of unforgivable cruelty. Our society has a duty to protect our children from exploitation and danger.

George W. Bush, July 27, 2006.

A terrorist killed by an Israeli bomb in Lebanon.















Another dead terrorist.






















More dead terrorists.












By JENNIFER LOVEN, Associated Press Writer

WASHINGTON July 27, 2006-
President Bush declined Thursday to criticize
Israel's tactics in its continuing offensive against Hezbollah guerrillas in southern Lebanon,

Now here's an adverse effect I hadn't thought of before

According to a report in Radiology Journal, discussed here by the BBC, increasing numbers of Americans are too fat to fit into imaging machines. Also, more and more people are so fat that they can't be scanned by ultrasound because the fat blocks the sound waves. So, they are likely to have cardiovascular disease, but the doctors can't image your coronary arteries to see where the blockages are.

You may also have read about a new report in JAMA (subscription only, natch, but here's the abstract) which found that people who acquire Type 2 diabetes as children had about 5 times the risk of end-stage renal disease as people who became diabetic as adults; and 3 times the death rate before age 55 as non-diabetic people. I would call this another open door crashed through, but sometimes it takes the hard facts to get people's attention.

The good news is that this study is one of a series of studies on diabetes that have been conducted among the Pima Indians of what is now Arizona, and that the Pima may be showing the way to preventing overweight and diabetes. The Pima, like Native Americans generally, are at high risk for Type 2 diabetes -- but only in the modern era. Their genetic heritage, forged in an environment of scarcity, is particularly unsuited to conditions in industrial society. In a pilot study with 95 Pima, many succeeded in adopting a traditional diet and lifestyle, and the intervention shows real promise. A larger study involving additional Indian tribes is now underway. Perhaps the real Americans can save some of us illegal immigrants from ourselves.

Yeah, I'm worried

And really, really pissed off. I try to stick to subjects I know something about here -- unlike the vast majority of pundits and politicians. Well, I happen to know something about the Middle East. Without boring you with the details, I have a long history of involvement with activism around Middle East issues and in fact I once made my living in the field.

The people in control in this country are nuts, delusional, horribly dangerous. There are exactly two nations on earth opposing an immediate cease fire in Lebanon: the U.S. and Israel. The U.S. leadership apparently sincerely believes that it can get its way in the Middle East by means of force and violence, and that the violence going on right now is beneficial to its ends. Whether the Israelis also believe this, or are simply trapped in the logic of the situation they created,* is not clear. I won't try to analyze their thinking. I'm also not going to offer a superfluous analysis of the whole thing. I recommend Billmon and Juan Cole as obvious starting places.

What I will say is that it is very obvious that the elite classes in the U.S. -- and that includes most Democratic politicians, news analysts, and even investors -- have not grasped the danger of a wider war, and the terrible consequences. There are many ways in which the violence could expand -- not that it isn't bad enough as it is -- some of which have nothing directly to do with Israel or Hezbollah, all of which would reveal the grotesque and deranged position of the United States.

For example, Turkey might see this as an opportunity to deal with the PKK in Iraqi Kurdistan -- whereupon sovereign Iraq would be technically be at war with a NATO country, although in reality Kurdistan is already independent. The chattering classes also seem unaware that Nuri al-Maliki, the Prime Minister of Iraq, who depends for every breath he takes on the 4th Infantry Division based at Fort Hood, Texas, is head of the Dawa Party, which was instrumental in creating Hezbollah and Islamic Jihad. He spent much of his exile as Dawa bureau chief in Damascus, now a new, honorary member of the Axis of Evil, where he was no doubt intimately involved in the development of Hezbollah. And he's addressing Congress this morning as a symbol of our triumphant liberation of Iraq. This is insane.

*Yes, yes, Hezbollah kidnapped two soldiers. Israel then destroyed the Beirut airport, all of Lebanon's major highways and bridges, and blew up a couple of hundred children, among other actions taken in self-defense. They have had a plan to do this for years. They just needed a pretext. That is on the public record. And no, Hezbollah did not start launching rockets until after Israel started bombing, although you frequently hear the opposite in American news accounts.

Just say no?

We can't, and shouldn't, just say no to drugs. It makes a lot of sense to take some drugs, under some circumstances. Surgery without antibiotics, for example, would be a very bad idea. So would treating pneumonia with chicken soup. It is pretty clear that for people who have heart disease and have had coronary events, taking drugs such as statins and ACE inhibitors prolongs life, and it is at least a reasonable decision for people who have established risk factors for heart disease to take such drugs. And so forth.

However, it is often -- no, I'll say usually -- the case that sorting out whether it is in a particular person's interest to take a particular drug at a particular time is very difficult. It may well be a matter of judgment with no clear answer. It's often a bad idea, even a very bad idea, but it's easy for prescriber and patient not to know it. Here are some of the reasons.

First of all, drug trials are designed to show that drugs do good; they generally aren't designed to detect or establish harmful effects. There are at least four problems here, two of which are fundamental philosophical difficulties (FPDs).

1. Since we can't generally predict in advance what harms might be caused by a drug, we don't even collect data on all possible adverse effects during a clinical trial. We couldn't if we wanted to, since the possibilities are unlimited. We will keep track of deaths and events of major clinical significance, but we can't measure every possible biological parameter that might be adverse, but doesn't produce immediately noticeable symptoms.
   
2. Clinical trials used to establish safety and efficacy usually don't go on for very long -- seldom more than six months. It often takes longer than that for adverse effects to emerge.
   
3. Here's an FPD: tests of statistical significance depend on specifying end points in advance. We want to prove that Rebleckafecklameckla* lowers blood pressure, and we note a difference between the treatment group and the control group which is too large to have arisen by chance. There are bound to be innumerable other differences between the two groups, just by coincidence, but we can't establish p values for them because if you make ten or more comparisons, you're likely to get at least one spurious association.
   
4. Here's another. The study is sufficiently "powered" - i.e. has enough participants -- to detect the clinically important effect we're looking for. But there might be adverse effects which are relatively uncommon, which the study is too small to detect, but which are serious enough to outweight the benefits, even if they are rare. I.e., Vioxx relieves pain very reliably, but so do lots of drugs. It also occasionally kills you, which many of the alternatives are less likely to do, but the study was too small to prove that. (Actually it wasn't, but the drug company didn't want to interpret it that way. Which is another problem, I suppose.)

So, evidence of adverse effects typically emerges only after a drug is approved and used in thousands or millions of people. But then we aren't doing controlled studies of its effects. If we start to get reports that people taking Rebleckafecklameckla are developing excessive nose hair, is that really an effect of the drug or are people just attributing it to the drug because they happen to be taking it?

But it gets even more complicated. Drugs may be risky for some people but not others, depending on factors such as what other drugs you're already taking and any number of medical conditions. With 7,000 drugs the number of possible interactions is astronomical. Doctors can't possibly keep track of all the counterindications, cautions and interactions, and for patients to truly make informed choice about taking drugs is, quite frankly, a totally unrealistic goal. And, of course, what we know about adverse effects, counterindications and interactions continually changes, long after drugs and their "labels" (really novelette length essays written in highly technical language) are approved, while it can take years to update the labels.

And, of course, drugs can be very expensive.

So what's a person to do? I say, the best you can do is to be conservative about taking medications -- if not doing it seems like a reasonable choice, it's probably the right one. Ask questions. Read that damn package insert. Check out the info from Consumer Reports on the "best" drugs, or, for a more negative view, check out what Public Citizen has to say about the worst drugs. Of course, a lot of drugs get both ratings. Hmm.

Whatever you do, don't depend on the FDA to protect you. They aren't working for you.

*Obviously I made up the name but they are starting to run out of decent names for drugs, as you may have noticed from their increasing bizarreness.

Can't anybody do anything right around here?

I'm actually not talking about impending World War Last -- I think I'll have to get to that however. I'm talking about the usual subject, doctoring. After a weekend away from the beat, I wake to up to read:

According to a new report by the Institute of Medicine, issued under a Congressional mandate, 1.5 million Americans are harmed or killed by medication errors every year, costing $3.5 billion just in excess medical expenses to treat the injuries, who knows how much in damage to lives and lost income. As a matter of fact, it works out to 1 error per hospitalized person per day, plus innumerably more errors that happen in outpatient settings. In other words, when the nurse shows up with the little cup of pills, it's probably about an even bet whether the right stuff is in there. (As I said in an earlier post about health care quality, they can't even get it together to give an aspirin to somebody who comes in with a heart attack? What gives here?)

The ever more popular stomach reduction surgery results in substantial complications for 4 out of 10 patients within six months, according to the Agency for Healthcare Research and Quality. And I don't just mean a tummy ache -- we're talking infections, pneumonia, respiratory failure, and uhh, a minor thing like gastric juices leaking into the body cavity. Average cost per complication? More than $36,000. If you're readmitted to the hospital? $65,000. That'll buy a life-time membership in the gym, you bet, and a lifetime membership in Jenny Craig. Of course, that's if you don't die. Doctors who make their yacht payments from doing this kind of surgery defend it, and say they're getting better at it, if they do say so themselves, but they can't actually prove that.

The simple fact is, we can and should do whatever we can to assure that health care is provided safely, effectively, respectfully, and to whoever needs it, when they need it -- BUT -- slicing, dicing and dosing the incomprehensibly complex ecology that is the human body is just something we aren't very good at yet, and quite possibly never will be. We just have too many moving parts that interact with each other too critically, mostly in ways we don't even understand. A tiny little mistake, or a wrong understanding of what we're doing in the first place, and you ain't got no red corpuscles.

We get much more value by staying healthy in the first place, in ways we understand very well how to do. Obesity is the result of a genotype that evolved in people chasing antelopes and digging up roots on the African Savannah being transplanted into a toxic environment in which we can drown in calories while barely having to lift a finger. Result? You get fat.

Well here's another open door crashed through: Play is Good for Children, Study Says. Yup, somebody got a grant to prove this:

Concerned by flaws in previous studies, Andersen and his colleagues set out to examine the connection between children's physical activity and risk factors for heart disease and diabetes. The study looked at 1,732 9- and 15-year-olds from Denmark, Estonia, and Portugal. Physical activity was monitored for four consecutive days by strapping little machines to the youngsters' hips, which monitored accelerations in body movements.

Despite differences among the three countries where children were monitored, the benefits of physical activity were consistent. The more-active children had healthier numbers for blood pressure, cholesterol, and insulin. Because it measures activity objectively, without relying on questionnaires, Andersen's research may lead to a reconsideration of physical activity guidelines by countries and global health organizations.

``This is much stronger evidence than we've ever had before," said Nick Cavill, a research associate in the public health department at Oxford University, who wasn't involved in the study.

So turn off the TV and kick 'em out the front door. It beats the hell out of bariatric surgery.